03 December 2009

Dissecting Aortic Aneurysm

Okay, I gotta talk a little crap...
Medic types that stop here to read, feel free to correct me where I'm wrong.

The aorta is the largest artery in the human body. It's also series of intersections... most of the major arteries branch off the aorta. Sometimes, in some people, the tissue gets brittle... "frangible",
and tears. This is a serious problem because the aorta is such a large vessel, even a small tear can allow large quantities of blood to leak into the abdomen. These tears present a problem for healing hands because fixing them is like trying to sew old cloth with new thread...
The tissue tore because it was old and worn out. The tears frequently happen where the vessels branch off, leaving specialists with an almost impossible problem to fix.

Our patient was a 69 year old man. A nice guy, he had never flown and was frightened of the idea of spending 30 minutes in the helicopter. To the degree they could, my crew, a Flight Nurse and Paramedic... (both attractive females), tried to reassure him. He obviously enjoyed their attention, but his fear was still up-front evident.

Up the elevator to the helipad...
"A little bump here sir." We're trying not to jostle him any more than necessary to avoid tearing that aorta further. I open the clamshell doors and as we're about to slide him into the cabin of the BK117 he says, "I don't think I'm gonna make it."
My crew responds, "Sure you will!" as positively as they can.

I start both engines, do my before takeoff checks and ask, "All secure back there?"
"Yes we are."

I'm ten seconds into my takeoff when over the intercom I hear, "Sir? SIR?!!"
In the next few seconds I hear voices increase in pitch as Flight Nurse and Paramedic commence CPR. I've already started my 180 degree turn to return to the hospital and I've dialed in 155.340 on the Wulfsberg to let the hospital we just departed from know what's going on.

I make the radio call...
"********* Memorial, ******3 is returning to the helipad. CPR is in progress on our patient."

I land, secure the cyclic and collective, then open the clamshell doors. As my crew offloads the patient I open the starboard sliding door and grab the small oxygen bottle, the "E" tank. I turn to hand it to my crew and crush my forefinger between the E tank and the stretcher as they race by. The pain is excrutiating and I drop to my knees, but succeed in passing the O2 bottle to the Paramedic without dropping it. They race to, then down the elevator, hoping for a miracle.
My finger is already turning deep blue as I shut the aircraft down. MAN! That hurts.

Our patient died.
So did my fingernail.


Capt. Schmoe said...

Impending doom. Most of the times that I've heard it, I've seen it.

Good luck with the finger though.

Anonymous said...

ouch ,want me to kissit and make it well?
your momma

cj said...

I believe that sometimes, you know. As for the finger - plan on bumping it continually while it's healing.


Greybeard said...

I should have said in the post-
this happened some time ago.
The nail turned absolutely black, but quit hurting after a couple days. I thought maybe the bruising beneath it would go away and maybe I had dodged a bullet...
No such luck. The nail rotted and slowly chipped away. It took almost six months for the new nailbed to slowly grow and cover its old territory.
Still, it was interesting to watch the process, and it left me with a story to tell, didn't it?

Cissy Apple said...

Damn aneurysms. Killed my Grandpa Riley, then his grandson (my cousin Mike) when he was only 45. Mike's dad, my dear Uncle Doyle, had one a few years later. Surgery was successful in fixing the aneurysm in his abdomen, but the long surgery left him paralyzed from the waist down. He died a year ago. Like my Dad, I'll never quit missing him. Their sister, my Aunt June, died in her front yard due to an brain aneurysm. All four of these aneurysms were in different locations.

A couple of years ago on Memorial Day I closed the door of my car on my left thumb. It shut all the way, and instinctively I pulled my thumb out of the shut door instead of opening the door first.

It hurt so freakin' bad that I couldn't even cuss. All I could do was scream at the top of my lungs.

An aneurysm would've been a welcome relief.

the golden horse said...

The same thing killed my grandfather. Unless you are in the surgery room when it happens, survival is hard.

I feel for you on the fingernail, I did the same thing a couple of years ago. While riding my bike, I tried of move one of those large green trash containers that was totally full and sitting by the curb, end result, trash bin 1
my finger 0.

cary said...

Sorry to hear about the patient. Sometimes, you know.

As for nails - I stepped into the bathroom where MEG was taking a (very splash-filled) bath, in my bare feet. Stopped (actually, planted my right foot to stop) next to the tub, the foot went sliding on the wet tile. Big toe, meet bathtub. Nail is still dying off, and the new one is still trying to come in. At least the pain stopped after four or five hours of not cussing loudly.

Greybeard said...

Ouch Cary.
I think big toe would be MUCH worse than forefinger!
(Are you trying to one-up me?!!)

cary said...

I would never try to one-up you - all you gotta do is play the "life-saving helicopter pilot" card and I would have to stand down!

Flightfire said...

Just for public education purposes: Current USPSTF recommedations state that all men older than 65 who have EVER smoked more than 100 cigarettes in their life should get an abdominal ultrasound to screen for Abdominal Aortic Aneurysm. Easy test, could save your life.

2nd point, if you ever have a situation like this again, ask your flight nurses to think twice. Patient anxious to board helicopter means that his catecholamines are sky high which means his heart rate and BP are also going to be sky high, which makes rupturing that fragile aneurysm that much more likely, no matter how careful you are about not jostling him. I'm actually kinda surprised an ER attending would send him by chopper if he was so anxious about it.

Sorry about your finger.

Greybeard said...

We've discussed this before, FF.
We get a call from a small-town hospital...
"Come get this patient", and we go get the patient. The Docs have all the control, and as I have stated before, many of them abuse the heck out of helicopter EMS.
(Many will "chopper shop"...
Turned down by one service due to weather, they'll call another to see if they'll take the risk! Turned down by all the available services, they'll start at the top of the list again.)

My nurses/paramedics have Zero control over whether we'll transport. They will, however, ask for orders to give sedating and airsickness drugs for before and during the flight.

This flight would have taken 40 minutes by helicopter vs. a little more than two hours in the back of a rough riding truck. I'm sure the ER physician took that into consideration when he made the decision to call us.