Crashes Last night my student and I only did one case. It involved a 23 year old man who had wrecked his motorcycle. He stated that he was making a U-turn when he was struck buy a car. Both of the bones in his lower left leg were badly broken and swollen. The surgeons used an external fixator to stabilize the break. The fixator attaches to the leg bones by several pins that extend out and are connected by several parallel rods. It looks like a combination of tinker toys and an erector set for those of you old enough to have had those toys when you were young. The man obviously was not wearing any form of protective jacket or shirt. He had extensive, deep "road rash" from his right shoulder, across his back, to his left hip. When the surgeons were done with his leg we scrubbed the road rash with soap and peroxide while he was still asleep otherwise I think the pain would have been unbearable. While we were doing that case another trauma arrived from the ER that was done by another anesthesia team. It involved a man who had been in a bad car accident. His face was severely cut and bruised. The worst part was that his left arm had been ripped off in the crash just below the shoulder. The surgeons determined that it was too badly damaged to try and reattach it. One more night.

Beware of Horses! My student and I had another busy night last night. Most of our night was spent doing a kidney transplant on a 53 year old man. My student got to see the full circle of transplants as the donor of the kidney was the poor man from the car wreck that we worked on two nights ago. Before the kidney case we took over another case involving a 60 year old women. We were told that she had been grooming a horse. Apparently she had the reins wrapped around her arm to restrain the horse. Something spooked the horse and it ran dragging her along with it. Her left leg was severely broken but worse still her left arm was literally ripped off below the elbow! The wound was badly contaminated with dirt, making infection a real risk. One more night to go.

Bad, Bad Blogger! They say the first step to change is to admit you have a problem. Okay I admit it I am a bad blogger. When I am at work doing an interesting case I think to myself "I should blog about this one". Then my night shift is over and I come home and go to bed. When I get up I get busy with other things and I forget to blog. I will try to do better in the future. I have a student on the night shift again. For the next few months the Army will be sending a CRNA student from Tripler Army base in Hawaii to spend a month doing the night shift with me. The goal is to get them some experience doing trauma cases. The current student has been here two weeks and has already gotten some really good cases. Last weekend we did cases involving a 21 year old soccer player who got kicked in the flank so hard it ruptured her kidney so bad the surgeons had to remove it to stop the bleeding. Another case from last weekend involved a 20 something young man who fell off his bicycle breaking several ribs. Unfortunately one of the jagged rib edges cut a small artery in his chest wall. By the time we finished his case he had lost 4000cc of blood and we had given him 16 units of blood products in replacement. This weekend we have also done several interesting cases. Thursday night started with a 28 year old man who was hit by a car. He had obvious head injuries but was bleeding to death in his abdomen. He was rushed to the ER without any kind of CT scan or xray of his head to stop the bleeding and save his life. After over 40 units of blood products the bleeding in his abdomen and chest was stopped. Unfortunately the CT scan of his head afterwards showed severe, irreparable brain damage, essentially he was brain dead. His family decided to allow him to be an organ donor and his kidneys were removed for donation Friday evening. Last night my student and I did two more trauma cases involving 20 something year old brothers who had both been shot with a shotgun. the first young man had been hit in the left chest. It must have been from fairly close range because there was one large golf ball sized jagged hole just below his left collarbone. The xray showed buckshot scattered throughout his left chest. His left lung took most of the damage and had collapsed. He also had a few pellets in his heart but the heart function appeared normal and the trauma surgeon elected to not take them out at that time. The patient will be reevaluated by a heart surgeon later to determine if they need to go back in. The first brothers wound was life threatening but in the long run I think the second brother's wound will be the more life changing one. He was shot on the right side of his face. His right eye and upper cheek were completely destroyed and several pellets hit his left eye. The eye surgeons attempted to salvage his left eye but they were not very hopeful about how much he would be able to see. My student and I were replaced by the day shift before this case was finished. The plastic surgeons were going to come in and work on the rest of his face after the eye surgeons were done. I am not sure how much good they will be able to do with what is left of his face. Two more nights to go. I will try to be a better blogger.