Warning:  Morbid Post Ahead.

The twisted car had trapped him in the drivers seat, steering wheel crushing his chest.  Firefighers and medics worked in full turn-out gear for 45 minutes trying to get him out.  Placing him on a backboard as is standard care, the man was gratefully thanking them, nearly crying in happiness that he was out of the mass of metal, smoke and gasoline.

Then  a few drops of blood came out of his mouth.  He began coughing and blood sprayed the nearest EMT in the face.  The man’s eyes grew large and widened, a look of fear overcame him.  He could no longer speak.  The medics tried to get him to talk again, but instead, his eyes rolled back into his head and his arms fell limp at the sides of the stretcher.

When he arrived and I first saw him in the ER, the story was obvious without being told.  Trauma arrest.  Talking at the scene and shortly after extricaiton his heart stopped.  The sight of the man on the gurny told the entire tale.  Firefighter performing CPR.  Medic attempting one handed bag mask ventilations while the stretcher was on the move, blood spray covering the patient’s face.

The mans belly was large.  Ridiculously large.  Like he was pregnant with twins.

The physicians in the room (there were many), jumped into action while the charge nurse barked orders for equipment and supplies.  Things went (mostly) smoothly with a few exceptions.

As I was ready to make my first quick incision to insert a chest tube, I hear a nurse call out, ” He’s on Coumadin.”  I hesitated for only a second.  He was dying, died, nearly dead…it didn’t matter.  IF this could save him then it didn’t matter if he bled.  Meanwhile his belly grew larger.  A second chest tube went in on the other side.  He was intubated and the blood spray finally stopped.

I stuck a needle into his heart to blindly decompress a tamponade when the whole time I knew he was dying…he was already as good as dead.

Traumatic arrest.  Good and dead on the spot, unless you have an surgeon and OR immediately at hand.  THis man needed an operating room that was fully staffed ready to go, on the spot, right at the scene of his accident.

As his belly continued to fill with blood, I sucked more fluid from around the heart.

VFib…Shock…Asystole…CPR…aspirate, repeat.