Memoirs of an Emergency Nurse by Elizabeth Nicholl Read Free Book Online Page B

resuscitation room , where all equipment was at hand if the patient’s condition deteriorated . D espite the patient breathing on his own and being able to tell me how he was feeling, there was no colour in his face, he looked as if he was bleeding internally and the paramedics measurements of blood pressure showed a related drop in circulating blood volume . H is skin was cool and clammy and he had several open wounds under his ripped clothes . The patient indicated that his right arm and leg hurt like crazy and he "felt like crap . "
    G loved and armed with trauma scissors, we transferred the patient to the emergency trolley.  A ll of his clothes were removed, an ECG was performed and vital signs measured and interpreted . The doctor suspected internal bleeding and possible compound fractures where the open wounds bled . The man was covered in glass scratches and had bloody abrasions over most of his uncovered skin. His jeans had ripped and he had imbedded material in his wounds on his legs . Despite the patient being conscious and fully aware of his surroundings, his vitals showed tachycardia and hypotension , meaning that his blood pressure was very low and his heart was racing . These signs we interpreted as the first stages of shock and fluid resuscitation was commenced . IV access had been gained by the paramedics at the scene and the doctor ordered one litre of Hartman’s fluid to try to increase his circulating blood volume which would increase his blood pressure. After 15 minutes , the fluid did little for his sheet white colour and lethargy. Due to the patient's lack of normal vital signs , the trauma team was called to review the patient for potential surgery to correct the suspected internal bleeding. T he potential fractures and open wounds could wait.
    The police then took me to one side to give me some information about the patient. The y were first on the scene and stated that the patient had been found by the driver’s side of a car just after the collision. All of t he damage to the car was down the driver’s side .   T he patient swore blind that his friend had been driving and crashed the car before absconding from the scene. However, the damage done to the patient was mainly on his right hand side, which is the position of   impact. There was also white powder sprayed inside the car; quite  a lot, according to   the officer and white residue was found around the patient’s lips. He was also currently banned from driving. Taking this into account , the doctors were informed that the patient may be under the influence of cocaine or speed and that would cause more masking of injuries.
    A t en-minute observation indicated that the litre bags of Hartman’s w ere not helping to push his blood pressure up as quickly as we all would have liked and his skin colour remained pa le despite the fact that we were keeping him warm and comfortable under blankets.
    The surgeon assessed his abdomen . T he patient said that his abdomen did hurt but his right arm hurt more . His arm had a slight bend to it and an old scar amongst many tattoos . With his d ropping blood pressure , the trauma team w ere unwilling to give the man any pain relief, as one side effect of morphine was lowering blood pressure.
    I kept asking him to score his pain on a scale of one to ten ; ten is the worst pain you can imagine and zero is no pain . H is score was eight . I was not happy that this patient was without analgesia and was glad when a consultant anaesthetist arrived . I had told the anaesthetist that his pain score was 8/10 and asked could he have some morphine, which he agreed to. I drew up the morphine and 2.5mg was given to the patient to ease his pain . T he man’s blood pressure remained low and by this time we had given about three litres of fluid . W e needed to give him fluid resuscitation because he needed fluids to ensure that there was enough volume of blood to pump around his body.
    The surgeons continued to be