I had just started my third year of training in surgery and my friend and colleague was nearing the end of his training. We were covering trauma that Friday night and it was 3 am. A van driven by a drunken driver had ploughed into a group of young men (possibly drunk as well!). Two had died on the spot, one was dead on arrival and we got two badly injured men in their early twenties. Both had similar injuries – head trauma, pelvic and femoral fractures. And, both were in hypovolemic shock. It was difficult to say which one was worse. I took one patient and my friend took the other and we set to work.
Right, airway- happy for the moment; breathing – ok; circulation – zilch. Neither had a recordable blood pressure. ‘Wide bore cannula, please!’ And we got one green venflon and a handful of blue venflons to go with. If you have ever been punched in your stomach and kicked in your balls at the same time, you will know exactly what we felt that day. Two young men in shock and one 18G venflon!!! Well, my friend’s patient showed some signs (I don’t know what they were) of being better than mine. So, he got the cath and shoved it into his external jugular – because that was the only access available. While, I started a series of futile cut-downs. (We did not have any CVP lines, either – in case, you were wondering) I still remember clearly how a anxious + curious + tired + awestruck house officer held a torch light to my patient’s groin as I cut down to the long saphenous vein to pass a large drum catheter into his femoral vein. (I don’t think many surgical trainees these days have seen a drum catheter at all. It is a wide bore tube that is wound on, well, a drum. It is used as a peripherally placed central line.) We weren’t thinking whether it was worth the effort or if this guy was going to make it. We didn’t care. We didn’t want him to die because we hadn't tried hard enough. But, by the time we got fluids and blood into him, he had been hypovolemic and hypoxic long enough to go into irreversible shock.
He died within the next hour. And my friend’s patient died a few hours later. And both were men in their early twenties. And the next day morning we found a stock of central venous kits in one of the cupboards and the duty nurse had not known where to look. F^$#!
Right, airway- happy for the moment; breathing – ok; circulation – zilch. Neither had a recordable blood pressure. ‘Wide bore cannula, please!’ And we got one green venflon and a handful of blue venflons to go with. If you have ever been punched in your stomach and kicked in your balls at the same time, you will know exactly what we felt that day. Two young men in shock and one 18G venflon!!! Well, my friend’s patient showed some signs (I don’t know what they were) of being better than mine. So, he got the cath and shoved it into his external jugular – because that was the only access available. While, I started a series of futile cut-downs. (We did not have any CVP lines, either – in case, you were wondering) I still remember clearly how a anxious + curious + tired + awestruck house officer held a torch light to my patient’s groin as I cut down to the long saphenous vein to pass a large drum catheter into his femoral vein. (I don’t think many surgical trainees these days have seen a drum catheter at all. It is a wide bore tube that is wound on, well, a drum. It is used as a peripherally placed central line.) We weren’t thinking whether it was worth the effort or if this guy was going to make it. We didn’t care. We didn’t want him to die because we hadn't tried hard enough. But, by the time we got fluids and blood into him, he had been hypovolemic and hypoxic long enough to go into irreversible shock.
He died within the next hour. And my friend’s patient died a few hours later. And both were men in their early twenties. And the next day morning we found a stock of central venous kits in one of the cupboards and the duty nurse had not known where to look. F^$#!
Comments