The traumas are getting easier for me. Yesterday I had my first pediatric trauma. A 10 year old who was thrown out of a car that his brother was driving. He wasn’t wearing a seat belt. He had gross deformity of his left lower leg. He was awake when he arrived, talking, but didn’t remember the accident. I listed to his lungs and his heart, his vital signs were good. we rolled him over and examined his back…he screamed in pain whenever we touched his left leg. I was wearing a lead jacket for the x-ray machine and he was hitting me in the chest with his fist over and over while they splinted his leg. He had a skull fracture as well, but otherwise no injuries. While I was trying to get all of his paperwork in order to get him a bed and get pain medicine ordered, his 16 year old brother called and was hysterical. “Where’s the chaplain?” I shouted across the department…I didn’t need to be doing the chaplain’s work on top of my own. The boy was hysterical because he couldn’t find out where his mother had been taken. Five minutes after hanging up the phone, I found the chaplain and the mother together. I gave them the son’s cell phone number, asked her please to call her son because he’s very worried about you. Then I returned to my patient.
Several hours after he was admitted, I had forgotten all about him and was paged for another trauma. This time, the senior trauma resident was in the OR, and for teh first few minutes before the attending arrived, it was me, the flight crew and the nurses. A young man was riding his dirt bike, without a helmet, and was thrown to the ground. He was awake and talking as well. His initial survey went quickly. He had been transferred from another hosptial and his foley was full of blood. The attending asked me what studies I wanted to do. It seemed so obvious…scan his belly to look for the blood I had seen on ultrasound, find out where it was coming from…a CT cystogram to look for bladder rupture or leaking. He had a spleen laceration, a fractured kidney and a large clot in his bladder. He nearly required conscious sedation just to tolerate the foley in his bladder. We admitted him to the Special Care Unit, a step below Intensive Care. By morning, he was feeling better, but his blood loss continued. We’ll keep an eye on him.