Today at work in GSH trauma unit was again the daily plethora of traumas...
as I just came in a motorcyclist MVA arrived. Completely smashed up face, numerous facial fractures, huge facial /head swelling....his tongue was in a plastic bag...... the impact was so hard he bit 80% of his tongue off. His upper dentures where deeply imbedded into the upper gums as the lower dentures severly embedded in the lower gums. The facial fractures where extremely bad but the paramedics managed to tube but he needed a trachy. Also had pneumo/limb fractures and severe head injury... he went to theatre pretty quickly after we stabilised him.
Other traumas MVA, stabbings, pelvis fractures with bladder ruptures, more severe assaults with head injuries, diffuse axonal head injuries, SDH, +/- le fort fractures. Many very young patients involved in MVAs- again severe head injuries. All these pateints having GCS below 8 so intubated and ventilated in the resus room where the emergency trauma room doctors (medical officers) and nurses look after these patients for 24 hrs plus before they move to wards or HDU. Some patients dont even need sedation due to the injuries, otherwise midazolam is sometimes used.
The team again works extremely well in resus traumas- the nurses automatically insert catheter, NG, ventilator, immobilise, monitoring, set up for ICD, CVP, femoral stabbs and IV lines/fluids, emergency O +ve blood... like clock work. Continue to monitor... then lodox the patient. Although the equipment and resources are low and old- they make do.
The practices here are very doctor orientated as its the traditional doctor- nurse model unlike most EDs in England with nurses leading and nurse practitioners. The nurses do the nursing and that's how the doctors see the nurses.... the old traditional individual professional roles and conflicts??
I realise even more how lucky we are to be able to practise as advanced nurse practitioners, advanced nursing roles and enhanced nursing profession... we are also very lucky to have access to uni courses and in house and mandatory training. We do have an advanced proactive system and governance.
I even saw a doctor that I worked with back in Worthing ED! Small world!
I really like working in this government hospital, the team, the patients and really making a difference... :-)
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