The Rest of the Weekend First an update. The 13 year old with the stab wound to the heart from my previous post will survive. Unfortunately it appears that he has suffered rather significant brain damage. It probably occured at the first hospital when they coded him and performed CPR on him. Saturday night at work turned out to be as busy as Friday night was. We started the night with a bad trauma. A 45 year old man had shot himself in the abdomen. It was a large caliber bullet and it caused a very large hole in his liver. The liver is a highly vascular organ. The man was literally bleeding to death as they rushed him to the operating room. The surgeons quickly opened him up and my student and I started pumping in blood products. The surgeons worked on his liver but were unable to completely stop the bleeding due to the severity of the damage. We pumped in about 50 units of blood products as the surgeons packed off the wound to take him down to radiology. It was hoped that a radiologist would be able to place an iv line in his leg and run a line to his liver and stop the bleeding from the inside. Unfortunately the radiologist was also unable to stop the bleeding and the patient died about 4 hours after we started working on him. The final case of the night was a a kidney transplant on a 55 year old women. In this case the donor of the kidneys had been 6 months old. Because of the small size of the kidneys both of them would be placed in my patient. According to the surgeon the infant kidneys would actually grow bigger in the recipient and would eventually be almost normal adult size. Sunday night was quiet until about 4 in the morning. A 45 year old woman was brought to the operating room. We were told that she had collapsed at a casino. The CT scan showed she had suffered a massive bleed on the left side of her brain. The surgeons opened her skull and removed a lot of clotted blood. They found the source of the bleeding and stopped it and closed her back up. Unfortunately the surgeons felt that she had suffered permanent brain damage. How bad it would be would have to wait to be determined. For my student this turned out to be a very good weekend with lots of trauma experience for her. Unfortunately several of the outcomes were not what we would have liked them to be.

Straight to The Heart Last night was my second of four nights at work. I have another student who is working with me this weekend and last night turned out to be a great night for her. We started out with a 13 year old who was helicoptered to our hospital from another. He had multiple stab wounds to the chest. We never did hear the how or why he had been stabbed. He already had a breathing tube in place when he arrived and we were told that CPR had been done for a short time at the other hospital. He had already received 5 units of blood. In the operating room the surgeons opened his left chest and found that he had been stabbed in the left ventricle of his heart. The hole was about a centimeter in size. The surgeons were able to close the hole while we gave the young man 5 more units of blood and 4 units of plasma. We left the breathing tube in at the end of the case and took him to the Peds ICU. Later last night we did a second case involving a 28 year old man with multiple stab wounds to the abdomen. He was stable when they brought him up to the operating room. We put him to sleep and my student placed the breathing tube. It turned out that there was only very minor damage inside and we were able to remove the breathing tube at the end of the case. Two more nights to go.

An Update I am at work on my third of three nights and it has been quiet so far. I did get the chance to check up on the 11 year old from my last post. The breathing tube has been taken out and he is talking and moving appropriately so it appears for now that he will make a full recovery! Hopefully his parents will learn from this close call and keep him safer in the future.

Stupid Parents Piss Me Off It is almost 4 in the morning of my first of 3 nights at work and so far I have only done one case. It involved an 11 year old boy. He was brought to the operating room with a head injury. He had an epideral hematoma which means he was bleeding just under the skull. This is not the brain itself bleeding but bleeding in the space between the bone of the skull and the layer of tissue that surrounds the brain. Because it is an enclosed space bleeding here fills the space and starts putting pressure on the brain. Left untreated the pressure can build up until it causes permanent brain damage or death. Now you may be asking yourself "I wonder how and why this 11 year old started bleeding inside his skull?" The answer is because his parents are idiots!! Fair warning, I am about to stand up on top of my soap box so continue at your own risk. This 11 year old boy got injured when he over turned the ATV (that's an All Terrain Vehicle by the way) he was driving by himself. Since he wasn't wearing a helmet, when his head hit the ground he started bleeding inside his skull. Personally I wouldn't own an ATV especially the highly unstable 3 wheeled kind. But if I did own one I would not let an 11 year old kid drive it by himself and he and I would always wear helmets when we rode. I don't know the legality of an 11 year driving an ATV but in my book this boy's parents are guilty of child endangerment. The surgeons removed a 4 inch diameter piece of the boys skull on the left side. They drained a large amount of blood clot and were able to stop any further bleeding. They replaced the skull bone and closed his scalp. I left the breathing tube in place and took him to the ICU. He will be kept heavily sedated for a day or more before they wake him up and remove the breathing tube. The surgeons were pleased with their work but we will not know if there was any permanent brain damage for several days. If I have offended any ATV riders all I can say is; oh well. I will get off my soap box now.

Something Good from Something Bad If you read my post from 20 July I wrote about how I hate doing organ harvest cases. This case involved a 20 year old woman who had a gunshot wound to the head. In my mailbox at work tonight I found a letter. It was written by the coordinator for the Organ Donor Services. This is the group who oversees organ donation in my area. They arrange for the organ harvests and then get the organs to which ever hospital needs then for transplantation. The letter was a thank you to me for my part in the organ harvest. Here is a paraphrase of part of the letter... "The family felt that their loved one was a loving, giving person...They decided to say yes to organ donation, and 4 lives were saved from those gifts. We recovered the heart which went to a 43 year old woman in Arizona. The left kidney and pancreas were transplanted into a 32 old woman at another local hospital. The right kidney was transplanted into a 61 year old woman in my hospital. The liver went to a 4 year old boy in southern California." It was a very nice letter. It is nice to know that I had a small part in changing the lives of 4 other people. I think organ harvests will always be one of my least favorite cases, but at least something good comes out of them.