Thursday, May 6, 2010

Routine Stabbing

It was 3am and I was sleeping soundly. We had been having radio tower problems with the local dispatch so sometimes our pagers didn't trip, or only one would. I woke to a persistently, irritating drumming on my bedroom door.

"What?" I rolled over facing the wall.
Sarah my partner opened the door, "I said get up, we have a stabbing, sounds bad."
I rolled over again. "Don't mess with me Sarah it's not funny." I put the pillow over my head.
She walked in the room and pulled me off the bed and said "GET UP! I'm not kidding!"
I grumbled and got up, putting my boots on, then I remember the radio problem. Maybe she's telling the truth.
"If this is a joke it's not funny." In our area we don't get a lot of stabbings.
We run out and hop in the rig and put ourselves in route with dispatch. We had a rider that day and she hopped into the back.

The radio keyed up, "District 111, and County Medic 111, you are responding to a 42y/o male reported with multiple stab wounds to chest and back. Bleeding heavily. Scene is secured by PD."

Wow. Sarah wasn't just being mean and telling me it was a stabbing when we really had an intrafacility or something like that. Please note, Sarah is not normally mean, but having me as a regular partner tends to change people's personalities. I am one of those guys that cannot sit still and often this gets me into trouble. I also have a little bit of a sadistic steak and like to play jokes on the unwitting.

Sarah lights it up and we clip off down the road. There is some confusion as to where the patient is located once we get there. Apparently the stabbing happened in one house and he ran a few blocks to another to get help.

When we got to the scene the was a long run up to the house, so I hopped out with just my stethoscope and ran up to see what we had. Just inside the front door, the patient is laying on the tile in a pool of blood gasping for breath. He's white as a sheet and profoundly diaphortic.(means he's extremely sweaty, that he's in shock). I lean out the door and yell to Sarah and the rider, "Leave the gear! Grab the bed, we need to get out of here!"

I bend over and ask the guy where he's hurt while slicing off his shirt with my trauma shears.

He looks at me incredulously and says, through his gasping, rapid respirations, "Dude!(gasp)I'm bleeding like(choke) a pig and I can't(hack) breath!"

I see four wounds in his front and one in his back, most seem superficial but the one over his upper right quadrant is right in line with his liver and diaphragm. And it is the one that is bleeding. I listened to his lungs, left was clear and right was dull and very quiet with little movement of the chest wall. Hemo/pneumo I think. A Tension Hemothorax is when the lung cavity fills with blood, collapsing the lung. It is fatal left untreated.
Sarah came in the door with the bed and I helped the guy stand to transfer to it. As soon as he stood, blood literally gushed out of the hole over his liver. Ok, gushed is not a good description. You know when you turn on the hose full blast without a nozzle? It was like that. At least a liter of blood shot out of him and splashed all over the gurney and on Sarah's legs. He looked at me and said, "You gonna stop that?"
I replied "No! Sit down!" It suddenly seemed breathing was better. I even asked him, "Hows your breathing. sir?"

"Uh, it's a lot better..."

I give him a dressing to hold at the wound and I tell him not to block the blood. There's no way my little 14g chest needle is going to make a big enough hole to compete with that big of a hemothorax. We pick him up and run for the ambulance. A volunteer EMT met us on the way and jumped in the back. Our scene time was 6 minutes. I called for an airlift to the trauma center, which is about 2 hours away by ground. In the back of the rig I had plenty of help, the rider was an EMT too. We got bilateral 14g IVs with warm saline flowing great as we tore off for the local hospital.

En route to the ER the patient exhibited increased shortness of breath again so I had him uncover the wound and stretch a little and blood again gushed out, over the patient's leg and sloshed across the floor. I had to do that 3 more times on the way in. Each time it relieved the patient's breathing. By the time Sarah opened the back doors at the ER, the blood made a macabre waterfall off the floor and back step onto the ground. Pouring out.

When we got inside the doctor started in on me. I let him off easy because it was his first day there and he didn't know the medics yet. But he argued that it wasn't a hemo, canceled airlift and stitched up the hole. I warned him to get his chest tubes out if he was going to insist on stitching the guy and he told me to leave, so I went out to write my report, a little miffed. Within a minute he came out and said "Uh, the patient's getting really short of breath, what makes you say it's a hemo." So I described it to him again(third time), and he ran back in and did an emergency chest tube, blood covering the floor of the ER room. I tried hard not to gloat. He also called airlift back and started the man on bloods.

Once at the ER we got the rest of the story, the guy had gotten drunk with a buddy and he decided to shut up his friend's wife by hitting her. His friend took exception to this and carved him up like a Christmas Turkey. The patient did well after having the hemo and his liver repaired and lived to assault another day.

Hope I don't see him again.

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