Sunday, August 29, 2010

"I don't think you've ever seen this before.."

The previous post (Lord, I apologize..) made me think about some of the jobs I have worked while at the paying job over the years and I thought I'd share one with you. There was the one where a co-worker opened up his arm from the shoulder to the pinky tip down to the bone is a spiral cut that circled his arm once. But I thought that wasn't really a good one, and then I remembered this one which happened many years ago:

I met the rig in the parking lot of the shop. I had gone outside for three reasons: 1) We had the patient in as good a shape as we good expect and there was nothing more to be done at the moment, 2) I felt that the previous person I had sent out to meet the ambulance and guide the crew in was not doing his job because they weren't on scene yet, and when I realized why... 3) to call dispatch one the phone and talk them through giving the responding crew directions to find us. I could hear their siren going up and down streets a half mile away on a road with a similar, but different name. I followed the sound through every wrong turn and re-direction. It was comical, even in light of the serious issues my co-worker was coming to terms with just a few feet away in the shop.
 So I greeted them in the parking lot and reached to grab a bag and give them a hand. I said to the Medic, "before you go in. let me explain that you have probably never seen anything like this and there are special treatment procedures involved, I have printed out detailed ...." She just walked past me saying "yeah, everybody says that, but I've seen it all. Where is he?" OK, I think, guess we'll just have to see what she wants to do with this one and I followed her into the building giving directions from behind. As she approached the patient seated calmly in a chair with a crowd of slack jawed people around him she started to say "SO, Whats going on gu.... WHAT HAPPENED HERE?! HOW did this happen?! WHAT is that?" She was looking at a male patient in his early thirties and good physical condition except that his right arm was more than twice it's normal size, and his hand was nearly three times normal. It appeared that his arm had been inflated, which it actually had. In truth, it looked like a plastic gag arm because the skin was so taught it was shiny (it was also wet which added to the plastic effect). "It's his hand" I said calmly, now relishing the fact that I had the attention of this mighty Paramedic that has 'seen it all'. She looked at me and said "I have NEVER seen anything like this!" I cleared my throat and suppressed a smile, "Well, it's an injection wound. We have that machine over there  that cuts anything from steel to glass using water. It pushes the water out of a tiny orifice at 55,000 PSI and carries an abrasive medium along the outside of the water column. It can pop a hole through 1/4" stainless steel in 750 milliseconds. Matt here was distracted for a moment and let his hand get under the jet. The force of the water filled his hand and forearm in the 2 seconds it took to pull his arm out. There is no exit wound, all the fluid went into his arm. As far as we can tell, the jet did not cut any bone, but you'll need x-rays to confirm, as this thing cuts bone like paper. Now I have a medical treatment document from the machine manufacturer here that has detailed clinical treatment procedures. They have a lot of experience with these wounds. There is also an 800 number the physician can call for consultation. The biggest threat with these wounds is infection and sepsis. Urgency is needed to minimize the spread. His arm has, in effect, just been pumped full of bacteria. Any other questions I can answer?"
"Just one" she politely said, "Can I have that 800 number?"


  1. Wow that sounds like... I can't even describe it! What's the treatment for it? drain the arm?


  2. And that's why one should never say "oh I've seen it all!" I stick to "I've seen a lot, but there's more to see!"