upended it and dumped the contents onto the pavement. The wrist BP cuff she still carried with her rolled free—her second guilty security blanket. She grabbed it and wrapped it around the man’s wrist.
“You carry a cuff?” Enzo asked, but he was listening to her as he went back to the abdomen and began prodding gently, looking for injury.
Kimberlyn didn’t answer, just pressed the button to start the automated machine and leaned forward to listen to his breathing again. “We need an ambulance. Did anyone call an ambulance?”
A beep announced the measuring of vitals had finished and she looked at the small display.
Pulse one twenty-nine. Pressure ninety-five over seventy-five.
“Crap. Crap, crap…”
Enzo’s eyes snapped to her and then to the display on the little cuff. “That’s not good.”
“No,” she said, looking around again. “Did anyone call 911?” Repeated it louder.
No one answered. The ones who’d helped push the car had already abandoned them. Enzo fished his phone from his pocket and dialed.
“We need a large syringe, and I don’t have one of those in my bag.”
Either he wasn’t worried by the situation or he didn’t realize the extent of what was going on.
“Enzo, listen to me.” She used his first name this time to capture his attention. When his eyes met hers, she had to force the words through her clenched throat. “Cardiac tamponade.”
Attention captured. “How do you know?”
“See the veins in his neck? Fluid’s coming on fast, filling his chest, and there’s no time for the pericardium to stretch and accommodate it to let his heart beat right. Either blood or serum. Probably both. Preferably more serum than blood.” More blood would probably mean a tear, but serum could just be trauma.
A cold pit opened in Enzo’s middle. They were close to the hospital, but that was the kind of diagnosis you wanted to say after remedying it.
He barked their location into the phone and followed it with, “Possible cardiac tamponade.” After demanding two additional crews and the NYPD, he ended the call and stashed his phone again. The borrowed stethoscope replaced the phone at his ear and he listened hard. The faintness bothered him. “You think pericardial effusion from the impact?”
She nodded, and from the lack of color in her face he believed her. No one could go pale for show like that.
He hadn’t had a cardiac tamponade patient in his four years of residency, but she sounded certain and had the look of someone with first-hand knowledge.
Something had to be blocking the sound of the heart. If anything, the man was underweight, nothing else made sense besides a wall of fluid muffling the sounds.
Sam Napier, his best friend in the residency program, had warned him that one of the many women in Sam’s House of Gorgeous Roommates had a cousin transferring in to chase Enzo’s fellowship. He’d expected… well, someone sunnier in disposition and appearance. A duplicate of Caren’s golden-blond curls, dimpled cheeks and the too-cheerful smiles that made it hard for him to be around her before at least two cups of coffee. Not this soft-spoken, dark-haired creature with the delicate features and soulful brown eyes.
“He was hit chest first,” she said, taking the blood pressure again. “As in he landed with his chest on the front top edge of the grille of the car. Then bounced off. I’ve seen this before in another crash. Three big symptoms, Beck’s Triad. Muffled and faint heartbeat. Distended neck veins. A narrow difference in the blood pressure readings… One, two, three.” She pointed as she counted, chest, neck and the cuff. “There’s barely anything between the systolic and diastolic.”
The cuff beeped again, the new results darkening the screen. Pulse one sixty-two. Pressure eighty over sixty-five.
Damn. She really was right. He was either bleeding out or something else was filling his chest.
The sound of sirens close by caught his attention. They were only a couple of blocks from the hospital, and the sound came from the right direction. Closer than Dispatch, and coming toward them now. Lucky.
They’d have a defibrillator, and other tools…
He could hear her little cuff running again, beneath the blessedly loud siren of the ambulance as it rolled to a stop just ahead in the intersection. “You.” He jabbed a finger at a woman in a power suit who still stood nearby, watching, “Meet the ambulance. Tell them we need a huge syringe.” He placed the stethoscope on the patient’s chest again, doing what little he could do to monitor the situation as help arrived.
Before the suited woman even got to the ambulance, the medics came running with a bag of tools, defibrillator and a large hypodermic syringe they slapped into his hand. His order had done the trick.
“Have you aspirated a pericardium before?” Enzo asked, looking at Kimberlyn. He hadn’t. Normally he’d like to try, but she’d made the diagnosis. Even if it weren’t a professional courtesy, he wanted to see her perform so he could gauge her skill level. It was the best way to ascertain if she was simply another trauma resident or an actual threat to his fellowship.
Whether she had ever done it before or not, the small brunette crammed her hands into the gloves presented by the medic and indicated an area on the right side of the man’s chest, “I can do it. Swab around and between the fourth and fifth ribs.” She joined him on the patient’s right side.
He ripped into the alcohol prep and broke the canister within the squeegee to disinfect the area.
“Tell me if his heart starts sounding louder or if there’s any other change.”
Would chest compressions even work if the pericardium was full of fluid? It’d be like trying to squeeze a water balloon inside a larger, overfilled balloon…
Even with the stethoscope buds in his ears, he could hear the tremor in her voice. Still scared. Was she steady enough to perform the aspiration?
“I will.” He listened and directed the EMT, never taking his eyes off Kimberlyn, “Get him wired up and on the monitor.”
Cardioversion was possible now at least.
With the extra-large hypodermic in hand, she braced one elbow on her knee for support and explained. “I’m going from the right side because the heart juts to the left, and I don’t want to hit it.”
Yeah. Don’t hit the heart…
She looked steady enough now. Whatever had her fighting panic, it came and went in waves.
Enzo backed up enough to make room but stayed close enough to keep the stethoscope in place to listen while the monitor was hooked up.
This might have been a bad call. She seemed competent except for those nerves. Her nerves triggered his. If she ended up doing more damage… Maybe they should just move him now and hope he lasted another five minutes, or however long it took to get to the hospital.
With her arms steadied and braced, she waited patiently the long seconds it took for the electrodes
