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Carrie was still musing over the problem a couple of minutes later when Angela burst through the door.
‘I need you. Now. I have a GSW outside.’
Carrie startled at the receptionist’s abrupt entry and rapid-fire demand. A gunshot wound? Oh, no! She stood on shaky legs. ‘Get Charlie.’
Angela glared at her impatiently. ‘Do you think I’d be here, asking you, if Charlie was around?’
Good point. She watched Angela’s brisk retreat.
‘Stat,’ Angela bellowed from down the hallway.
Carrie jumped, her heart leaping in her chest. Her legs responded to the brisk command, her thoughts jumbled as she felt the familiar edge of panic.
She entered the treatment room, nausea slamming into her gut at the bloodied victim.
‘Shotgun blast to the abdomen,’ Angela said, thrusting a pair of gloves at her. ‘That car backfiring earlier was not a car backfiring. The ambulance is eight minutes out.’
The patient looked like a teenager. He had an oxygen mask on and was writhing around the examination bed, holding his abdomen. Blood was oozing out all over his hands, and its metallic aroma wafted towards her, fuelling even more nausea. It was all over his clothes and the clean white sheets. Oh, God, why wasn’t Charlie here? Where the hell was he?
Another teenager was pacing in the corner. He had blood all over his clothes, too. ‘Help him. Don’t just stand there. Help him,’ he yelled at Carrie, running his bloodied hands through his hair.
Angela looked at her sternly. They were it. She was it. She was what stood between this boy and death. Did she want another boy to bleed and die before her eyes?
Her thoughts crystallised. Her thinking became ordered. D.R.A.B.C.H.
The first four letters checked out already. There was no danger, the boy was obviously responsive and, at a quick glance, his airway and breathing weren’t compromised. She noticed a blood-pressure cuff wrapped around his arm and a pulse oximeter attached to his finger.
She strode closer. ‘What’s his pressure?’
‘Eighty systolic,’ Angela returned quickly. ‘Heart rate one-twenty. Sats ninety-eight per cent.’
Carrie nodded. ‘I’ll get some lines in. Have we got a plasma expander?’
Angela nodded as she pushed the IV trolley towards her. ‘I’ll set up two Haemaccel lines.’
Carrie snapped on a tourniquet. Her hand trembled as she attempted and gained access to a vein in the crook of the teenager’s elbow. In trauma situations these veins were the most commonly used. They were big, allowing a decent-sized cannulae to be placed for rapid infusion of large amounts of fluid, and were generally easy to find.
Angela taped it in place while Carrie moved around to the other side and placed one in the opposite arm. In a few minutes they had two litres of fluid running into the patient. ‘Pressure?’
‘Ninety systolic.’
Improving, but there was no way of telling just how much blood their patient had lost or was continuing to lose. Carrie turned her attention to the wound. There was a large hole in the abdominal wall, with loops of bowel protruding. Blood oozed out continuously. Where exactly it was coming from was anyone’s guess. In all probability there could be multiple sites. Bowel, kidney, liver, stomach. And that wasn’t even counting the threat to major blood vessels.
‘He needs a laparotomy,’ Carrie said. There could also be spinal complications although, given the boy’s powerful thrashing, everything appeared intact.
Angela nodded. ‘In the meantime, let’s put some moist packs in the hole to protect the exposed bowel. The ambulance should be here in a couple of minutes.’
Angela opened a pre-packaged trauma pack and poured sterile saline onto the large white hanky-sized sponges. Carrie snapped on the sterile gloves Angela opened and placed two of them over the hole, gently tucking them inside.
‘Pressure?’ Carrie asked as she watched the packs turn red instantly.
‘Holding at ninety,’ Angela confirmed. ‘Here, put this sterile towel over the wound.’ Angela passed her a sterile green towel. Carrie draped the hole and Angela taped the towel to the skin.
‘Pity we don’t carry any S8s. He could do with some pain relief,’ Angela commented over the loud moans of the patient’s distress.
Carrie nodded. That was one of the many proposals in Charlie’s expansion plans for the centre. The ones she was going to dash. ‘His blood pressure’s probably a little dicey anyway.’
The wailing of a siren grew louder and Carrie realised she’d been so focused on stabilising the teenager that she’d tuned everything else out. She’d been like a machine. Like she’d been doing this all her life. Like she’d never stopped.
