support his head and neck in a neutral position, and then the splint was taken off his leg and his clothes were cut away to reveal his injuries.
‘If he lives he’ll complain like mad about this,’ the nurse working alongside Ginny said with a grin as she sliced up the side of the expensive leather gear the man was wearing.
‘Let’s just hope he lives to complain,’ Ginny muttered under her breath, and then ran her eyes over each part of him as it was revealed.
As the paramedic had said, his femur was distorted just above the knee and his right wrist looked very strange, but it was his chest that Ginny was concerned about. The left side was not inflating properly and when she pressed down gently she could feel the crepitations of the bone-ends scraping together.
‘Lower ribs have gone on the left—I think he’s got a punctured lung,’ she told Ryan.
‘Watch him for shock—the spleen might have gone too,’ Ryan mumbled, and then swore as his patient began to shudder and convulse. ‘Damn—I need to get this airway sorted,’ he growled.
Ginny tuned him out and concentrated on her patient. His pupils were equal and reactive to light, which she was grateful for, but he didn’t respond at all to voice and only slightly to pain.
She recorded the information on a neurological observation chart because of the suspected head injury, but she was more concerned for the moment with the immediate problem of his chest and abdomen.
She put in two chest drains—one for air and one for blood—using local anaesthetic in case he could feel it but not react, and asked the nurse for a report on his status as she watched the steady ooze of blood from the lower chest drain. She was glad she’d done it before. Now was not the time to learn!
‘Pulse one-twenty, thready, blood pressure seventy over thirty and falling.’
‘Damn. Let’s get some IV lines in and fill him up a bit. Is the X-ray coming?’
The door opened then and the radiographer came in. They worked round her, Ginny refusing to step back and continuing to put in the IV line into his left arm while the pictures were taken.
‘You shouldn’t do that—you’re a young woman,’ the radiographer scolded gently.
‘Don’t worry about me, I’m fine,’ Ginny said shortly, withdrawing some of the precious blood for cross matching. ‘Can we have the chest results quickly, please?’
‘Sure.’
They were left in peace then, squeezing the plasma expander in fairly rapidly to bulk up his blood volume while they waited for cross-matching. His blood pressure picked up a little, and they inserted another line into his damaged right arm.
‘I don’t want to use his legs because of the femur injury and possible internals,’ she said to Ryan, ‘and the neck I want to avoid until we’re sure he hasn’t got a head injury, so is it OK to use this broken arm?’
‘You’ve got no choice,’ he told her absently. ‘That’s more like it. OK, aspirate, please; get the blood out of her trachea. Can you cope, Virginia?’
‘Yes, I think so.’
‘Get four units of blood into him stat—use O neg while you wait for cross-match. There should be some coming up.’
There was, and she was glad to see it. Her patient’s pulse was very weak and thready, although they had boosted his blood volume, and she wondered how much he was losing into the thigh and how much through what she was beginning to be sure was a ruptured spleen.
‘Should we do a peritoneal lavage to see if he’s haemorrhaging?’ she asked Ryan.
He shook his head. ‘No. Treat as if he is—there should be a general surgeon on his way down to check. If he’s not here in five minutes—or if the lad deteriorates—I’ll stick a needle in and see what we come up with. Better catheterise him anyway—he’s going to have to go to Theatre. Do we have any ID?’
The sister lifted her head from the catheter she was already inserting. ‘Yes. The police are on it, apparently. They’re contacting relatives now.’
A man came in then, tall and rangy, his white hair in sharp contrast to the bushy black brows beneath. ‘Query abdomen for me?’ he said in a soft Scottish burr.
‘Oh, hi, Ross. Yeah, Virginia’s got it. She’ll fill you in.’
She met his eyes and smiled briefly. ‘Hi. I think his spleen might have gone. His ribs have penetrated his left lung low down, but he’s also got a possible head injury and his left femur and right wrist have gone.’
Ross nodded. ‘OK. Can I have a trocar, please?’
He scrubbed quickly while they prepared the abdomen for his incision, then Ginny watched as he carefully pushed the sharp instrument into the abdomen and pressed gently.
Blood welled rapidly out of the little hole, far too much and too fast to be because of the incision.
‘Damn. Right, we’d better have him now. Have we got head and spinal X-rays?’
‘Just done.’ They were snapped up on the light box by the radiographer, and Ross scanned them quickly. ‘That looks OK. Right, we can assume his head injury is of secondary importance to his internal haemorrhaging. The spleen looks enlarged and the abdo contents are displaced—aye, I’m sure it’s gone. I’ll get the orthopaedic boys to sort his leg and arm out after I’ve finished with the spleen and chest. How stable is he?’
‘Not bad,’ Ginny replied. ‘I think he’s improving. He’s certainly not getting any worse, but his blood pressure’s still a bit low.’
Ross nodded. ‘OK. Can you send him up as soon as he’s stable enough, please? I’ll go and scrub. How about this one?’
Ryan grunted. ‘Smashed mandible, lacerated tongue—I’m just suturing it now to stop the bleeding. Apart from that and the coma and the leg fractures, she’s fine.’
Ross snorted and left the room.
Ginny’s patient’s parents arrived at that point, so he was covered with a blanket; Ginny warned them about the breathing tube and the chest drains and IV lines, and then they came in for a few moments.
They were shocked and upset but, as Ryan said later, at least they knew he was still alive and recognisable, which was more than could be said for the girl who had been on the back of his bike. Her facial injuries were extensive and would require the intervention of a plastic surgeon—if she survived the head injury. Ryan thought her helmet must have been too big for her, as it had come off at the scene. Either that or it had been ripped off, thus damaging her jaw.
The boy’s parents were distressed by her condition, as well as their son’s. It seemed they were going out together and had been for some time.
‘Do you know where the police might find her parents?’ Ryan asked them.
‘Possibly.’
‘Would you talk to them? Sister has some forms for you to sign first, then if you could talk to the police?’
‘Of
