Wednesday, September 18, 2013

This incident occurred during my internship as a student nurse. We were alerted that two ambulances were in bound with two men who were injured in an industrial accident. They had been working in a scrap yard moving metals of old appliances and crushed cars and trucks, with a fork-lift. The machine upset while the scrap metal was the hoisted high in the air falling to pin them both.

The first man who was brought in had abdominal trauma. He was in shock and very pale. His blood pressure was thready and low. His abdomen was distended.  Marks of abrasions and small puncture wounds crisscrossed his abdomen. All of the personnel rushed to that end of the emergency department with the victim.
The doctor made the decision to open his abdomen and clamp off the major bleeders right there in the emergency room. It would give the man a fighting chance to survive until they could get the man into the operating room. Large bore I. V.s were started and the laboratory was called to have O negative blood brought to the emergency room immediately. O negative blood can be given to anybody without typing. It is the universal donor and this guy needed blood.

The second ambulance arrived hard on the heels of the first and I was the only one available to assess and treat the new patient until someone else could free themselves to help me. I was a senior in our nursing class doing my internship and had been a corpsman in the Navy, but this now was flying solo. My preceptor was at the other end of the room. This was something I’d never done as a nurse without a preceptor looking over my shoulder.
I helped the ambulance crew move the man from their stretcher onto ours. I transferred the oxygen from their portable to the hospital’s supply. I began cutting off the man’s shirt to apply patches for the cardiac monitor. I noticed that something with the chest wasn’t exactly right. I listened to his breath sounds with my stethoscope. While I bent closer to the man’s chest, I noticed his chest was deformed slightly and both sides didn’t rise simultaneously when he would take a breath. The center section of the chest sank down when the rest of the chest was rising.
BINGO!! He had a flail chest. My eyes bugged out. I called to the team with the other man, who were almost elbow deep, covered with blood. “This guy has a flail chest.”
“We can’t come yet. Turn the oxygen up and start an I. V. You know what to do. You learned it in classes. Keep track of his vital signs.”
I found a five pound sand bag and placed it across the section that had broken free and was “flailing”, turned the oxygen to ten liters, and started the I. V. The man was stable and I was relieved in more than one way. By that time the team had managed to clamp off the worst of the bleeders and send the man on his way to the operating room for the surgeons to finish the repair work.

The doctor came and evaluated my patient. He ordered x-rays and blood work. The man remained fairly stable, and without much ado, the doctor admitted the man to the intensive care unit to be watched.
My nurse preceptor told me later the man that they had previously opened up had a lot of abdominal trauma. The falling junk had lacerated his liver and damaged his spleen. “He wouldn’t have made it to the operating room without being opened up down here. His liver looked like hamburger.” Then she said, “Well, how does it feel to be a nurse?”
My first trauma patient as a nurse and he lived. I guess I passed the test.

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