艮
“Stable”
Stopping, Desisting, Stilling
It is too soon to have the printed labels, instead patient identifier aka chart # is hastily scribbled on the blood tubes. For some reason in this already crowded trauma room, there are two lab techs to collect the specimens both carrying lab trays. When one receives the tubes, they both exit, disappearing behind the curtains and out of the room. Packed into the room, arranged in strategic order and specialty of anesthesia, nurses (3, 2 from ER and one from ICU), the ER MD, a trauma resident, a surgeon and sitting out of way, a recorder. Behind a glass partition stands a radiology technician. Several films been imaged from the neck, chest and pelvis, encased in heavy flat plates, rushed off for immediate processing. Hanging IV poles hold liters of LR and squeezed in blood bags, units of PRBCs. All the IV fluids are wide open, pouring through tubing, through a blood warmer, through contrasting clear and red lines to large bore IV sites. On the side of the LR bags are magic marked “#4” and “#5”. All three doctors are facing a viewing screen peering at a cross table image of the cervical spine. 6 and the top of 7 cervical vertebra are visible and do not appear to have abnormality but there is large amount of subcutaneous air in the soft tissue. Also evident just in the edge of view are basal skull fractures. An AP chest film now is placed on the viewer. From across the room someone with a trained eye could see the multiple ribs fractured and massive SQ air. The resident who has been asked for an interpretation is enumerating the findings and does not miss the significant first rib fracture. The ET tube is in good placement. In a green moving line on the lifepack 10 LED, a single wide sine waves past leaving a straight line and then again. a wide agonal complex. The surgeon nods and, it is the ER doc who turning simply notes the time. With that further resuscitation compressions and assisted ventilations cease. The patient is stark naked but more starkly white.
Beyond the pale in exanguination contrasts sharply with how much blood there seems to be. It is everywhere, covering the backboard, dripping off the stretcher onto the floor, in the wall suction, coating the ET tube, running out of a chest tube and collecting scantly from the foley and unused in a cell catcher for autotransfusion. An impressive enmasse exodus of blood perhaps simply frightened by what will soon be charted as “massive head and chest trauma”. Cervical immobilized on the backboard, a head framed in orange foam and Velcro, with a small white halo where scalp has been evulsed. A distorted face, eyes swollen closed, the entire structure of the face is compressed and mobile. Aforementioned blood, black and dried along the chin and neck. Below the chin, the neck and upper chest is spongy and crackles under touch. A lower leg is splinted for a femur fracture, but more then likely there is a large pelvis fracture.
The ER nurse is on the phone to the house supervisor to stand down the surgical team. A call is placed to the coroner and all lines and tubes are kept in place until the body is released. Two surgical staff attired in booties, scrubs and surgical caps appear and simultaneously their beepers start chirping. After stopping to look at the message, they turn, chatting down the back hall. A single unused unit of PRBCs, the last many taken from the referring facility is returned to the blood bank. There is a bag of patient belongings which is opened to document any valuables. The bag brought in transport holds what at first appears to be a dead cat and eerily the bag weighs about the same as midsize cat. Closer gloved examination reveals a blood soaked wig. The ER RN is looking in disbelief at the Flight RN. “Hey, they were handed to me by the ambulance crew, it is not like we have TSA up there, and…we were sort of preoccupied”. The final film is on a viewer revealing the suspected pelvis fracture. The surgeon is dictating on the phone, but waves at the flight crew who exits out to go up.
