A Knight for Nurse Hart. Laura Iding
years old, vitals dropping, BP 86 over 40, pulse tachy at 128,” the paramedic standing at the patient’s head announced. “Her GCS was only 5 in the field, so we intubated her. She probably needs fluids but we’ve been concerned about brain swelling, and didn’t want to make her head injury worse.”
Raine took her place on the left side of their trauma patient, quickly drawing the initial set of blood samples they’d need in order to care for Becca. Luckily, the rhythm of working in Trauma came back instantly, in spite of her four-week absence. Amy, one of the other nurses, came up on the right side to begin the initial assessment. One of the ED techs cut off the patient’s clothes to give them better access to any hidden injuries.
“Raine, as soon as you’re finished with those labs, we need to bump up her IV fluids and start a vasopresser, preferably norepinephrine,” Caleb ordered. “Shock can kill her as much as a head injury.”
“Left pupil is one millimeter larger than the right,” Amy informed them. “I can’t feel a major skull fracture, just some minor abrasions on the back of her scalp. It’s possible she has a closed cranial trauma.”
Raine’s stomach dropped at the news. Patients with closed cranial trauma had the worst prognosis. When the brain swelled there was no place for it to go, often resulting in brain death. And Becca was too young to die.
Suddenly, she was fiercely glad Caleb was the physician on duty. Despite their differences, she knew he’d work harder than anyone to make sure their patient survived. Determined to do her part, Raine took her fistful of blood tubes over to the tube system to send them directly to the laboratory. En route, she noticed two uniformed police officers were standing back, watching the resuscitation. It wasn’t unusual to have law enforcement presence with trauma patients, so she ignored them as she rushed back to increase their patient’s IV fluids and to start a norepinephrine drip.
“We need a CT scan of her head, stat. Any other signs of internal injuries?” Caleb demanded.
“Bruises on her upper arms,” Raine said, frowning at the dark purple spots that seemed to match the size and shape of fingertips. She hung the medication and set the pump to the appropriate rate as she talked. “Give me a minute and we’ll roll her over to check her back.” She finished the IV set-up and took a moment to double-check she’d done everything correctly.
“I’ll help.” Caleb stepped next to Raine, adding his strength to pulling the patient up and over onto her side, so Amy could assess the patient’s backside. Caleb was close, too close. She bit her lip, forcing herself not to overreact at the unexpected warmth when his arm brushed against hers.
Memories of the wonderful times together crashed through her mind and she firmly shoved them aside. Their relationship was over. She wasn’t the same person she’d been back then.
And they had a critically ill patient to care for.
“A few minor abrasions on her upper shoulders, nothing major,” Amy announced. Raine and Caleb gently rolled the patient onto her back.
“She’s the victim of a domestic dispute,” one of the police officers said, stepping forward. “Her husband slammed her head against the concrete driveway, according to witnesses.”
Dear God, how awful. A small-town girl at heart, Raine had moved to the big city of Milwaukee just two years ago after finishing college. But she still wasn’t used to some of the violent crime victims they inevitably cared for. She tried to wipe the brutal image from her mind.
“Raine?” Caleb’s voice pierced her dark thoughts. “Call Radiology and arrange for a CT scan.”
She nodded and hurried to the phone. Within minutes, she had Becca packed up and ready to go.
“I’m coming with you,” Caleb said, as she started pushing the cart towards the radiology suite next door. Thankfully the hospital had had the foresight to put the new radiology department right next to the emergency department. “I don’t like the way her heart rate is continuing to climb. Could be partially due to the norepinephrine, but it could also be her head injury getting worse.”
She couldn’t argue because Becca’s vital signs were not very stable. Usually the physicians only came along on what the nurses referred to as road trips, for the worstcase scenarios.
As Becca’s blood pressure dropped even further, Raine grimly acknowledged this was one of those times she would be glad to have physician support.
She was all too aware of Caleb’s presence as they wheeled the patient’s gurney into the radiology suite. There were unspoken questions in his eyes when he glanced at her, but he didn’t voice them. She understood—this was hardly the time or the place for them to talk about the mistakes they’d made in the past. About what might have been.
She kept her gaze focused on their patient and the heart monitor placed at the foot of her bed. They were only part way into the scan when Becca’s blood pressure dropped to practically nothing.
“Get her out of there,” Caleb demanded. The radiology tech hurried to shut down the scanner so they could pull the patient out from the scanner opening. “Crank up her norepinephrine drip.”
Raine was already pushing buttons on the IV pump. But then the pump began to alarm. She looked at the swollen area above the patient’s antecubital peripheral IV. “I think her IV is infiltrated.”
Caleb muttered a curse under his breath and grabbed a central line insertion set off the top of the crash cart the radiology tech had wisely brought in. “Then we’ll put a new central line in her right now.”
“Here?” the radiology tech asked incredulously.
Caleb ignored him. Raine understood—they couldn’t afford to lose another vein. A central line would be safer in the long run. Anticipating his needs, she quickly placed sterile drapes around the patient’s neck, preparing the insertion site as Caleb donned sterile gloves. Luck or possibly divine intervention was on his side when he hit the subclavian vein on the first try.
“Here’s the medication,” Raine said, handing over the end of the IV tubing she’d disconnected from the non-working IV.
The moment Caleb connected the tubing, she administered a small bolus to get the medication into her patient’s bloodstream quicker, since the woman’s blood pressure was still non-existent and her heart rate was dropping too. For a moment, Raine held her breath, but their patient responded well and her blood pressure soon returning to the 80s systolic. Caleb anchored the line with a suture and then quickly dressed the site.
But they weren’t out of the woods yet. Worried, she glanced at Caleb. “Should we complete the scan?” she asked.
He gave a curt nod, his expression grave. One of the things she liked best about Caleb was that he didn’t build a wall around himself to protect his emotions. He sincerely cared about his patients. “We have to. The neurosurgeons are going to need to see the films in order to decide whether or not to take her to surgery.”
The radiology tech didn’t look very happy at the prospect, but took his place to continue running the scan. Raine and Caleb together slid the patient back onto the exam table. She was startled when he took her arm, and instinctively pulled away. She winced when she realized what she’d done, knowing he’d done nothing to deserve her reaction. Her issues, not his.
His stormy gray eyes darkened with hurt confusion but she avoided the questioning look he shot her way. She felt bad about hurting him again, but at that moment her patient’s heart monitor alarmed so she was forced to go over to adjust the alarm limits. The ten-minute exam seemed excruciatingly long, but they finally finished the procedure.
Caleb didn’t say anything as they pushed the gurney back to the trauma bay. The moment they arrived, he crossed over to page the neurosurgeon to discuss the best course of action for their patient.
“Becca?” Raine glanced over at the shrill voice. She saw Amy bringing in a woman who looked to be a few years younger than their patient. “Oh, my God, Becca. What did he do to you?”