10 July 2015
Sunday’s shift was a looooong shift. I was here, there and everywhere around the Cambridgeshire area. I had mentioned at the beginning of the day that I would quite like more exposure in certain areas, particularly trauma.
One of my most stand-out jobs of the day came through on the terafix as ‘arm run over by a bus’. Trauma is a tricky thing: you have to assess the patient in under a minute, adding 2 Cs to the ABC primary survey to make it <c>AcBC and try to work out if there’s anything more seriously wrong with them than what they present with. You work from the head to the toes, covering every long bone, every part of the body where blood could pool. This poor patient had cycled into a bus, fallen off of his bike and then where he had been laying, the bus then moved forward and drove over his right arm at the elbow. This patient had two open fractures (an open fracture is a fracture where the bone has broken and pierced through the skin) one on his distal humerus and the other on his radial at the elbow end. It was slightly chaotic but thrilling at the same time. As a student I was given the opportunity to introduce myself to this patient and then attempt an assessment. This is the first time I have been attending, taking the lead, and I tried my best to assess this patient with my mentor also treating on the other side.
The air ambulance was dispatched to this job due to the mechanism of injury, as they can bring skills to the table such as extra pain relief, sedation and a different type of splinting. On an ambulance we carry a box splint or a vacuum splint. The splint that the air ambulance used on this job was a soft spongy material that, when mixed with water, hardens around the area to support it. The arm was manipulated to re-align the bones and then this splint was applied. The patient was also sedated using ketamine and midazolam, for pain relief. It works on different receptors to morphine (which is the strongest painkiller a paramedic carries) and has fewer side effects; for example, the drop in blood pressure that morphine produces, ketamine doesn’t. The midazolam that is given to the patient helps reduce the aggression that can sometimes come with a bad ‘trip’ on Ketamine. The patient was completely relaxed and sedated and happy for the short trip to hospital. (He even called me cupcake!)
Like I say, be careful what you wish for, you just might get it!