What do guns and machetes have in common? They can both be used to hurt and kill people, usually causing some serious bodily harm. Where I work it’s not uncommon to have 5 or 6 gunshot victims come in on any given night. Stabbings are less frequent, but we still see a lot. Most are puncture wounds, often causing damage to the organs underneath. Gunshot and stab wounds don’t always require surgery, some are stitched up in the emergency department.
It was a busy night for traumas. My assignment had me covering the trauma bays, of which we have 4. Call came in for a stabbing. Said somebody was stabbed with a machete. I expected the worst, given the nature of a machete, but what we got was not what I expected.
As with every trauma we receive, the patient was moved from the EMS stretcher to our stretcher. The trauma team were present as were our ED physicians, nurses and me as the paramedic. The patient was supine (laying flat on his back) with blood around his head on the sheet. We began our assessment with my manual blood pressure and proceeded to roll the patient on his side to check his back.
The patient was awake and in obvious pain. He had cuts on his arms, chest and neck. How extensive the woulda were would not immediately be revealed.
The bleeding appeared to be under control, so the patient was sent to the CT scanner to check for internal injuries. We returned to the trauma bay and waited for the results.
I didn’t think too much of it for now and left the patient in his room with his call button. He said he was homeless and somebody had stolen something from him. He went to the tent where he thought his possession was and was attacked by the occupant of the tent with a machete.
I walked by the room later only to see the full extent of his injuries. The physicians were in the room and preparing to stitch the wound on his neck. The patient was seated upright and leaning forward. I walked around behind the patient only to see part of his spine showing! The machete had slit the back of his neck open down to his spine! Here I could see all of the muscle and fatty tissue under the skin. This was going to take some work to fix!!
Several hours later his wounds were stitched up and he was resting comfortably. I would be resting too if I was given the pain medication he was.
We see people with gunshot wounds all too often. At times we have 3 or 4 people from the same scene arrive after being shot. Some people are discharged the same day, some are sent straight to the operating room and some don’t make it.
One of the first I remember working here didn’t make it. He was just a kid, 18 years old and had been shot in the chest several times. The EMS crew said he was talking to them on the way to the hospital, but that his vital signs were a bit off. His blood pressure was low and his heart rate high - these are signs of hypovolemic shock (blood loss).
When he rolled in the room he was awake and able to tell us his name. We started our assessment, of course with the manual blood pressure first. His pressure was again low and his heart rate high. As we proceeded through the assessment he became unresponsive.
The trauma surgeon, who was standing in the doorway, immediately called for the thoracotomy kit. The patient was already stripped of his clothes, so they were ready to go. A finger thoracostomy was done first (cut through the skin and down to the lung tissue to see if there is a fish of air, meaning the lungs were collapsing.
The chest was sprayed with disinfectant and the procedure began. First step is to cut through the layers of skin, fat and muscle, down to the lungs. The retractor is then used to spread open the skin so the surgeon can see the heart. I’m this case the view was not good enough, so they called for a second kit.
The procedure now became a clamshell thoracotomy. Once the second side has been cut open a hammer and knife are used to cut through the breast bone. It’s quite a barbaric procedure, but it can be life saving. The surgeon now had access to the entire heart.
After quickly exploring the condition of the patient's heart, the surgeon decided it was not possible to save him. He counted 7 holes in the patient’s heart, which could not all be stitched up quickly enough to save his life. After a moment of silence, all that was left was to stitch his chest up so his family could see him.