Self-inflicted GSW to the head - ETA < 2 min

The last EMT clinical I had was also at a Level 1 Trauma ED. As I said in my last post I made it through my first heart attack patient and my first cardiac arrest and active participation in CPR compressions, a Code Blue. (If you missed it, you can check it out here at: http://rnagain.blogspot.com/2008/03/why-ed-nursing-why-volunteer-as-emt.html )
The other thing I wondered was how will I do seeing a major trauma. This particular clinical helped answer that.

I was able to observe a medivac helicopter bring in a patient with a self-inflicted GSW (gun shot wound) to the head. I went with my preceptor up to the roof after learning the medivac's ETA was less than 2 minutes. We watched as the helicopter landed in front of us on the helicopter pad. I rode down in the elevator with the patient, other ED techs and the flight paramedics. We went straight into the trauma room where the trauma team awaited gloved and gowned up. It looked like an operating room. The patient had put a .22 in his mouth and pulled the trigger. The exit wound was just superior to the right occipital area. It must have missed his brain stem because his heart was still beating but only at about 32 beats a minute, he was not breathing on his own. His Glasgow Coma Scale was 3 (the lowest possible). The charge nurse started telling the extra people in the room to leave, including my preceptor. My preceptor went to bat for me and asked if I could stay and observe since I was there to learn. I held my breath as the charge nurse looked at me for a few seconds and then said, "OK". I could have hugged my preceptor!

The trauma team unwrapped his head to assess the damage and I saw gray matter up close and personal. There was also small pieces of brain matter on the backboard and stretcher and of course blood. I was fascinated as I watched the trauma nurses, trauma attending, trauma residents, respiratory therapist, ICU nurse (usually an ICU nurse comes down for Level 1 trauma cases to help titrate emergency IV meds), ED charge nurse, recording nurses, flight paramedics, and many others work on this patient. He was stabilized as much as possible and sent to CT scan. If he made it through CT scan depending on what it showed he would go to either the OR or the trauma ICU.

At one point the charge nurse came and asked was I ok. I said I was fine. In my mind I was actually saying, "are you kidding, this is amazing!" Please don't get me wrong, a self-inflicted GSW is anything but awesome - but when you are only doing a 4 hour (at a time) clinical you rarely get to see this kind of Level 1 trauma. It is a great learning experience for trauma medicine.

I don’t know what ever happened to the patient. I wish I did. My clinical shift ended shortly after he was transferred to CT. Most of the ED staff I talked to later didn’t think he had much chance, but that didn’t stop them from giving a 110% and doing everything they medically could for the patient. You never know and miracles still do happen. I knew for sure right then I wanted to be an ED nurse and work in emergency medicine. I know this sounds hokey, but on the way home from one of my clinicals the song lyrics "this is what I want to be. Finally I see, why it means so much to me [sans bad language]". And I smiled and said yes, this is what I want to be.

I had worried about seeing trauma, but I had seen gray matter and wasn’t fazed, but instead fascinated. I knew I have a long way to go, seeing it and being able to treat it are vastly different I realize. But at least I could handle the sight of gray matter and some intense injuries. I think I was hooked after that clinical. It's why I decided to also volunteer with our volunteer fire and rescue department. I joined in February. I'm still in training and not able to ride yet - hopefully by the end of April/May.

Well it's getting late here on the east coast. I probably should be studying about PR intervals and sinus arrhythmias right now. Got a quiz next class.

Until next post....