Consultant In Crisis

Kelly suppressed a sigh. ‘We’ve been talking to her through the wall, Kyle. She’s been answering us. She’s told us she doesn’t have any breathing problems. There’s no sound of respiratory distress and her respirations are normal depth and rate. We can probably assume her airway is patent.’

Tony was supervising their scenario. ‘Airway is patent,’ he told them, ‘but the respiration rate is 30 and shallow. What are you going to do next, Kelly?’

‘Check circulation.’

Kyle reached for Wendy’s wrist. ‘Good radial pulse,’ he said happily.

‘No.’ Tony shook his head. ‘Pulse is weak and thready. Tachycardia of 120.’

‘I’ll do a body sweep.’ Kelly smiled at Wendy’s look of relief as she got in before Kyle to run her hands down each side of their ‘patient’s’ body.

‘No evidence of major haemorrhage,’ Tony confirmed.

‘We’re assessing the general condition as we look at our patient,’ Fletch contributed. ‘Her colour is good and she’s not diaphoretic.’

Tony smiled. ‘Your patient is pale, sweaty and cool to touch.’

‘We want to check for neck tenderness and put a C-collar on if it’s indicated.’

‘No neck pain,’ Tony decided.

‘She’s in shock,’ Kelly said. ‘We need to get an IV line in and start some fluids.’

Wendy gave a convincing groan. ‘My leg hurts,’ she moaned.

‘We need some pain relief on board as well,’ Fletch murmured.

Kyle shook his head impatiently. ‘Her leg hurts because she’s got a dirty big bit of concrete on top of it,’ he stated. ‘What we need to do first is get rid of it.’ He made a show of putting real effort into shifting the polystyrene ‘concrete’ slab. ‘Now we can extricate her,’ he announced with satisfaction. ‘Let’s go, team.’

‘No hurry now, Kyle,’ Fletch said dryly. ‘You’ve probably just killed our patient.’

Kyle’s grin faded as it dawned on him that Fletch was being serious.

‘That was a large piece of concrete, Kyle. Fortunately it would have taken more than one person to shift it, which would have given us time to give some prophylactic treatment for a crush injury.’

‘But it was the concrete causing the injury. The sooner it gets shifted the better. It’s hardly likely to kill her.’

‘Actually, it could,’ Kelly told Kyle. ‘We were told in the scenario set-up that Wendy had been trapped like this for more than twenty-four hours. Crushed tissue exudes toxins and when you move the weight the toxins get released into the body. The patient can die very suddenly and very quickly due to a cardiac arrhythmia.’

Kyle’s face tightened angrily and his voice rose. ‘How the hell am I supposed to know something like that?’

‘You’re not,’ Tony said quietly. ‘The lesson here is that no unilateral decisions should be made. Especially by the least medically experienced person on the team.’

Other groups in the classroom had finished their scenario work. Kyle’s angry query had attracted attention and people edged closer to see what was going on with the crush injury scenario.

‘How would you have dealt with this, Kelly?’ Tony queried.

‘I’ve only dealt with one serious crush injury victim before and we worked under a radio link to an emergency department at a major hospital in Melbourne.’ Kelly searched her memory eagerly. ‘We gave a huge fluid loading of four or five litres of saline. We didn’t have some of the drugs indicated so we had to make do with what we had. We gave Ventolin and glucose and insulin and I think it was atropine.’ Kelly frowned. ‘It’s a while ago now.’ She looked directly at Fletch without hesitating. ‘How would you deal with it?’