And that is why I carry that in my shirt pocket...

                Recently I was working my preferred rescue station when we got a call for pedestrian accident. It was early enough in the morning where I figured it would be a fender bender that was the result of two soccer moms that wanted the same parking space. As we are coding along to the call, dispatch had information that was very much the opposite of what our original hypothesis had to say.

                As it turns out, it was a pedestrian vs vehicle call. Depending on what had happened, it could be a serious call or it could be nothing and we sign off the pt. This call was very much not the case. As it turns out, our pt was backed over. Yes, backed over by a rather large vehicle that most rednecks in the area would be proud to call their own. So needless to say, this poor pt was not exactly happy or feeling all that well. Btw, both axils passed over this pt at a fairly slow rate of speed. Thankfully the driver of the “Cletus-mobile” got out to see what he monster jammed into the ground and didn't flea the scene.

                Upon our arrival we find our pt on the ground in front of the vehicle in what looked like a yoga position. If I had to give it a name, it would be the dead cockroach since the pts legs were folded in such a way. Looked like the pt was sitting Indian style and fell back with their legs stuck in that position. It was a bit of challenge securing this one to the back board, but we got it done.

                On further inspection, questioning, and assessment, we come to find the pt was struck by the truck while it was backing up and it then proceeded to roll over this poor person twice. So in the back of our toasty warm ambulance we did our “eyes and scissors” assessment. The revealed a couple of small abrasions and lacerations, and an open tib/fib fracture but not real bleeding. And although the laying of hands may be therapeutic, it is also a good diagnostic tool. Our pt had crepetus to the left anterior chest wall and pain upon palpation to the pelvis. Our findings with our super duper ALS equipment showed relatively normal vitals and a good cardiac rhythm. Auscultation of the lungs did however show absent breath sounds to the left chest.  The pt was tachypniec, orthopniec, and dyspniec. So I reach into my front shirt pocket and pull out a 14 gauge IV catheter that will be placed into the second intercostal space, mid clavicular line with a flutter valve in just a moment. The pt tolerated well and respiratory effort was no longer as exaggerated. That is why I always carry one there. You never know when you might need it for a decompression or a needle cric. Just saying…

                Anyways, as soon as we get our basics down, we tell the FD to drive to the local trauma center and we take off priority 1. Enroute we do two large bore lines, get a bit of a better history, and what not. Pt has a GCS of 15 the entire time, btw. So we get some pain meds on board and continue to monitor and continue treatment as best that we can. The lungs of this pt are now diminished on the affected side, but they are actually there now. Score!

                Upon arrival to the ER, the trauma surgeon meets us at the door and is given a basic report. Upon arrival to the trauma bay, my partner and I are asked 1,000,000 questions, much of which was multiples or obvious (Is the pt intubated? Really?). We get our pt over to the bed and try to make it out of the room alive.

                After the report is done, I inquire to the condition of our pt and find out there was a displaced femur, which explains the odd leg positioning, broken ribs, a chest tube, and a tib/fib fracture. This pt was very lucky because this could have been so much worse.  Now that is one way to start a 24 hour shift.