Monday, April 27, 2009

Door Time

We joke about the bus full of little old ladies that are all hard of hearing and on coumadin that hits a bus full of non-english speaking hemophiliacs in a van full of razor blades. Its the perfect storm for a big trauma.

I was not in the trauma room Saturday night. I had a zone and was fine with it, thank you very much. I just so happened to answer the phone call from triage that told us we had a pt on a motorcycle that was shot in the left chest and then wrecked the bike. Our eta was 10 minutes... they showed in 3. The patient had a c-collar on, was COLD and clammy to the touch and was screaming that he wanted his collar off. His first blood pressure was 80 systolic (he was laying down at the time) and his rate was 140's. No huge blood loss on the outside, but he looked like shit. The trauma doc wanted an upright chest X-ray to see what it had hit. As soon as we sat him up, his pressure went to 60. I was hanging blood before the doc had the trauma line in. He was packaged and expedited to the OR. When his chest was opened he had a hemo-pneumo on the left, a posterior aortic injury (good thing his bp stayed low!), a pneumo on the right and the bullet ricocheted through the diaphragm and ended in the stomach. Amazing!

Our front door to OR time..... 11 minutes! That was with him fighting. Not to shabby. I spoke to the medic later and from our estimation his injury time to OR door time was less than 30 minutes. That's pretty fucking good.

When you get a great team together things just flow like that. We did a stroke alert at 650 this morning. There was another great team on and we had EKG, labs, CT scan done in less than 10 minutes. He was getting tPA at 715 and had started to resolve his symptoms when I left at 730.

It is starting to get warm here. Traumas are back to back non-stop and people are starting to aim better. JCAHO is going to be here any week and our ER admits are through the roof. Spring has obviously sprung.


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