Monday, March 02, 2009

If I Ventured Into The Slipstream

Managed to survive nights; again.

Something of a week for stabbings. I've seen six since I've been at South Coast Hospital. I suspect my North American readership will sneer at this, since, if t.v. is to be believed, every shift in US EDs is a stabfest. Anyway, it's a big deal for me. Five of the six have been in the last week.

Number three was perhaps the most eventful. Young fella, stab to the epigastrium. Over the phone, his obs didn't sound too bad - lowish BP, normal pulse. 'Course, its all relative, but I worry about the young ones that are tachy more...

These calls are always a bit like Schrodinger's Cat. Until they arrive, they might be really sick, or not too bad; so they exist in a kind of quantum state in between. Then they arrive...

It didn't take a modern day Astley Cooper to figure out which end of the spectrum this guy lay. Agitated, pale, clammy. His hands and feet, ice cold, were mottled. They looked like the skin of someone having a Bier's Block, if that helps. It's not a good colour.

On our monitor, his obs weren't quite so encouraging - pulse of 160, BP hovering around 100 systolic. His wound, square in the epigastrium, was small, maybe half an inch across. This measurement is worth knowing if you know how wide the knife is. No-one was quite sure, but we thought it was narrow.

Anyway - epigastric stab, shock... good air entry bilaterally, benign looking belly... I peeked at his neck. His veins stood out like cords.

Our survey said... tamponade.

Cardiology did the decent thing and confirmed on echo what Sonosite had hinted at, and the call went out to CardioThoracic. For a moment, when resus filled with the Surgeon, the Anaesthetist, the CT Intensivist, the General Intensivist... we were in danger of forming a sort of 'brains trust'. Lots of clever docs, all offering opinions about what needs doing, no-one actually doing much...

Fortunately, the Surgeon wasn't shy, and made his intentions clear. Five minutes later Stab three was in theatre, and I'm told, came out the other side.

It's nice when stuff works.

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