TRAUMA! Real Trauma!

Hello all,

Sorry we haven't written in a few days, but we have been quite busy. Hopefully the weekend will give us some more time to update everyone.

As for the title, I am sure your curiosity is piqued. I am on call tonight. Just as I was fininshing my evening rounds at about 8:30 the staff came to get me to see a pateint at check in. I walk around the corner and here is an 18 year old man on a stretcher with an obvious head injury and blood literally everywhere, and on the ground lying is a 20 year old man who looks like he has just been beaten up very badly. On questioning, we found out the two were riding in the back of a truck and either jumped or fell out. the rain returned today, so I am not sure if this had anything to do with it or not. The 20 year old, ended up only have a small laceration to the back of his scalp and to one of his fingers and lots of road burn all over him.

The 18 year old is another story. I have honestly just spent the past 4 hours suturing his head. His scalp was almost completely removed, his lip and lower nose were completely mutilated, he had a large laceration to his temporal area and a few small lacerations on his face. (keep in mind I am just talking about his head now). Wendy, the wife of one of the missionaries, who is also a nurse, happened to be there as well and stayed to help. We sutured for nearly 4 hours, using almost every suture available whether it would have been appropriate or not in the US. He was bleeding profusely from his scalp, literally pulsating blood out onto the table. He also had what looked like a gravel embedded in his skull in the front top part of his head. I tried to get it out, but given the large blood loss he was having, I opted to just clean it well and start sewing to try to save his life. I would venture to say there are more than 100 stitches in his scalp alone. One I had it all closed up, though, the bleeding seemed to slow down significantly and only remained with a little oozing. As for the gravel, I hope it didn't penetrate the bone completely, because it could set up an abscess and cause infection near his brain on the inside.

As for the remainder of him, I crafted him a new form of a lip and nose on the upper left. It was completely multilated when I first looked at it and I thought there would be no good way to fix it, but after a slow approach, it finally came together and I am proud to say looks semi-decent given how terrible he looked on arrival. He has many other lacerations as well on his face, elbow, and knees that were sutured, and hopefully will heal well. His teeth are also dstroyed. He has several missing, the majority of the rest are displaced, and his palate is more swollen than anything I have seen in a mouth before. He does talk some though.

Given the mechanism of injury, there is still a good chance he may not survive because he could easily have an intracranial injury that could be lethal. When not under the drugs I gave him to do the repairs, he was moving everything well, and seemed to be somewhat consciously aware of what was going on. I placed him on strong antibiotics, steriods for brain swelling, and ordred some labs, so that he may get blood if his blood counts are very low.

Please keep him in your prayers. I can honestly say this is the worst injury I have ever sutured and I could not have done it without the support of Wendy, and a lot of prayer to guide me as I went through the wounds trying to close them. I explained to his family the possible outcomes of death, neurologic impairment, and the slim chance he may be normal, and they seemed to understand, but they are not religious and need prayer for support and strength.

I will update you tomorrow when I have some time in the evening.
Love and prayers,
Steve