A trauma alert is transmitted to the ULH ER by Louisville Metro EMS. “We have a trucker, Charles Weston, who is impaled through-and-through on a 3-inch metal pipe in the right chest coming your way from Bullitt county. He is awake and alert and vitals are: T 97.5 HR 135 BP 90/50 RR 30. We have 2 IV’s with saline boluses running and have him on an 100% non-rebreather. ETA 15 minutes.” Trauma surgery is paged and meets the EMS team and patient in the trauma bay with the ER team. The patient’s injury is shown below:
Mr. Weston is conscious and has been given morphine but is able to answer questions. He says his home medications are aspirin, and he takes blood pressure and cholesterol medicines but cannot remember the names, and that he is not allergic to any medications.
The trauma surgeon, ER physician, and anesthesiologist quickly huddle to evaluate Mr. Weston’s injury to make a plan for approaching his problem as well as how and when to remove the pipe and the best strategy for doing so. Airway and vital sign stability and maintenance, ventilation strategies, cardiac status, bleeding management, addressing infection, and a review of potentially injured structures and body systems are all discussed rapidly and their interdependence acknowledged and priorities set in care. In addition, the charge nurse communicates that a police detective is present in the waiting room and asks that blood be collected for toxicology testing on Mr. Weston due to the accident causing 2 fatalities.