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Today was a busy day.  It actually started at 4 am.  We got called to the EMT for three urgent patients.  Apparently a vehicle full of Iraqi National Guard soldiers collided with a Stryker.  Bad news.  One of the Stryker Battalion docs told me that the accident scene was complete carnage.  Seven dead on the scene.  Two beheaded.  Several broken necks.  They needed to cut the vehicle apart to get some of the bodies out.  Whoa. 

All three patients arrived intubated.  Apparently they had some weather problems and they had to wait out in the cold for a medevac.  Not good for trauma patients.  The first patient was quite unstable when he arrived.  His blood pressure was very low and his heart stopped quickly after arrival.  We were able to get it started again, but this did not last for long.  An x-ray revealed a massive pelvic fracture.  He had two fractures on each side, as well as a dislocation of the joint between the right hip bone and the sacrum.  A very bad injury that results in massive blood loss.  He was beyond resuscitation at this point and when his heart stopped a second time, we were unable to get it going again.

The second patient had both clavicles (also referred to as the collar bones) fractured, a number of ribs fractured, and a collapsed lung that was full of blood.  The docs and medics from the Battalion Aid Station did a good job doing the initial stabilization, especially considering they had to hold on to him longer than they would have liked.  His initial temperature was 90 degrees F and because he was so cold, he had an abnormal heart rate.  We quickly went to work warming him up.  A chest tube was placed and we took him to the CT scanner to look for internal injuries.  Other than the collapsed lung, all he had was a minor liver laceration.  It seems weird saying this, but he was very lucky.

The third guy was intubated because he was knocked unconscious.  After our initial assessment, we were unable to find any additional injuries.  A CT scan of his head revealed no fractures or bleeding.  Another lucky guy.

After that excitement, I had enough time to run home shower and grab some breakfast.  Back at work, I started off by discharging the patient I admitted yesterday with an altered mental status.  I helped out with sick call for a bit.  Than I had to teach two lectures on OB/GYN Emergencies and Infants and Children for the Emergency Medical Technician (EMT) refresher course the CSH is conducting.  I made it back just in time to help out with a bunch of Post Deployment Health Assessments on about 20 people in our unit who are redeploying early as the advance party.  When that was done I had a few patients show up to see me for a variety of issues.  After that I spent some time organizing a plan to perform G6PD testing on everyone on this FOB.

Then in the early afternoon the casualties started rolling in.  The first patient was an Iraqi Commando who got shot right through his jaw.  The bullet entered in the left side, blowing a hole in the lower jaw on the left.  It exited on the right causing severe damage to the lower (mandible) and upper (maxilla) jaws.  Our oral surgeon is on leave right now, so we had to send the patient to another CSH in Balad for surgery.

Next in was an Iraqi National Guard soldier who fell out of the back of a large 5-ton truck and landed on his head.  He was conscious, but a little dazed, and he had a large laceration on his chin.  His head CT was normal.  His medic sewed up his chin laceration. 

Next a medevac helicopter landed with two more patients.  One patient had severe back pain after he was blown back into the hatch of a Stryker vehicle from two forceful IED's (improvised explosive devices).  His Battalion Surgeon was worried about a spinal fracture.  His neurologic function was completely normal and x-rays revealed no fracture.

The second guy was sent down for evaluation of worsening testicular pain (we see all kinds of stuff in here, you never know what is going to be coming through those doors next).  Our radiologist performed an ultrasound with our Sonosite which revealed an infection of the testicle.  That's no fun.

Next, back to the Specialty Clinic to see a few more follow-up patients.  Then I packed it up and called it a day...  I hope....  You never know what is going to come through those doors next.