if it bleeds, put your finger on it
Friday at work, we were getting a lecture from a trauma surgeon about doing open thoracotomies, which means cutting into someones chest to do open heart massage, or to clamp an aorta to stop bleeding, or to do some other life saving thing in the ER because the person will die before you get to the operating room. The outcome, as one might guess even if one is horrified by even the thought, is grim, especially in pediatric patients. However, the outcome is certain to be death without this last ditch effort.
Anyway, the surgeon said there are two simple rules to remember. I thought he was going to mention the right sized rib spreaders or aortic clamp, but I was wrong. Here's his two rules:
1. If it bleeds, put your finger on it.
2. Don't be a dork.
I think his point was to not panic. One good way to not panic is to have all the necessary equipment...much of it looks like tools one would use to build something - thinks that maybe you could buy at Sears. Did you know that we have had to get bigger rib spreaders because kids are getting so fat? Luckily we don't do this procedure very often. I can only remember doing it twice in my 33 years of being an ED nurse.
I don't do clinical much any more and don't do trauma patients at all even if I do clinical things. But I do vividly remember those two times we did open thoracotomies on two kids in our ED about 28 years ago. One was on a cold January 2, my first day back to work after having given birth to one of my kids. I walked in the small 6 bed ED at 6 AM and the night nurse came flying out of the trauma room yelling "We are cracking a chest, get in here". "Welcome back", I thought. I did not think about being a dork. I was at that time, angry at the adult surgeon working on a pediatric patient that was already dead. Someone's child on the day after New Year's. We had no crisis intervention support in those days.
The second time the patient was an older child who had been shot through the heart. Maybe he could have been saved by this drastic maneuver, but as it turned out, the bullet went through both the lower chambers of the heart and putting a finger on it would not have saved him. I remember looking at his lungs, and his damaged heart, and realizing just what I was seeing. Not many people come to work and view such tragedies. The student nurse working with me left the room and I went out to see how she was doing. As it happened, she was thinking the same thing I was. "I just all of sudden realized that I was seeing the inside of someone's precious child", she said. I think at that moment, we both realized how lucky and privileged we were to do what we do even if we didn't say it out loud. And if I didn't remind myself throughout the years that most kids get better and go home, I would never have stayed.
I think the surgeon's advice is good for many things in life. If it bleeds, put your finger on it. And don't be a dork! Words to live by.
Anyway, the surgeon said there are two simple rules to remember. I thought he was going to mention the right sized rib spreaders or aortic clamp, but I was wrong. Here's his two rules:
1. If it bleeds, put your finger on it.
2. Don't be a dork.
I think his point was to not panic. One good way to not panic is to have all the necessary equipment...much of it looks like tools one would use to build something - thinks that maybe you could buy at Sears. Did you know that we have had to get bigger rib spreaders because kids are getting so fat? Luckily we don't do this procedure very often. I can only remember doing it twice in my 33 years of being an ED nurse.
I don't do clinical much any more and don't do trauma patients at all even if I do clinical things. But I do vividly remember those two times we did open thoracotomies on two kids in our ED about 28 years ago. One was on a cold January 2, my first day back to work after having given birth to one of my kids. I walked in the small 6 bed ED at 6 AM and the night nurse came flying out of the trauma room yelling "We are cracking a chest, get in here". "Welcome back", I thought. I did not think about being a dork. I was at that time, angry at the adult surgeon working on a pediatric patient that was already dead. Someone's child on the day after New Year's. We had no crisis intervention support in those days.
The second time the patient was an older child who had been shot through the heart. Maybe he could have been saved by this drastic maneuver, but as it turned out, the bullet went through both the lower chambers of the heart and putting a finger on it would not have saved him. I remember looking at his lungs, and his damaged heart, and realizing just what I was seeing. Not many people come to work and view such tragedies. The student nurse working with me left the room and I went out to see how she was doing. As it happened, she was thinking the same thing I was. "I just all of sudden realized that I was seeing the inside of someone's precious child", she said. I think at that moment, we both realized how lucky and privileged we were to do what we do even if we didn't say it out loud. And if I didn't remind myself throughout the years that most kids get better and go home, I would never have stayed.
I think the surgeon's advice is good for many things in life. If it bleeds, put your finger on it. And don't be a dork! Words to live by.
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