Trauma Activation

Trauma activations can be terrifying. When a trauma is called in, all our pagers go off (20 yo male GSW belly eta 5 min or 50 yo f mva gcs 7). If we're on call or on the trauma service, we drop everything we're doing and rush to the trauma bay. We put on a gown, hat, face shield, and gloves, ready for anything. About 10 people stand around the prepped bed, kits open and ready to go, a portable x-ray outside the room. When the helicopter or ambulance arrives, the patient is rushed in and immediately everyone descends. It's controlled chaos. As the emergency medical technician rattles off the patient's vitals and pre-hospital course, various people intubate, get vitals, attach monitors, attain vascular access, cut off the patient's clothes, talk to the patient if responsive, do a neurologic exam, examine the rest of the body, draw medication, and document. The head of the team, from either the Emergency Department or the Trauma Surgery Service, watches the flow and directs key activities.

The mantra of trauma resuscitation is the "ABCs" - airway, breathing, circulation. But in real life, these happen in such rapid succession that they seem to occur all at once. It's quite amazing; within 10 minutes, the initial survey is done, a CXR has been taken, the labs are sent, and the patient is off to the CT scanner. Already the decision is made whether the OR needs to be fired up.

When I was on call, we had several trauma activations. The first was a drunk man who was assaulted and found down in the middle of the road with a severe facial fracture. The second was a young man who had been shot with a pellet shotgun, about 12 bullet entry and exit points on the chest, abdomen, and back. During both trauma resuscitations, I was assigned the job of a femoral artery stick for blood gases and laboratory studies. In the second case, I also did the Foley catheter and chest tube. Everything happens so quickly it can be scary. On the first case, there was a little trouble intubating and when the patient's oxygen saturation started dropping, the attending grabbed the cricothyrotomy kit in case an emergency airway was necessary. On the second case, the room was prepped for a thoracotomy if needed.