Thursday, April 29, 2010

Good Samaritan

He was on his way to work, driving through his village, when he saw a lady laying on the ground with blood all over her. He stopped, and along with the families help, brought her in his vehicle to our hospital. You could easily see where she had been by looking the trail of blood that followed her everywhere she had gone. The nurse who was there, quickly donned gloves, found some gauze, applied pressure to the arm that was limply hanging at her side with blood squirting out, and called for help. I was just finishing up my ward rounds when a nurse came to say there was an emergency in the ER. There is often an emergency in the ER, but some emergencies are more emergent than others and this was definitely one of them.
I found the nurse standing over a puddle of blood with his hands wrapped tightly around her upper arm and the gauze he had just placed there soaked in blood. He (correctly) didn't say much, but said enough when he said, "she has blood shooting out of her arm when I release pressure." (This wasn't the time for a full history of what happened, this was the time to quickly evaluate the situation and determine how much damage had been done. Saying blood is shooting out is telling me she has an arterial bleeder that needs stopped urgently.) So I too, quickly donned gloves and took a look. Taking a look wasn't easy as she was awake, feeling pain and moving, almost falling off the bed. She looked pale, and the amount of blood on her clothes and floor was concerning. Just like he said, when we quickly removed the dressing, blood just started pumping out at me from what was left of her biceps and her L upper arm. I quickly realized, I needed help, but despite there being 3 nurses in the ER at that time, it wasn't enough. There was a baby who was coding on one of the other beds (Steph was attending to the baby). and with 2 of us giving orders as to what we needed (i.e. gauze, a suture set, IVs x 2 started, lab called to Type and Cross the patient for a transfusion, find Dr. Jim), both of which were life and death, it became apparent we needed even more help. Thankfully, more help arrived quickly. After determining Dr. Jim was already in surgery and that this wound was too high to try and use a blood pressure cuff as a tourniquet to stop the bleeding, I knew I was going to have to find the bleeders and stop them before she bled to death.
As the nurse and I got prepared, the Good Samaritan, who remained at her bedside, tried to help however he could with the lighting and anything else he could get for us. As we released pressure the blood quickly pooled into her arm and blocked off the needed visualization to clamp off the vessels. The patient moving on the table wasn't helping, after talking to her to try and calm her down, we prayed and asked for God to help us find the bleeders and to help her remain calm. With the nurse's help, I was able to find 2 of the arteries that were the closest to her elbow and clamp them. This slowed the puddle that was continuing to form under her arm, but it was still pooling as I needed to find their 2 opposite ends that were bleeding up by her shoulder. After trying and only getting blood squirted all over me, I asked Steph to help. (Steph sent a nurse to ask Susan to help with the child who was still coding). With the 3 of us working gauze, blotting, and hemostating we were able to clamp off the remaining two arteries and have a relatively dry field for the first time. Thankfully, I was then able to keep the field pretty dry as I tied them off.
It was at this time, that I was finally able to breathe a sigh of relief. Her life threatening bleeding was now under control, she had blood running into her, and she was still conscious and able to talk to me. It was at this time when I learned what had happened. She had been outside, holding a bush knife under her L armpit, when she got into an an argument with the "husband-in-law" (her husband's brother). During the argument, he grabbed the bush knife and in the process the knife cut her on her upper arm. How long she was down before the Good Samaritan came, I can't say, but I know she wouldn't have lasted much longer out there with the amount of bleeding that she was having. He kept thanking me for helping to save her, but I thanked him for his part in this. In the Gospel of Luke (Ch10) we read the parable of the Good Samaritan. v36-37 Jesus asks, "Which of these three do you think was a neighbor to the man who fell into the hands of the robbers? The expert in the law replied, 'The one who had mercy on him.' Jesus told him, "Go and do likewise." (v37) This gentlemen sure did that today.