A/N Warning this chapter has a lot of medical jargon. I will put explantion of terms at the end : )
Chapter 38.
EPOV
Nothing could of prepared me for what was in that ambulance. I see people on deaths door brought into the ER everyday, sometimes they pull through and sometimes they don't. It's completely different when the people are your family and you love them.
I saw Alice first, I knew that Soph was talking to me and running over what injuries Alice had but I was in a state of shock and wasn't taking anything in. Once Alice had been wheeled out Bella jumped down and wrapped her arms around me "Edward, I'm so sorry" she cried. It took a few moments for my brain to register that there was blood covering her top. I walked away from her brace and unable to keep my voice steady I asked "Bella are you hurt?"
"No, I'm fine" she answered, tears rolling down her cheek. Thank God for small favours I thought. I don't think I would have been able to continue to function if both my sister and wife had been brutally attacked!
"But what about all the blood on you?" I asked. If she wasn't hurt why did she have so much on her?
"It's all Alice's" she sounded distraught. All I wanted to do was to hug her and tell her that it would be OK but I couldn't, I had a job to do. It broke my heart that I couldn't comfort Bella in her time of need.
"Edward, I told her to just hand over the bags but she wouldn't listen to me, I begged her" she sobbed. It was the hardest thing I had ever had to do but I walked away from her and over to Alice
"Let's get her straight into Trauma 1" I said.
Bella followed us down the corridors, as the gurney burst through the doors to the trauma room I turned to face Bella and told her to wait outside. I was cold when I did it, I had to make sure that she would listen to me. It killed me to be so mean but I had to worry about Alice at the moment.
The team worked like clockwork, we took hold of the stretcher and on "1,2,3" moved Alice from Soph's gurney to ours. "Pulse is weak" I commented. "Spin a crit" I told Rosalie, who immediately got to work. Alice needed to be intubated "push accommodate and suxs" I ordered.
"Stab wound to the left neck and chest and two more to the belly, right and left upper quad" Eric, my resident said, doing a primary survey of Alice's injuries.
"Get me an 8.0 ET tube, get four units, hang two on the rapid infuser." I was having difficulty passing the ET tube "I need some cricoid pressure" Eric pushed on Alice's throat and I was able to pass the tube.
"Pulse ox is 83" Rosalie called across to me.
"Edward, look at this" Eric pointed to a deep gash on Alice.
"Tracheal laceration, we need to trache her. Where's surgery?" My voice broke, my eyes were prickling, tears threatening to spill out and down my cheek. Come on Edward, you have to keep it together and pull Alice through this. I wasn't entirely sure I could cope though.
That's when Rosalie came back into the room, bringing Mike with her. "Edward, I need you to step out" Mike said, his voice stern but at the same time full of compassion.
"I can handle this Mike. I'm fine I don't need to leave" I shouted back.
"Edward, you're too close to this case. Bella is outside, she needs you, go and be with her. Emmett's on his way down."
"Fine" I spat. If I hadn't looked towards the door and seen Bella's pale, tear-stained face I wouldn't be leaving without a fight.
"Hook up the thora-seal" Mike said. He had just inserted a chest tube into Alice and it was draining a steady stream of blood.
When I reached Bella I took a hold of her hand and squeezed. I hated having to be out here and watching. I should be in there working on Alice, helping to save her life. What if they couldn't save her I would never be able to forgive myself for leaving that room. Would I resent Bella for being the reason that I had left the room? I shouldn't be thinking like this I needed to think positively, Alice was strong and she would pull through this! She had to, she was going to be an Aunt.
"Coming through" Emmett rushed past us and into the Trauma room. I felt slightly relieved that he was there now. If anyone could save Alice it would be him. He was an excellent surgeon who never gave up. Within moments he had trached Alice. She wasn't out of the woods yet though. Emmett was brandishing a sternal saw in his hands, I knew what that meant.
"Edward, what's that?" Bella asked, curiously.
"That's so they can cut through her breastbone. Their going to crack her chest" I explained, a tear rolling down both my cheeks as we continued looking on, through the door. This was not a good sign at all. Usually when we have to crack someone's chest they don't make it. As if confirming my worst fears I heard Alice's heart monitor change from PEA to V-tach and right on cue Mike grabbed a hold of the internal paddles and began shocking Alice, trying to regain a regular rhythm.
I couldn't take it any longer I had to look away from that room and what was happening to Alice. Bella was doubled over. "Bella what's wrong?" I asked, worried that more had happened to her then she had let on.
"Ahh" she screamed, wrenching her hand from mine, and moving it to herself. When she lifted her hand back up, it was red with her blood.
"Oh God, Bella you're bleeding" I cried out in panic. I focused all my attention on her now. I was still worrying about Alice but she had good Doctor's looking after her. "Bella, Bella stay with me" I held on to her as she slipped into unconsciousness. "Bella, I need you to stay awake. Please God let them be okay" I sobbed. I couldn't lose either of them let alone both.
MPOV
As soon as I entered the room I knew that Rosalie had been right to call me in on this case. After a bit of convincing I got Edward to leave the room.
Emmett had come down and was traching Alice "Get ready to bag her" he instructed Eric.
"I've got good breath sounds" I said, having used my stethoscope to listen to Alice's chest.
"How much has she lost?" Emmett inquired.
"400 in the thora-seal and who knows how much in the field" I answered.
"Wound looks deep. How long was the blade?"
"I don't know"
"Pressures down to 60" Rosalie shouted out.
"She needs volume now"
"Maybe not" Emmett interjected. "Could be tamponade, open a thoracotomy tray"
"Check her CVP" I suggested, not convinced we were there yet.
"Too late, lost her pulse. We're in PEA, starting compressions" Eric said, standing up on the rail of the gurney in order to exert more pressure whilst compressing Alice's chest.
"We need to crack her chest, amp of epi, sterile gloves please" Emmett ordered. "Ten blade" I handed the instrument to him, he used it to make a vertical incision along the chest wall. I handed him the sternal saw and he cut through the breastbone.
"Sats are down to 85" Rosalie read.
"Rib spreader" Emmett made quick work of opening up Alice's chest.
"V – fib" It was Eric, keeping an eye on Alice's heart monitor.
"Internal compressions" I used my hands to massage her heart, trying to bring it back into a stable rhythm. "There is an effusion, pericardium is open, we've got a major haemorrhage here"
"More suction" Emmett requested. "I need 4.0 prolene on a rb1 needle now"
At the same time Emmett and I were working on the heart Eric was using the ultrasound to look for internal injuries. "Lot of blood in the belly, probably got the spleen. We've got to cross clamp the aorta?" It was more of a question than a statement.
"One thing at a time" Emmett said, concentrating on what he was doing. "Auto transfuse from the cell saver" he suggested.
"Charge the paddles to 15" I said. "Clear" I shouted before shocking Alice.
"Still in v-fib" Eric called.
"Another amp of epi. Clear" I shocked her again this time we got sinus tach.
"Check the pressure, get a portable monitor, we're moving her to the OR now" Emmett stressed.
"Hang the other units" I said.
"Pulse ox 92, pressure 90 systolic" Rosalie informed us.
"Is she making urine?" I asked.
"Only 50 cc's in the foley" Eric replied.
"It's better than nothing"
"Call the OR, tell them we have an open chest, will need a laparotomy" Emmett said as we were wheeling Alice out to the corridor.
"Still waiting on type specific" Rosalie shouted, following us.
"Have the blood bank send it upstairs. You putting her on bypass?" I asked Emmett.
"I don't know, have a perfusionist standing by" then the elevator doors closed and they were on their way upstairs. I just hoped that it had been caught in time for Alice to be saved. I went back to inform Edward of Alice's care. That's when I noticed he and Bella weren't there! I guess I had been so preoccupied with getting Alice to the OR I hadn't noticed their absence a few minutes ago. I saw the pool of blood on the floor and knew that something had to be wrong with Bella.
Medical Terminology :
Suxs: Suxamethonium chloride (also known as succinylcholine) is a medication used to induce muscle relaxation, usually to make endotracheal intubation possible. Suxamethonium is sold under the trade names Anectine and Scoline.
Spin a crit: They would have taken some blood and put it in a machine called a centtrifuge. This spins the blood sample really fast and separates the blood into two parts--the liquid plasma and the cells, both white and red. red blood cells are those that carry oxygen, so i believe a low crit is dangerous because there is decreased ability of the blood to carry oxygen to the cells.
ET tube: Endotracheal tube
Rapid Infuser: the rapid infuser is a device that warms fluids or blood products and delivers them, using pressure, very rapidly. It's for when your patient needs that volume and/or blood about twenty minutes ago. It is how you keep up when your patient is bleeding out-- treading water while trying to identify, pinpoint the location, and hopefully fix the problem.
Cricoid Pressure: This involves digital pressure against the cricoid cartilage of the larynx, pushing it backwards. The oesophagus is thus compressed between the posterior aspect of the cricoid and the vertebrae behind. The cricoid is used because it forms the only complete ring of the larynx and trachea.
Trache:Tracheotomy and tracheostomy are surgical procedures on the neck to open a direct airway through an incision in the trachea (the windpipe). They are performed by paramedics, veterinarians, emergency physicians and surgeons. Both surgical and percutaneous techniques are now widely used.
Thora-seal: THORA-SEAL™ III Chest Drainage Unit (CDU) is a wet suction chest drainage unit used to reestablish normal lung function.
PEA: Pulsless Electrical Activity
V-Tach: Ventricular Tachycardia
Tamponade:
Cardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium (the sac in which the heart is enclosed). If the fluid significantly elevates the pressure on the heart it will prevent the heart's ventricles from filling properly. This in turn leads to a low stroke volume. The end result is ineffective pumping of blood, shock, and often death.
Thoracotomy: Thoracotomy is an incision into the pleural space of the chest.[1] It is performed by a surgeon, and, rarely, by emergency physicians, to gain access to the thoracic organs, most commonly the heart, the lungs, the esophagus or thoracic aorta, or for access to the anterior spine such as is necessary for access to tumors in the spine
CVP: Central Venous Pressure
Effusion: Build up of fluid
Sats: Oxygen Saturations
Autotransfuse: Autotransfusion is an established technique for the collection and subsequent reinfusion of the patient's own blood. It not only prevents transmission of diseases but also avoids immunological complications of homologous transfusion. Autotransfusion permits greater flexibility in the use of blood bank supply.
A perfusionist, also known as a clinical perfusionist, is a trained health professional who operates the heart-lung machine during cardiac surgery and other surgeries that require cardiopulmonary bypass A/N Like I said lots of medical terminology (hope it didn't ruin your enjoyment of the story) Next chapter up tomorrow. Only 2 left now :(