Hey dude, that ain't the bathroom...
That title is words of wisdom that a patient of mine should have heard before he went and made himself the first pucker-factor trauma pt of my paramedic career.
I thought my Cardizem guy got my pulse rate up a bit. pfft. I have learned over the last few months that I, unlike many EMTs and Paramedics i know, am not a trauma junkie. No sir, no how. I do not like trauma. I know it's relatively simple... Airway Airway Airway, secure the spine, large bore IV's, pump some fluid into them, do your exam, evaluate extent and possibilities of injuries, patch em up, etc etc etc. Still, I do not enjoy trauma at all. Give me a cardiac call any day of the week.
I was hanging out at my girlfriend's house by the fire station when my pager went off for an "Injuries from a fall down some stairs, bleeding from the ear." Hmm... this could be interesting.
Mike (the best damn driver in the world) and I got to the station at around the same time, but no one else was showing up. We waited for a minute, then I called home to mommy (because she just happens to be the scheduler and I wanted to see who was on with us). Well, the EMT who was supposed to be on with us no-showed so we said screw it, we gotta get going. If she decides to show, she can meet us on the scene. On the way to the call, Mike called another one of the EMT's with his cell and asked him to meet up with us. Mom also volunteered to join up with us if we needed her. So anyway, the call was just outside of the village by not even a mile so we were there quick.
Mike and I got out, grabbed our stuff, and started walking in. Near the door, one of the 3 or 4 people who were there said that he was in the basement. I walked in the door with the backboard and related equipment and followed the directions to the basement door.
I reached the top of the basement stairs, looked down, and promptly thought, "Ohh, Shit..." as my pucker factor went into overdrive.
Looking down the stairs, I see a man and a woman holding the arms of a good sized fella who is posed with one knee on the floor, one foot on the floor (like he was trying to get up), one arm on the womans shoulder, and the other hand on the stairs. Any hopes for a minor case of "Fall down, go boom" went out the window as I realized this guy was about 1.5" from FUBAR.
He was looking up at me with Bad Head Injury Eyes. You know the look. The wide-eyed, terrified, glazed over, lights-are-on-but-nobody's-home look. And he had blood all over his face/head. And shoulders that were soaked with blood.
I made my way down the stairs and asked what happened. Apparently, this guy had had 4 or 5 beers over 2 or 3 hours, needed the bathroom, and since he was at a friends house, he didn't know where the bathroom was (I'm sorry, but that's one of the first places I look for anywhere I go. That and secondary exits.) Well apparently, this guy grabbed the wrong door.
Instead of door #1 (the throne-room of the porcelain princess) he grabbed door #2 and entered without looking. And backwards, I believe. Problem with door #2? Door #2 causes your 6'2", 260 lb ass to fall down 13 rough cut wooden stairs headfirst onto a bare cement floor. Yeah. Ouch.
I took a look at this guy and the more I looked, the more my stomach dropped. A large, bright red and bleeding goose egg (ostrich, maybe) on the back of his head, copious amounts of blood coming from his ears, running down his neck, soaking his shoulders... No CSF that I could see though.
I began trying to talk to the guy, to calm him down, to get him on the backboard... Well, he didn't want none of that. He wanted to get upstairs. We were trying to calm him down, hold him back, trying to do a standing take-down. The more we tried, the more combative he got. His wife was standing in front of him with her hands on his shoulders, trying to calm him down... I realized for certain how seriously screwed this guy was when he began looking over her shoulder, yelling her name.
We finally got him on the backboard, then he really started fighting. We eventually got him strapped down, immobilized, hands secured... Then all of a sudden his LOC dropped. We got him up the stairs, out into the rig... by then, he would respond to verbal, just barely. As we were loading him into the rig, I was standing by his head when he chunked up some of the chicken noodle soup he had been eating earlier and sprayed me. Just luckin' fovely. Before we left, I called fire control and asked for a status on the trauma center. The replied that the trauma center was open. I told them we were enroute with a serious head injury and would call when we got closer to give report... We started heading for Syracuse to the trauma center and Mike asked if I wanted a helicopter, to which I promptly answered "Most definately!"
I was definately nervous. This guy was FUBAR'ed, and how. Anyway, we got him ALS'ed and were told the bird would meet us on the way there. He continued to vomit, we continued to roll and suction. Once we were settled in, it was pretty much chunk, roll, suction, monitor vitals. Pupils equal, sluggish, and dilated, by now responsive to pain only, resps were sufficient, pulse rate of 56, BP 150/P. Hmmm. Looks like we have the start of some Cushing's Reflex here...
By the time we got to the LZ (about a 15 minute ride), he was completely unresponsive. I had considered tubing him along the way as a precaution, but he was totally clenched. All we have for intubation meds is Etomidate, which I've been told is sketchy in trauma scenarios... plus Etomidate will only keep him under for a few minutes, and I had no Valium or Versed (long story there).
We were at the LZ, I turned around to do something, and the EMT said, "Hey Adam, is he breathing?"
"He was just a minute ago..." I look... Oh, fudge. He's not. Oh wait... he is... I watched for a second... Mr. Head Injury has just gone into Cheyne-Stokes Respirations. WTF. Where the hell is Mercy Flight??? I grabbed the BVM, started bagging, and a firefighter stuck his head in and said that the medivac was on final approach. Sweet. A minute later, the flight crew jumped in, saw the bagging, raised the eyebrows, and started getting all their supplies and drugs out as I gave them the report.
In goes the Lidocaine, in goes something else, in goes the Succs. Flight medic goes for the tube... Nothing. Tries again, Nothing. After the 3rd unsuccessful attempt, he breaks out the Blue Stick (not the technical name, just what I call it). Blue stick goes in and I felt it in his trachea and told the flight medic so. He pulled the stylette out of the tube, slid the tube over the blue stick, inflated the cuff... Chest rise and equal lung sounds. Sweet! Wish I could use that lil gadget...
We got him loaded into the bird and they took off. We then got the nice task of cleaning and disinfecting that comes with trauma calls.
The next day, my suspicions were confirmed. Massive Basilar Skull Fracture. One of the paramedics I work with told me the guy had pronounced Racoons Eyes and Battle's Sign the next day.
Things were iffy as to his chances for a while, then I didn't hear anything more.
I did find out recently that he is home. Not sure how much of a lasting effect he has from it, but he is home.
That call officially blew away my white cloud.
I've had several other calls worthy of writing about, but i'm just going to post this one for now... I've been pecking away at this post for way too long, a little here and a little there... I'll write more soon.