On the way into work on Sunday, I came upon an accident scene before the paramedics arrived. I'm a new RN, with less than a year of experience (no trauma experience), and I'm still a bit shaken by the whole thing.
A woman had been thrown from a motorcycle, and was lying face-down on the pavement. She was unconscious, had a compound fracture of the femur, blood coming from her mouth and nose (helmet was intact), and her spine was twisted in such a manner to indicate that a spinal cord injury was likely. There was also some tan matter coming from either the mouth or nose. My first thought was OMG, that's brain tissue. But now I wonder if it was just vomit.
There was another RN on the scene (we were just a couple blocks from the hospital). She supposedly worked in ER. She claimed the victim had a pulse and respirations, and was phoning into work to tell them she'd be late, and that the victim would be arriving soon. She told me they were not going to move the victim, due to the potential SCI. The victim's husband was holding pressure on the leg wound.
I only had a minute or so before the paramedics arrived, but it felt like an eternity. The woman looked dead. The only thing I did was offer to hold pressure for the husband, who was trembling almost uncontrollably (he rufused). I felt the victim's rib cage for respirations, and felt none.
I read in the newspaper on Monday that the woman died "of her injuries" at the hospital.
I keep wondering if I should/could have done more. The other RN acted confident, but she wasn't doing anything for the patient. I wonder if she knew the patient was hopeless or dead, and just didn't want to traumatize the husband by performing CPR in the field.
I have so many questions. I feel like I was completely useless, and I never want to feel that way again. I don't know who else to ask these questions, so I'm hoping those of you with trauma experience can help:
* Did the other RN recognize this as a hopeless case? If so, Is it ever appropriate to do nothing?
* Should I have reassessed the patient myself? I'm thinking that even if the victim had a pulse when initially assessed, in such a horrific trauma, she could have arrested at any time.
* In general, is an unconscious/unresponsive patient more likely to have a pulse/respirations? Or more likely not to?
* Is it likely that was brain tissue? (Not to be gruesome, but what would I expect brain tissue to look like? I've only ever seen it "preserved.")
* If it was brain tissue, is there any point in resuscitation efforts?
* Should I have remained on the scene after the paramedics arrived? If so, what would my role have been?
My first task on Monday was to put together a kit to keep in my car, in case this type of thing ever happens again. I want to be as prepared as possible, so please tell me what I should keep in the car. So far, I have a small backpack with: CPR mask, stethoscope, tourniquet, disposable gloves, ABD pads, and VetWrap (had it in the barn!). I'm thinking I should have some Emergency notecards, too, with instructions for care.
Thanks for listening. I really need to talk this out.
