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.No sooner than he had removed the clots of blood, more filled the cavities.“Forceps,” Dr.Warner called.“Will, take the suction.”Handing the suction wand to Dr.Fullerton, he accepted the forceps from Nurse Booker and entered the wound.“There’s the fractured seventh and eighth,” he said aloud as he carefully moved the broken ribs to one side.“Spreader,” he called.Already in hand, Dr.Fullerton placed the surgical instrument between the broken ribs, creating an opening for Dr.Warner to work in.Using forceps and a dissector, he worked his way into the chest cavity toward the damaged spleen.“I’ve got the spleen.More suction,” he called out again, as he battled the never ending flow.Dr.Fullerton pushed the wand deeper into the wound, now suctioning around the spleen.Barely able to keep up with the flow, he worked frantically to find the source of the bleed.Dr.Warner now used his dissector to delicately examine the spleen.As an area of blood was suctioned away, he quickly inspected its fibrous surface, searching for tears or punctures in the outer tissue.With blood rushing in to fill the void, he had only a moment to determine his finding before more blood covered the exposed surface.Suddenly, he saw a heavy line of blood that seemed to pulsate.Directing the suctioning wand over the region, it picked up the flow and evacuated the area.In seconds, the flow into the cavity ceased and was now being drawn directly into the suctioning wand.“Got it.Right there.There’s the bleed,” Dr.Warner said with minor relief.“Looks like the broken ribs nicked the spleen,” Dr.Fullerton concurred.“Ok, give me a 4-0 prolene on an R.B.-1 needle,” Dr.Warner asked.Instantly, Nurse Booker handed him the suture and needle, taking back the bloody dissector in return.With a few delicate stitches, Dr.Warner repaired the damaged tissue, as Dr.Fullerton continued suctioning.Moments later, the flow of blood ceased completely.“Ok, what’re his sats?” Dr.Warner asked, anxiously.“BP’s holding at eighty over forty-one, pulse is coming up too at forty-five.Pulse ox is seventy-eight,” Dr.Fullerton responded instantly.“Ok, he’s stable for now.Call CT.Tell ‘em we’ll be sending him up shortly,” Dr.Warner shouted to Nurse Holder.Looking back to Nurse Booker, he said, “Another 4-0 and an R.B.-1.”With the retractors removed and the broken ribs repositioned, he began to close the wound.Fifteen minutes later:Dr.Warner stood in front of the illuminator and examined the CT images of the patient’s brain.A disturbing frown enveloped his face as he realized the extent of the damage.“Massive hemorrhaging along the frontal and temporal regions,” Radiologist Dr.Jeremy Styles said in serious tone.Pointing to the lighted X-ray, Dr.Warner replied, “Hmm, agreed.There’s significant hemorrhaging of the left temporal lobe extending into the external capsule and across into the frontal lobe.He has a slight midline shift and I’m seeing significant mass effect.”“With the extent of the hemorrhaging, intracranial pressures must be massive,” Dr.Styles concurred.“Who’s on call tonight?” Dr.Warner asked.“Dr.Gates.”“Call him.He needs to get here ASAP.”“He’s been called.He thinks he can be here in about thirty minutes,” Dr.Styles responded in grave tone.“THIRTY MINUTES?!” Dr.Warner shouted.“We don’t HAVE thirty minutes.His sats are dropping again.That kid will be dead in fifteen if we don’t get someone in here before then.Is there any other neurosurgeon we can call?”“Not in this area.Not close by.”Dr.Warner stared at the films.Beads of sweat formed on his brow as he contemplated the options.He turned to Dr.Styles and his face became resolute.“Call OR.Have him prepped and ready for a craniotomy,” he said, in a low confident voice.“You’re going to do it?” Dr.Styles responded incredulously.“I don’t have much of a choice.”“But you’re not a neurosurgeon,” he replied, apprehensively.“I am today,” he shot back.“Call the OR.”Waiting Room:Geoff Robbins sat on the uncomfortable faux leather chair and stared at the blank wall across the room.The short time in trauma unit two had done little to ease his worry and now his mind raced with speculation about his brother’s survival.Sitting alone, he nervously rubbed his thumb into the palm of his hand as his mind rushed from one tangent to the next.After nearly thirty minutes, he winced in pain as his palm had now become red and swollen.“Geoffrey?” he heard his name shouted loudly from behind.The voice instantly registered in his mind and he leaped to his feet.“Mom, Dad,” he shouted back as they hurried across the waiting room.As she neared, his mom could see his red swollen eyes and the distraught look on his face.She immediately grabbed her son and hugged him tightly, his father clinging to the two, comforting them like a blanket.For the moment, words were impossible as the three cried in anguish.Still vague with details, his mother swallowed the knot in her throat and forced herself to speak.“Geoffrey, what happened? Have you heard anything yet?” she asked, struggling with every word.“There was an accident.Some redneck crashed into Bobby,” Geoff responded, his voice filled with anger as he wiped away his tears.“I think they said Bobby broke his leg, arm and some ribs.”“Oh my God!” his mother shrieked in grief.“No… this can’t be happening.”“There’s more,” Geoff muttered grimly.Both parents pulled back and stared fearfully into Geoff’s eyes.The torment on his face telegraphed the gravity of his next statement and they stood and listened with reluctance, knowing full well his next words would be nearly unbearable to hear.“I heard the doctor’s say he had a severe head injury… something about massive bleeding,” he responded in a low grave tone.He stopped, swallowed hard and forced himself to continue.“Mom, his heart stopped.They had to shock him… it was just awful.”For his mom’s sake, he bravely fought to hold back his tears.Staring at her son in disbelief, denial momentarily insulated her from the truth.Suddenly, she noticed Geoff’s body trembling slightly and a tear that streamed down his face.In an instant, the reality of his words registered in her mind.“My God NO!” she cried out in angst.Her knees buckled and she began to collapse.Quickly, Geoff and his father grabbed an arm and lowered her to a chair.As the three sobbed with unrelenting despair, their grief grew in intensity as the unknown hung over them like a heavy weight.The O.R.Nurse Holder burst through the doors as Dr.Warner scrubbed in for surgery.Even before she spoke, he could tell the situation had turned critical by the intensity in her eyes.“Dr.Warner, his sats are dropping again.You better hurry,” she said, her voice emotional, yet distinct.“Shit!” he blurted out uncharacteristically.“What are they now?”“BP is seventy-eight over thirty-nine, pulse is only thirty-five.”“What about his pulse ox?”“Pulse ox is seventy and dropping fast,” she replied, nearly in frantic tone [ Pobierz całość w formacie PDF ]