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  • One for Boyd and the Boyz

    Posted by Charles Cameron on February 1st, 2011 (All posts by )

    [ cross-posted from Zenpundit ]

     

    2 Responses to “One for Boyd and the Boyz”

    1. Michael Kennedy Says:

      Surgery can be a little bit like combat except the person at risk is not the surgeon. Major trauma surgery is the best example. We used to develop strategies for certain combinations of injury. One was what we called “an arterialized abdomen.” This is an instance where the patient has had trauma and comes in with an abdomen so tense that it feels like arterial pressure. If you open that abdomen, the patient exsanguinates before you can find the source of the bleeding.

      One night the son of the hospital central supply chief came in this way. He had been in an auto accident. He had no apparent injury except his tense abdomen. We opened his chest and clamped his aorta. Then we opened his abdomen. It was full of blood but once that was suctioned out, there was no bleeding. We looked everywhere but found no injury. Finally, we were reduced to opening the aortic clamp just a bit to see what was the source. Blood shot up like a fountain and we quickly reclamped the aorta. With more searching, we finally found that the celiac axis, a huge artery that supplies all the upper abdominal organs, had been torn off the aorta. We repaired it with a little graft and closed him up. He recovered completely. That was almost certainly a steering wheel injury.

      A few years earlier, a friend of mine, who subscribed to the same strategy, had a patient come in with a similar picture although he had scars from previous surgery and the history was kind of vague. He decided to do what we did; open the chest and clamp the aorta. He opened the abdomen and found an advanced bowel obstruction with dead bowel. He had a bit of trouble explaining the chest incision. You can’t win them all.

    2. Charles Cameron Says:

      I always read your stories with keen appreciation, Michael, as I am sure others do, and my hat’s off to you. You say, “Surgery can be a little bit like combat except the person at risk is not the surgeon.” It would seem to me that that would make the situation, if anything, even more serious and demanding of courage.