Wednesday, September 14, 2011

"Busy Season"

The last few days have managed to keep our Forward Surgical Team rather busy.  Multiple traumas have been thrown our way and we dealt with them effectively.  One of these traumas was a U.S. Soldier who during a route clearing mission was shot by an insurgent in the arm by an AK-47.  Here is how the events played out.
It was 8:00PM and “dust off” called our FST to inform us 2 U.S. soldiers were being medevac to our FST.  The only information was one of them was likely a traumatic brain injury that was stable and the other was a GSW (gunshot wound) to the arm; ETA 30 minutes.  After about 20 minutes we received further info that the medevac team was becoming increasingly worried about the soldier with the GSW as he was losing a lot of blood on the Blackhawk so the medic placed a tourniquet on the extremity.  My excitement went up not only because of the injury at hand but because this was turning into a technical orthopedic case for me to treat.  After about 5 more minutes the Blackhawk landed and Charlie Company went to meet the bird.  They transferred both patients to our FST and then the real work began.  Sargent H was the soldier who sustained the GSW to the arm and he was blood soaked from the bleeding from his arm.  Initial inspection showed a significant injury with obvious boney and soft tissue injury just above the elbow.  We left the tourniquet intact for 5 more minutes while x-rays were taken to better evaluate the injury and then wheeled him back to the OR to stabilize and save his arm.  While the patient was being prepped for surgery I went back to radiology to view the x-rays of his arm; this injury was more severe that I initially thought. After I quickly came up with a mental game plan I headed back to the operating room where our Sargent was ready for me to scrub in.  This ended up being a 3 surgeon event with me at the lead.  The field tourniquet was removed and a machine controlled inflatable one was put in its place after we saw the extent of the injury and bleeding.  Mike M and I focused on finding and surgically exposing the brachial artery to gain control of the bleeding. After a careful dissection we came upon the artery and repaired one of many vascular injuries found.  My attention was then directed to the forearm where I performed a fasciotomy and found the AK-47 round severed his radial artery.  This was where the majority of his bleeding was coming from but with as damaged as it was it was un-repairable; so I tied it off after confirming another major artery to the forearm was still intact. I fixated the Sargent’s arm after the best reduction of his bony anatomy I could get to protect the repairs performed.  There was a significant nerve injury at his elbow as well as other injuries but I feel I attributed greatly to saving his arm.  I can’t say what his functional outcome will be but can assure you when he left us on a “Steel Angel” for the higher levels of care, some of the best surgeons in orthopedics will be awaiting him to start the reconstruction and rehabilitation efforts he will need. 
Another notable patient I saw today was my cute little Afghan girl “Kaenat”; she was doing well with the exception of her hip spica cast. Two weeks in the Afghan world was like 6 weeks in the United States; I ended up having to completely replace it.  This is just part of the farm I bought taking on this case so I tried to stay positive.  After I was done and she recovered from the anesthesia she left to go back in the Afghan world. I will be seeing her in one week now to follow closer her progress. My faith in her care is low at this point. 
Otherwise my NFL combine bench press event went very well; I won. I bench pressed 225lbs 19 times with only weighing 183 lbs. It was nice to win on September 11th and I dedicate all that effort to our troops.  I had a U.S. army trainer take interest in me after watching my performance; he feels I have more potential after seeing mechanical issues with how I bench pressed the weight.  So another competition will be in my future; should be fun.
Talk to you soon.
P.S. I miss my wonderful wife and family.


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