I've waited a wee while to post this, so as to avoid anyone reading this, then the paper and thinking "ahhhhh".
At seaside hospital we were encouraged to be on the receiving surgical team, and accompany them between teaching sessions, clerking patients in, examining them, taking bloods etc. This was quite good fun, though could be very slow depending on what turned up.
One Friday night, at the end of another quite long week - pub quiz, many cases to write up and lots of tutorials, Irish Hunter, with whom I had been at DepCat Hell Hospital, and I decided we fancied some A&E action....or laughing at drunks as he termed it. So one Friday night, after some food we headed down to A&E. At first it was quite quiet, with only a few early drinkers in having fallen (it was freezing) after a few too many (it was near payday). The first patient was Irish and had a scalp wound which was bleeding like crazy, so while Irish Hunter tried to get enough blood from his cold arms to fill the tubes (and try to do so in the right order), i as set to work suturing his wound, after the middle grade had injected some nice local anaesthetic. It was quite tricky as his head was lolling all over, and the needle was hidden under the blood, and it was the first tie I had done it, except on the chicken....
Anyway, he was patched up and sent round to the observation ward for the night. We wre just commenting on how quiet it was and why weren;t more drunks alling over, when the ambulance radio squarjked into life
"XXX to Seaside Hospital, Over"
"Seaside Hospital Casulaty receiving, over"
"We are inbound with a [young adult] male, RTA, unrestrained driver, with no obvious broken bones, but a sore neck and no feeling in the legs. He is not bleeding and has minor bruising and scratches to face and arms. ETA 15 minutes"
"Received. Can you give GCS? over"
"GCS 15, Over"
With this, everyone sprung into actions, Orthopaedics were paged, and everyone went into the resus room. Over the next 15 minutes, the consultants ran through the importance of ATLS assessment with us, and indicated roles which we could assist with at various stages, depending on the various scenarios. When teh patient arrived, he was on a spinal board and had dirt and grazes on his face and arms, but no bleeding or obvious wounds. However, as we ran through the ABCDE, it became clear that D was his mahjor issue. He had altered sensation below the nipples and no sensation below the waist.
A trauma series of Xrays (neck, chest and pelvis) was ordered and when these came back, they showed a strange shape to his spine at the chest level. Since he was otherwise fairly stable, with oxygen and fluids, he was transferred round to the CT scanner where teh duty radiologist and radiographer were both present.
The CT of his neck was unremarkable except for a congeital malformation at C1, but when his chest CT came through, there was a gasp from the consultants, who were nearest the monitor, as it became clear that he had a complete dislocation of two of his vertebrae, with a movement o about 3 inches laterally, and complete transection of his spinal cord.
The neuroscience institute were consulted and so on.....but as we came to leave at 1am, the consultant said, "remember guys, wear a seatbelt....." And as we stood in the car park, waiting for the car to warm up and scraping ice off the windscreen before the drive back home, we were reflecting on how different life would be if people did things slightly differently - split second timings etc......