Why So Serious?

There were cops everywhere. The blue and red lights on their vehicles mixing with our red and white lights caused an almost strobing effect on the scene.

A sergeant met us at the sidewalk and said the guy was inside on the floor. The assailant was gone. Walking around the outside of the house were several other officers. From the back of the K-9 unit a police dog could be heard excitedly barking. In the front yard a woman sat in a state of shock.

The blood trail started on the walkway to the house. As we followed it up the three steps to the front door the splotches of reddish brown grew in size. Through the door I could see my patient laying on his right side. He was wearing a sweatshirt and Levi's which were both soaked with blood. The man was trying to cradle the side of his face and head with a towel.

I squatted down (I didn't want to kneel like I would normally do because of all the blood on the floor) next to my patient and introduced myself. He was alert and oriented but understandably a little panicked. He said that he had been stabbed at least once and then had walked into the bathroom to get a towel. On his way back outside he had only made it to the living room.

I had the man remove his hands and his towel so I could get a look at what I was dealing with. He had a full thickness laceration starting about 2 inches behind his left ear. The knife had sliced forward from that point just missing the ear lobe and stopping less than an inch away from the corner of the mouth. It looked like the knife wielding bad guy had tried to slit my patients throat but was thwarted by a downward tilted head. Unfortunately for my patient the bleeding had stopped. He was too low on blood the keep bleeding from this serious wound.

My engineer started cutting the clothes off my patient while I applied a trauma dressing. As we rolled the patient off of his right side we discovered another stab wound. This one was in the upper right quadrant of his abdomen right where his liver should be. It was bleeding quite a bit and his skin was bulging from blood that had accumulated it. In my mind my patient just went from very serious to critical.

Thankfully AMR showed up just then. The paramedic had been told outside that it was a bad facial wound but realized as soon as he saw us working that it was more serious. We placed a hasty dressing on the abdominal wound and lifted the patient onto the gurney. On the way out we put him on oxygen. Since we couldn't strap the mask to his face we simply tried to balance it as best we could.

In the back of the ambulance I checked lung sounds to make sure the knife hadn't caused a pneumothorax. The EMT had everything set up for an IV so I went for it. I heard the driver jump in the front seat. She asked if we were ready to roll. I asked for 5 seconds. Within three seconds there was a large bore IV in his left arm. We then rolled code 3 to the trauma center at the local university.

The patient was compensating well for the loss of blood. While his heart rate had increased his BP stayed above 110 systolic. We watched his BP closely. If it fell too far we would have to give him some fluids to make up for the loss of blood.

With one IV in and dressings on the wounds I found I had the time to do another quick head to toe.I hadn't missed any other wounds. Then I focused on keeping the oxygen mask on my patient and talking to him. Both to reassure him and to continually assess his mental status. An altered mental status would probably be one of the earliest signs that he was losing too much blood.

While talking to my patient I noticed there was some blood coming out from the bandage on his face. A lot of blood. I asked for another trauma dressing and held both in place with direct pressure. The patient was now becoming slow to respond to my questions. His BP was falling. We gave him a fluid challenge to keep it up. The problem with that is that blood carries several vital things to and from the body which saline is not capable of doing. At best we were stop gapping. The patient needed blood and surgery, fast.

The AMR medic started a second line, put the patient on the heart monitor and rechecked vitals. He also called ahead to the medical center to let them know we were coming.

Just a few never ending minutes later we pulled up to the ER. Everyone cleared out of our way and stared at out blood covered patient and gurney. Inside we were met by an army of hospital staff. We swapped the patient over to the hospital gurney and I started to give my report to the MD.

Now I don't mean to offend trauma docs but you guys are arrogant pricks. At least a lot of you are.

I had not even finished my first sentence and the doctor put up his hand and ssshhhhh'ed me. He didn't want to hear a thing I had to say. No chief complaint, vitals, treatments....not a thing. He wanted his trauma nurse to do a once over on the patient and to tell him what she had found. The last thing I heard was the MD yelling (so much for staying calm, cool, and collected) that he wasn't interested in the laceration to the patients face.

After the call the AMR crew cleaned their rig and did paperwork. They were kind enough to drop me off at my station as well. When I got back to the station I had to swap out my turnouts so I could wash out the blood on the ones I was wearing. Then it was back to bed.

Back Stabber

The gate to the back yard was open and we were being waved down. The woman ushered us into her backyard where we found her elderly father laying on the ground. It was apparent that he had been gardening but had DFO'd for some reason.

My patient was laying face up, half on the walkway and half in the bushes. I stepped into the bushes and grabbed his head, protecting him from moving it and possibly aggravating a spinal injury. I asked the daughter about her fathers medical history.

He was a diabetic, had hypertension and a fairly recent onset of seizures. She said that they had been gardening together that morning. She went to answer the phone and came back after a short conversation. That's when she found her dad laying where we found him.

While I continued to question the daughter my engineer started a head to toe assessment. Other than a couple of cuts and bruises there was nothing obviously wrong. He checked a blood sugar which came back WNL and placed the guy on some oxygen.

As a precaution we placed the old man on a backboard. That's when things got interesting. The patient started coming around, appearing to be postictal. Then he started to get combative. Understandably so. Can you imagine waking up confused to find several men strapping you to a board all while trying to tell you that they were there to help you? I'd be confrontational too. We enlisted the daughter to help calm him down and between us and the AMR crew we were able to get him strapped down.

By the time he reached the back of the ambulance he was lucid and answering questions. He did have head and neck pain and didn't remember what happened. At least the backboard and C-collar were justified.

After the call was over I had my captain pull a couple of thorns out of my back. The bushes that I had to crawl into to take care of my patient had been rose bushes. I was fine and careful until I had to struggle with the patient. Then the bushes stabbed be in the back. Ouch.

Assault With A Deadly Weapon

The tones interrupted my morning workout. And for the second time that morning we were dispatched to a stabbing.

This call was again in district 52 at one of the local hotels. One of the nicer ones actually. As we approached we could see the sea of police vehicles (most of which were at our last call) and the AMR unit. For once they had beat us on scene.

As the air brakes set I jumped off the truck and walked over to the victim. The AMR medic gave me a quick run down. The patient appeared to be in his 20's and had been robbed. Or at least someone attempted to rob him. I don't know if they got anything. The poor guy had a defensive stab wound on one of his hands and another minor wound on his arm. The cut that we were worried about was the one in his chest.

He had about a on inch laceration about 3 ribs down from the middle of his clavicle. The puncture was bleeding slowly but steadily. The patient denied any trouble breathing and his lung sounds were equal bilaterally. He would be closely monitored all the way to the ER. With his vitals stable we bandaged him up and sent him on his way to the trauma center.


As we were leaving we were joking about the poor people trying to check into the hotel. They would be met at the front by several police cars, crime scene tape blocking the entrance and bloody clothes on the sidewalk. I can hear it now, "Honey, let's get another hotel."

Fillet Knife

Engine 52 was off at training and that left us covering their district. First think in the morning the tones went off. We were being dispatched to a stabbing in 52's district.

When we arrived on scene the Barney Fife patrol was already there. They directed me to the top of the stairs in the apartment where, just inside his bedroom, I found my patient.

According to his son the old man was in the late stages of dementia and had been hallucinating. That's when he took a knife and stabbed himself about 3 inches to the left of his belly button. It was very obvious where he had stabbed himself because the fillet knife was still embedded in his abdomen.

While the officers held the hands of my patient I carefully stabilized the knife with bulky dressings and a lot of 2 inch tape. The bleeding had been minimal, at least on the outside, and had already stopped. After taking care of the wound we decided to get a quick check of his vitals. They were all within normal limits.

By that time AMR was there and we packaged him up. On the gurney he was placed into restraints. This was as much for his own protection as for ours. He was obviously willing to stab himself once and we weren't going to take a chance since the knife was well within his reach.

The patient was lucky that he didn't hit anything vital or this call would have been a little more intense.

Stabbing...Kind Of

For the fourth time that afternoon we were toned out to a medical aid with staging. This time it was for a stabbing at Rite Aid. We staged a half block away and watched as PD swarmed the area. They set up a perimeter really fast. They left us waiting for what seemed like an hour.

After about 5 minutes we were cleared to enter. We pulled up and jumped out. There was already caution tape stretched across the entrance. One of the officers raised it so we could slide past. Another officer, just inside the front door, directed us to the center of the store. We asked how bad it was and he said it wasn't.

As we approached the center of the store I noticed random drops of blood on the floor. As I turned onto the center isle I noticed a young man, in a security guard uniform, sitting on the floor. I didn't notice any bleeding so I asked him if he was hurt. He held up his and and I could see a bit of dried blood. I've seen paper cuts that have bled more.

The assailant had managed to take a small slice of skin off of the security guards thumb. I asked the guy if he wanted to go to the hospital, which he thankfully refused. As I placed a band-aid on his wound I asked if had had a recent tetanus booster. He had no idea. So before signing him out AMA I made sure he understood that he needed to go to his MD or a free clinic or an urgent care to get that shot.

As we walked out we canceled AMR. Another life saved (this last statement is literally dripping with sarcasm).