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Resuscitation

Posted on Sun Jul 15th, 2018 @ 3:26am by Lieutenant Jason Eldridge

Mission: Flowering Judas
Location: CASREC, Sickbay - BS Solaria
Timeline: MD 23 - 12:00

The klaxons wailed long enough to alert the entire medical staff that the ship was, yet again, set to condition one. They eventually stopped after about half a minute, as forcing everyone to work under a screaming alarm would no doubt be ridiculous.

There were only a few details. An explosion of sorts, on E deck. Jace had absolutely no clue where that was. Unknown number of injured, no information regarding any deaths. Damage control and paramedical personnel were still on their way. No one knew whether this was an attack, an act of sabotage, or no more than an unfortunate accident.

Reports began to flood in about ten minutes later. Several dead, a number of wounded. A few of them quite critically. No further details on what their injuries were, but only that they appeared bad.

The entire CASREC (Casualty Receiving) deck of sickbay had sprung to action. The few number of patients they already had within the department were shuffled around to make space. Equipment was brought out. Staff were allocated roles, particularly those assigned to be members of the resuscitation teams.

Jace's mind raced. There were too many unknowns. First and foremost, he had no idea how many casualties their CASREC needed to prepare for, and no idea exactly how ill any of them were. Admittedly, such uncertainties are to be expected in his specialty of emergency medicine, where life-altering decisions must be made with minimal information. But then there was the staff - as a newcomer, Jace was completely unaware of how well-trained or experienced (or not) any of his resus team members were, and to what extent he could rely on them. On top of that was his unfamiliarity with his new work environment as a whole - where equipment was, how the staff might coordinate the flow of patients, et cetera.

But none of those thoughts would be helpful. He shook his head subtly, bringing himself back to the emerging chaos that was the CASREC deck, as people rushed madly about.

Like everyone else in the resus team, Jace pulled on a blue isolation gown over his scrubs, the kind worn front-to-back, tying the flimsy straps behind his back. He pulled on a pair of surgical gloves, and slid a set of protective glasses in front of his eyes.

"What's the ETA for the first casualty?" he calmly asked the lady whom he had finally identified as the CASREC's charge nurse.

"Ten minutes."

Still some time, he thought to himself. Enough for him to touch base with each of the four other members of his resus team, to ensure the right equipment was out, and to have drugs drawn and ready.

"Does the transfusion lab know we're on mass casualty alert?" he asked, trying to bring forth his best 'team leader voice'. "Make sure they've got at least another four units of O-neg immediately available, if we end up using up the two we've got."

The first patient arrived, and the resus bay began to fill with a flurry of activity. A young engineering NCO, or technician... whatever he was, it didn't matter. Blown back against the bulkhead from the force of the detonation. His face covered in soot, dirt mixed with dried blood, a swollen bruise bulging over one eye.

Jace easily slipped into the job he'd trained years for. "All right everyone, listen up! Once we've completed the primary survey, we'll get the C-spine collar back on, perform our log-roll, remove the backboard, run a quick e-FAST, get him covered up and warm, send off a set of bloods, then take him to CT. Got it?!"

Much to his surprise, the team coordinated their efforts much more efficiently than expected.

"Airway is patent. He's got diminished anterior chest wall motion on the left with significant bruising and tenderness. Relatively equal breath sounds bilaterally... Saturating 95% on ten litres."

"He's tachy to 130. The last systolic was 92."

Jace kept his distance. As team leader, it was important for him to take a hands-off approach, and to maintain situational awareness. He reached out and pointed towards the patient's head. "That scalp lac there," he said. "It looks awfully arterial, someone grab some gauze and put a heap of pressure over it, please."

"I've got a 16-gauge on the right ACF," one of the nurses announced. "Pushing that gram of TXA."

"No obvious free fluid in the abdomen and pelvis," one of the other medical officers reported, his eyes focused on a display screen, his gloved hand maneuvering an ultrasound probe over the casualty's abdomen. "Pericardial space looks fine. Might have a pneumothorax on the left."

Despite keeping a calm face, Jace felt overwhelmed on the inside. He'd been on the Solaria for a mere five days, with a completely new crew, the only familiar face being the CMO's, and now had the task of leading a trauma team. That, along with the ever-present risk of coming under harm's way himself... although that had been much more substantial when he was on the Panacea, drifting in space, waiting to be nuked the moment they were detected by a Cylon Raider.

Get yourself together, he pressured himself quietly.

"There's a lot of peri-orbital swelling on the right, with a bit of proptosis. Pupil's sluggish... but reactive. Tender maxilla, and there's a step over the zygomatic arch. The eye's not clinically entrapped. IOP's 21 on the right, 14 on the left."

"What's his acuity?"

"Umm... roughly six-on-nine for the right eye. Six-six on the left. Visual fields seem to be intact on all quadrants."

"All right. Just make note of it and we'll sort that out later, once we're done with the secondary survey. I want you to run that first unit of packed cells, wide open."

"Got it, boss."

With information being fed from all directions, Jace had to prioritise tasks for his team, and formulate an overall management plan for the patient. A learned skill - one that had taken him years to build upon and was expected to be an expert on. But like any other time-critical resuscitation, everything felt frantic and rushed, bits of chaos forced into something they hoped would resemble a systematic approach.

"Left chest drain output is bubbling nicely."

"All right, let's get things wrapped up!" Jace finally said, after nearly half an hour of effort poured in simply to keep their patient alive. "I want him heading to CT in the next ten minutes!"

And soon enough, the team pushed the gurney, along with their patient, out into the corridor, leaving behind a room littered with blood-soaked gauze, empty syringes and discarded equipment.




Dr Jason Eldridge
MBBS, FRCEM
Emergency Physician
Battlestar Solaria
Colonial Fleet

 

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