but Katsuko was one of the most gorgeous women he’d ever set eyes on. She might be small but she had curves in all the right places. One thing was for sure—if she was only six inches taller she would be on the catwalk.
It was odd. Avery had always gone for blondes—usually leggy. But all of a sudden leggy blondes had flown straight out of his mind.
She crossed her arms over her chest and met his inquisitive gaze. From the determined tilt of her chin it was clear she knew he’d been checking her out.
She plonked his hat back on his head, then turned and walked away, giving him a clear view of her tight, perfectly formed ass. The pale green scrubs looked good on her.
He couldn’t help but laugh.
Shaking his head, he walked after her, stopping at the nearest sink to wash his hands. He didn’t even have time to catch his breath. The siren sounded again and another trolley crashed through the doors from an ambulance outside. This time the patient was an adult. His colour was poor and he was rasping.
The ambulance crew spoke rapidly in Japanese. Katsuko didn’t even blink, she just translated. ‘Thirty-five-year-old also injured in the factory explosion. Bruising across his torso already visible. No penetration wounds. They suspect broken ribs. Poor oxygen saturation. He’s complained of chest pain and he’s tachycardic. Probably tension pneumothorax.’ She bit her lip. ‘First the kid, now the adult.’
She was mirroring his exact thoughts. Two cases of pneuomothorax, each requiring different management.
In their absence, someone had cleared the resus room. Both bays were empty again. Avery grabbed the pink stethoscope that was hanging around Katsuko’s neck. ‘Hey!’ she shouted.
‘Needs must. Haven’t been able to find mine yet.’
As the trolley eased to a halt he listened carefully to both sides of the man’s chest. He waved his hand. ‘Sit him forward so I can check his back.’ Two nursing assistants responded instantly, helping to sit the man forward. The back was clear. No sign of any wounds. The patient was eased back. The shift in the trachea was evident. There was no need for anything else. A pneumothorax was air in the chest cavity. This had probably resulted from a fractured rib puncturing his lung and releasing air into the pleural space. A pneumothorax wasn’t usually life-threatening unless it progressed to a tension pneumothorax, causing compression of the vena cava, reducing cardiac blood flow to the heart and decreasing cardiac output—and that was exactly what had happened here.
A tension pneumothorax could be life-threatening and needed prompt action. The military had collected vast amounts of data regarding tension pneumothorax and subsequent treatment. In a combat setting, tension pneumothorax was the second leading cause of death, and was often preventable. Today Avery was going to make sure it was preventable.
‘Tension pneumothorax.’
Two words were all it took. Packs opened around him. Surgical gloves appeared. He pulled them on and swabbed the skin. Katsuko was speaking into the man’s ear in a low voice. She waved Avery on with a nod of her head.
‘Let’s get some oxygen on the patient.’
The staff responded instantly.
‘Do we have a name?’
His body was already starved of oxygen. They had to supplement as much as possible.
One of the physician’s assistants put his hand in the man’s pocket and pulled out a wallet. ‘Akio Yamada.’ He frowned as he calculated in his head. ‘I make him forty-four.’
Avery leaned over the man. His eyes were tightly closed and he was wincing, obviously in pain. He put his hand gently on his shoulder. ‘Akio, I’m a doctor. I’m going to do something that will help your breathing. It might be a little uncomfortable.’
This wasn’t a pleasant procedure but the effect would be almost instant relief. Air was trapped and had caused the man’s lung to collapse. As soon as the pressure was relieved and the lung reinflated he’d be able to breathe more easily again. Katsuko gave a nod that she’d finished translating.
There were specially manufactured needles designed just for a tension pneumothorax. Avery held out his hand. ‘Fourteen-gauge needle and catheter.’ He’d done this on numerous occasions in the past. It only took a few seconds to feel with his fingers for the second intercostal space, at the midclavicular line. It was vital that the needle be inserted at a ninety-degree angle to the chest wall so it would be positioned directly into the pleural space. Any mistake could result in a chance of hitting other structures—even the heart. But Avery was experienced.
The room was silent during the procedure. In a few seconds there was an audible release as the trapped air rushed out and the tension was released from his chest. Avery removed the needle and disposed of it, leaving the catheter in place. He secured it with some tape as he watched the man’s chest. Sometimes the lung inflated again immediately, sometimes it took a little time. The patient would need to be monitored.
He pulled off his gloves. ‘Can we keep an eye on his sats for the next few hours and get a portable chest X-ray?’ The man’s eyes flickered open.
Avery put a hand on his shoulder. It didn’t matter that the patient couldn’t understand him. ‘You should feel easier now. Just relax. We’ll keep a close eye on you.’
Katsuko’s gaze met his and she translated again. At least, he hoped she was translating. The truth was she could be saying anything at all and he’d never know. In a way it frustrated him. When he’d thought he was being shipped out to Portugal and Italy he’d learned a few words and phrases that he could use in clinical situations to reassure patients. He’d need to try and learn some basic Japanese.
‘Doctor?’
A clerk was standing at the door. ‘Yes?’
She waved an electronic tablet at him. ‘I’ll need you to write some notes on the two patients you’ve seen and fill some orders.’ She hesitated for a second. ‘Because you’re not officially on duty yet I’ll need to get another doctor to sign off on your cases.’
He met her worried gaze with a smile. ‘No problem.’ He could almost hear her inaudible sigh. Was she really worried he’d be offended? Of course he wasn’t.
He turned back to the patient. The male African-American nurse he’d met earlier had appeared back in the room. This time he held out his large hand towards Avery. ‘Frank Kelly, pleased to meet you.’ Avery had thought he was big at six feet two, but this guy was a giant. With his regular runs and gym workouts he normally felt pretty fit, but Frank would make a professional wrestler shrink away.
‘I’ll take over, Katsuko,’ Frank said confidently. ‘The other two majors are fractures, one a femur, the other a humerus and shoulder displacement. Do you want to check them over? Katia is triaging the walking wounded.’
Katsuko paused. He could see her hesitation to hand another patient over. Didn’t she let anyone else take charge?
He tried to hide his smile and he turned back to the patient. The colour in his cheeks was gradually improving.
He scribbled some instructions on a chart for Frank. ‘I’ll write him up for some pain relief and order a chest X-ray. Can you monitor his obs every ten minutes for the next hour?’
Frank
