“A man has been stabbed in the neck. He is going to die.”
These words, spoken calmly and as a matter of fact by the ICU head nurse, came as we were doing an early morning ward round prior to our planned weekend getaway to nearby Awassa. Glancing up at Dr. Ryan and Dr. Kyley, our visiting maxillofacial surgeons from the States; our eyes met and without much ado, hurried to the emergency department. Reports of a large wound at the back of his neck with bone visible and a smaller wound in his anterior neck, among other injuries, made us realize that the best place to care for the patient was in the operating suite.
Meanwhile, the entourage surrounding the patient arrived in the OR with his relatives commandeering the stretcher, bringing him to the OR via the shortest route through the back door. Having gone in head first, the stretcher could not be turned around and had to be reversed into the corridor for a 180 degree spin and re-entry made, allowing a hurried transfer onto the operating table. Never mind the ABC’s of airway, breathing, etc in this race to get him to the destination.
“Oxygen, mask, laryngoscope” barks Kyley to the man standing next to him. A blank look in reply, the commands were to no avail as he was the patient’s brother, not an OR worker. Amidst the chaotic, frantic activity, equipment arrived after what seemed an eternity. Blood miraculously materialized in record time, (thanks to the medical director’s dash to the blood bank) and was quickly administered after a dunk in warm water. An emergency crico-thyroidotomy was necessitated to secure his airway as we were unable to effectively ventilate him with bag and mask. All along, the maxillofacial surgeons orchestrated the airway and resuscitation.
The neck injury was a through and through stab wound, entering from the posterior neck and exiting anteriorly, severing several healthy arteries supplying the posterior neck muscles. Brachial plexus, trachea, esophagus and the great vessels of the neck were spared anteriorly. Other major injuries included two deep lacerations into his left proximal thigh, a through and through laceration of one hand and another into the knuckles of his other hand.
It all ended well, the patient woke up with smiles.