would only give us thirty to forty minutes’ effective ventilation. This lad’s going to need CT scanning to rule out a skull fracture and C-spine injury before he even gets near the operating theatre.’
‘Heart rate’s dropping. Down to 90,’ a nurse warned.
‘And pulse pressure’s widening. One-fifty over 95.’
Tension in the trauma room went up a notch. The signs could be a warning of rising intracranial pressure from an as yet undiagnosed injury. Airway control and adequate ventilation had to be instigated as quickly as possible.
‘Surgical cricothyroidotomy should be enough.’ Mark joined the discussion between Jack and Jeremy. ‘Fewer complications than a tracheostomy, which could be done later in Theatre if it’s needed.’
‘Are you happy to do it?’
Mark nodded. He glanced at Jeremy. ‘Unless you want to?’
Jeremy shrugged. ‘Go for it, mate. I’ll look after the bag mask and Penny can assist you.’
Penelope relinquished the ventilation equipment, taking a quick glance at Jeremy as she did so. Was he bothered by his unusual failure to intubate a patient? Less than happy to hand over the imminent procedure to a newcomer? If so, he didn’t show it. Jeremy smiled at Penelope.
‘Seen one of these done before, Penny?’
‘No, but I know where the kit is. I’ll find it.’
She opened the roll of sterile drape on top of a fresh trolley to reveal the sterilised equipment that would be needed.
‘Clean the whole area over the cricoid and thyroid cartilage,’ Mark directed her. ‘Then we’ll infiltrate with one per cent plain lignocaine.’
Penelope swabbed the young man’s neck.
‘I’m going to stabilise the thyroid cartilage here,’ Mark told the onlookers. ‘Then I make a horizontal incision over the cricothyroid membrane. Scalpel, please.’
Everyone in the trauma room was crowding in for a closer look. This wasn’t an everyday occurrence. Mark appeared confident as he cut carefully into their patient’s throat. He reversed his hold on the scalpel and inserted the handle.
‘It’s helpful to rotate it through ninety degrees to open the airway,’ he explained. ‘Can I have a size 9 endotracheal tube, now, please?’
The tube that Penelope handed him was carefully inserted and the cuff inflated. Penelope had the sutures ready to hand over next. She watched as Mark stitched the tube into place.
‘I’ll get us hooked up.’ Jeremy was adjusting controls on the ventilator. ‘Let’s see if we can get some better-looking oxygen saturation figures.’ He nodded at Mark. ‘Well done.’
‘Thanks.’ With the airway and breathing for their patient now under control, Mark’s attention was diverted. He was examining Richard’s chest for injuries and had his stethoscope in his ears to recheck breathing.
‘Let’s have another neurological check,’ Jack requested. ‘What are the pupils like?’
‘Equal and reactive. Bit more sluggish than they were.’
‘Let’s run off a C-spine, chest and pelvic set of films,’ Jack directed. ‘Then we’ll send him for a CT scan of his head and neck.’ He was watching Mark as the registrar took a moment to re-examine their patient’s abdomen. He glanced at Penelope. ‘Give Neurology a call and get someone down for a consult, will you, please? Don’t worry about Orthopaedics just yet. That femur and wrist can wait.’
The doctors moved back as the radiographers positioned equipment.
‘Chest and abdomen look OK,’ Mark informed Jack. ‘I’d say he’s pretty stable for the moment.’
‘Now that we’ve got that airway sorted out, he is. Nice job, there, Mark.’
‘Thanks.’ Mark was looking at Penelope. ‘Thanks for your help. Penny, isn’t it?’
‘Penelope Baker.’ Penelope wanted to add her compliments about the surgical intervention but, while Mark smiled at her briefly, his attention was obviously still on their patient. He reached for a lead jacket so he could move back while the X-rays were being taken.
‘How bad is that femur?’
‘Feels like a clean break. Minimal swelling thanks to the traction splint. There’s a Colles’ fracture of the right wrist but everything else is superficial. With a bit of luck we might even keep him out of Theatre.’
‘What’s wrong with Theatre?’ Jeremy appeared relaxed as he joined the other doctors. He winked at Penelope as Mark moved away. ‘I’m quite happy in there myself.’ A glance at the wall clock prompted a frown. ‘In fact, I should be in there right now.’
Jack nodded. ‘Mark can take over monitoring the ventilation. Thanks for your help, Jeremy.’
Penelope watched the senior anaesthetics registrar leave the room. An Australian, Jeremy Lane had only taken up his new position at St Margaret’s a couple of months ago but Penelope had noticed him the first time he had come into the emergency department. Tall, blond and lean, Jeremy looked as though he’d spent a lot of his time on Australian beaches to acquire that tan. Maybe a lot of time surfing or swimming as well to gain the muscular build that Penelope hadn’t been the only one to notice. Neither had she been the only one to notice the fact that the anaesthetist wore no wedding ring.
Penelope swallowed a small sigh. Jeremy was undeniably good-looking and she didn’t mind that he had left the trauma room now without a backward glance. The wink had been sufficient for the moment. Jeremy had also made sure that she’d had front-line involvement in the unusual procedure. Penelope was rapt. This had been an exciting resuscitation and it looked as though their young patient was not only going to survive: he might even come through relatively unscathed.
‘We’ve finished here,’ a radiographer called. ‘We’ll have the films through on screen in a minute.’
‘Right. We’ll tidy up our secondary survey and get things moving,’ Jack directed. ‘Let’s have a few extra hands here for a log roll.’
* * *
‘Wasn’t that awesome? Imagine just cutting into someone’s throat like that.’
‘Mmm.’ Penelope dropped the bloodied scalpel into the sharps disposal container and put the holder with the other instruments destined for resterilisation. ‘You’d better put the mask from the bag mask unit in with this lot, Bindy.’
Belinda Scott pulled the mask free from the unit. ‘He’s good, isn’t he?’
‘Who?’
‘Mark Wallace. Our new registrar.’
‘Mmm.’ Penelope turned her attention to the suction unit. She stripped off the disposable tubing, coiling it up as she reached for the biohazard rubbish bag. ‘I wonder why Jeremy didn’t do the cricothy-roidotomy?’
‘Maybe
