It's Not Rocket Science

So...


Stabbed in the face, eh?


The blade entered, externally, just below the right eye, and appeared to be directed superomedially, that is upward and toward the midline. As best as we could tell, the right eye was functionally intact.


What happened next is both instructive as a comparison to what we might have liked to have happen, and, it should be remembered, coloured by being fired through the prism of my memory.



If that last don't make sense, what I'm getting at is that memory is very plastic. Two people seeing the exact same thing often have very different memories of what it was, more so when they are both interacting with whatever it is; and of course, there is sometimes considerable change in even a single individual's recall.




So, maybe this isn't how it happened; but it's how I remember it happening...




It seemed obvious to us that MaxilloFacial needed to know about this guy; the radiograph from before was taken in something of a hurry, hence the monitoring lead in situ; it's not ideal, but it seems churlish to moan. It's not really in the way...



My first thought, on seeing the film, was indeed: 'Ooo look. That looks an awful lot like the blade is in his brain'. I shouldn't have to tell you that that scores fairly highly on the ShroomScale of places you'd rather a knife was not. My MF colleague was less convinced, making the (entirely valid) point that a single view doesn't give all the info you need. So, what you're getting is a 2D view of a 3D structure; fair point. It still looks like it's in his brain, mind.


The situation got slightly distracted while a discussion ensued between MF and Ortho as to who should take the patient...


(MF: 'I think he's got a head injury... that's Ortho'
Ortho: 'I'd say the knife in his face is probably the most pressing injury...')


Meanwhile, his GCS was slowly, ever so slowly slipping downward. Fortunately the Charge Nurse was a little more focussed and brought this to our attention. MF seemed less concerned by this - 'He is drunk, after all.... maybe you guys can just watch him here for a bit..?'



Maybe.




My arse.




If you have a knife in your face, that might be sticking into your brain, if you might have a blunt head injury on top of that, and if you are becoming less and less awake...


Observation is probably not the way to go.