Wednesday, November 4, 2009

Next Up: What the Hell Happened to Me?

Before I could do the aforementioned highly anticipated rectal exam, I heard the sound of the trauma pagers going off (perfect timing! They sounded like angel's wings).

A male motorcycle rider in his 60's and the drunk who crossed lanes to hit him were both being brought in. We staked claim on the more equipped private trauma room and therefore got to take care of the motorcyclist.

The first steps in assessment when someone comes in to the ER (or really anytime you're assessing an emergent situation) are to look at the ABC's: Airway, Breathing, Circulation. Well, he was mumbling and had a (Thank God) full helmet on, so he had an airway and was breathing.

While we had him talking, we asked if he had pain anywhere. Well, my leg's bothering me. Yeah no kidding, I can see your bones sticking out of it. Of course I didn't say that out loud. But they were.

Overall, he seemed like he was in pretty good shape and he no internal bleeding that we could find. The only thing that worried us, besides the aforementioned bones sticking out of his leg, was that he kept asking what happened to him. I personally explained 4 times, and I think each of the nurses took several turns doing the same. "OH. Ok. Well, my leg is kinda bothering me." That's it? This guy must have had the pain tolerance of Valentina Vassilyeva.

The EMS team had called it an open tib-fib fracture, and we referred it to that for quite a while, until we got the X-rays. It was weird; there was no tibula or fibula fracture that we could see, but something wasn't quite right. Then on a different angle we could see it. Yikes. He had popped off the whole distal end of his femur and relocated it up a little higher in his leg. OOOHHHH.

The orthopod was already in the ER, so he started prepping for what we had to do next: Irrigate the hell out of the wound and try to relocate the leg as best we could before he went into surgery. (The OR team was currently tied up cleaning out my earlier patient with the acute abdomen). Irrigation is never particularly pretty, and since we were in the trauma bay with a big nasty wound it took on an even more rushed tone than usual. We doped the patient (but not too much b/c we didn't want to intubate) and started putting chucks (large disposable absorbent pads with plastic backing. I saw plenty of these in my nursing home days) under him, with a half-assed plan to funnel all the wound juice into a trash can. My glamorous job was to hold his leg up. Nothing like old man toes in your face at midnight to put you in a happy place.

Next came the saline. If you're doing a small wound you can use a syringe. If you're doing a large wound, sometimes all the docs do is grab a bag of saline, get a tube for it, and squeeze the bag directly. Always wear a mask with a face shield during something like this. The expertly designed chuck funnel didn't work (surprise) but I couldn't drop the guy's leg...so I stood there and watched while a big puddle of bloody saline slowly eased toward the side edge of the chuck before plopping at my feet. That was the first time my scrubs were soiled that night.

A wound like that looks like raw meat; it's amazing how the orthopods put something like that back together. Unfortunately, we had to put his leg back in line. He kept saying things like, "Watch my leg, it's a bit tender" and "I think my leg is hurt" (he couldn't remember why, but he picked up on the fact that somethin' weren't right). Since I was the tallest in the room (at least of disposable medical people who didn't have an MD behind their names), the orthopod made me stay on the job of holding up his leg while he worked it over.

I've mentioned before how much I like orthopedic injuries and manipulations. I couldn't leave, and I was standing on a stool surrounded by a puddle of bloody saline so I didn't feel like fainting was an option either. All I could do was zone out and do this forced quick breathing technique I've developed for any time I feel like I'm going to pass out or throw up. It's kind of like Lamaze, which makes sense because the time I use it most is when I have to watch someone give birth. Meanwhile the orthopod is working the guy's leg, pulling and shaping it like it's putty. Which, without proper bone structure, it kind of was. Deep breath, breathe ooooouuuuuuuuttt.

Then we wrapped a new quick-dry soft cast on it (man what I would give for a medical supply catalogue) and went to talk to his wife who had just gotten there.

I am probably done collecting dangerous hobbies. The more I see things like this, the less I feel inclined to ride a motorcycle, or a bike down a mountain, or talk smack in the car to that big jerk who can't drive.

I don't even know what happened to the drunk who hit him; he was in another room and out before I could see him.