Tag Archives: Stabbing

Heart Attack 2/2

There’s a saying in paramedicine: trauma is trauma. Basically that just means that it is what it is. Unlike a complex medical emergency with co-morbid factors on a patient with chronic conditions who takes ten medications, treatment for trauma is actually pretty simple. If it bleeds, plug it. If it’s floppy, splint it. Then go find a trauma surgeon quickly. Yet the real nuance to effective trauma care is staying ahead of injuries by anticipating problems before they happen and caring for the injuries that you can’t see.

All of Maria’s vitals are recovering nicely and she’s answering my questions well enough, although she’s understandably in a lot of distress and on the verge of freaking out on me. I made sure to apply the occlusive Asherman dressing to the chest wound. In a perfect world that will reduce the risk of a collapsed lung. In the imperfect world that I live in I’m not certain I could do a needle decompression to re-inflate a lung on Maria because she’s just too fat. But for now she’s breathing effectively in all lung fields.

I call my vitals up to Kevin as all of my assessments and treatments are pretty much done. I just need to start a couple IVs before we get to the ED. I take the oxygen mask off of Maria, as her saturation is at 100%, and put on a nasal cannula that tracks her expelled CO2 and gives me a visual waveform of each breath. I’ll be able to see a change in respiratory effort if she develops any complications.

She’s still a little scared and crying now and then. I cover her up with a blanket and tuck it around her shoulders. On one hand I want to stay ahead of the impending shock symptoms by keeping her warm yet on the other hand the simple act of tucking a blanket around someone tends to calm them. Despite the constant bouncing of the rig and melodic whine of the siren Maria seems a little more relaxed.

“Maria, you’re doing really well. I’m just going to start a couple IVs in your arm. You can help me out by talking to this nice officer over here. She has a few questions for you.”

The officer has been waiting patiently for me to finish my initial assessment and treatment. Hearing my prompt she stands up so Maria can see her and begins the question process.

“Maria, who stabbed you?”

With tears rolling down her cheeks she answers. “My boyfriend…”

I’m in my own little world as I preform the rote task of starting IVs and reassessing vitals. It’s strangely calming to have a single task in front of me as I’m a fly on the wall listening to the back and forth between the officer and Maria, as she tearfully describes the melodrama of an argument that escalated to attempted murder.

As Kevin and I push the gurney into the brightly lit trauma room we’re met by a room full of hospital staff. Fresh baby docs are pacing nervously wondering who gets to do the chest tube today, seasoned nurses are leaning against the wall, thinking about the twenty other things they should be doing while they are interrupted by this trauma, and the stoic teaching docs are standing in the background to observe everything and be ready to jump in the second before someone makes a mistake.

“Good morning, this is Maria…”

The officer was able to get suspect information before we even reached the ED. His name, vehicle description, address, and associates were relayed to police dispatch during the trip. By the time we rolled into the ED police were already on the man hunt. I heard the police dispatch tell them that he has prior warrants for violent crime and to consider him armed and dangerous. I stood in the corner of the trauma room with the officer who rode with me and explained what the doctors were finding as they did their assessment.

A quick sonogram showed that Maria had plural effusion – excessive fluid pouring into the lungs. And then a second pass showed that the knife tore open the pericardium – the sac that surrounds the heart. The fact that Maria was a large girl actually saved her life. Had she been any smaller the knife would have punctured the heart. She was up in the operating room before I even finished my paperwork. By the end of my shift she was recovering in the ICU and the (now ex) boyfriend was in custody. Had the officer not come with me the suspect information would have been delayed until after the anesthesia wore off and that would have given him a 6 hour head start.

 

 

Heart Attack 1/2

heart

1 : a hollow muscular organ that pumps the blood through the circulatory system by rhythmic contraction and dilation

2 : regarded as the center of a person’s thoughts and emotions, especially love or passion

at·tack

1 : to set upon with violent force

2 : the act or an instance of attacking; an assault

Passion is the enemy of precision. Forget the misnomer ‘crime of passion’. All crime is passionate. It’s passion that moves the criminal to act, to disrupt the static inertia of morality.

Daryl Zero; The Zero Effect 1998

Kevin angles the rig behind the BRT in the parking lot of the apartment complex and puts it in park with the strobes still flashing. I can see the firefighters grouped around some shrubs and by their actions I can see it’s a serious call. All scenes that we go to have a vibe and once you get used to reading body language you can usually tell how serious a call is before even getting to the patient. Bags are open, oxygen is about to be administered, clothes are being cut away, officers are asking questions of bystanders, the police dog is barking from the back seat of the K9 unit… this is a serious call.

Kevin looks over at me, “Just go, I’ll grab everything.” It’s my tech and Kevin knows I want to get to the patient and start my assessment and treatment quickly.

As I walk up to the shrubs I see an officer holding her hand on the patient’s chest. Judging by the amount of blood covering my new patient’s clothing it appears that the officer is holding direct pressure on a wound.

The fire medic is applying the oxygen mask as he looks up at me. “We just got here a second ago. Looks like a penetrating wound to the chest; maybe a stab wound. Unknown downtime; she was found a few minutes ago by a bystander.”

The bloody shirt is finally removed and I ask the officer to lift her hand briefly so I can visualize the wound. She lifts up her bloody glove and I clear off some of the blood with a dressing. I see a three centimeter horizontal stab wound just to the left of the sternum. Pushing my fingers into the chest for landmarks I find that the wound is directly over the 5th intercostal space and it’s likely the knife slipped between the ribs. Judging by the length of the wound the knife likely traveled pretty deep. Crap! That’s a bad place to miss the ribs!

I look over to the rig just as Kevin rolls the gurney next to the shrubs. “I need an Asherman and C-spine.” Kevin nods and rushes to get the supplies, returning in just a few seconds. Kevin and I tend to truncate our communication to the bare minimum on stat calls. More often than not we’re thinking the same thing and we really don’t need to verbalize most things during treatment. It makes things flow so much better when partners are on the same page and have worked together for a while.

As we cut off the rest of my patient’s bloody clothing and look for any additional wounds, I try to get a baseline on her mentation. She’s not tracking with eyes or answering questions yet she has spontaneous, erratic movement of all extremities. Actually a little too much movement – she’s slowing down our attempts to strap her to a board. I look forward to the day that we adopt a protocol that allows us to forego spinal immobilization when a patient presents with no neurological deficits. But for now we have to do it based on an abundance of precaution.

With my patient strapped down and the occlusive Asherman dressing applied, we’re ready to start transporting. It takes four of us to lift the gurney as my new patient is a bit on the obese side. I’m at the head as I push her towards the ambulance. She yells out as we lift the gurney and her big round eyes look up at me with a terrified gaze as she locks onto my eyes.

I smile down at her. “Hi, I’m KC, what’s your name?”

“Maria.”

“Maria, we’re going to the hospital because you got stabbed. I’ll ask you some more questions in a minute.” We load the gurney into the rig and I turn to Kevin before jumping in. “Code-3 trauma to Big City Trauma Center, I’ll get you vitals on the way.” Kevin nods and goes up front to drive.

I turn to the officer that was holding pressure on the wound. “She started talking just a second ago. Do you want to come with us?”

The officer gives me a big smile as she pulls off bloody gloves and tells her sergeant that she’s going to ride with us to the ED. There are usually only two reasons to take an officer with me: to get suspect information, or to witness a dying declaration. As we pull away from the apartment complex I’m hoping it’s the former. I’d really rather Maria didn’t die on me.


Reception

re·cep·tion

1. the act of receiving or the state of being received

2. a manner of being received; a cool reception

3. a function or occasion when persons are formally received; wedding reception

I hear the dispatcher call our unit number, preparing us to receive a Code-3 call. Medic 40, copy Code-3. Respond Code-3 to 123 Main Street for a 242, assault – possible stabbing. Your scene is not secure, please stage out.

The sun went down maybe an hour ago so the strobes on the rig are creating high contrast shadows on the surrounding traffic and graffiti covered fences as we speed through the hood to the call location.

Sitting in the dim light of the back of the rig I’m considering treatment and transport decisions for trauma victims. The call came in as a “possible stabbing.” I’ve run a few pretty severe stabbing calls but not in this large urban county. Having just moved here from the predominantly rural county where I trained this is a slightly different call than I’m used to. Treatment is basically the same but I now have designated trauma centers for patients who meet the criteria.

Sitting up in the passenger seat is Hank, my FTO (Field Training Officer). It’s his job to evaluate my performance on the call and ensure that I’m sufficiently acclimated to work independently in this county. Hank is a twenty-year medic and much of that time has been spent in the military with multiple deployments to the Middle East. He’s seen more trauma calls in a year of service than most medics see in a career so this is pretty run-of-the-mill for him.

As for me, the actual trauma doesn’t freak me out either. I look at it as a series of tasks that need to be prioritized and completed by the time I arrive at the ED. What does freak me out is being evaluated – having every move scrutinized. Sometimes I’m my worst enemy in that respect – I seem to make mistakes when being evaluated that I normally never make on my own.

It’s our second shift together and I’m still in my grace period. Hank is available for questions and will offer suggestions. In the next shift or two he will transition to full evaluation mode but we’re not quite there yet.

Five blocks from the call we see a fire engine with four fire fighters parked in a red zone. We flick off our lights and siren as we pull in behind them. This is our staging area – the place where we’ll wait until the police secure the scene so we can approach safely.

A minute later the BRT (big red truck) comes to life with lights and siren. We fall in behind them to cover the five blocks to the call location.

As we turn the last corner we find that the street is a parking lot of police cars with red and blue lights flashing. Officers with assault weapons strapped to their backs are rolling out yellow police line tape. We can’t get any closer so we pull over and start walking up to see what we have.

Hank sees an officer he knows and asks what’s going on. Continuing to walk towards a reception hall he answers. “I don’t know, our radio just said multiple stabbing vics.”

As the fire and ambulance crew turn the corner of the parking lot it’s obvious this is a total cluster fuck. Thirty to forty young men and women are standing in the parking lot wearing party dresses and variations of rancher style tuxedo attire. Women are screaming in a different language, men are moving with rapid motions trying to find something to fix, and kids in party outfits are crying. Secure scene my ass, this is chaos!

As we approach, a slim man in his twenties staggers towards us, blood on his hand. He sees the blood and wipes it on the salmon colored ruffles of his tuxedo shirt, managing to miss the bolo tie. Hank walks up, seeing the blood stain centered on the man’s back and lifts up his shirt. Dropping the shirt Hank says, “This guy is yours, package him up and I’ll see what else is going on.” As Hank walks off with the fire captain into the crowd I see the Paramedic Supervisor show up. He must have been following the incident on the police radio. This is probably the biggest call in the county right now – otherwise he wouldn’t be here.

Having been given an order by my FTO I tunnel vision into my patient and ignore the rest of the commotion. I take two fire fighters and Hank’s EMT partner to help me evaluate and treat the young man. I lift his shirt to see a two centimeter stab wound in the mid lumbar area, and not more than an inch away from the spinal column – close enough to the spine to warrant strapping the guy to a spinal immobilization board. He walked to us so I know he has use of the lower extremities – I’m not really suspecting any neurological complications distal to the wound but I can’t say which direction the knife penetrated so precaution is the best course of action.

We get him immobilized to the back board with a trauma dressing over the wound. The direct pressure of the board stops the bleeding. Once moved to the ambulance I look out the back and see three more ambulances pulling up behind us. More patients on back boards are being loaded into them as I start two IVs on my patient. Just as I’m finishing up Hank jumps in and tells his partner to drive. Code-3, trauma activation to the trauma receiving hospital that is closest to our location.

Throughout my assessment and treatment my patient has been agitated, yelling in another language to his girlfriend who is sitting in the front passenger seat wearing a matching salmon colored party dress. I can do a decent medical assessment in his language but I can’t follow the rapid fire dialogue between them except for the profane adjectives which leads me to believe he’s pissed off at someone; probably the person who stabbed him.

On the way to the trauma center I can see another ambulance, strobe lights blazing, fall in behind us headed to the same hospital. As we both pull into the ambulance bay I prep my patient for the ED. We take him in the side door to the waiting trauma team. I do a quick hand-off to the resident and head back outside to start on paperwork.

Hank comes over for a critique of the call. Basically I did everything I was supposed to do and accomplished all the necessary tasks in the time that I had with the patient. Finally he tells me what all the craziness was about; a different faction of the family crashed the festivities and things escalated to a series of knife fights. The supervisor who arrived just after us assumed command of the medical responsibilities of triage, transport, and calling additional resources. Ultimately seven people were transported with penetrating wounds and lacerations, four of which were critical enough to qualify as trauma activations.

As I’m finishing paperwork, using a laptop and software that are unfamiliar to me, I wonder what I just got myself into. I had some crazy calls in the rural county that I interned and first licensed in yet nothing like this. I mean seriously; a multiple stabbing MCI (mass casualty incident) with 20 cops on scene with assault weapons?? Acclimating to this urban county is going to be a challenge and in a few weeks I could be responding to a similar call as the only paramedic on scene with no supervisor.

This could get interesting