Lara recorded the patient’s observations again and glanced towards the screen, hoping that Penny would spot whatever it was she was supposed to spot.
The girl needed a boost to her confidence.
‘She has an antero-posterior compression fracture.’ Penny leaned closer to the screen and touched it with her finger. ‘It’s causing separation of the pubic symphysis and widening of both sacroiliac joints.’
Lara breathed a sigh of relief and slipped her pen back into her pocket.
‘Well done.’ Christian nodded. ‘Also known as an “open-book” fracture. Significant opening of the sacroiliac joints is associated with tearing of the major blood vessels that overlie the joint. So what we’re looking at here is potential for serious vascular damage.’
‘And major blood loss.’ Lara grimaced as she looked at the blood-pressure reading. ‘Christian?’
‘I’ve seen it.’
Penny frowned. ‘But the X-ray doesn’t look that bad.’
Lara handed Christian a set of results. ‘With every pelvic fracture it’s important to think about the mechanism of injury because the damage on the X-ray may not actually reflect the degree to which the bones were separated during the actual injury. So you need to be alert for major soft-tissue damage.’
Christian scanned the results. ‘I want to take her straight to angio. Everything else can wait.’
Derek adjusted the oxygen. ‘You don’t want to examine her back?’
‘That can wait, too. I don’t want to risk dislodging the clot in her pelvis.’
Lara watched him, envying the ease and confidence with which he tackled every case that came his way. In two months, working alongside him in the ED, she’d never seen him remotely rattled and she loved working with him.
‘Penny, what do you know about interventional radiology?’
‘Very little,’ the junior doctor admitted frankly, and he gave a nod.
‘Perhaps you should go along and observe.’
‘Oh, yes, please.’ She nodded immediately and then fell silent as one of the nurses drew his attention to the monitor.
‘Her blood pressure is dropping into her boots.’
They worked swiftly, using the rapid infuser to push blood into the critically ill patient.
‘Her pressure is coming up a little.’ Christian looked at Lara. ‘Let’s do another FAST test, just in case things have changed.’
He performed the test, satisfied himself that interventional angiography offered the best chance for the patient and the team transferred her to the angio suite.
Left alone in Resus, Lara started clearing up and restocking, ready for the next patient.
She worked methodically, following the agreed protocol, and she had just started on the intubation tray when Christian came back into the room. She glanced at him expectantly. ‘How’s our patient doing?’
‘Well, she didn’t die in the corridor, if that’s what you’re asking me.’ His eyes were tired. ‘It’s too soon to say. Can I ask you a question?’
‘Of course.’ She picked up a laryngoscope and snapped it open, checking the bulb. ‘Ask away.’
‘Why didn’t you do medicine? You’re easily the brightest nurse I’ve ever worked with.’
‘You think nursing is a career for those too thick to become doctors?’ Lara’s eyes twinkled. ‘Be careful where you voice that opinion, Dr Blake. You might just find yourself with a compound orbital fracture.’
‘You’re threatening to black my eye?’He strolled into the room. ‘I never would have suspected that you have such a violent nature. For the record, that wasn’t what I was suggesting. Obviously nursing is a distinct career choice. The reason I wondered about you is because you’re so obviously interested in the diagnostic side of things.’
‘I’m not sure that I am.’ Lara wrinkled her nose thoughtfully. ‘I think I probably just have a naturally interfering nature. And a big mouth. If I think I know what’s going on, I have to speak up.’
‘Did you consider becoming a doctor?’