Surgeon On Call by Alison Roberts

Author:Alison Roberts
Language: eng
Format: epub
ISBN: 9781460376393
Publisher: Harlequin

CHAPTER SIX

‘GOOD grief!’

The reaction to the initial sight of the traumatic injury was not the most professional but Felicity murmured her whole-hearted agreement.

‘I’m so glad you’re on duty, Joe. We couldn’t decide whether to call in Orthopaedics first or Neurosurgery or Vascular Surgery. With you we get all three rolled into one.’ She smiled wryly. ‘It’s crowded enough in here already. We’ve even had the photography department excited.’

‘I’m not surprised. Looks more like a shark attack than a close encounter with a concrete mixer. How old is David?’

‘Twenty-seven.’

‘How stable is he?’ Joe was still making a careful visual inspection of the mangled lower arm of the unconscious young man occupying the trauma room bed.

Felicity’s report on the patient’s condition revealed how serious his condition had been on arrival. The blood loss had been severe enough to be immediately life-threatening. David’s blood pressure had been too low to record and his level of consciousness very low. He had been intubated to try and improve his oxygenation level but it was still low enough to be giving concern. Volume replacement with a blood transfusion was needed as soon as the cross-matching was completed. Joe was now evaluating the torn muscles and broken bones. Blood was still oozing steadily from multiple sites.

‘Direct pressure hasn’t been enough to control the haemorrhage completely even with elevation,’ Felicity told him. ‘I didn’t want to put a tourniquet on in case the limb is salvageable. C-spine and chest were clear on X-ray,’ she added. ‘And the secondary survey hasn’t shown any other major injuries.’

Joe caught Felicity’s eye. He raised an eyebrow. ‘I think this one might be quite enough.’

‘It’s a mess, isn’t it? The little finger was torn off completely. It’s in a bag in iced water over there.’

‘The bone could be useful for grafting. We’ll take it up to Theatre with us.’

‘Do you think there’s a chance he’ll keep his arm?’

‘We’ll do our best. I want to get it thoroughly cleaned up and debrided and have a better look.’ Joe nodded at the house surgeon standing beside him. ‘You can put that pressure dressing back on again. The less exposure this gets the better as far as infection goes.’ He turned back to Felicity. ‘What prophylactic antibiotics have you started?’

‘Cephalosporin and gentamicin. He’s had a tetanus booster as well.’

‘Good.’ Joe moved towards the X-ray viewing screens. ‘The head of the radius is a mess,’ he commented. ‘But the elbow is salvageable. The fingers aren’t great and there’s not much left of the midradial shaft, is there?’

‘Can it be grafted?’

‘Depends on how many bone fragments are available.’ Joe’s smile was rather grim. ‘And how much cement we’ve got. Reducing the fractures isn’t the main problem, though. There’s the tendons, nerves and blood supply to get back together well enough to provide some function. It’s going to be a long job.’

‘I’d love to watch,’ Felicity told him. ‘I was actually going off duty when David came in. Is it going to be too crowded in Theatre for an extra?’

‘Not if the extra is you.

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