Wednesday, 3 June 2009

The Fall


Another 999 call. A fall in a retail park
"It's probably some old dear who has tripped over in one the shops" I joked.
About 3 minutes later we pulled into the retail park.
Jokingly I said "Nah it's probably someone who's fallen through the roof"
Before we knew it we had an update on the radio "Cardiac arrest, young male fallen approx 40ft through the roof"
"SHIT!"
Now on scene, ambulance doors swung open. I grab my Para bag, response bag and drugs kit. My crew mate grabs the suction and critical hemorrhage kit. Through the doors we are confronted by a crumpled heap. Above him is smashed ceiling panels and about 40-50ft above that is a smashed skylight.
The patient isn't in cardiac arrest but he's not far from it. Massive head, facial and chest injuries are obvious. We needed to act fast if we were going to give him any chance of survival.
By now a RRV Paramedic from base had arrived and we quickly set about suctioning the airway and then moved the patient onto his back. He wasn't breathing adequately and his radial pulses were virtually non existent.
First thing to sort was airway. I had a quick look with my laryngoscope but saw nothing but blood so I suctioned some more then started to assist his breathing with a BVM. Another look, more suction and then in with an ET tube. Airway was now secured. Next was breathing. It was quite evident that there was significant blunt chest trauma. One side of the chest was higher than the other, breath sounds were diminished and it was hyper resonant. I opted to insert a wide bore IV into the chest to allow the air to escape. Radial pulses started to get stronger. All the while my colleagues were getting other kit sorted. My crew mate then took over ventilations while my self and the RRV Paramedic both got big IV lines into the arms. At this point various other colleagues turned up including a local Basics DR. He just wanted to know how far we had got and then we reassessed ABCs. Next thing we know HEMS are en-route and within minutes they are walking through the door. The HEMS DR gave some RSI drugs to make sure the patient was properly asleep while the HEMS Paramedic performed a thoracostomy on the damaged chest. This made a huge improvement with ventilations, my needle decompression improved things as well but the thoracostomy really did the trick. Next we started some Hypertonic saline. Epistats were also inserted as there was significant bleeding from the severe maxillofacial injuries. A pelvic splint was also applied just as a precaution and a rapid ultrasound of the chest and belly was carried out to detect internal bleeding. Now with everything in place and all the best possible treatment it was time to load the patient into the aircraft. Many shoppers were filming us as we walked through the car park, probably out of morbid curiosity. When the helicopter lifted off there were even more people filming on their phones and as soon as the helicopter vanished they had all practically disappeared. The young lad was flown to the Royal London by passing all the local A/E units as it is the UK's main trauma centre.
We had to give our details over to the police, which is the norm in these situations. Next was the task of clearing up which was now like a war zone. Police asked if we could check over the patients work mate who was in a state of shock so I went over and had a chat with him. He was just dumbstruck.
After a quick debrief in the car park we were back on base restocking.



I've since found out the poor lad died this morning.
Everything that could be done was done right there and then. We gave him a chance.

8 comments:

RapidResponseDoc said...

A very difficult job. Well done!

Tazambo said...

Nice work.
Sometimes it's just their time, no matter what you do for them.

shadysidebury said...

Hello-

forgive me- non-medic, longtime reader here- but what does "hyper-resonant" mean?

Thanks,

Shady

Hua said...

Hi Mac,

That is sad to hear. Thank you for sharing this experience

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mac said...

Hi shadysidebury, hyperresonance is all about sound. In terms of the chest when we listen we expect both sides to be resonant. i.e we will hear air rush in and out with each breath. When we percuss (tap) the chest wall we expect there to be a slight hollow sound. When one side is damaged and air is escaping into the chest cavity (between the lung and the chest wall) the air builds up pressure and can make the injured side of the chest hyperinflated. When we percuss there is usually a more pronounced echo or hollow sound on the injured side. That is hyperresonance. I think I've explained it right.

medicblog999 said...

Wow Mac,
Big job, tough job, sad outcome.... But I bet you can reflect and feel good about the rapid decisions and interventions you performed. The lad had the best chances he could have had with great support from your colleagues, BASICs and Hems.
The scary thing for me is that if that job were up here, if lucky, there would have been me ( on the car ) backed up by a para/ emergency care support worker crew. There is no way we could have been that effective.
Job well done mate!!

shadysidebury said...

Thanks for the explanation.

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