There was one point the other day where all the senior residents associated with the trauma team had disappeared – some into the OR, and others apparently into thin air. The attending had also dematerialized out of the middle of rounds. Probably to the OR, but he never said where he was going, and we were left in limbo, wondering where exactly everyone had gone.
Then the trauma pagers went off. (You always know it’s a trauma page, because in the trauma unit it’s like an orchestra of pagers has started – all kinds of beeps and trills and cheeps and buzzes, in complete unison. The charge nurses and respiratory therapists and other random people get these pages, as well as us.) “50yo male pedestrian struck by car, thrown 20feet, chest pain.” You can never tell from these brief summaries, which often grossly overestimate or underestimate the severity of the injuries. They’ve even been known to report patients as intubated who are not only breathing on their own, but wide awake and talking. Nevertheless, it seemed like the kind of thing that ought to be properly attended to.
We couldn’t tell who was supposed to be doing what, so pretty soon the whole group of interns and medical students trickled over to the trauma bay in the ER. It was a good thing we did, because for a trauma that was reportedly minutes away, there was very little of the usual crowd present. So we got dressed, lead aprons and gloves, and the medics rolled in. The patient was sitting bolt upright, very quiet. We moved him onto the stretcher, and tried to get him to lie back so we could look at him. He started protesting that he couldn’t breathe, especially when leaning back, and his side hurt.
Well, that one wasn’t hard. We’d suspected it the minute we saw the page (ok, we suspected it because we’re procedure-hungry interns, and we read the trauma pages only to gauge what and how many procedures we might get out of it), and his symptoms were classic. We skipped a couple steps in the trauma protocol (actually, come to think of it, treating an immediate threat to Breathing, in the ABCs, probably counts as a good reason to leave finishing the entire survey till later) and opted for a simple chest xray and chest tube. (He had a pneumothorax, of course, quite glaring. It wasn’t a tension pneumo, but big enough to be bothersome.) By the time the seniors came around to investigate, we had a chest tube in and he was breathing better, enough to let us finish our survey and do CT scans.
I know to our friends in South Africa this will seem quite ridiculous (their medical students could probably handle a pneumothorax unassisted), but it’s always exciting to discover that you can do something completely on your own. (This makes only four chest tubes for me, counting medical school; I’m planning on several more this month. Yes, my city has quite a deficiency of penetrating trauma.) (For the non-medical folks, that means we don’t have a large drug and gang population shooting each other; which really one ought to be thankful for.)