Tuesday, May 29, 2007

It's Summer - Sort Of

I know it's not officially summer yet; that happens in about three weeks. However, since Memorial Day is the unofficial start of summer, then I guess we're finally into it, aren't we? I'm happy about that! I prefer warmth to cold except when it's nearly 100 degrees with 95% relative humidity (and we know THAT will happen during the summer, don't we?), and I appreciate sunlight and blue skies. Nothing like it, especially when everything is in bloom and beautiful. I just make sure I have some Claritin-D on hand during this time of year.....

I worked over the weekend, which seems like a normal thing for me to do as of late. It was opening day at Rockingham Park on Saturday, and they had a good turnout for racing. We didn't know that a qualifier was going on at 11:00 that morning, and I got a panic call from my boss Friday night asking me if I could go in for that. I did go in, but I paid a heavy price for it in terms of sleep. I didn't get to finally put my head down until about 10:00 that night. The good thing was that I got to spend some quality time both Saturday night and Sunday during the day with my wife. That doesn't happen nearly often enough.

Yesterday wasn't terribly busy, but there was one call that we did that was notable, and I am glad I got it right because there were a lot of bad things that could have happened. We got called for a car vs. bicycle at about 12:30 in the afternoon. When we got on scene we saw a car with its 4-way hazards on and a small pink bicycle about 20 feet away. That immediately caused my stomach to churn; I jumped ahead 3 steps in my thinking that it was a little one who was going to be our patient, and I was right. A 5 year-old female, rode out behind the car as it was backing up. She got hit - at low speed - and knocked off of the bike. By the time we arrived on scene, we had an engine company and two police officers with us. When we got to her and I got a chance to look at her, she had a laceration next to her left eye and a hematoma across the width of her forehead. I have to mention that she was ambulatory, and that her parents had brought her back into the house before we arrived; we had some trouble locating her initially.

She was very quiet, which is also not a good thing when it comes to a child, and that also got my attention. Her English wasn't good, either, and we found out that the primary language in the household was Swahili. A very loud "CRAP!" went through my mind as we're dealing with this situation. She at least was able to understand me when I asked her simple questions and she answered them appropriately. When I saw the hematoma on her forehead, the bells started to ring very loudly in my head - my parter asked me if we were going to walk her out or put her on the stretcher as she was. My instincts said the opposite, and I told him I wanted her immobilized as we didn't know anything further, like whether or not there was loss of consciousness. So we immobilized her cervical spine with a horse collar made from a towel as I didn't have a C-collar small enough to fit her; the pediatric collars were either too small or too big. Plus, we didn't have a pediatric long board; we had to put her on the middle of an adult-sized board and secure her really well.

After we did all of that and loaded her on the ambulance, I assessed her from head to toe. Pupils equal and reactive, grips equal and equal extremity movement, lungs clear, abdomen and pelvis stable, alert and oriented to person, place, and time. Very quiet and appearing rather frightened. When we arrived at the hospital, I'm not sure the doc took this as seriously as he should have because within 10 minutes of our getting her there he took her off of the board and removed the horse collar. Big mistake.

I found out later on from one of my friends who's a nurse in the ED that a head/neck CT revealed a fractured skull, a fractured jaw, and a transverse fracture to C-1 with left lateral displacement. She was transferred to DHMC in Lebanon within two hours of our bringing her into the hospital.

When my friend filled me in on what was going on with my patient, she asked me why we didn't immobilize her. When I told her that we had ans well as the measures we had taken, she stopped talking for a minute, then said in a really quiet voice, "Oh. The doc must have taken her off of the board." Again, another "CRAP!" flashed through my head. Not something I wanted to hear, especially after finding out the extent of her injuries.

Needless to say, I'm glad that I did my job the way it was supposed to be done.

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