I saw a guy lose half of his face the other day.
So this guy was in a single vehicle wreck on the interstate. He swerved off the left side of the road and clipped the front of a bridge. Then the car slid sideways into the right side of the bridge wall, crossing 2 lanes of traffic. He wasn't wearing his seat belt, but the car had airbags, which definitely saved his life. So the impact (from what we could tell) was him lurching forward, hitting the airbag, bouncing up and hitting the windshield, then slamming into the passenger side door. When we arrived on scene, he was bleeding heavily from the top of his head. His feet were in the drivers side floor area, his butt was in the passenger seat, and his head was slumped against the dash. Blood had begun pooling in the passenger floorboards, running down his arms. He had about a 7 inch avulsion to the scalp starting at the left outer part of his orbital socket and travelling in a lazy "s" shape across his head. He had also split his lip in two, chipped a tooth, and had a 3 inch laceration under his right eye with a subdural hematoma beginning to form under the right eye.
Our hospital is ill-equpped for severe traumas like this, so we knew that we would be transporting him to a level 1 trauma center in another city. I guessed Loyola in the Chicago suburbs, the others said Peoria. They were right. It's about 70 miles to Peoria, and I got to drive. It's quite a rush driving with full lights and sirens 85 mph down the highway, really it's what I love about being an EMT. There's a certain adrenaline rush you get doing this that so many other extreme sports don't give, but I digress...The whole way down to Peoria I haerd a lot of chatter in the back. I had the patient, 2 EMTs and a nurse in the back of the rig and they were all working on his face, keeping his airway clear, controlling bleeding, and checking vitals every 3-5 minutes.
So, we arrive at the ER in Peoria and were greeted with about 20 doctors and nurses. We rushed into the trauma room, and I thought my job was finished. However, after we transferred him to the hospital bed, one of the doctors asked if we would stay and assist with their initial assessment. They needed someone to maintain C-spine while they removed the collar and got xrays. I got voted to stay and work while the others got something to eat (our breakfast got interrupted by the call for the wreck, How RUDE!). I was given a gown and a scrub by the nurses and then began my task of holding this guy's head. Literally, if he had a break somewhere in there and I moved slightly, he could have been killed or paralyzed. It was stressful, but exciting at once. After xrays, I had to stay and hold him for the remaining trauma assessment.Earlier, I mentioned an avulsion. It's what happens when the skin is ripped from the underlying muscle. Use Wikipedia if you want to learn more, Google image if you have a strong stomach. So while I'm holding this guy's head, he's on his back looking at me. Did I mention that he was concious the entire time? He was given a lot of painkillers en route to Peoria, so I knew that he didn't feel any pain, but he kept looking around very lazily. He didn't have any real fear in his looks, just, uh, curious or wonder. I think that he may have been viewing the whole experience like it was a TV show or something.
The doctors began a detailed examination fo his head wounds at this time. He was pretty much bandaged up from his chin to his forehead, save for the nose and left cheek, but they were just dressings and pressure had to be applied to control the bleeding. The doctor removed the one on his chin first. His airway was still patent and in tact, with some blood and mucus in his mouth. His upper lip was split like an upside down V. The nurse began suctioning his mouth a little to get a clean view for the doctor, when the foley got clogged. She pulled it out, and it was a piece of flesh. His tongue had no damage, and the doctor's initial assessment was that this was the area of the upper lip called the philtrum. It was placed on ice to hopefully be used in the reconstruction. I doubt it would be any good, but I'm not a surgeon.Next, the doctors checked out his orbital sockets. Now I knew what that funny feeling was under my right fingers as I held his head for C-spine. His orbital socket had been shattered. The eye wasn't really sitting properly in the socket. Maybe that was the cause for his gaze, I don't know...It was then that I noticed his face sag...One of the nurses yelled that he was "stroking out". Facial droop on one side is a classic sign of a stroke, both during it and for a long time after. The doctor told her to calm down, that it was a result of the avulsion. I thought that the skin had seperated at the top, but it really was pretty much loose on the entire side of his face. The doctor actually peeled it back from the eyebrow and exposed the entire orbital socket. The same was done near the scalp in a upwards direction once those dressings had been removed. Most of the blood had congealed at this point.The worst part was that he was still conscious. Not fully alert, but he kept trying to talk. He yelled about how he lost a tooth. He wanted to see his wife NOW. He also wanted a priest. The prognosis from the doctor was critical, but not life threatening. I should have left about the time of the orbital exam, but was fascinated by the amount of damage that had been done to his face. The way that the skin just slid down once the pressure was released is something I'll have a hard time forgetting.
And now that you've read all of that, here's something to clear that mental image...
http://216.218.248.240/datastore/bc/5b/b/bc5b991d3b526974bf8d62a5e689d9cc.jpg
http://216.218.248.240/datastore/09/80/b/09804fcb2da43a04aaf47de23f440b80.jpg
Our hospital is ill-equpped for severe traumas like this, so we knew that we would be transporting him to a level 1 trauma center in another city. I guessed Loyola in the Chicago suburbs, the others said Peoria. They were right. It's about 70 miles to Peoria, and I got to drive. It's quite a rush driving with full lights and sirens 85 mph down the highway, really it's what I love about being an EMT. There's a certain adrenaline rush you get doing this that so many other extreme sports don't give, but I digress...The whole way down to Peoria I haerd a lot of chatter in the back. I had the patient, 2 EMTs and a nurse in the back of the rig and they were all working on his face, keeping his airway clear, controlling bleeding, and checking vitals every 3-5 minutes.
So, we arrive at the ER in Peoria and were greeted with about 20 doctors and nurses. We rushed into the trauma room, and I thought my job was finished. However, after we transferred him to the hospital bed, one of the doctors asked if we would stay and assist with their initial assessment. They needed someone to maintain C-spine while they removed the collar and got xrays. I got voted to stay and work while the others got something to eat (our breakfast got interrupted by the call for the wreck, How RUDE!). I was given a gown and a scrub by the nurses and then began my task of holding this guy's head. Literally, if he had a break somewhere in there and I moved slightly, he could have been killed or paralyzed. It was stressful, but exciting at once. After xrays, I had to stay and hold him for the remaining trauma assessment.Earlier, I mentioned an avulsion. It's what happens when the skin is ripped from the underlying muscle. Use Wikipedia if you want to learn more, Google image if you have a strong stomach. So while I'm holding this guy's head, he's on his back looking at me. Did I mention that he was concious the entire time? He was given a lot of painkillers en route to Peoria, so I knew that he didn't feel any pain, but he kept looking around very lazily. He didn't have any real fear in his looks, just, uh, curious or wonder. I think that he may have been viewing the whole experience like it was a TV show or something.
The doctors began a detailed examination fo his head wounds at this time. He was pretty much bandaged up from his chin to his forehead, save for the nose and left cheek, but they were just dressings and pressure had to be applied to control the bleeding. The doctor removed the one on his chin first. His airway was still patent and in tact, with some blood and mucus in his mouth. His upper lip was split like an upside down V. The nurse began suctioning his mouth a little to get a clean view for the doctor, when the foley got clogged. She pulled it out, and it was a piece of flesh. His tongue had no damage, and the doctor's initial assessment was that this was the area of the upper lip called the philtrum. It was placed on ice to hopefully be used in the reconstruction. I doubt it would be any good, but I'm not a surgeon.Next, the doctors checked out his orbital sockets. Now I knew what that funny feeling was under my right fingers as I held his head for C-spine. His orbital socket had been shattered. The eye wasn't really sitting properly in the socket. Maybe that was the cause for his gaze, I don't know...It was then that I noticed his face sag...One of the nurses yelled that he was "stroking out". Facial droop on one side is a classic sign of a stroke, both during it and for a long time after. The doctor told her to calm down, that it was a result of the avulsion. I thought that the skin had seperated at the top, but it really was pretty much loose on the entire side of his face. The doctor actually peeled it back from the eyebrow and exposed the entire orbital socket. The same was done near the scalp in a upwards direction once those dressings had been removed. Most of the blood had congealed at this point.The worst part was that he was still conscious. Not fully alert, but he kept trying to talk. He yelled about how he lost a tooth. He wanted to see his wife NOW. He also wanted a priest. The prognosis from the doctor was critical, but not life threatening. I should have left about the time of the orbital exam, but was fascinated by the amount of damage that had been done to his face. The way that the skin just slid down once the pressure was released is something I'll have a hard time forgetting.
And now that you've read all of that, here's something to clear that mental image...
http://216.218.248.240/datastore/bc/5b/b/bc5b991d3b526974bf8d62a5e689d9cc.jpg
http://216.218.248.240/datastore/09/80/b/09804fcb2da43a04aaf47de23f440b80.jpg
posted by monkeybrigade at 5:33 PM
2 Comments:
Brilliant posting Mr. Diaree. Absolutely riveting. I would have turned away normally, but I've been mentally preparing by researching "The Walking Dead" comic books.
Brilliant posting Mr. Diaree. Absolutely riveting. I would have turned away normally, but I've been mentally preparing by researching "The Walking Dead" comic books.
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