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Well, it was an eventful weekend. I work as a emergency medicine physician assistant in rural North Dakota (well, it’s all pretty much rural.) To support my gear addiction, I occasionally moonlight at some of the smaller hospitals in the area. The town I was working in this past weekend is very small. No surgeon, no anesthesia. I was the sole healthcare provider, with 2 nurses, a lab tech, x-ray and the ambulance crew. The weather has been crappy lately-Lots of freezing and thawing, snow, freezing rain, etc. A patient in a full-sized pickup was speeding and passed a semi, proceeded to lose control, and got hit in the driver’s side door by the semi which was going 65-70 mph. After a 45 min. extrication, they show up at my ER (LifeFLight was grounded due to weather.) The patient had a 7 rib flail chest and a tension pneumothorax, pulmonary contusions and was in the hurt locker big time when she got to the ER. Fast heart rate, absent breath sounds on the left, hypotensive. After intubating the patient, I asked the nurse for a 14 ga., 3 1/2 in. catheter to decompress the chest before I put in a chest tube. The nurse gave me a blank look and proceeds to rummaging through the crash cart, pulling out a 14 ga. 1 1/2 in. catheter, which is not long enough to get through the chest wall. A call to the central supply manager at home to see if they had any in central supply went unanswered. So, I went to the doc’s lounge, got my decompression needle from my trauma kit, and decompressed the patient’s chest.
[video=youtube;bC8u_IEh1AY]http://www.youtube.com/watch?v=bC8u_IEh1AY&feature=plcp&context=C39c3300UDOEgsToPDskIm-L06zMmG0DTRN0LiQAhp[/video]
(This is the kit I carry)
At any rate, that bought me some time to get the chest tube in. I transferred her to our trauma center where she is still in critical condition. I guess her injuries where isolated to her chest. Man, I sure am glad I had that needle, but not as much as the patient. The semi driver and his daughter were banged up, but didn’t have anything life-threatening. I ended up discharging them.
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