Motor Vehicle Collison

I toss the rest of my sandwich into a trashcan, and rush out of the fast food joint toward my ambulance, my partner behind me.

Less than five minutes later, we roll up on scene behind an arriving ladder fire truck. I slip mybright orange reflector EMS vest over my head and lurch toward two cars mangled together in a huge intersection, their hoods now one. The EMS #22 crew heads to the one patient in one car, so my partner and I bolt for the two patients in the other.

A civilian is leaning inside the driver’s door.

“Sir?” I say, approaching.

He looks at us, eyes wide, face pale. “Glad you’re here. I’m a doctor, an urologist, but I see patients in my office. I don’t deal with emergency—”

“It’s okay. We got it.”

Blowing out a sigh, he backs away.

Unconscious, the driver’s face is buried in the deployed air bag, arms dangled around it in a laxhug.

“Sir?” I feel his pulse. It’s thready and rapid. Blueness surrounds his mouth and colors his lips, his chest not rising and falling. “Respiratory arrest,” I say to my partner who’s assessing the unconscious passenger, the lifeless patient’s head caught in the shattered door window.

Frowning, my partner shakes his head. “Cardiac arrest over here. Facial skin ripped away. Neck twisted 180 degrees and split open. Bled out.”

Code for: We can’t do a thing for her.

My partner rushes our equipment-loaded stretcher around the trunk to the driver door, as I wave a firefighter over to climb into the backseat. With both hands, the firefighter stabilizes the patient’s head straight against the headrest as I assess the minor facial wounds caused by flying glass. Another firefighter grabs the airbag, punctures it and rips it out of my way.

I insert an oropharyngeal down my patient’s throat to protect his airway. I cover his mouth and nose with a BVM—bag valve mask—connected to oxygen tubing and a D-tank running at 15 liters per minute. As I squeeze the football-size bulb every five seconds to oxygenate his system,I assess his legs. Right femur appears fractured, left is covered with bleeding abrasions and lacerations, but no hemorrhage threat.

I strap a C-collar around his neck. Keeping his spine in-line, my partner and two firefighters place his body on a backboard on top of the stretcher, as I continue to bag him. I check his pulse again. Still present. I check for spontaneous breathing. Still nothing, although cyanosis no longer blankets his lips. I brace his entire right leg in a traction split to assist with hemorrhage control.

Inside the ambulance, my partner hooks our patient up to the cardiac monitor via a 12-lead, a firefighter bags the patient, and I perform a rapid trauma assessment, head to toe. After I find no other significant trauma or issues, I spike a bag. Less than a minute later we have an IV bolus in place, running high fluids.

Spiked and dipped lines display on the monitor screen. “Normal sinus rhythm,” I speak out loud. “But hypotension and tachycardic.” Meaning low BP and high pulse rate. I’m thinking it’s possible this patient is headed to hypoperfusion (shock) due to internal blood loss.

“Ready?” another firefighter asks from the ambulance’s driver’s seat.

“Yep, take off.” I listen to our patient’s chest. Heart beating rapidly but strong. Lungs sounds absent on the left side. Diminished on the right.

I eye my partner. “I’m thinking left pneumothroax. Right may be heading in that direction.” I read the monitor screen. “Severe hypotensive now. How about administering Dopamine?”

“Already on it,” my partner says, filling the IV catheter with the med. “He needs chest decompression. Let’s—”

“I’m having trouble bagging,” the firefighter says. “You wanna intubate him?”

“Do you have full resistance or only some?” I ask.

“Full.”

Blood quirts out of the patient’s mouth.

I gain my partner’s eye contact. “Cricoid intubation?”

“Yep. Chest decompression can wait.”

I locate the cricothyroid membrane, and prep the area with betadine. My partner punctures the skin with a needle while aspirating for air with a syringe, then slides a cannula along needle and syringe. I secure the cannula with a neck strap, and osculate for breathing with my stethoscope.

I hear solid breath sounds. “We’re good,” I say then eye the firefighter. “Continue bagging.”

I snag the radio and switch the channel to the number one trauma hospital.

“Wake Med? This is EMS #16. We’re en route with an MVC patient. Unconscious. Absent left lung sounds. Diminished in right. Surgical trach in place. O2 saturation 90% with BVM at 15lpm. Bolus IV in place. Dopamine dose administered. BP 90/50, pulse 162.  ETA 15 minutes.”

“Chest decompression,” my partner says as he arranges equipment.

To prep the site, I rub iodine to the patient’s second intercostals in the mid-clavicular line. My partner inserts a 14-guage catheter into the skin over the third rib. He advances the catheter through the parietal pleura.

“Pop,” he says indicating he felt a pop, which is the goal. He advances the catheter to the chest wall, then removes the needle, leaving the catheter in place.

I secure the catheter to chest wall with dressings and tape.

Six days later, I see the patient exiting the hospital in a wheelchair, his right leg casted. Two hospital employees assist him into an awaiting car. I smile huge and thank God.