Trauma Surg: last shift

SO! It turns out my shift was about 30 something hours. Which was long and the first shift where I worked that long without even a half hour of sleep.  We saw about 17 traumas in that time and it was pretty crazy. 

So the only three things we see in trauma are: falls, Motorvehicle/motorcycle accident, and assault (gunshot, stabbing, or fists)

Here are some stories.

This is a 300 pound woman who came in from a rehab facility after having surgery. Since surgery, she was confused and lethargic. She has had diarrhea for two weeks but hasn't gone in about 3 days now.  I have to shake her shoulder and repeat questions everytime and her answers aren't particularly coherent.  It was crazy because she had the biggest anterior hernia  I have ever seen and it had been repaired at least twice and was still so large it would never be fully healed unless she lost weight. Anyhow the rehab center thought she had a bowel perforation, but as you can see from the xray here, it looks more like small bowel obstruction from all the air in the bowel.  Poor lady barely fit in the xray film and didn't fit in the MRI or CT machine unless we called the zoo.

This next case is very sad. It was a 3day old baby that has air in her brain. You can see the black spot in the upper left side. Unfortunately, air in the brain is always always bad. These parents were new and left their baby unattended around the family dog. The dog treated the kid like a puppy and picked her up by her head and carried her around. When she came in her brain was visible and she was bleeding profusely. She coded twice before the parents finally let us stop.  I can't imagine what they were going through.  I could have taken picture of this one, but it seemed so irreverent. I could not, so I settled for the CT. You can see that her skull is in pieces and her brain matter looks pretty swirled. She was not going to make it.

This case was 2 people on a motorcycle who were hit by a car. It was interesting because both the man and his wife ended up with almost the exact same injuries except the male's were worse. The couple was engaged and they were freakin out! She didn't want their clothes cut off and he was just trying to not scream. His bones were open and sticking out of his leg.  He broke every bone in his knee. I did get a crap picture of the bone sticking out and the xray of the knee. That way you could see what was under.  In Motorcycle vs. Car accidents, its always worst when its the car that hits the motorcycle.  This particular injury is caused in a complex mechanism. First the pressure of the car rolling on top of the knee breaks the femur then as the leg twists from the weight of the car and the body of the person does not, the two lower bones are torqued enough that they twist and break. In this xray you can see two white bars, these are the cards we put under broken bones. So don't get confused by them :)  Later the ortho guys took this guy to surgery and pinned basically every bone in the whole knee.  It was quite the process.

Hmm... There were three gun shots this night. All three gave the same story, which we all know was a lie. "I was walking through the field/street/store/house all by myself minding my own business when suddenly some guys ran/drove by and I heard shots."  Nobody is ever walking by themselves when they get shot.  One kid was shot through the neck, one through the chest, and one through the ankle. Then we found a hole in the pants of the ankle kid- so obviously he shot himself. Pft boys thinking guns are fun. Ridiculous.

Let's see another story was of some drunk dude who fell off a roof. Of course, he didn't believe he was sick or hurt. So he pulled off his collar. This is obviously not a good idea. He left the ER and then of course the xray came back. He has a crush fracture of his c7 vertebrae. So hope he doesn't die/go paralyzed, which he most likely will.  Great right?

Also, another drunk guy came in, unconscious and shoring like a banshee. He wouldn't wake up and he had dried blood all over his face and we were guessing that maybe he had a jaw fracture. Witnesses said he had hit his head when he fell, apparently hit the curb.  But before we could do anything his heart rate dropped, he quit breathing and we intubated. It was quite fast and we couldn't get tube in and I was sitting there holding his neck for the residents and thinking, shit this guy is going to die. And then they got it and gave him some good old atropine and he came back.  I have to say, I wish i could be there when he woke up and tell him how fucking close he was to dying on that table because he thought drinking and fighting were cool. But then again, his tox screen will probably come back with more than just alcohol. I wonder what it was like to know that you almost died.  I almost think it worth it to videotape that stuff so they could see how bad they were in trouble.  The sad thing is, i know it wouldn't change any of their choices.

Whelp, that's it for trauma i guess. There is really nothing you can say or do to teach/talk most people out of their stupidity. Even the ones that change eventually go back. Its hard to feel the thrill of excitement about saving someone's life when you know they don't much care for that life anyhow.  I think this is why I can't dedicate myself to trauma. Its why I want to do ER where every once a shift or so you actually get someone who genuinely WANTS your help. Not for drugs, Not to continue bad choices.  Maybe this is why I can stand the psych cases who just want medical attention....  Something to ponder for later.