"Doctor T, Emergency Room, Doctor T, Emergency Room"

Shit. I begin the walk across the hall to the trauma rooms. There's almost always time before the squad comes in. Occasionally, someone will dump off a trauma at the ambulance bay, or someone will walk in saying "I've been shot." Mostly, though, they come in by EMS, who calls ahead.

Carol is the nurse assigned to the trauma rooms today. She's checking to make sure IV lines are set up, beginning the paperwork, finding scissors. Within a few minutes, Carol and I will be joined by another of the nurses, Rick or Sharon, Dr. W, the ED attending MD, the senior and junior residents on duty and two or three surgical residents. X-ray is standing by. Respiratory always comes down to take care of the airway. The nursing supervisor comes down, too, mostly, I think, to make dumb comments and get in the way. That's my prejudice, though.

"What's coming?", everybody asks as they hit the door.

Carol patiently repeats, "Gunshot to the chest, no exit wound. Patient is awake, pressure is 80 palp with a pulse of 120 (translation: shitty vital signs). EMS got two lines. They''ll be here in five."

The four trauma bays occupy one quarter each of a single large room. Three of the bays are stocked with everything needed to run a trauma or full arrest. The fourth is devoted to pediatric trauma or childbirth. There is a bed, siderails down, with a tray to hold x-ray plates and places for IV bags and oxygen. Oxygen and suction equipment is on the wall at the head of the bed. Cupboards and counter space on one side, Shelving on the other side to hold trays for doing cutdowns, chest tubes, tracheotomies or opening up ("cracking") someone's chest. There are two operating room-style lights overhead.

This is a teaching hospital, so Dr. W. is there to watch his residents run the case, ready to step in if needed. The noise increases as people reach for gowns and gloves, break open the chest tube insertion tray, set up the drainage bag so that any blood collected can be given back to the patient. The surgeons discuss other cases while they're waiting; the nurses good-naturedly harass the residents and people begin to take their places.

Finally, EMS rolls in.

"This is K.M. Bystander saw him get shot once. . ."

"Lets get him over."

"What is your name, sir?"

". . .in the chest. . ."

"two, three!" The patient on the backboard is lifted onto the stretcher.

" . . .he's got an entrance wound . . ."

"Anybody get a pressure yet?"

"Sir! Are you allergic to any medicines do you know who shot you where you are how many times you were shot what is your address can you feel this squeeze my fingers where do you live who's your next of kin"

"How 'bout a pressure?"

" . . .under the right collarbone. no exit . . ."

"head is clear. Reduced breath sounds on the right"

"I've got another IV, 16 gauge to the right antecub"

"pressure's 96/60, monitor shows sinus tach at 120"

". . .there's family on the way. . ."

KM is in the middle of a swarm. He's getting lots of oxygen, plenty of IV fluids to keep his pressure up. The ED resident begins a head-to-toe assessment. His clothes have been cut off. The registration clerk tries to get information from EMS and the police. One of the aides begins to gather the clothes, checking the pockets for an ID, drugs or weapons.

KM has been in the ED for about two minutes.

(to be continued.)
9:35:18 AM    Comments?()