Today I arrived into the trauma resus room- on my far left lay a poor man prone with a huge knife stuck in his back into T10 with CSF leaking, he was still there at the end of my shift before being moved to the ward then surgery some 12 hours later. I have nice pictures!
Apparently I missed a good resus earlier, 20 week pregnant lady shot by her partner in the abdominal cavity just hitting the uterus entrance and exit wounds, HB 4.0 and haemorrhaging intra-abdominally- she died in theatre 5 hours later.
Other patients I encountered today more severe assaults with metal rods, open sucking pneumothorax due to stabbing and a haemo/pneumothorax due to stabbing pericardium- echo showed blood surrounding the pericardium as only 4.3mm for surgery in 2 days.
What amazes me is the physiology reserve of these patients- they are sick but maintain these vital signs for hours/days.
As there was only 1 doctor for the entire trauma unit and approx 30 patients waiting to be seen I spent most of the day helping the doc out, suturing patients up (severe lacerations that max fax would usually see from stabbings). The suture kits where poor and one sharps bin available in the next area. I just got on with what I know best and carried out my emergency nurse practitioners skills, assessing patients sending for x-rays, referring to plastics, treating etc.
These patients wait for hours, in fact I don't look at the hour of arrival I look at the date... they wait 12-24hrs for treatment to discharge. The ENP role seemingly is not a role available but its evident this would be vital in seeing and treating these patients. However this maybe difficult to introduce with the nursing and medical historical differences.
What strikes me the most is how thankful and humble these patients are, just for you giving them the time and assessing them sending for an x-ray, talking to them like you care. They don't moan or complain. Apparently if they leave before completion of treatment they will get a red card which means they cant be treated again. One patient I stitched up had be there 24hrs waiting for completion of his treatment, desperate to leave but couldn't. My heart does really feel for them all. Even the ones with bullets and knifes still in them don't complain.
The shift today was DIY... do it yourself as the doc said to me! Don't bother asking its quicker doing it yourself! I can certainly see a difference with particular nursing teams on and generations of nursing and therefore reflection of active skills. Today myself, one doc - and more nurses.
When the young night staff came on, I was back in resus trauma and another resus came in- suicide down 2 storey building. The nurses assessment trauma skills where excellent, quick efficient and pro active, one step a head and knew exactly what do it.
Erm yes- a reflective day. Heart out for those patients today and how I could help them.... or how I would like to do more....
More tomorrow weekend frantics in the trauma room
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