Dr. Reyna Ramirez Arelano, Anastasia Resident
03:00am
Los Angeles County General, Post-OP ICU
"God don't stop, " Reyna begged.
Silena sniggered. "Don't you dare mention this to Annabeth. In her universe, I am her private ER nurse."
The ER was one of the newest in the country and a fully equipped Level One Trauma Center with three Trauma bays. They weren't the biggest ER imaginable, but from their capabilities, they rivaled any in the Western World. Additionally, this was the quietest night they had had in a long time which was good, seeing as they were critically understaffed.
Reyna chuckled tiredly and felt like she was melting away under the head nurses' skillful hands. She was just about to properly fall asleep with one of those pesky Interns turned up. "Doctor Solace? Patient male, sixty-seven years old with Pneumonia. Bloodwork and X-rays confirm the Diagnosis. I would now admit him to the hospital and begin therapy with antibiotics?"
Reyna opened an eye and glared at the doctor. "Gwen? Are you asking or telling me?" Doctor Solace, the attending from Internal Medicine asked.
"Telling sir, " The first year Intern replied.
"Then do that, " Will replied and leaned back in her chair.
"I've been in surgery the entire day," Reyna almost wined. "
"Sorry Rey, " Will hissed.
"Hazel, mind getting Dr. Arelano a coffee?" Silena asked one of her nursing students who was pouring over thick books.
"On, it." The cute chocolate skinned girl jumped to her feet and sped off towards the ready room.
"Your amazing Silena, " Reyna said.
The nurse laughed. "Get the top Brass to send me to med school then."
Reyna chuckled. "You've got my vote but I'm on the board."
Reyna fell silent when she heard the all too familiar sounds of sirens wailing in the distance. They all perked up and started at the glass double doors that led straight to the ambulance bay.
"Please no. Please no. Please no." Silena muttered.
"That sounds like the cops, " Will finally said.
"There's definitely a rig in there, " Reyna finally decided. "Silena?"
"I'll have Trauma 1 warmed up just in case," The nurse replied and then turned around and called back into the breakroom. "Drew, warm-up Trauma 1."
The nurse in question signed dramatically and rose to her feet and hurried over and unlocked the heavy double doors of the trauma room. A moment later the nurse switched the lights on, bathing the room in cold white light.
Reyna glanced at the fax machine and red phone, asking herself why no one was announcing the incoming patient.
A glance at the security monitors finally showed an LAPD cruiser followed by an LAFD ambulance speeding onto hospital grounds, past the security checkpoint, and towards the trauma bay.
"They could have called ahead, " Silena groaned mournfully and rose to her feet.
Reyna sighed, her dream of a peaceful night gone. With any luck, this was an Internal case. Maybe a Stroke or something that would end with her being free to sleep a bit.
By the time the light show from the ambulance became visible she had already stepped into the trauma room. A black stretcher stood in the middle of the room surrounded by medical equipment. Her part of the party, monitoring and respirator were suspended from the ceiling with empty power sockets and a dozen perfusion waiting to be put into action. Small tables, wardrobes, shelves, and tablets were set up surrounding the stretcher stacked with everything from an abundance of IV needles, medications and intubation equipment.
"Hazel, wake radiology up!" Silena snapped at the student. "Double time, I want their CAT up and running in two minutes."
Hazel squeaked in terror and almost dropped the cup of steaming coffee, set it down on the counter, and hurried off again. Smiling Reyna pulled on a
"They are always so timid in the beginning." Silena sighed dramatically.
"Here they come," Will announced and joined her in the room.
Reyna had already started to anticipate the possible stroke, maybe followed by a good old fashioned ALS after which she had every excuse to go to sleep and let the interns handle the rest. The goofing around disappeared however when the cop and two firefighter medics wheeled their Stryker stretcher around the corner.
"Hey, Reyna, Will" Charles Beckendorf, the A-EMT and rescue squad Lt. greeted her as they rounded the corner. His partner, an almsot just as big and buff Asian dude with a babyface, grinned at them as if he was having the time of his life.
"Charles, Leo, what do you have..." Reyna trailed off when she saw the bloody mess that had once been a young man.
The massive, muscular African American man crossed his bulging arms.
"John Doe, from what I can tell in his early twenties. Two GSWs to the thorax, one to the abdomen. No exit wounds. Got hit by some gangbangers about twenty minutes ago. I was able to cover up the thorax wound four now but no joy with the abdomen wound. Bullet caused a tension pneumothorax, therapy via puncture. Looks like they hit some major artery in the abdomen. Airways secured via Endotracheal intubation. I've got him on a respirator for assisted breathing. SPO2 is at seventy-one. Giving fluids via the IV lines in both arms and an EZIO in his left chin. The patient is in hypovolemic shock and fully centralized. RR is at sixty to -. HF is at one hundred seventy. The patient is GCS three. Sugar is at one hundred fifteen. Pupils are wide and none reactive. He was still somewhat conscious when we arrived but I put him under. The temperature is at ninety-five. As far as I can tell he drank a beer or two so far but nothing more. No known history of drug abuse or prior ailments. Analgesia via Fentanyl and Morphine. Write you up with the exact dosages and times. Didn't think we'd get here in time."
Leo and Charles maneuvered the stretcher next to their procedure table and Will, Silena, and Will joined them.
"Silena, page Annabeth now and have them prepare an OR for her upstairs," Will ordered.
"Transfer at three," Will then ordered and they officially transferred the patient from EMS justification to hospital jurisdiction by moving him onto their table. Unfortionatly the transfer seemed to undo whatever patching up EMS had done because the chest wounds started bleeding freely again.
"Rey, you do yours, I do mine?" Will asked.
Reyna only nodded. "Okay, I want CBC, BUN, PT, PTT, T, BGA and C, and a UA when you get the chance. Call the blood bank. We need universal!" And while Reyna turned her attention to her arena Will, Silena, and Drew started working on the openly bleeding wounds. went to work on the openly bleeding wounds Reyna dug into her happy place. She put on blood pressure Cuff, PulseOxy, monitoring EKG. Simultaneously Silena hurried off with blood samples to start the lab work.
With those kinds of wounds, Reyna estimated his chances to be poor at best so she gave a few meds, partly to make sure he was comfortable, and then to help stabilize him to the best of her abilities. Soon enough Gwen joined them too and to help stabilize the patient. While will tried to control the bleeding she put down a chest tube. When Hazel finally returned and looked around for what Reyna was shoving in a central line down the jugularis when Hazel hurried back into the room and looked around, clearly waiting for orders. Then she froze and stared at the young man, all color draining from her face, and then screamed in horror.
"Hazel," Drew asked just as Silena returned, holding a piece of paper in her hand.
"Give that to me!" Reyna ordered and took the paper. It was the BGA-
"And?" Will asked.
"What you'd expect. HB is at four point five.
"Sammy," Hazel yelled and rushed forward, only to be shoved back by Will who really had more important things to do.
"Sammy, oh god!" Hazel screamed.
"Is this that Sammy?" Silena asked, already holding the crying nursing student back with one arm.
Hazel nodded, tears running down her face.
"Piper, it's Hazel's boyfriend. Get her out of here!" Silena ordered, and let the LAPD officer drag the nurse out.
"Where the fuck is Annabeth!" Will cursed.
A few seconds later Annabeth arrived and she could hear Will sigh in relief. It was obvious that Annabeth had snuck off to sleep somewhere. The attractive blond trauma surgeon had dark shadows under those hard gray eyes of hers and her hair was tied up in the messiest bun Reyna had ever seen. To add to the image of disrepair Annabeth Chase was five months pregnant.
"Why did you wake me up?" Annabeth growled and glared at the dying man angrily.
"Annabeth, shut up, get dressed, and I'll get you a donut later," Will yelled.
This seemed to pacify the young woman and so she pulled on an apron, safety goggles, and joined will at the patient, taking over without saying a word. As she got dressed Will summoned the general situation up. "Will! Suction! Silena, I need arterial clamps. We'll secure the bleeding in the abdomen and then we are taking him upstairs. Rey, put him down deep." Annabeth ordered. "What's up with the new kid?"
"It's her boyfriend," Silena explained and Annabeth paused for a moment.
"Drew, page Dr. Brunner. This is family business. Also, page the on-call general surgeon. I need more hands in this," Annabeth then ordered.
"More suction!" She snapped at Will and was met with a jet of blood splattering across her apron.
"Fuck, that was the inferior mesenteric. I hate hollowpoints!" Annabeth snarled.
"More suction. Gwen, you too. Silena, more volume. He's lost at least three liters by now."
They had had their ups and downs in the beginning but Reyna had to admit that Annabeth was a superb surgeon. She moved fast, precise, and despite her fatigue and pregnancy once she got to work she kept the cursing to a minimum. So, while Silena and Drew both squeezed the fluids into the young man Annabeth continued to do her work. Annabeth mannaged to clamp the offending arteries.
"Come on guys, let's get him upstairs right now or I won't have anything left to operate on. Cat will have to wait." Annabeth snapped. "Have the blood bank send the blood straight upstairs and tell them to keep it coming. If this goes well I'll be upstairs for the next eight hours so when I come down I expect a box full of donuts. And ice cream. Rey, I want you upstairs with me before I am stuck with some intern."
So, what are you guys up to. Wrote this down on a whim could have been more accurate. Sadly I can't go into detail as much as I would like to, otherwise, this will get very dry, very quickly. Unfortionatly I could be a lot more detailed with what happens in the ambulance than what happens in the Trauma room. I will let my GF look over this. She is an ER doc. after all. I work in German EMS so I am not exactly up to date on US protocols. Depending on how interested you folks are I might or might not continue with this.
I hope you folks have a nice day.