Today there was only 1 doctor again for the entire unit and a excellent doctor too, this is not ideal and recognised but 2 doctors have just resigned.
The days patients mainly consisted of severe community assaults from metal rods or stones causing gross head injuries- SAH, DAI. Again these patients are ventilated in the resus room. Haemo/pneumothorices due to stabbing of the chests, fractured ribs/sternums. Multiple stabs to the head, back and legs with acute abdomen- emergency lap was performed. Interestingly so many young men have huge thoracostomy scars from stabbings.
The emergency/trauma doctor (medical officers) stabilises the patients first then call the specialties, they could have multiple patients in resus too – so its hard work and can be very demanding. Unlike our system- the specialties come first in a trauma call then we eliminate but we are better placed to be able to do that.
Mid afternoon man came in due to being stabbed into the floor of his mouth, facial lacerations and swelling to the left side of his neck. Now I’ve been looking after many patients here who are thankful and I have felt very safe with... this man you instantly knew was not a pleasant chap. He in fact was the gang leader of the largest gang in
Clinically this man was unstable ... lost 1L blood out of his mouth and counting, HB 4.6- despite 650 mls colloids and 3 units O Neg blood and the swelling was getting worse. His airway was patent but dropped sats when lying him flat to 87%... and pouring with blood (very unemotional to his clinical state). All adjacents where put in place.. NG, catheter, IVs, fluids etc. The bleeding needed to be stopped and before his airway was comprised, the specialties are impressive at GS government hospital so we rushed him (me and the 1 doc) for angio and embolisation in the vascular radiology theatre room where he was ET tubed by the anaesthetic consultant otherwise he would of needed a surgical airway and the procedure performed.
Highly impressive the team in the room and equipment, up through his inguinal artery up to the linguinal artery and the facial artery to stop the severe bleeding and glued! After he went to the high care ward tubed -he was saved, if that facility had not been available I doubt he would of survived so well . The other nurses felt the same when nursing him- we saved him but how many people has he harmed and killed…. but that’s what we have to do- non judgemental.
So many of the patients I have seen are stabbed in the neck or face- they injure to kill.
The resources are poor ie no head blocks, no portable suction or slings… but then this 1st class imaging and surgery!
Earlier part of the day I observed the nurse educators with the new post grad nurses on the emergency, trauma and critical care course go through the resus patients and how you should assess primary surveys.
The nurses do have a code of conduct with the SANC and the practise does seem limited to ours, although the emergency nurses do catheterise its not really in there scope apparently. Also they do not suture and plaster- the doctors do this.
I had a lovely conversation with one of the nurses today, she has been nursing for over 20 years in emergency and trauma, she loves her job and what she does- she is very good. Really enlightening- they apparently have really enjoyed having me and I have just got stuck in with them in the team. They have been a pleasure to work with, overall the nurses are skilled, caring and I have the up most respect for what they do.
Another good day in trauma resus…..
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