their own tasks within the set protocols. So much happening and so much information being gathered and passed. It took a special ability to be able to assimilate the details, to focus on each task and to switch focus with speed should the situation dictate a new urgency.
‘This is Daniel Lever. He’s nineteen years old.’ The ambulance officer was reinforcing information they had previously radioed through to the department. Transmission was often patchy. ‘Car versus truck. Daniel was the single occupant of the car.’
The stretcher was positioned alongside the bed.
‘High-speed impact with vehicle rollover.’
Amy noted the cervical collar around the young man’s neck and the backboard he was strapped onto. Spinal injuries had to be high on the index of suspicion after the description of the accident.
‘Daniel was trapped in the car for approximately forty-five minutes.’ The ambulance officer shifted the portable cardiac monitor out of the way. ‘Are we ready? One, two…three!’
Amy moved to help lift the backboard. Entrapment time had already eaten well into the ‘golden hour’.
‘Systolic BP of 90, heart rate 125, respiration rate of 30. Daniel has remained conscious but confused with a GCS of 13. He has chest injuries, including a flail segment with possible pneumothorax, abdominal tenderness and a compound fracture of the left femur.’
Jennifer Bowman was the airway nurse on the team. She was first into action as their patient was transferred to the bed.
‘Hello, Daniel. Can you open your eyes for me?’ Jennifer disconnected the portable oxygen cylinder and reattached the line to the wall outlet as Daniel groaned in response. She adjusted the position of the high-concentration oxygen mask he was wearing. Amy used shears to clip away the remnants of clothing on Daniel’s chest. She glanced at the other nurse as she heard the encouraging murmur of her voice soothing their distressed patient. Jennifer was also responsible for talking to the patient and giving support. The rapport she could establish quickly with people was a strength that Amy appreciated more than most. Jennifer was perfect for the job.
Gareth Harvey, the senior emergency consultant, listened to Daniel’s chest with a stethoscope while still receiving information from the ambulance crew.
‘He’s received 1.5 litres of saline so far. He’s also had 10 mg of morphine. Cardiac rhythm’s been stable.’
Amy attached the leads for the department’s cardiac monitor. Now she wrapped the automatic blood-pressure cuff around Daniel’s arm and clipped an oxygen saturation probe over his index finger. They had been unable to get an accurate reading in the ambulance. Judging from Daniel’s colour, it wasn’t going to indicate a good level of circulating oxygen in his bloodstream. A junior nurse, Janice Healey, was struggling to cut away the denim of Daniel’s jeans. He groaned loudly as she tried to pull some fabric clear of the splint on his left leg.
‘Leave that for the moment, Janice,’ Amy advised. ‘And don’t take the dressing off the wound until a doctor is ready to look at it. The more exposure it gets, the more likely it is to get contaminated.’
Jennifer was still trying to establish communication. ‘Do you know where you are at the moment, Daniel?’
‘Can’t…breathe…’ Daniel gasped. ‘Help…me.’
Amy glanced at the monitor. Oxygen saturation was well below ninety per cent. She was reaching for the chest-drain pack before Gareth Harvey requested it. Their patient was desperate to sit up to try and ease his breathing difficulty. Being strapped to a backboard due to the possibility of spinal damage was increasing his distress.
‘Left-sided tension pneumothorax,’ Gareth informed Amy.
Amy was already drawing up the local anaesthetic. A chest drain had to be inserted as the first priority. Air had entered Daniel’s chest outside the lung, probably because of laceration from the broken ribs. The pressure had collapsed the lung and was now threatening the function of the other lung and his heart.
Jennifer had her head bent close to Daniel’s. ‘We’re going to do something to help with your breathing, Daniel,’ she told him clearly. ‘You might feel a bit of stinging. That’s some local anaesthetic going into the side of your chest.’
‘BP’s dropping,’ Amy warned Gareth. ‘Systolic’s down to 80 and we’re getting a few ectopics.’ She kept an eye on the irregular beats showing up on the cardiac monitor as she ripped open sterile packs and assisted the consultant to insert the chest drain.
Daniel’s breathing improved dramatically as the internal pressure of air was relieved but his blood pressure was still dropping. The registrar who had been busy assessing the abdominal and leg injuries looked worried. He directed Gareth’s attention to the abdominal distension that was becoming obvious. Amy changed the bag of IV fluid as the level dropped. The registrar was directed to put in a second IV line and start running Haemaccel instead of saline. Amy ripped open more sterile packs.
The team member responsible for documenting the resuscitation attempt was Peter Milne, one of the department’s nurse managers. Amy showed him the empty bag of saline.
‘That’s the third one so far.’ She glanced at the large preprinted form Peter was filling in. ‘Oxygen saturation’s come up to ninety-three per cent,’ she told him. ‘BP’s dropped to 75.’
Janice Healey was ferrying blood samples. She came back with a distraught-looking middle-aged woman beside her.
‘This is Daniel’s mother,’ she told the team nervously. ‘Is it OK if she comes in?’
The registrar had just exposed the open fracture of Daniel’s leg for assessment. Daniel’s mother lost all the colour from her face. Amy moved to help the woman but Peter beat her to it. He supported her with a firm hand on her arm.
‘Janice, take Daniel’s mother down to the relatives’ room for the moment and stay with her. I’ll come down as soon as we have all the information we need to give her the full picture.’
Janice stepped away. ‘Come with me, Mrs Lever,’ she said hesitantly. Daniel’s mother remained glued to the spot, her terrified gaze fixed on her son. Peter raised an eyebrow at Amy, who nodded. She would take over documenting the case until Peter had settled Mrs Lever somewhere a little less traumatic. Amy was confident she could remember the details and be able to record them during the lull coming up when X-rays would be taken. It took another twenty minutes until the team were satisfied that their patient was stable enough to transfer to Theatre. Surgery was certainly the next priority. The cause of the abdominal bleeding had to be found and treated if Daniel was going to survive.
‘Orthopaedics might want a look at that leg at the same time,’ the registrar suggested. ‘Limb baselines are all well down.’
At the mention of the orthopaedic department Jennifer caught Amy’s eye and winked. Amy ignored the gesture but was immediately reminded of the knot of tension she had been harbouring all morning. Not that she could do anything about it right now. The trauma case had added to an already busy shift. Amy had two other patients she needed to go back to monitoring.
The adrenaline rush of working on Daniel’s emergency admission wore off only too quickly and Amy was left feeling strangely nervous. The soft peal of laughter she heard only minutes later made her turn swiftly. She couldn’t see anything, of course. The curtain around cubicle 4, which she had
