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Well, unless you have had your head under a rock during the last two days, there is no hiding the stuff going on up here in Northern Iraq.  I am not really sure why, but for some reason the violence up here has significantly increased during the last two days.  Some people say it is new terrorists coming in from Syria and Jordan, some say it is due to the terrorists fleeing Fallujah and seeking refuge elsewhere, and some people say it is because of the festivals during the last few nights of Ramadan.  At any rate, the insurgents tried to attack a number of Police Stations and key bridges in downtown Mosul, and started a big fight.  The Iraqi Forces with the assistance of US Forces finally started some fierce operations here and struck back hard.  All day and night we were hearing A LOT of small and large arms fire.  We have also been hearing a lot of jets flying over dropping some BIG bombs on the insurgent positions.  It is great hearing our forces kick some butt.  Last night I guess some insurgents got a little too close to our fences and started firing all kinds of rounds over our FOB.  It was pretty alarming at first, but then I realized that the shots were way up in the air.  Looking around the area today, I could not find one bullet hole.  Thank god these guys can't shoot for shit.

So far today we have had only one serious casualty.  And, once again, our surgeons come up BIG.  Around 1030 this morning a Stryker came rolling up and they pulled a seriously injured infantryman out of a very bloody vehicle.  He had a wound on the side of his neck, and there was a lot of blood.  He was awake, his eyes were open, he was breathing on his own, but he was not very responsive.  He was moving his extremities, but not really responding to our commands.  Immediately we went to work.  He did not have an IV and he needed fluids and medications STAT.  One of our medics got a large bore IV into his arm within 30 seconds.  One of the most important sticks we have seen.  Fluids were going in.  Medications were given so we could intubate.  Initially we were thinking that he had a head injury, but we quickly realized that the neck wound was bleeding a lot.  Instead of getting a CT scan of the head, the surgeons decided to take him right to surgery to explore the neck to look for a life-threatening bleed.  It turned out to be a good call.

We have two kick-ass surgeons.  They opened his neck and were a bit surprised at what they found.  The bullet or fragment had entered the left side of the neck and lacerated the external and internal carotid arteries (see below for diagram).  The carotid artery is often referred to as Big Red, because it is big, pulsatile, and full of blood.  Injuries to the carotid artery are frequently fatal.  The fragment had also traversed across his neck and exited out the right side.  Amazingly, it did not touch the spinal cord or the brainstem.  It did injure one of the arteries that branches off of the external carotid on the right side.  So, this guy had three major arterial injuries...  The hardest thing about repairing any type of arterial injury is controlling the bleeding long enough to get a good look at the injury and to repair the injury.  They somehow managed to control the bleeding, just barely getting a hold of the upper part of the internal carotid.  They were then able to repair the external carotid and the small branch on the right side.  The left internal carotid was so badly injured, that they had to tie it off.  The good thing about the neck and brain is that blood essentially flows in a circle from side to side.  In other words, your entire brain receives blood from the left side AND the right side, as well as the front and the back.  Therefore, the loss of a single blood vessel will not compromise blood flow to the brain, provided that the other blood vessels are healthy - which, in this young infantryman, they are.  So, his injured arteries were now repaired.  Our surgeons had made another HUGE save.  Although, this guy's problems are far from over.  He lost a lot of blood during the surgery, probably over half of his blood volume.  That does not include the amount of blood he lost after the injury before he go to the CSH.  He received multiple units of packed red blood cells during surgery.  However, one big issue with a massive blood loss is the loss of platelets as well.  As the platelet counts drop, the body's ability to clot disappears.  This can result in a situation where the patient starts bleeding spontaneously from any, and usually every, orifice.  Platelets are not easy to store or transport and they have very short shelf lives.  As a result they are very difficult to get here in Iraq.  So when we need platelets, we do a whole blood drive.  That means we find soldiers with the same blood type to donate their blood to the patient.  An announcement was made overhead for people with O POS blood to report to the lab.  Within three minutes we had the four people we needed.  In additional three minutes we had four more people as back-ups.  Someone recently asked me what was the BEST thing I have seen here in Iraq?  It was a good question.  We are constantly talking about the bad things: the terrible injuries we see in our troops, being away from our families, the mortars, etc.  We do not often stop and think about good experiences.  However, it did not take me long to come up with an answer.  I was particularly touched by an episode (which I have previously written about) where some soldiers had been ambushed and came in with some pretty significant wounds.  Instead of being emotionally hurt or scared about future incapacitations (which they all were going to have), these soldiers were proud of the wounds and proud of the jobs that they were doing when they got their wounds.  Well, I had forgotten about our blood drives.  We have done many of these, but it has been a few weeks since our last one.  It is a pretty amazing feeling seeing all these soldiers come forward so quickly to donate blood for a wounded comrade.  None of us knew the soldier in question,, and people were upset that were turned away because they did not arrive in the first three minutes.  Amidst all these bad times, there are still many moments that make you feel proud to be here doing this job. 

The wounded soldier responded well to the whole blood.  He is currently in the ICU in guarded condition.  He should be on a Critical Care Air Evacuation tonight to Landstuhl.  He has a ways to go before he is out of the proverbial woods, but his prognosis right now is much better than when he arrived here.