One of the downsides of working in a Level One Trauma Center is, well, taking care of Level One Traumas in the OR. A patient arrives to the Emergency Room labeled a Level One Trauma when he/she has acquired possible life- or limb-threatening injuries.
As challenging as these cases are to manage anesthetically if they come to the OR, they are heartbreaking too, as someone who woke up in their normal state of health that morning is now fighting for their life in an operating room. All judgment by healthcare personnel must be checked at the door with cases like these – we are all human and we are all frail, and there but for the grace of God go I, as someone once said, and I agree with them.
Yesterday’s Level One Trauma at XYZ Hospital was the victim of multiple gunshot wounds – to the chest, leg, and abdomen. Said victim came to the emergency room intubated and with CPR in progress. Due to the nature of the gunshot wound in the chest, and no detectable cardiac rhythm, the next step in the algorithm of care was for the trauma surgeon to crack this patient’s chest open and deliver open cardiac massage, possibly hoping to see inside what caused the heart to stop beating, with the hopes of immediately ameliorating the situation. The site of bleeding could not be identified, because there was so much blood coming from the chest. After a chest tube was inserted, and multiple rounds of epinephrine and shocks administered, the heart began feebly beating, along with a femoral pulse detectable by doppler (ultrasound), and said patient was therefore MANDATORILY WHISKED to the OR.
So began the next 3 hour saga of trying to save this patient’s life. The chest bullet had severed both the left subclavian artery and vein, of which either damaged vessel alone could reliably cause the loss of someone’s total blood volume. Together, a recipe for disaster. The surgeons never addressed the abdominal bullet, as the chest wound alone ultimately mortally wounded the patient.
These cases are extremely hard to take care of, because everyone is fighting the battle so hard but the war is being lost. All OR, surgical, and anesthesia personnel available were struggling to save this patient’s life. It was a messy (bloody) case, and in the end I am just thankful that it was not me afterwards who had to talk to this person’s family who were all gathered in the waiting area, frantically pacing.