Hey everybody! Remember that time I said I had witnessed the grossest thing ever in my ten years of nursing? Yeah well I beat that last night. Not trying to brag on myself or anything but I'm pretty proud of the fact that I didn't vomit directly onto the patient when I saw this. Or, more appropriately, heard this.
Let me set the scene.
Typical middle aged generally unhealthy guy who thinks "I can definitely do that activity even though it requires getting on a roof and I've been north of 270 lbs for at least twenty years" comes in to the ER. He's got a litany of injuries, including an eye injury causing proptosis and a non-reactive pupil. It's either lose the vision or do a relatively uncommon procedure to temporarily relieve the pressure.
We called in the OMFS guy, who very excitedly came in to do a canthotomy. Only a few of the people in the ER had seen this actually done before so when we sedated the guy everyone gathered around to watch. OMFS gave us the anatomy lecture, pulled the corner of the eyelid out, then just poked a pair of sterile scissors in and cut. He then told us that to really relieve the pressure, the tendon needs to be released from the skull. It honestly wasn't that bad, until one of the ER docs asked how he knew he was in the right spot and how he didn't go too far.
And you know what he did? POKED THE SCISSORS IN EVEN MORE. He goes "oh, it's just eye socket here, you can't really hit anything important. You just listen for this - " AND SCRAPED THE SCISSORS ON THE SKULL - "and then scrape everything off the bone." If you've ever heard the sound of someone scraping scissor points along a skull, it's not a good sound. It gave me goosebumps and heebie jeebies and extreme nausea. It's not a natural sound. It's...awful.
The canthotomy itself wasn't even that bad, compared to the aftermath of the only other one I've seen. Apparently when the doctor is competent and it's done right it's not even really a thing. It just looked like a little laceration by the eye. Oh, but I know. I know that sound, and it's forever in my brain now. Bleegh.
***
I will say that I would have been debilitatingly grossed out by this whole eye thing except that the next patient to come in was even worse and while looking for identification in his pants pocket I accidentally dropped a piece of his leg bone on the floor. Femur? Tibia? I don't know, but it wasn't where it was supposed to be and there were lots of openings it could have come from. Really puts things into perspective, honestly.
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3 comments:
That must have been similar to watching a lobotomy. Visions of an icepick making it's transorbital journey is the stuff nightmares are made of. Can you believe they gave the inventor of the procedure a Nobel Prize?
Wow. I don't ever want to hear that sound. But it does sound much better than not being able to identify someone's bone splinter because there are so many of them. Yikes.
Regarding the bone in the pocket discovery........1981, while I'm in Nursing school, I'm a Resp Therapist, working ER one night. Major trauma is on a gurney, and my pal RT proceeds to help by removing the old guy's shoe.....and the foot came with it! Well, he had no heartbeat, so he didn't bleed.
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