The radiographer hurried in and Mac glanced in her direction. ‘Sue, I’ll need standard X-ray films—chest, pelvis and lateral cervical spine.’
The radiographer nodded and started preparing the machine just as the doors to Resus swung open and the paramedics hurried in with the stretcher.
‘This is Tim Norton, fifty-five-year-old man from Plymouth—lost control of the car on the ice.’
Together they transferred the patient from the stretcher to the trolley, carefully checking that the lines and leads didn’t become disconnected or snagged.
As airway doctor, Josh was responsible for clearing and securing the airway and he quickly ran through the necessary checks. ‘He’s apnoeic. We need to intubate him. Louisa?’
He held out his hand and Louisa immediately passed him the laryngoscope and endotracheal tube, anticipating his needs.
‘Tim, we’re just going to put a tube into your mouth to help you breathe,’ she said, speaking clearly in case the patient could hear her. She knew how important it was to give reassurance and explain everything that they were doing. ‘You’re in hospital now and we’ll soon have you feeling more comfortable.’
Once the airway had been cleaned and secured, they turned their attention to Tim’s cervical spine while the other members of the team quickly removed his clothing.
Mac stepped forward, examining both sides of the chest for bruising, abrasions and other trauma. ‘Rapid, shallow breathing,’ he muttered. ‘Flail chest?’
Josh finished helping Louisa apply the spinal support. ‘Paradoxical breathing?’
‘Only if the segment is large, central or if the patient is fatigued.’ Mac frowned, listening to the patient’s chest carefully. ‘He’s got a haemothorax. We need to insert a chest drain and he needs a blood transfusion. Fiona—did you get those lines in?’
He was slick and smooth, totally in control of the situation as he carefully monitored what each individual was doing.
What an amazing doctor, Louisa thought to herself as she continued to talk quietly to the patient, offering reassurance and comfort even though there was no response.
She’d worked in several different A and E departments over the past two years and had encountered a variety of different doctors. Some fumbled, some panicked. Mac did neither.
The drain was inserted into the chest with the minimum of fuss and the blood arrived from transfusion and was duly warmed before being attached to the giving set.
‘His vital signs aren’t improving,’ Josh muttered, and Mac nodded, his expression grim as he checked the patient’s obs.
‘Which means that either the shock isn’t caused by hypovolaemia or that the patient is bleeding faster than we can replace it. My money is on the latter. Are the surgeons on their way?’
‘Right here.’ Phil Douglas stepped up to the trolley, his eyes on the patient. ‘What have you got for me?’
‘He’s fractured ribs 5 to 11 and he’s showing all the signs of an intra-abdominal bleed,’ Mac told him, outlining the situation in a clear, concise fashion while Phil listened.
‘Haemodynamically stable?’
They continued to talk and examine the patient and finally Phil gave a nod.
‘All right, if he’s stable enough let’s get him straight to Theatre.’
Mac frowned. ‘Are there any relatives?’
One of the nurses nodded. ‘We’re contacting them now.’
Mac looked up. ‘Your patient, Phil.’
Phil rolled his eyes. ‘And a merry Christmas to you, too.’
* * *
‘Phew, I’m exhausted.’ Louisa surveyed the mess in Resus and gave a sigh.
‘Go home.’ Hannah, the A and E staff nurse who had acted as circulation nurse, gave her a smile. ‘You’ve been on since the crack of dawn. You deserve a rest.’
‘I’ll help you first. The last thing we need is another accident in here before we’ve restocked.’ Like all A and E staff, Louisa understood the importance of keeping Resus ready for the next emergency. ‘It will be faster if we do it together.’