Trauma. It's not really my thing.

WARNING: this is a detailed and gruesome encounter of a trauma i saw today!!
I've finished ER and have now moved on to surgery. Instead of doing general surgery I chose to try the trauma surgery route. It's been three days and I have yet to see the inside of an OR. I have however spent more than enough time in the trauma bays. Today was the first time I have ever been in the trauma bay but I made it there three times. Two of them weren't so bad; one was a patient who was run over by a dump truck and drug 40 feet and the other fell from the top of a ladder that was two stories up. Both of these patients had non-life threatening injuries. The first trauma of the day was not quite so "nice." I was hoping my first trauma experience would be something not so intense like the man falling off the ladder but that wasn't the case.

We got the page that a level one trauma was coming in while we were in the middle of rounding. The entire team stopped mid round and ran to the trauma bays. I wasn't sure what to do but the residents were very friendly and helpful and directed me. We all threw on lead and gowned and gloved up. While waiting for the helicopter to land we were briefed on what was coming. It was a 50 y/o male who was driving a mini van and was hit by a tractor trailer. We were told he had bilateral lower extremity crush injuries which resulted in amputations and had coded in the field. We were also told that there was massive blood loss, the paramedic reported seeing 2 inches of blood on the floor of his vehicle while cutting him loose. We knew it was going to be bad. I however did not realize just how bad. The gurney came barreling through the trauma bay doors and the room exploded into chaos! There were around 20 people in the room, everyone of them doing something or looking for something. The attending was barking orders out and the team frantically attempted to follow them as quickly as possible. My eyes immediately landed on the patients mangled legs. His feet were flipped around with his toes pointing towards his back instead of the front like normal. I have never in my life seen that much blood, not even in a horror movie. It was unreal. There was not single person in the room who didn't have blood on them. The patient was in cardiac arrest when he came in so the team worked feverishly to resuscitate him. The patient would get a pulse and a rhythm then two minutes later he would lose it again. This went on for an hour and half. Every ten minutes someone knew would do compressions. You never knew when you were going to be yelled at to do something. It was overwhelming for someone who had never been in a trauma bay let alone seen one of this magnitude. Every single person was doing something different, one guy was intubating, another was putting a central line in, another was putting bilateral chest tubes in, and still another was placing tourniquets on the limbs. We ended up getting a pulse and a rhythm for long enough to transport him to the OR where we could better manage the bleeding. I did not get to go to the OR but later found out that the patient died during surgery from blood loss. When it was all said and done he had received a total of 14 units of packed cells. That's a lot of blood!

After the trauma was over everyone was utterly exhausted. We all turned into zombies for the rest of the day. It is hard to watch that kind of thing and not be affected. You replay the event over and over in your head looking for anything that you could have done better. I was later told that people who sustain crush injuries in car accidents with major blood loss very rarely survive. The battle was lost before it even began. This didn't really make me feel any better. It didn't make it any less horrific. I would be perfectly happy to never see anything like this again. I'm going to have nightmares for the next two weeks. I don't think trauma is my thing. This hospital sees an average of 2-3 traumas of this magnitude per month. This could be a very very long and emotional 6 weeks.