subjectifucked

By: ApocalypseSoldier Mood: other Date: 12/16/2007 08:00:54 Music: Gods gonna cut you down - Johnny Cash

You can run on for a long time, sooner or later god will cut you down...

1)Tension pneumothorax with jugular vein distension, penetrating trauma  at the fourth intercostal space mid clavicular R side. 4 percent BSA third degree burn. 2)Flail chest with agonal respirations and penetrating trauma to the head3)Partial amputation L arm distal elbow, complete amputation at the R knee.  Tension hemo-pneumothorax.  blunt trauma to the chest.4)Cerebral spinal fluid oozing from the ears and nose.  crepitus present at the base of the skull. 5)evisceration.

what do you do??  Which two do you try and save?  All the injuries are life threatening.  The casualties are loosing blood and body heat quickly.  Their peripheral veins are beginning to constrict, shunting the blood flow to their arms and legs, trying desperately to preserve their vital organs.  Which ones get the ivs?  Do you use a colloid to pull water from the interstitial space via osmotic pressure?  be careful, you might just end up dilluting his hemoglobin to the point where coagulation and hemostasis is impossible.  you might put so much in that his blood pressure shoots up, blows out his clots and he bleeds to death.

You do what you need to do.  Thats what.  You ignore the screams of your friends and start doing what they trained you to do.  Triage and treat.five critical casualtiesOne medic.enough resources to treat three.

Number 3- Hes bleeding out, and fast. Kneel over him and dig one of your knees into the pit of his groin on the right side, cutting off the flow of his femoral artery while you slap a combat tourniquet onto his left arm.  without releasing pressure pivot around and slap another on his leg.  Rip his shirt off quickly and jab a 14 gauge catheter into his chest, midclavicular at the 4th intercostal space to relieve the build up of pressure in his lungs, allowing them to reinflate.  lay him on his side, start pushing fluids, 500ml Hextend to replace the volume in his veins from the massive hemorrhaging.  You remember how he used to tell you how much fun he had playing football with his son. 

Number 1- 14 gauge catheter mid clavicular at the 4th intercostal.  release the pressure.  whip out a large sheet of plastic and secure it over the chest wound with a shit load of duct tape.  it keeps the air that hes breathing in from escaping out immediately and allows his punctured lung to reinflate.  wrap his burns with dry gauze and start pushing fluids.  lactated ringers, to replace all the vital nutrients lost through his burns.

Number 5- dont let him try and push his intestines back inside.  get a large abominal dressing, soak it in water and secure it over the wound and intestines.  make sure to keep them moist.  start an iv, normal saline.

number 4- Nothing much to do.  Put him in a cervical collar and pray. 

number 2- Expectant. you pass him by  Hes dying and you cannot afford to waste your time or supplies on him.  You wont be playing spades with him anymore in the middle of the night when neither of you can sleep.

you wait impatiently, jumping from patient to patient monitoring and tryin to reassure them.  number two dies after only a few minutes.  i have yet to hear anything that shakes your soul like the sounds a man who was shot in the head makes.

number four is suffering.  screaming in pain.  his brain is bleeding, building massive amounts of pressure, and slowly cutting off its own source of oxygen.  blood begins to pour from his ears and nose.  you give him 30 mg of morphine, he passes out and dies silently in several minutes.Five is doing good.  it takes a long time to die of an abdominal wound.  you keep him warm, and keep his intestinal wrapping moist.

Number one is able to breath now that the pressure has been released.  hes still in massive pain, but you cannot give him morphine because of his injuries. 

number three is unconcious.  you finish off the hextend and hook up some normal saline and run it slowly to keep him hydrated and prevent from busting out his blood clots.  his pulse is strong.