under the edge of his shirt, she ran her hand carefully over his ribs. Several were sticking out at a strange angle, but the skin seemed intact.
She worked her way down, her fingers tracing his hipbone on the far side. So far so good. Her hand explored the rim of the steering-wheel, and she could feel something warm and wet on his abdomen. It didn’t feel sticky, so it was probably urine. Certainly she could smell it. The question was, had his bladder been punctured or had he simply wet himself?
She asked, and he didn’t seem to know. Still, there was no evidence of blood on her hand, which was a good sign. She continued her search, her fingers gentle but thorough, and found the full sweep of the steering-wheel, distorted but intact. So far, so good. She moved on.
His right femur seemed all right, lying awkwardly but unbroken, as far as she could tell. His knee, though, was a different matter. She approached it with caution, but the really painful part was embedded in the remains of the dashboard. The area below his knee was out of reach, but she could see in the light from the torch Patrick had passed her that it was trapped in the distorted footwell.
His left leg seemed to have fared better, and he said he could wriggle the toes of that one although she couldn’t see them because of the bent and twisted metal in the way.
His voice was growing weaker, and she checked his blood pressure again. It was falling still, but whether because he was losing blood internally or because the steering-wheel was digging into his abdomen so hard it interferred with his venous flow she couldn’t tell.
She squeezed the bag of Haemacel for a minute, to boost his circulation, and then turned her attention back to Patrick, who was calling her from the tunnel.
‘They want to know about this beam. They’re going to send in the smallest man they’ve got to check it out and put in supports and airbags, if necessary, to protect him while they remove the rubble from around the cab. OK? So you have to come out.’
Just then she sensed rather than heard a change in Nigel. ‘Hang on,’ she muttered, and, turning, she wriggled back towards him. ‘Nigel?’
‘It’s getting bloody hard to breathe,’ he muttered.
She flashed the torch at his face, noting the blue line round his lips and the bulging veins in the side of his neck.
‘I’m just going to check your ribs,’ she told him, and tapped the side of his chest nearest to her.
Sure enough, it sounded hollow and unduly loud.
She wriggled back to Patrick. ‘I don’t like to rock the boat,’ she said quietly, ‘but our patient’s got a tension pneumothorax—I think his right lung’s collapsed.’
Patrick’s language deteriorated rapidly. ‘You’ll have to come out and let me in.’
‘Don’t be ridiculous. Get me a cannula and I’ll do it.’
‘With or without anaesthetic?’
‘We don’t have time to wait for the lignocaine to work. Just give me the stuff and talk me through it. If it hurts, no doubt he’ll be grateful later.’
Muttering, clearly reluctant, he handed her the cannula. ‘Between the fourth and fifth ribs, to the side and just below his nipple. And for God’s sake mind the intercostal nerve and blood vessels—they run just below each rib.’
‘Fine. Got that.’ Cutting away Nigel’s shirt, she cleaned the area quickly and opened the packet containing the cannula.
‘Right, Nigel, I’m going to make a hole through into your ribcage and let out the air that’s trapped outside your lung stopping you from breathing—OK? I’m sorry, it may hurt a bit.’
Nigel, now desperate for air, nodded. She guessed the other side of his chest might have similar problems, or perhaps a haemothorax. Whatever, if she didn’t move soon, he was going to die.
Taking a steadying breath, and with Patrick’s calm voice instructing her from behind, she slid the thick, solid trocar instrument through the intercostal muscle, which filled the space between the ribs, and into the pleural cavity, then slid the cannula over it and withdrew the trocar. There was a rush of air, and within seconds Nigel’s colour changed back to a healthier pink.
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