{"id":234,"date":"2017-06-22T14:50:00","date_gmt":"2017-06-22T18:50:00","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/healthcasestudies\/?post_type=chapter&p=234"},"modified":"2017-08-17T18:58:43","modified_gmt":"2017-08-17T22:58:43","slug":"emergency-room-5","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/healthcasestudies\/chapter\/emergency-room-5\/","title":{"raw":"Emergency Room","rendered":"Emergency Room"},"content":{"raw":"
Day: 0<\/h5>\r\n
Time: 23h30 (1 hour post-MVC)<\/h5>\r\n
Place: Emergency Room<\/h5>\r\nThe ambulance pulls in and the paramedics easily lift the stretcher out of the back onto its wheels, and enter the triage doors.\r\n\r\nNurse Jackie looks up from the triage desk. \u201cIs this the male driver from the single vehicle collision?\u201d\r\n\r\n\u201cYes, it is,\" responds James. \" I believe his name is Aaron Knoll. I have his wallet and some of the paperwork. We stabilized in the field and I\u2019ll need to complete the paperwork here.\u201d\r\n\r\n\u201cThey\u2019re waiting for you in Trauma 2,\" says Jackie. \"Give me his wallet and I\u2019ll get him in the system. Next of kin?\u201d\r\n\r\n\u201cWe don\u2019t know. It was just him and a female passenger.\u201d\r\n\r\n\u201cThanks. Head to 2. Dr Pierce is expecting you and they\u2019re set up and ready.\u201d\r\n\r\nThe two paramedics navigate the stretcher through the doors at the back of triage and into the trauma area. Looking in at Bay 1, they see the female passenger getting an X-ray. Moving a bit farther down the hallway, they turn the corner into Trauma bay 2.\r\n\r\n\u201cGood evening, Dr. Pierce.\u201d\r\n\r\n\u201cHello, James. What have you brought us this fine evening?\u201d\r\n\r\n\u201cThis is Mr. Aaron Knoll, driver of a single motor vehicle collision on Hemlock and Willow. Air bags deployed. Was wearing his seat belt. Fire had to remove the roof and doors for extraction. We placed a hard collar and he is on a backboard. Vitals are sinus tachycardia at 130, resp rate at 32 last check, SpO2<\/sub> 90% on 10 LPM rebreather<\/a>, BP 90\/70. Lacerations to scalp and primary survey did not show any additional injuries to limbs. My partner found that his abdomen is tender and firm. Initial GCS<\/a> is 13\/15\u00a0and he has not fully regained consciousness, but is now moving all limbs spontaneously. We have not given him any analgesics. He has received two liters of D5NS<\/a> [footnote]normal saline with dextrose 5%[\/footnote]. No next of kin notification. Anything else, Dr. Pierce?\u201d\r\n\r\n\r\n\r\n\r\n
Day: 0<\/strong><\/td>\r\nPulse Rate<\/strong><\/td>\r\nBlood Pressure<\/strong><\/td>\r\nRespiratory Rate<\/strong><\/td>\r\nTemperature<\/strong><\/td>\r\nO2<\/sub> Saturation<\/strong><\/td>\r\n<\/tr>\r\n
Time:\u00a023h30<\/strong><\/td>\r\n130<\/td>\r\n90\/70<\/td>\r\n32<\/td>\r\n-<\/td>\r\n90% 10 LPM<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n\u201cNo, let\u2019s get him on the bed and give him a closer look,\u201d replies the doctor.\r\n\r\nThe paramedics and the nurses move Aaron over to the hospital trauma bed. He moans quietly as he is repositioned.\r\n\r\nActing quickly as a team, the two Emergency nurses begin cutting off Aaron\u2019s clothing, hooking him up to the monitor, and checking his IV site. The respiratory therapist checks the oxygen flow<\/a> and auscultates his chest. In under five minutes, Aaron is on the telemetry monitor<\/a>, covered with a light sheet. Vital signs are charted and communicated to Dr. Pierce.\r\n\r\n\u201cOk, he looks like he\u2019s waking up a bit more now. BP is still a bit lower than I would like to see. Ingrid, start a second IV and draw the usual trauma bloodwork. Give me a glucose <\/a>now in case we\u2019re dealing with some sort of diabetes issue.<\/a>\u201d\r\n\r\nIngrid easily starts a 16 gauge IV in the opposite ACF the paramedics used. She draws eight tubes of blood and hangs normal saline wide open. \u201cDr. Pierce, the blood glucose is 10.\u201d\r\n\r\n\u201cThank you, Ingrid.\u201d Looking over at the RT, the doctor asks, \u201cHow does the chest sound<\/a>?\u201d\r\n\r\n\u201cSo far, pretty good,\" Ingrid replies. \"Good air entry to the bases, equal throughout, and no extra sounds. On\u00a095% rebreather<\/a> with equal expansion. Sats are 99% right now and I\u2019ll begin to titrate the FiO2<\/sub> down.\u201d\r\n\r\n\u201cGreat. When you get the FiO2<\/sub> below 70%<\/a>, draw an ABG <\/a>to see where we are.\u201d\r\n\r\nDr. Pierce moves closer to the patient and begins an assessment <\/a>of his limbs and trunk<\/a>. Finding nothing abnormal with the limbs, he moves to the abdomen and finds Aaron guarding<\/a>, abdomen firm, no bowel sounds, and some bruising over the left upper quadrant<\/a>.\r\n\r\n\u201cThe BP is coming up a bit with the fluid. Let\u2019s see what the HGB is before giving any blood<\/a> here. I\u2019d like to clear his C-spines<\/a> and see what is going on in his abdomen. How is urine output right now?\u201d\r\n\r\n\u201cFoley<\/a> has been in about five minutes and we have 200 cc of light coloured urine,\" says the nurse. \"Sample has been sent.\u201d\r\n\r\n\u201cFantastic. I\u2019ll go out and contact the radiologist-on-call and see if we can get a CT scan done pronto.\u201d\r\n
Time: 01h00 (2.5 hours post-MVC)<\/h5>\r\nGlen, the porter from the X-ray Department, enters Trauma 2 and announces that the CT technologist is now ready for Aaron Knoll.\r\n\r\nIngrid looks up. \u201cHey, Glen. Thanks. Are you helping to get us to CT?\u201d\r\n\r\n\u201cYeah, it\u2019s been a slow night up till now.\u201d\r\n\r\n\u201cMaybe for you. We\u2019ve been swamped down here.\u201d Looking at the RT, Ingrid asks, \u201cYou ready?\u201d\r\n\r\n\u201cYes, let\u2019s go.\u201d\r\n\r\nGrabbing all the paperwork from the desk, Ingrid indicates she is ready as well.\r\n\r\nThe three push and pull the stretcher through the Emergency Department and out the back doors to the elevator that will take them directly to the X-ray Department.\r\n\r\nOnce in the X-ray Department, Glen indicates the hallway to the right of the reception desk. \u201cThey have CT 3 ready. The other room has the female passenger in it.\u201d\r\n\r\nIngrid nods and guides the stretcher down the hallway to find the CT technologist holding the door open for them.\r\n\r\n\u201cGood morning, Ingrid. How\u2019s your night? Is this Aaron Knoll?\u201d\r\n\r\n\u201cBeen busy and yes. Did you get called in?\u201d\r\n\r\n\u201cYeah, two of us due to the accident and some other issues going on this evening.\u201d\r\n\r\n\u201cWow. Ok, Dr. Pierce did the req, but we want to clear the C-spine to see if anything is going on inside his head and see what is happening with the abdomen, as he is quite tender,\" Ingrid reports. \"Urine output has been good. Labs indicate no renal insufficiency, so we can use dye for the abdomen. No dye for the head scan, because, as you know, contrast and blood look too similar on the scan. Helical scan, because that is faster, and then we can reformat the images.\u201d\r\n\r\n\u201cGreat. Let\u2019s check for cerebral bleeding before abdominal. Move him onto the table with his head to go into the scanner first.\u201d Ingrid and the technologist work together using the CT scan trauma protocol. <\/a>\r\n
Time: 02h00 (3.5 hours post-MVC)<\/h5>\r\n
Place: Triage Desk<\/h5>\r\n\u201cCan you help me. I\u2019m looking for my son?\u201d\r\n\r\nJackie looks up to see a very anxious woman who has obviously been crying. \u201cCan you tell me your son\u2019s name?\u201d\r\n\r\n\u201cAaron. Aaron Knoll. I\u2019m his mother. Is he alive? Oh, please don\u2019t tell me he\u2019s dead!\u201d\r\n\r\n\u201cNo, Mrs. Knoll, your son is not dead. He is here in the Emergency Department,\" Jackie says reassuringly. \"I\u2019m going to get Dr. Pierce to talk to you and then take you to see your son.\u201d\r\n\r\n\u201cOh, thank goodness.\" Mrs. Knoll looks relieved. \"What about his girlfriend?\u201d\r\n\r\n\u201cI'm sorry, but I can\u2019t say anything further. Let me get Dr. Pierce.\u201d\r\n\r\nA few minutes later, Jackie comes back to the waiting room and guides Mrs. Knoll to the family room.\r\n\r\n\u201cDr. Pierce, this is Mrs. Knoll.\u201d\r\n\r\n\u201cHi, Mrs. Knoll,\" greets Dr. Pierce, shaking her hand. \"This is Ingrid, one of the nurses that is helping me care for your son.\u201d\r\n\r\n\u201cOh, my. What happened?\u201d\r\n\r\n\u201cPlease sit down,\" he says and guides Aaron's mother to a chair. \"So, about three and a half hours ago your son was in a single vehicle collision not far from what we think is his girlfriend\u2019s house. The car was significantly damaged. He was unconscious at the scene, but is slowly waking up. We have done some tests and it looks like he will need surgery for some internal bleeding.\u201d\r\n\r\n\u201cOh, no. That\u2019s awful. Will he be all right? When can I see him?\u201d\r\n\r\n\u201cWe are hopeful that with surgery and some time to recover, he'll be ok. However, many things can happen in the meantime, and he\u2019ll need a lot of support to get better.\u201d\r\n\r\n\u201cI\u2019m feeling a bit overwhelmed right now,\" says Mrs. Knoll. \"He never drinks and drives. How did this happen?\u201d\r\n\r\n\u201cMrs. Knoll, he was not impaired by alcohol or drugs,\" the doctor says reassuringly. \"Our best guess right now is that he fell asleep while driving, but only he can tell us when he wakes up.\u201d\r\n\r\n\u201cHe will wake up, right?\u201d\r\n\r\n\u201cWe believe so. At this point, it looks like a concussion. The CT scan did not show any damage to his head or neck. As time goes by, we\u2019ll know more. There is reason to hope for a full recovery. Like I said, though, things can happen in the meantime and he will need a lot of support to recover.\u201d\r\n\r\n\u201cOk, I think I\u2019m getting it. He\u2019s seriously hurt and will take a long time to get better, and there may be complications that you can\u2019t see.\u201d Mrs. Knoll looks at the floor as she tries to take in the information.\r\n\r\n\u201cYes, that is correct. He is young, which often means a better outcome than if he were my age.\u201d\r\n\r\n\u201cCan I see him now?\u201d\r\n\r\nIngrid stands up and moves closer to Mrs. Knoll. \u201cYes, let me show you where he is and explain some of the equipment at his bedside. I believe the surgeon will want to talk with you as well.\u201d\r\n\r\nIngrid then leads Mrs. Knoll out to Trauma 2 to see Aaron.\r\n\r\n\u201cMrs. Knoll, before we go in, you need to be aware that there is a lot of equipment around him and that there will be quite a few people coming in and out of the room. Not all will introduce themselves or even interact with you. It is taking quite a few health professionals to look after your son. It\u2019s stressful for us to see your son this way as well.\u201d\r\n\r\n\u201cOk, ok.\" Mrs. Knoll nods as she talks. \"Can I just see him now?\u201d\r\n\r\n\u201cFollow me.\u201d Ingrid takes Mrs. Knoll around the corner into Trauma 2. There she sees her son lying flat on a stretcher with a clean, white sheet over top of him. Wires snake out from under the sheet to the monitor on the wall. Clear IV tubing goes from bags hanging on hooks, through blue coloured IV pumps, down under the sheet to Aaron\u2019s arms. Clear plastic tubing is at the end of the bed with light yellow liquid in it.\r\n\r\n\u201cOh, my. He looks so ill. What are the bandages on his head for?\u201d\r\n\r\n\u201cMost likely he hit his head on the steering wheel before the air bags deployed, or on the side window,\" explains Ingrid. \"He has a couple of cuts there that we had to suture.\u201d\r\n\r\n\u201cWill he have scars? He has such a handsome face.\u201d\r\n\r\n\u201cI\u2019m not sure. It depends on how he heals up. It\u2019s a bit early to be thinking of scars. Let\u2019s get him through the next couple of days and then we can consider whether scarring is an issue.\u201d\r\n\r\n\u201cCan I touch him?\u201d\r\n\r\n\u201cMost definitely, and please tell him you are here and where he is. Somewhere under there he can hear us, but he is familiar with your voice and trusts you, so hearing things from you will have more meaning for him. Let me get you a chair and you can sit and hold his hand for a little bit.\u201d\r\n\r\nPulling a chair out of the corner, Ingrid assists Mrs. Knoll to sit at the bedside with Aaron.\r\n
Time: 03h00 (4.5 hours post-MVC)<\/h5>\r\n\u201cMrs. Knoll? I am Dr. Labinski. I\u2019ve been asked by Dr. Pierce to take a look at your son and take him to surgery to fix some internal bleeding.\u201d\r\n\r\n\u201cYes, I\u2019m Mrs. Knoll. How bad is it?\u201d\r\n\r\n\u201cWell, it\u2019s bad enough that they have asked me to take a look and fix it. So it\u2019s serious. Let me explain what I want to do, and then if you can sign the consent, we\u2019ll get him up to surgery and hopefully have him on the road to recovery quite soon.\u201d\r\n\r\nDr. Labinski then explains to Mrs. Knoll that Aaron has mostly likely torn part of his spleen<\/a>, and that without surgery he will continue to bleed. He\u2019s lost a bit of blood but is reasonably stable now. However, this won\u2019t continue without surgery. He also explains the risk for anaesthesia, infections, and scarring, along with the chance of further bleeding that can\u2019t be stopped in the operating room.\r\n\r\nMrs. Knoll signs the consent form.\r\n\r\n\u201cI\u2019m now going to go up to the OR to let them know that we\u2019re going to do his surgery tonight, within the next 60 minutes, I would say. I\u2019ll phone you when we\u2019re done. I strongly encourage you to either go home for a couple of hours or ask Ingrid if you can sleep in the family room. You\u2019re going to need some rest. Aaron will need your support when he wakes up. I expect the surgery will take about two to three hours, then about four hours in the recovery room, and then up to the surgery floor, so you\u2019ll be able to see him around 10am.\u201d\r\n\r\n\u201cOk. I don\u2019t feel right leaving, so I\u2019ll talk with Ingrid.\u201d\r\n\r\n\u201cThat\u2019s fine. I will phone you after.\u201d\r\n\r\nWith that, Dr. Labinski leaves Trauma 2 and heads to the OR.","rendered":"
Day: 0<\/h5>\n
Time: 23h30 (1 hour post-MVC)<\/h5>\n
Place: Emergency Room<\/h5>\n

The ambulance pulls in and the paramedics easily lift the stretcher out of the back onto its wheels, and enter the triage doors.<\/p>\n

Nurse Jackie looks up from the triage desk. \u201cIs this the male driver from the single vehicle collision?\u201d<\/p>\n

\u201cYes, it is,” responds James. ” I believe his name is Aaron Knoll. I have his wallet and some of the paperwork. We stabilized in the field and I\u2019ll need to complete the paperwork here.\u201d<\/p>\n

\u201cThey\u2019re waiting for you in Trauma 2,” says Jackie. “Give me his wallet and I\u2019ll get him in the system. Next of kin?\u201d<\/p>\n

\u201cWe don\u2019t know. It was just him and a female passenger.\u201d<\/p>\n

\u201cThanks. Head to 2. Dr Pierce is expecting you and they\u2019re set up and ready.\u201d<\/p>\n

The two paramedics navigate the stretcher through the doors at the back of triage and into the trauma area. Looking in at Bay 1, they see the female passenger getting an X-ray. Moving a bit farther down the hallway, they turn the corner into Trauma bay 2.<\/p>\n

\u201cGood evening, Dr. Pierce.\u201d<\/p>\n

\u201cHello, James. What have you brought us this fine evening?\u201d<\/p>\n

\u201cThis is Mr. Aaron Knoll, driver of a single motor vehicle collision on Hemlock and Willow. Air bags deployed. Was wearing his seat belt. Fire had to remove the roof and doors for extraction. We placed a hard collar and he is on a backboard. Vitals are sinus tachycardia at 130, resp rate at 32 last check, SpO2<\/sub> 90% on 10 LPM rebreather<\/a>, BP 90\/70. Lacerations to scalp and primary survey did not show any additional injuries to limbs. My partner found that his abdomen is tender and firm. Initial GCS<\/a> is 13\/15\u00a0and he has not fully regained consciousness, but is now moving all limbs spontaneously. We have not given him any analgesics. He has received two liters of D5NS<\/a> [1]<\/sup><\/a>. No next of kin notification. Anything else, Dr. Pierce?\u201d<\/p>\n\n\n\n\n
Day: 0<\/strong><\/td>\nPulse Rate<\/strong><\/td>\nBlood Pressure<\/strong><\/td>\nRespiratory Rate<\/strong><\/td>\nTemperature<\/strong><\/td>\nO2<\/sub> Saturation<\/strong><\/td>\n<\/tr>\n
Time:\u00a023h30<\/strong><\/td>\n130<\/td>\n90\/70<\/td>\n32<\/td>\n–<\/td>\n90% 10 LPM<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u201cNo, let\u2019s get him on the bed and give him a closer look,\u201d replies the doctor.<\/p>\n

The paramedics and the nurses move Aaron over to the hospital trauma bed. He moans quietly as he is repositioned.<\/p>\n

Acting quickly as a team, the two Emergency nurses begin cutting off Aaron\u2019s clothing, hooking him up to the monitor, and checking his IV site. The respiratory therapist checks the oxygen flow<\/a> and auscultates his chest. In under five minutes, Aaron is on the telemetry monitor<\/a>, covered with a light sheet. Vital signs are charted and communicated to Dr. Pierce.<\/p>\n

\u201cOk, he looks like he\u2019s waking up a bit more now. BP is still a bit lower than I would like to see. Ingrid, start a second IV and draw the usual trauma bloodwork. Give me a glucose <\/a>now in case we\u2019re dealing with some sort of diabetes issue.<\/a>\u201d<\/p>\n

Ingrid easily starts a 16 gauge IV in the opposite ACF the paramedics used. She draws eight tubes of blood and hangs normal saline wide open. \u201cDr. Pierce, the blood glucose is 10.\u201d<\/p>\n

\u201cThank you, Ingrid.\u201d Looking over at the RT, the doctor asks, \u201cHow does the chest sound<\/a>?\u201d<\/p>\n

\u201cSo far, pretty good,” Ingrid replies. “Good air entry to the bases, equal throughout, and no extra sounds. On\u00a095% rebreather<\/a> with equal expansion. Sats are 99% right now and I\u2019ll begin to titrate the FiO2<\/sub> down.\u201d<\/p>\n

\u201cGreat. When you get the FiO2<\/sub> below 70%<\/a>, draw an ABG <\/a>to see where we are.\u201d<\/p>\n

Dr. Pierce moves closer to the patient and begins an assessment <\/a>of his limbs and trunk<\/a>. Finding nothing abnormal with the limbs, he moves to the abdomen and finds Aaron guarding<\/a>, abdomen firm, no bowel sounds, and some bruising over the left upper quadrant<\/a>.<\/p>\n

\u201cThe BP is coming up a bit with the fluid. Let\u2019s see what the HGB is before giving any blood<\/a> here. I\u2019d like to clear his C-spines<\/a> and see what is going on in his abdomen. How is urine output right now?\u201d<\/p>\n

\u201cFoley<\/a> has been in about five minutes and we have 200 cc of light coloured urine,” says the nurse. “Sample has been sent.\u201d<\/p>\n

\u201cFantastic. I\u2019ll go out and contact the radiologist-on-call and see if we can get a CT scan done pronto.\u201d<\/p>\n

Time: 01h00 (2.5 hours post-MVC)<\/h5>\n

Glen, the porter from the X-ray Department, enters Trauma 2 and announces that the CT technologist is now ready for Aaron Knoll.<\/p>\n

Ingrid looks up. \u201cHey, Glen. Thanks. Are you helping to get us to CT?\u201d<\/p>\n

\u201cYeah, it\u2019s been a slow night up till now.\u201d<\/p>\n

\u201cMaybe for you. We\u2019ve been swamped down here.\u201d Looking at the RT, Ingrid asks, \u201cYou ready?\u201d<\/p>\n

\u201cYes, let\u2019s go.\u201d<\/p>\n

Grabbing all the paperwork from the desk, Ingrid indicates she is ready as well.<\/p>\n

The three push and pull the stretcher through the Emergency Department and out the back doors to the elevator that will take them directly to the X-ray Department.<\/p>\n

Once in the X-ray Department, Glen indicates the hallway to the right of the reception desk. \u201cThey have CT 3 ready. The other room has the female passenger in it.\u201d<\/p>\n

Ingrid nods and guides the stretcher down the hallway to find the CT technologist holding the door open for them.<\/p>\n

\u201cGood morning, Ingrid. How\u2019s your night? Is this Aaron Knoll?\u201d<\/p>\n

\u201cBeen busy and yes. Did you get called in?\u201d<\/p>\n

\u201cYeah, two of us due to the accident and some other issues going on this evening.\u201d<\/p>\n

\u201cWow. Ok, Dr. Pierce did the req, but we want to clear the C-spine to see if anything is going on inside his head and see what is happening with the abdomen, as he is quite tender,” Ingrid reports. “Urine output has been good. Labs indicate no renal insufficiency, so we can use dye for the abdomen. No dye for the head scan, because, as you know, contrast and blood look too similar on the scan. Helical scan, because that is faster, and then we can reformat the images.\u201d<\/p>\n

\u201cGreat. Let\u2019s check for cerebral bleeding before abdominal. Move him onto the table with his head to go into the scanner first.\u201d Ingrid and the technologist work together using the CT scan trauma protocol. <\/a><\/p>\n

Time: 02h00 (3.5 hours post-MVC)<\/h5>\n
Place: Triage Desk<\/h5>\n

\u201cCan you help me. I\u2019m looking for my son?\u201d<\/p>\n

Jackie looks up to see a very anxious woman who has obviously been crying. \u201cCan you tell me your son\u2019s name?\u201d<\/p>\n

\u201cAaron. Aaron Knoll. I\u2019m his mother. Is he alive? Oh, please don\u2019t tell me he\u2019s dead!\u201d<\/p>\n

\u201cNo, Mrs. Knoll, your son is not dead. He is here in the Emergency Department,” Jackie says reassuringly. “I\u2019m going to get Dr. Pierce to talk to you and then take you to see your son.\u201d<\/p>\n

\u201cOh, thank goodness.” Mrs. Knoll looks relieved. “What about his girlfriend?\u201d<\/p>\n

\u201cI’m sorry, but I can\u2019t say anything further. Let me get Dr. Pierce.\u201d<\/p>\n

A few minutes later, Jackie comes back to the waiting room and guides Mrs. Knoll to the family room.<\/p>\n

\u201cDr. Pierce, this is Mrs. Knoll.\u201d<\/p>\n

\u201cHi, Mrs. Knoll,” greets Dr. Pierce, shaking her hand. “This is Ingrid, one of the nurses that is helping me care for your son.\u201d<\/p>\n

\u201cOh, my. What happened?\u201d<\/p>\n

\u201cPlease sit down,” he says and guides Aaron’s mother to a chair. “So, about three and a half hours ago your son was in a single vehicle collision not far from what we think is his girlfriend\u2019s house. The car was significantly damaged. He was unconscious at the scene, but is slowly waking up. We have done some tests and it looks like he will need surgery for some internal bleeding.\u201d<\/p>\n

\u201cOh, no. That\u2019s awful. Will he be all right? When can I see him?\u201d<\/p>\n

\u201cWe are hopeful that with surgery and some time to recover, he’ll be ok. However, many things can happen in the meantime, and he\u2019ll need a lot of support to get better.\u201d<\/p>\n

\u201cI\u2019m feeling a bit overwhelmed right now,” says Mrs. Knoll. “He never drinks and drives. How did this happen?\u201d<\/p>\n

\u201cMrs. Knoll, he was not impaired by alcohol or drugs,” the doctor says reassuringly. “Our best guess right now is that he fell asleep while driving, but only he can tell us when he wakes up.\u201d<\/p>\n

\u201cHe will wake up, right?\u201d<\/p>\n

\u201cWe believe so. At this point, it looks like a concussion. The CT scan did not show any damage to his head or neck. As time goes by, we\u2019ll know more. There is reason to hope for a full recovery. Like I said, though, things can happen in the meantime and he will need a lot of support to recover.\u201d<\/p>\n

\u201cOk, I think I\u2019m getting it. He\u2019s seriously hurt and will take a long time to get better, and there may be complications that you can\u2019t see.\u201d Mrs. Knoll looks at the floor as she tries to take in the information.<\/p>\n

\u201cYes, that is correct. He is young, which often means a better outcome than if he were my age.\u201d<\/p>\n

\u201cCan I see him now?\u201d<\/p>\n

Ingrid stands up and moves closer to Mrs. Knoll. \u201cYes, let me show you where he is and explain some of the equipment at his bedside. I believe the surgeon will want to talk with you as well.\u201d<\/p>\n

Ingrid then leads Mrs. Knoll out to Trauma 2 to see Aaron.<\/p>\n

\u201cMrs. Knoll, before we go in, you need to be aware that there is a lot of equipment around him and that there will be quite a few people coming in and out of the room. Not all will introduce themselves or even interact with you. It is taking quite a few health professionals to look after your son. It\u2019s stressful for us to see your son this way as well.\u201d<\/p>\n

\u201cOk, ok.” Mrs. Knoll nods as she talks. “Can I just see him now?\u201d<\/p>\n

\u201cFollow me.\u201d Ingrid takes Mrs. Knoll around the corner into Trauma 2. There she sees her son lying flat on a stretcher with a clean, white sheet over top of him. Wires snake out from under the sheet to the monitor on the wall. Clear IV tubing goes from bags hanging on hooks, through blue coloured IV pumps, down under the sheet to Aaron\u2019s arms. Clear plastic tubing is at the end of the bed with light yellow liquid in it.<\/p>\n

\u201cOh, my. He looks so ill. What are the bandages on his head for?\u201d<\/p>\n

\u201cMost likely he hit his head on the steering wheel before the air bags deployed, or on the side window,” explains Ingrid. “He has a couple of cuts there that we had to suture.\u201d<\/p>\n

\u201cWill he have scars? He has such a handsome face.\u201d<\/p>\n

\u201cI\u2019m not sure. It depends on how he heals up. It\u2019s a bit early to be thinking of scars. Let\u2019s get him through the next couple of days and then we can consider whether scarring is an issue.\u201d<\/p>\n

\u201cCan I touch him?\u201d<\/p>\n

\u201cMost definitely, and please tell him you are here and where he is. Somewhere under there he can hear us, but he is familiar with your voice and trusts you, so hearing things from you will have more meaning for him. Let me get you a chair and you can sit and hold his hand for a little bit.\u201d<\/p>\n

Pulling a chair out of the corner, Ingrid assists Mrs. Knoll to sit at the bedside with Aaron.<\/p>\n

Time: 03h00 (4.5 hours post-MVC)<\/h5>\n

\u201cMrs. Knoll? I am Dr. Labinski. I\u2019ve been asked by Dr. Pierce to take a look at your son and take him to surgery to fix some internal bleeding.\u201d<\/p>\n

\u201cYes, I\u2019m Mrs. Knoll. How bad is it?\u201d<\/p>\n

\u201cWell, it\u2019s bad enough that they have asked me to take a look and fix it. So it\u2019s serious. Let me explain what I want to do, and then if you can sign the consent, we\u2019ll get him up to surgery and hopefully have him on the road to recovery quite soon.\u201d<\/p>\n

Dr. Labinski then explains to Mrs. Knoll that Aaron has mostly likely torn part of his spleen<\/a>, and that without surgery he will continue to bleed. He\u2019s lost a bit of blood but is reasonably stable now. However, this won\u2019t continue without surgery. He also explains the risk for anaesthesia, infections, and scarring, along with the chance of further bleeding that can\u2019t be stopped in the operating room.<\/p>\n

Mrs. Knoll signs the consent form.<\/p>\n

\u201cI\u2019m now going to go up to the OR to let them know that we\u2019re going to do his surgery tonight, within the next 60 minutes, I would say. I\u2019ll phone you when we\u2019re done. I strongly encourage you to either go home for a couple of hours or ask Ingrid if you can sleep in the family room. You\u2019re going to need some rest. Aaron will need your support when he wakes up. I expect the surgery will take about two to three hours, then about four hours in the recovery room, and then up to the surgery floor, so you\u2019ll be able to see him around 10am.\u201d<\/p>\n

\u201cOk. I don\u2019t feel right leaving, so I\u2019ll talk with Ingrid.\u201d<\/p>\n

\u201cThat\u2019s fine. I will phone you after.\u201d<\/p>\n

With that, Dr. Labinski leaves Trauma 2 and heads to the OR.<\/p>\n

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