Trauma - like no other.

So this is a post that's unlike the others, this follows my experince of a patient, who suffered cardiac arrest while I was on-call. I've had people dying on me, but I've never seen anything like this before...so bare with me, this post will include plenty of medical jargon.

I was in for a quite day with one of the out reach nurses, J, who's basically a nurse skilled within the critical and ICU (or as it's called in the UK, ITU) field. We started our day with hand-over reports with the anesthesiologists, when suddenly the pages wen't off and a voice practically shouted "cardiac arrest MAU" and then all hell broke loose. Just to keep you with me, the MAU is the Medical Assessment Unit. Then one of the anesthesiologist doctors took of and J signaled for me to join. At first I was a bit confused, I mean, she couldn't have meant for me to actually join in with the cardiac arrest...oh but she did. So there we were, running like crazy for MAU. 

Once we got there, the patient hadn't actually arrested...but that scenario wasn't that far out in the future, so the defibrillation pads were put on the patient just in case. And while that was going on, the patient now arrested and the biotelemetry showed asystole, which rendered the pads useless, so they started pushing Epinephrine and Atropine. However, the patient's major problem was that she was in the process of bleeding out. I kid you not, if I say that the minute I got there, the scene looked like it was taken out of Grey's Anatomy or ER. There was blood everywhere, it looked like there was an Ebola outbreak - the patient bleed from her nose, throat and ears... The anesthesiologist intubated and started ventilating, while simultaneously sucking blood from the intubation tube, while she was concentrating on this, the leader of the Resus team started CPR. The regular staff, including J started hanging units of blood up - the only problem with this was, as fast as they were pouring it into her venflons (and I say this in plural, she had about 4 of them!), just as fast it left her body again. They simply couldn't keep up. However, nobody had called the MHP (Major Hemorrhage Protocol) even though in my oh-so skilled opinion, if this wasn't one of those, I don't know what else would qualify. Just to give you a clear picture of how much she was actually bleeding, the patient had -pre-arrest- gotten three units of blood and her Hgb was still merely 3, we ended up giving a total of 9 units of blood and two units of FFP's to boot. They even considered drilling a hole into the tibia in order to boost the effect of the blood. Her pillow was completely soaked, blood even dripped onto the floor from it - like I said, there was so much blood. There were also much melena, I had never in my life seen that much. The CPR was performed in 6 stages consisting of 2 minute rounds of chest compressions and ventilation. 
The regular staff tried to contact next of kin, they were successful, but I didn't see any relatives until she was transferred into ITU - as you probably can deduce by now, she actually made it. Even though that the doctors decided to end CPR, afterwhich she had no pulse, but then after a few seconds, the pulse came back and they continued trying to save her. 

It was chaos, plain and simple - there were 9 people surrounding the patient, all trying to help to the best of their ability. I mean, some of the doctors started filling out the DNR form in the middle of the process, one of the male nurses forgot to check the blood, before he started pouring it into the patient (a serious lawsuit waiting to happen!). It was like time just stood still.

After what felt like forever, but was more like two hours - the patient was semi-stable and could be moved. However, the doctors had difficulties sorting out their next step, because could she survive an emergency surgery? It was either that or giving the radiologists a chance to see, if they could do some damage control. They upped for the latter and she was transferred to the X-ray ward. I had to suit up for this one, wearing a led skirt and shirt, in order to protect myself from the radiation now blasting through the room. The radiologists went in through the femoral artery and started the embolisation. Safe to say that they were successful and the patient was now transferred into the ITU.

On a semi-finale note, the reason to her almost dying was that, she had had two DU's in the past and this was probably what had caused her to almost bleed out... 

On a final note...I still cannot believe that she made it! I really can't believe it! It really looked grim, when they were doing the chest compressions and you could hear the ribs cracking from all the weight. It was a surreal experience, but one I wouldn't want to be without!
The most shocking part of this was actually that no one seemed to know the name of the patient! It was embarassing to say the least and really undignified to the patient! She wasn't a Jane Doe - she was J.J.

-xoxo-