SALT LAKE CITY — The page goes out: “Code trauma, alert 1. Code trauma, alert 1.” This notifies the entire hospital that there is a trauma patient coming into the emergency room, expected to show within five minutes. This call rallies the troops, so to speak. People from different parts of the hospital come to lend a hand.
When called upon by the charge nurse to be the primary nurse on a trauma one patient, a little excitement goes through my body. I have no idea what to expect, but I have learned from previous experiences that many times I need to expect the worse.
When everybody arrives at the trauma room, gowned up with booties on their feet, the charge nurse, as with all trauma patients that come in, gives a quick timeout and gives us all the information available about the patient (which sometimes isn’t much) so we are all on the same page. This, in many instances, increases the anticipation in the room.
The patient arrives, intubated, at the room. Vital signs are taken and a quick primary assessment (airway, breathing and circulation) is performed. The crew then gives us another report with everything it knows about the accident and what it has done. The patient was riding a bike, wearing a helmet, crashed and was knocked unconscious and was intubated in the field prior to arrival. The patient has severe head trauma and is bleeding profusely from both ears.
The patient is lying in a pool of blood coming from his ears that is dripping all over the floor and on our shoes and pant legs. Towels are laid down so we don’t track blood all over the room, but the towels need to be replaced every few minutes. He is, remarkably, stable at this point and is transported to the CT scanner.
We have a saying that if a person is going to “go south” they will do it in the CT scanner. This was, unfortunately, true in this situation. While in the scanner, his blood pressure drops into the 70/40 range. Blood is immediately, rapidly infused per MTP (massive transfusion protocol), activated by the trauma surgeon. The CT is postponed and he is brought back into the trauma room.
After several units of blood, his blood pressure seems to stabilize and we feel a momentary sigh of relief. But that is short lived. The blood pressure again drops and more blood is started. This time we have a hard time stabilizing it. He is in hypovolemic shock and is losing blood faster than we can give it (which is incredible because we gave so much blood that we replaced his entire body's blood supply two times over).
With all the anticipation in the room and over all the noise I can hear the cardiac monitor beeping loudly. I look up and see ventricular fibrillation (V-fib), a life-threatening heart rhythm. I yell to no one in particular that the patient is in V-fib and immediately someone starts CPR and we get set to defibrillate the heart back into a normal rhythm. The defibrillation is successful and CPR is halted for the moment.
At this point, the emotion and tension in the room is building as a sense of loss fills the room. The look of defeat is evident on the faces of those present as we can all sense this is not going to end well. As quickly as we get the heart beating again, the patient, again, goes into cardiac arrest and we start CPR. The trauma surgeon asks if there is anything else we can do and leaves it open for discussion. When no one answers, he says to keep doing CPR and he will go out and speak with the family.
This is always an emotional moment for me, seeing the family come in. I can’t imagine saying goodbye to my spouse or child for a short time that morning and then several hours later saying goodbye to them forever. We continue CPR as the family hesitantly and slowly enters the room (a room that literally looks like a scene in the movie "Saw"; blood splattered all over the floor, on our gowns, and even on the walls) and sit next to the bed. The emotions in the room are high and I notice several of my co-workers (as well as me) are trying hard to hold back tears.
The family says their final goodbye. With tear-filled eyes, the wife looks at her family, then slowly looks at the trauma surgeon and gives him the nod. He then gives us the word, calls out the time of death, and immediately everyone stops. After 4½ hours of trying to save his life, the patient dies. The feeling of failure is a harsh and bitter feeling, especially when it comes to trying to save a life of someone who was way too young and healthy to die. My heart goes out to the family and friends and I find myself often thinking about this person and situation and thinking about what more we could have done to save his life.
These articles are intended for entertainment purposes, to shed light on the life inside an Emergency Room and not to be used in place of a doctor's care or advice.