Another Day

We have gotten a little busier the last few days. We have had several interesting cases. We had our first patient die under our care the other day. He was ANP and had been run over or something (the report was that he had "nausea and vomiting"). He came to us barely alive with a splint on his leg from a complete tib-fib fracture and vomiting. He didn't even have an IV. Needless to say, this was quite a different presentation than we expected. It turned out he had a pelvis fracture, several broken ribs in addition to the previously mentioned tib-fib fracture. So, it was some sort of blunt force trauma that did it (we are thinking he was run over by something). Anyway, he arrested within minutes of arrival, so we did the normal ATLS stuff. Greg performed a thorocotomy in the trauma bay (didn't find anything in the chest other than the heart was beating, but empty which signaled massave bleeding from somewhere other than the chest), I put in a right chest tube after getting IO access with the manubrium IO device (everyone at ECM, remember I said I was going to do that?). That FAST IO works really well. We are able to give the first two rounds of ACLS drugs though it in addition to IV fluids and blood products. An E-Fast exam was performed with the ultrasound and found nothing in the peritoneum (so now we were thinking the blood loss must be retroperitoneal, most likely from the fractured pelvis). We eventually got a SCL line in on the right side and moved everything to it. Anyway, the IO device did prove its worth. It took all of about 30-45 seconds to get it. After about 35 minutes of CPR with no perfusing rythm, we called it. If we could have gotten a rythm back, we would have done a laporotomy and packed the pelvis since that seems to be where he bled from. Anyway, that was a good case that had a bad outcome. I beleive the patient was salvagable if he had gotten to us in time. He was dropped off at a local ANP compound and then eventually transported to us by ground. That takes a lot of time here, especially at night when bad guys are walking around (we received the patient at 2345 or so). We take for granted a reliable and safe EMT service at home. We have to go to the front gate to get the patients in our FLA (Hummer ambulance) and we can't even do that without wearing full body armor, weapon and all. We also had a 10 year old boy that had a through and through GSWs to both legs. The projectiles missed all major vascular and nerve structures and we just washed out both legs. Apparently, he was caught in some crossfire between ANP and some Taliban. Changing the subject, we got to shoot some AK-47s the other day, so here's some pictures of that. I had made friends with some of the contractor and military trainers at the ANP compound, so in addition to shooting the AK-47s, we are going to get some combatives (hand to hand combat) training there next week. I think that will be fun. The military has 3 levels of combatives training and we should be able to get at least level one certified before I leave. It gives us something to do when we are not working on patients. Anything to keep yourself occupied makes the time go by faster. I had some combatives training when I was in the Marine Corps (a long time ago) and it looks like the new training is better than what I have had. It incorporates at lot of the MMA (mixed martial arts) techniques. Since its almost Christmas, I thought I would throw in a picture of me with my Santa hat on. That's it for this post, so see yall later!