was tough then, and he had grown even tougher over the years.
Heart rate one hundred ten. Rib cage and sternum intact to palpation. Carotid, radial, and left femoral pulses all present, although not very strong. The right groin, where the femoral pulse could usually be felt, was already swelling, probably from blood working up from the fracture site.
Airway, breathing, and circulation. All check.
He gingerly worked Cap’s backpack off and opened it on the ground next to his. The man’s muted cries echoed forlornly off the trees, and momentarily reminded Lou of the remoteness of their location.
Stay focused!
Neck seems uninjured.
Just in case, Lou used one of the ACE bandages and an empty backpack to improvise a stabilizing cervical collar.
Time to stop the bleeding.
“Cap, it’s me. It’s Lou. Hang in there, buddy. Hang in. I’m going to press on your forehead. Here, squeeze my hand if you can hear me.… Cap?”
Lou took half the gauze pads to wipe the blood out of Cap’s eye and off much of his face. Then he used the same gauze to apply heavy pressure to the laceration.
“Cap, it’s me. It’s Lou. Squeeze my hand if you can hear me.” Perhaps a flicker. “That’s it, buddy. Squeeze again.”
Lou kept up a steady stream of patter as he maintained pressure with his right hand. With his left, he soaked another gauze square with water from his backpack and wiped Cap’s face clean. Comfort. Every bit of comfort he could produce for the patient and the doctor was a help. He worked some water between Cap’s lips and then squeezed a few drops into his mouth. Cap swallowed. As Lou moved through the process he had mastered over the years of training and ER work, the need to extend his examination and to improvise treatment became increasingly important.
“That’s it, big guy. Hang on. Just hang on.”
The forehead hemorrhage had largely abated. Lou set a square of hi-tech hemostatic bandage over the laceration. There would be time for a dressing later. Another small squeeze of water between Cap’s lips. Again, he swallowed.
Pulses slightly stronger. Abdomen non-tender and flat. Arms and hands intact.
“Cap, it’s me, Lou. Open your eyes if you can. You’re doing better. Better and better and better.”
The leg was truly scary. Obscene to many. To a seasoned ER doc, it was just dangerous. The heavily muscled thigh was capable of holding literally quarts of blood—more than enough for someone to bleed out. The pain and internal bleeding had Cap hovering near shock. Lou had decided not to risk missing something potentially lethal by getting immersed too soon in the most obvious, spectacular injury. Now it was time to get to work on that.
He glanced back the way he’d come, wondering if he could possibly climb back up the cliff face to the trail. No chance. Besides, leaving Cap alone was something he could only bring himself to do after all other options had evaporated. For a half minute, while he collected his thoughts about the leg, he tried hollering for help. His cries were instantly swallowed by the dense forest. What about the river? If he could get Cap down there, perhaps he could fashion some sort of raft. But the woods were still shrouded in mist, and he could not even see the river from where they were.
Focus, Welcome. Focus!
The bleeding from the mid-shaft was continuing, and, if anything, seemed to be worsening. Lou checked for pulses behind each ankle and on the top of each foot. Left side, no problem. Right side, none. The femoral artery had almost certainly been torn. Big trouble.
It was then Lou realized Cap’s groans had stopped entirely. Again he went through the process—the A, B, Cs.
Pulse rate one fifteen. Pulse strength down from four to three on a ten scale.
“Come on, pal! Stay with me. Stay with me.”
Time was becoming even more of an enemy. He had to put on a tourniquet near the groin. Cap was still moving air effectively. His pupils were midsize and equal. Was
Heart rate one hundred ten. Rib cage and sternum intact to palpation. Carotid, radial, and left femoral pulses all present, although not very strong. The right groin, where the femoral pulse could usually be felt, was already swelling, probably from blood working up from the fracture site.
Airway, breathing, and circulation. All check.
He gingerly worked Cap’s backpack off and opened it on the ground next to his. The man’s muted cries echoed forlornly off the trees, and momentarily reminded Lou of the remoteness of their location.
Stay focused!
Neck seems uninjured.
Just in case, Lou used one of the ACE bandages and an empty backpack to improvise a stabilizing cervical collar.
Time to stop the bleeding.
“Cap, it’s me. It’s Lou. Hang in there, buddy. Hang in. I’m going to press on your forehead. Here, squeeze my hand if you can hear me.… Cap?”
Lou took half the gauze pads to wipe the blood out of Cap’s eye and off much of his face. Then he used the same gauze to apply heavy pressure to the laceration.
“Cap, it’s me. It’s Lou. Squeeze my hand if you can hear me.” Perhaps a flicker. “That’s it, buddy. Squeeze again.”
Lou kept up a steady stream of patter as he maintained pressure with his right hand. With his left, he soaked another gauze square with water from his backpack and wiped Cap’s face clean. Comfort. Every bit of comfort he could produce for the patient and the doctor was a help. He worked some water between Cap’s lips and then squeezed a few drops into his mouth. Cap swallowed. As Lou moved through the process he had mastered over the years of training and ER work, the need to extend his examination and to improvise treatment became increasingly important.
“That’s it, big guy. Hang on. Just hang on.”
The forehead hemorrhage had largely abated. Lou set a square of hi-tech hemostatic bandage over the laceration. There would be time for a dressing later. Another small squeeze of water between Cap’s lips. Again, he swallowed.
Pulses slightly stronger. Abdomen non-tender and flat. Arms and hands intact.
“Cap, it’s me, Lou. Open your eyes if you can. You’re doing better. Better and better and better.”
The leg was truly scary. Obscene to many. To a seasoned ER doc, it was just dangerous. The heavily muscled thigh was capable of holding literally quarts of blood—more than enough for someone to bleed out. The pain and internal bleeding had Cap hovering near shock. Lou had decided not to risk missing something potentially lethal by getting immersed too soon in the most obvious, spectacular injury. Now it was time to get to work on that.
He glanced back the way he’d come, wondering if he could possibly climb back up the cliff face to the trail. No chance. Besides, leaving Cap alone was something he could only bring himself to do after all other options had evaporated. For a half minute, while he collected his thoughts about the leg, he tried hollering for help. His cries were instantly swallowed by the dense forest. What about the river? If he could get Cap down there, perhaps he could fashion some sort of raft. But the woods were still shrouded in mist, and he could not even see the river from where they were.
Focus, Welcome. Focus!
The bleeding from the mid-shaft was continuing, and, if anything, seemed to be worsening. Lou checked for pulses behind each ankle and on the top of each foot. Left side, no problem. Right side, none. The femoral artery had almost certainly been torn. Big trouble.
It was then Lou realized Cap’s groans had stopped entirely. Again he went through the process—the A, B, Cs.
Pulse rate one fifteen. Pulse strength down from four to three on a ten scale.
“Come on, pal! Stay with me. Stay with me.”
Time was becoming even more of an enemy. He had to put on a tourniquet near the groin. Cap was still moving air effectively. His pupils were midsize and equal. Was
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