5.12.2007

Auto vs. train

The paramedic trauma run.

Rescue 23: "This is rescue 23 to Base with a trauma run."

Me: "Rescue 23, this is Base, go ahead with your run. "

R23: "We're here one the scene of an accident; auto vs. train. There is an approximately 22 year old woman here who was apparently trying to outrun the train according to bystanders, and was hit by the train while in her car. We've just extricated her, and she appears to be about 8 months pregnant. She is non-responsive, has no pulse, and no respirations. She has open fractures to all of her extremities, and an open head wound. She is in full spinal immobilization, and we've established 1 large bore IV. We are unable to intubate after 2 attempts, and she is difficult to bag. You are the closest trauma center. Our ETA to your facility is 2 minutes, over"

Me: "I copy that rescue 23...we'll see you in five in our trauma center. "

-overhead speakers-
*Code yellow to the trauma center. Code yellow to the trauma center. Code yellow to the trauma center....*

As I leave the box and run over to the trauma center, I hear the sirens.

Quickly we suit up, masks, gloves, gown. We set up airway equipment. Since the patient is reported to be pregnant we call a 'code purple' - for the OB team/crash c-section team. We call a 'code pink' - pediatric full arrest. By the time the paramedics are backing into our trauma center, everyone is ready.

They roll in a woman in full traumatic arrest, with all of her extremities dangling from obvious open fractures, blood dripping as the gurney is rolled thru the double (security) doors. She appears to be 8 months pregnant.

As the EM resident, I get to intubate her. It's a difficult intubation with blood everywhere, and cervical collar in place. Once the airway is secure, we do follow ACLS protocal, but full arrest from blunt trauma...is...not good for your health. Death is almost always certain.

After 15 minutes of unsuccessful resuscitation, we divert our attention to the fetus. OB performs a bedside ultrasound. It's difficult to see much of anything. No fetus is clearly seen, but perhaps her uterus perforated?? Perhaps the fetus is much younger than we thought. The OB detects 'movement.'

"Movement" is enough. So we perform a perimortum c-section. The senior resident gets to cut her abdomen open, and deliver the baby.

So he cuts. We huddle around. And 'ta-da'. No baby!! The uterus is small, and in her pelvis.

No way?

This happened over a year ago, and to this day, the family insists we 'stole' the baby from her uterus. A lawsuit is pending, no doubt.