When did that happen?
It’s 3am and it’s myself and one other attending struggling to keep up with an unusually busy night. From outside, I can hear a screech of brakes, which isn’t all that unusual is there is an intersection 20 feet from the doors. But about two minutes later there comes a shout and the sounds of commotion from the triage area, the main doors to the ED slam open and medics are wheeling some a guy towards Room 2, our one and only real resus room. “He’s been shot in the chest” one of the call out “He drove him self in and we grabbed him in the parking lot.” “Does he have a pulse?” “Um, if he did, he doesn’t now” “Shit, get him on the bed and start CPR”.
And so we did. We got back pulses. I got him intubated on the first attempt, despite that he vomited in the middle of it. We don’t deal with trauma at this little hospital, we stabilize and then send them up the road to big brother. And someone has to make that happen, so the attending looked at me from the end of the bed “You got this?” “Yeah, I got this”. And for really the first time, I felt like I did. I don’t know when that happened. When did I suddenly know what to do for a guy who’s been shot in the chest and has lost his pulses. It’s crazy. It’s awesome. I got this. I finally feel like I can think one step ahead. Airway is secured, satting 100%, good breath sounds, but I’m getting set up for a chest tube in case we can’t transfer, grabbing a needle to decompress his chest if his pressure or sats suddenly drop. I’m eyeballing the thoracotomy tray, making sure it’s nearby if he looses pulses again (no, I wasn’t NOT about to crack his chest on my own, but at this point, I could start it while someone got the attending), if this second IV doesn’t go in smooth, I’m putting in a cortis line. 2L are up and running, how’s that chest x ray looking? No pneumo? Okay, looks like a hemathorax, but he’s holding steady on his sats. What? He’s ready to go already? Awesome, get him out of here, the can put the chest tube in when he gets there. I’m not going to stay and play when he can go now. But better get some more sedation ready for when he wakes up on the ride though. And so it went, we got him out, alive and stable. We didn’t actually have to DO that much beyond the basics of ABC, but the point was, I was, or at least felt I was, ready for whatever needed to be done. And that felt pretty damn awesome.