Then I went to the weekly trauma teaching with the doctors, which was about organ transplant issues and referrals. Then a presentation on diaphragmatic injuries- all very good.
Then back to trauma resus-
One patient who had such severe community assault and sustained such a gross head injury with his brains coming out of his head arrested- RIP. Beaten to death.
Another- stab to the RUQ and large liver laceration hb 4.7 and haemodynamically stable quite the joker in fact lovely guy- awaiting surgical review.
Male with again severe community assault- open skull fracture and limb fractures. Crush protocol in place, regular monitoring CVP and fluids.
In 2010 GSH saw 9022 trauma patients- 1242 resuscitations and only 129 deaths. 572 GSW , 3343 assaults and 1601 MVA, 3440 other. Reflecting the good clinical management at GSH. Although can I be as bold to say these patients are robust... they are all young with this on there side... is this a culture heritage too though!!??
Some of the nurses on the diploma for trauma, critical, emergency course came down, they had done their first intubation, the course requires 5. In an emergency without the presence of a doctor they are able to tube, this is particularly useful for rural hospitals where doctors are not on site.
As I have noted I am working in the best hospital in the province, rural parts of
For a short period resus just had 3 patients so fairly quiet- then 2 trauma resus arrived within minutes:
20 year old male PVA- pedestrian- isolated head injury GCS 3, fixed dilated pupils, intubated, hypovolemic shock- ? cause the reason. Filled with fluids, non responder so we gave blood… responder for a while then started to deteriorate. Lodox- only fracture clavicle, abdomen soft. No bleeding from the head… ??? Awaiting CT.
Very sad as the family came in, grandfather a doctor… the medical condition was given to him doctor to doctor…. he knows the prognosis. He was just about to turn 21.
Trauma team run effortlessly- primary ABCDE, secondary survey he was even sutured all in less than an hour. One doctor, 2 interims and 3 nurses. At off all the trauma resus teams I've seen- no-one gets stressed, presses the panic button or speaks out of tone, all done with an air of ease.
At the same time a male GSW, he heard 4 shots.. 3 went into him.
Number 1- entrance into right side of his mandible- exit left side submandibular area… now this same bullet went into his chest and through into his back.. entrance, exit, entrance… then you could feel the bullet in the back!!
Number 2 – right distal forearm palmar side 2cm proximal to the wound you could see the bullet…. So we took it out. Old style bullet apparently… very large too!
Number 3- entrance and exit wound to right tibia. His comuniuted mandible fracture GSW site had facial swelling increasing, on arrival bleeding but not profusely…. Then profusely. Despite attempts at a NG tube which he would not tolerate.. he stayed haemodynamically stable. For CT., max fax and surgeons.
The daily 6pm ward round... then hand over to the 7pm night shift...
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