There were 8 intubated people in the ICU last week, and then there was 1. One patient, 4 nurses, 4 techs, and me covering the night shift. So, during the shift, I caught up on email, read my book, watched 3 hours of season 7 of 24 (crazy addictive), and now I write the blog. The trauma business is quite unpredictable, however, so who knows when we will be stretched thin again. I sent a young private to Germany the other night on a CCATT (critical care air transport team) mission. He was driving his humvee in Baghdad, and ran over an IED (improvised explosive device). The passengers in the humvee had concussions and minor lacerations, but were otherwise fine. He was not so lucky. His sacrum was fractured. He was eviscerated. All of the soft tissue between his lumbar spine and his upper thigh was missing. His bladder was ruptured. The surgeons made his bowel continuous again (they sewed up the loose ends in the OR), placed an ostomy as his perineum was without skin, and not suited for normal defecation, and packed his posterior wounds with wet dressings. I provided him with antibiotics and proper nutrition and fluids, and maximized his pulmonary ventilatory settings, and when stabilized, we sent him to a higher level of care in Germany. His spine was intact, and his thorax and brain were clear of injury. The injuries to his abdomen and soft tissue, however, have disfigured him permanently, committed him to many surgeries to come (flaps, grafts, cosmesis, etc), and he will likely have chronic pain and secondary psychological trauma. I was glad to see him stabilized and sent to Germany. Yet, a 3 year old with 3rd degree burns over more than 1/2 of her body remains.
The less business here, the better. Boredom means less trauma.