I put on the face shield and plastic gown that I had set aside earlier. The paramedics all gathered round me as I gently unwound the bright red, blood-soaked dressing on his forearm. I had a wad of 4×4 gauze pads in my left hand as I slowly peeled away the last layer covering the wound. Blood quickly pooled in a large oblong defect on the underside of the butcher’s forearm. I pressed the gauze directly over the wound a peeked under each corner to try and identify the bleeding vessel. It was not large, wherever it was, because the blood was not spurting, but it’s rapid spilling from the unseeen vessel told me that this was arterial bleeding, and not a vein.

The medic to my right placed a blood pressure cuff on the man’s upper arm and inflated it to 160 mmHg, higher than his systolic blood pressure on arrival. I peeked again and this time was able to see two distinct bleeding arterioles from the subcutaneous fatty layer that had been exposed.

I asked for suction. As the medicl held the suction tip directly over the vessel, the escaping blood was immediately removed from the area. No pooling, and perfect visualization of the tiny artery. With my left hand still holding direct pressure on the 2nd site, I quicly tied a figure 8 suture around artery #1. Success. The medic was pleased and so was I. Still aware that I had placed a blood pressure tourniquet, I moved quickly to the next vessel. Lifting the gauze, I again saw a small bleeding artery. The medic moved the suction over the second culprit and the process was repeated with success.

I now had a beautiful bloodless field and could clearly see the damage he had done to the muscles of his forearm. The nurse slowly lowered the pressure in the cuff and as he did so, another bleeding artery sprang open. We repeated the entire process a third time, then slowly lowered the cuff again. as the cuff deflated completely we waited for more bleeding arteries to spring open, but none did. I finally had the bleeding adequately controlled. Although my surgeon hadn’t shown up yet, I was feeling just a bit more in control.

His forearm now laid at rest, the meaty muscles ruptured out of their fascia and rope like, shiny white tendons sliding back and forth gracefully as I had him open & close his hand.

…part 3 to come shortly… (this writing stuff is hard work!)