Liver Lacerations??

This is continued from the previous entry.

We roll past the car on the shoulder and I see a woman in the driver seat (pregnant? Oh shit!) sitting with her legs out the open door, talking to a Firefighter and 3 kids in the back. (Shit, shit, and Shit!). The rear of the car is pretty deformed. It's basically been transformed from a sedan to a quasi-hatchback but the passenger shell (from the "C" pillar forward) looks good.

I grab the aide bag, portable O2 kit and the pediatric bag and head to the car. I see 3 kids who are not crying but are alert and orienting to the Firefighters that are collecting around the car. The woman in the front of the car seems pretty oriented but it's hard to tell as she'd on a cellphone, her husband is trying to reassure her and 2 Firefighters are talking to her. She looks pregnant to me and a quick eye shows me the kids in the back still wearing their seat belts and they're looking back & forth with free head and neck movement. The seating area shows no deformity and the seat back has not shifted. This is the car that got hit by the missing drunks in the pickup.

Time to get the woman out of there.

She's fine enough to walk to the ambulance. No complaint of neck pain, just a pain in her lower back, 3 on a scale of 1 to 10. (I'm still thinking she's pregnant and starting to get worried). She turns out to just be fat. Minor back pain, mostly anxious. This was much easier to determine and to give her a full trauma exam in the back of the ambulance.

All the while, Firefighters are giving me anxious glances. There's no fire and they want to leave. Too bad. Patient first.

Actually Patients first. Next is the 3 kids. One of the Firefighter/EMTs has checked out the kids and found them to be OK but one of them is complaining of abdominal pain.

"Can you point to where the pain is?" I ask her.

"Here." She points to the right side of her belly, just above the line of her navel and below her ribs. Where the seatbelt was resting.

At that precise moment, I recalled an entry by Doc Shazam where she specifically spoke about the insidious nature of liver lacerations in children who had abdominal trauma. I mean, this this jumped into my head almost word for word. Thanks, Doc Shazam! You're the best!

The 9 year old girl has her shoes off so, I carry her to my ambulance and I start checking her out. I don't have a CT scanner on my bus and I'm racking my brain to remember the etiology and symptoms of liver lacerations. All I can do is get a set of vitals (good and strong), determine her mental status (alert, oriented and laughing at my bad jokes), ask about pain (none) and check for tenderness in the entire abdomen (none). I even listened for normal gastric noises and heard some.

At this point, I'm torn. The kid seems fine to me. Do I recommend rolling or do I let 'em go? Am I even vaguely qualified to make that kind of decision? The woman and her husband (they're aunt and uncle from several states away) are already talking about getting back on the road. They are 1 hour away from the kids' house after about 9 hours of driving.

After examining the other two kids, I give both of the adults an honest assessment of what I found and explained to them that they can call 911 at any time after they leave us. I also tell them that i'd be more than glad to take the whole bunch to the hospital.

"But we won't all fit!" Says the little girl.

"I'll call every ambulance in the state if I have to." I say to the father. He can see that I mean it. So does a nearby firefighter and a brief look of panic crosses his eyes.

hee hee

Other than a crying 5 year old boy who's too tired for all this drama, everyone else is fine. I get a mountain of signatures and we roll on to the next bit of fun.

hee hee

The next bit of fun:

U-haul truck into Saturn Sedan, into Chrysler Sedan into Acura hatchback! Bang! + Bang! + Bang! = Maddog juggling patients in heavy traffic!!

(All in one night!!!)

Stay tuned...

--maddog