Scissors

One of my favorite calls so far was a stabbing that we were sent to.  Both because it was an interesting call and because it was the moment my preceptors really began to trust my skills.


When we pulled up to the scene a big muscular 30 year old male walked up to the truck.  I jumped out thinking he was going to take us to the victim, when I notices several little half inch cuts that were lightly bleeding on the man's chest and arms.  "Is there anyone else injured?" I asked, slightly disappointed that this was our supposed stabbing victim.  There wasn't and I started going through my assessment.  Turns out our patient had entered in a dispute with his little brothers friend over some football game or something, when the friend grabbed a pair of scissors from the counter and stabbed our patient several times in the chest and arms before running away.

After cleaning and examining the wounds only one slightly disturbed me.  It was a puncture on the left side just superior to the man's nipple.  The wound was not really bleeding and it didn't seem too deep, but it was hard to see.  Just to be safe we checked his lung sounds, Oxygen saturations, and started heading to the hospital.  Quickly, our patient started complaining of difficulty breathing and became very diaphoretic (sweaty).  I explained to the man the fact that it was possible that blood was seeping into his lung, however when I looked up I met the disbelieving gaze of my preceptor.  He, kind of, gave me that; "you don't know what your talking about look" and explained that there was no way the scissors went deep enough, since our patient was such a muscular man and since there was no air bubbling out.   However, I still was unswayed and placed the patient on oxygen, started a line, and kept trying to listen to the man's lungs.  As we approached the hospital the man vomited and I noted a drop in sats if the man laid flat (indicative of fluid on the lungs), all good indications that he was developing a hemothorax.


Rolled the patient into the trauma bay I could tell my preceptor was starting to agree more with my diagnosis, but his pride wouldn't allow him be bested by his brand new student.  That made it all the more difficult for me not to smile when the trauma surgeon immediately ordered a chest tube be placed, because it looked like a hemothorax had begun to develop.  Even after that my preceptor was reluctant  to admit to me that I was right, but ever since I have noticed a bit of a shift as he is eager to have my opinion and have me decide in what direction we should go with medical calls.