Page 44 of Prognosis So Done

Turning away she headed back to help clean up, her side aching with each footfall and her heart aching for what they could have been.

‘You OK?’ Katya asked, as Harriet entered the theatre, followed closely by Gill. ‘You look pale.’

Harriet rolled her eyes and forced a smile onto her face. ‘Looks like I’m going to need to top up my tan when I get home.’

The phone rang and Harriet answered pleased for the distraction. It was Kelly. ‘How did the burr holes go?’

‘Large extradural. He’s in HDU awaiting evac.’

‘I’ve got a chopper landing in approximately thirty

minutes,’ said Kelly. ‘He can go on that, along with the two

abdos Ben’s done. Can Gill call Megan and let her know?’

‘Sure,’ Harriet confirmed.

‘OK, thanks. Now, I’ve got a middle-aged male with circumferential full-thickness burns to the upper arms. He has

cyanosis and impaired capillary refill of his hands, with increasingly weaker radial pulses. He’s going to need bilateral escharotomies to return his peripheral circulation. His upper chest also has full-thickness burns but they’re not circumferential.’

Harriet winced. ‘How’d he manage that?’

‘In a car that was fired on. It crashed and burned, to coin

a phrase. Four others from the same accident are dead, a sixth

is arriving soon.’

‘Okay.’

‘Burns guy also has a deep thigh laceration that’ll need a

good scrub. Ask Gill if he can clean and suture it while you have him under.’

‘Will do.’

‘I’ve organised evac to a specialised burns unit within the hour.’

‘Slave-driver,’ Harriet teased. ‘Send it over, I’ll let the team know.’

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The already intubatedpatient arrived within five minutes

of the conversation and within ten minutes Gill was ready to put knife to skin. It wasn’t an operation that required a lot of materials. In fact, escharotomies were often performed in ERs and at bed sides with nothing but a scalpel blade.

But when you had the use of a theatre and a skilled surgeon, you used them.

Gill inspected what had been opened for him. Some drapes, a scalpel and some sponges. Also a basic suture pack for the thigh wound and a small metal bowl full of aqueous chlorhexidine so the wound could be thoroughly cleaned. The whole procedure shouldn’t take longer than twenty minutes.

He glanced up to see Harriet standing well back and to the side and smiled beneath his mask. Her dislike of burns was legendary. Not that he could blame her. Cutting into dead flesh wasn’t exactly his cup of tea either. But it wasn’t like he and Siobhan should need anything more and, if so, then Katya, who was quite interested in burns due to her younger sister having suffered extensive burns as a baby, could do the honours.

Starting on the left arm, Gill made an incision through the

eschar, into the deeper, viable subcutaneous tissues. It started at the armpit and followed a mid-lateral line down the length of the full-thickness burn and finished just beyond the demarcation line between burnt and viable tissue.

The incision gaped but surprisingly didn’t bleed very much and Gill inserted some sponges to absorb the small ooze and then quickly diathermied a few vessels. He noted the hand pink up immediately and was pleased that such a simple intervention could mean the difference between saving or losing an arm.

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