Free Mercy by Daniel Palmer Page B

gauze and were busy applying topical hemostatic agents using oxidized cellulose sponges to clean and sterilize some of the lesser cuts. Nearby, an intubation tray was prepped and ready with a complete set of endotracheal tubes, laryngoscope, and Magill forceps. Sam would be intubated before they moved him either to radiology for a CAT scan or to the OR for surgery. Two liters of normal saline hung from an IV tree and provided Sam with vital electrolytes as well as a source of water for hydration. EKG leads connected to the cardiac and hemodynamic monitors showed real-time vitals for his blood pressure, heart rate, rhythm, and oxygen saturation levels.
    “02 SAT’s ninety-four percent on a non-rebreather,” a nurse called out to the medical scribe, who entered that information into a portable computer. “HR is one ten. Occasional PVC. BP measures ninety palp.”
    The numbers were not horrible, and certainly a lot better since Julie had drained Sam’s blood from the pericardial sac. A respiratory therapist pulled aside Sam’s oxygen mask to check his airway for soft-tissue laxity, tongue blockage, or potential hematoma from a swollen blood vessel. Julie knew the process, as she’d done it countless times herself.
    “02 SAT’s maintaining on a non-rebreather mask,” the same nurse called out.
    “Thank you,” Dr. Gerber replied. “Dr. Benton, have you seen this? Both jugular veins are slightly distended.”
    Julie’s effort had fixed the problem only temporarily. Those veins were still symptomatic.
    “Dr. Julie Devereux performed a pericardial tap in the back of the ambulance on the way here. That’s what I heard, anyway.”
    Drs. Gerber and Benton stopped their exam to lock gazes with the nurse who supplied that information.
    “Is that true?” Dr. Gerber asked. He sounded incredulous.
    Julie took this as her cue, and she stepped into view. “Yes, I did. James, can I be of help? Please. I’m here.”
    Dr. Gerber took one look at the blood caked onto Julie’s face and clothes and his expression conveyed his deep compassion.
    “Not yet, Julie,” he said. “We’ll get you some scrubs, though.”
    “They’re coming,” said Julie.
    “Just hang back a moment. Nurse, let’s get an IV of seven milligrams lidocaine in him with epinephrine, please. Buffer that with a milliliter of sodium bicarbonate.” Dr. Gerber’s voice held no edge.
    Julie exchanged glances with an X-ray tech waiting outside the curtain with a portable unit. He would be called to the stage soon enough.
    “BP measures eighty-five palp,” a nurse called out.
    “I’m okay with that,” Dr. Gerber answered quickly.
    Normally, this would be more concerning, but Julie understood Dr. Gerber’s logic. Low blood pressure helped to lessen the bleeding, and the more blood they could keep in Sam’s body, the better.
    Dr. Gerber continued his primary survey, concentrating several seconds on Sam’s abdominal area. Dr. Benton leaned over Sam to listen for any speech. The surgical resident, a spitfire Indian woman named Dr. Riya Kapoor, diminutive in stature only, listened intently with her stethoscope and announced in a clear voice, “Equal breath sounds.”
    “We have some slight bruising surrounding the umbilicus,” Dr. Gerber noted. “Let’s get two units of plasma from the blood bank, O-neg of course. And tell them to keep it coming. And grab some splints, please. Need them for both arms and the left leg.”
    The ER tech took off at sprinter’s pace to fetch the blood and splints.
    “Oh two SAT’s ninety-three percent on a non-rebreather.”
    “Fine. Fine.”
    The phlebotomist got Dr. Gerber’s attention. “Trauma panel is set and ready … CBC, CHEM-7, coagulation profile, and tox screen. We’ll also type and screen for blood transfusion and liver function. Any other special orders?”
    “No, that’s good,” Dr. Gerber said. “We’re going to finish this survey quick and get him to the OR.”
    “Agreed,” Dr. Benton said.