Posted by Lieutenant Junior Grade Solomon Kane (Tactical / Medical) in Main Sim: Medical Triage

Posted by Lieutenant Junior Grade Solomon Kane (Tactical / Medical) in Main Sim: Medical Triage

Posted by Lieutenant Junior Grade T’Aria (CMO) in Main Sim: Medical Triage
Posted by… suppressed (15) by the Post Ghost! 👻
OOC: For the triage:

The doors slid open and Kane stepped through. He looked around the Sickbay for a few moments, and then threw his medical bag against one wall out of the way. He grabbed a passing nurse by the arm, halting him in mid stride “Where’s the triage list?” he asked abruptly. NE Klind looked at him and said “I.. I mean… we are just got gravity back and-” Kane cut him off with a glare. “Worthless.” he said and physically spun the poor Ensign around to face the room and grabbed him by the shoulders from behind. “There, there, and there. Unconscious, open head wounds, or not breathing first priority. ABC’s man. Airway Breathing Circulation. Get on it.” and he shoved the man into the maelstrom of injured. He looked across the room at the CMO. “Doc!” he yelled over the din. “I’ll start triage. How many surgical suites are open?”

Kane
Tac/Med

“One!” T’Aria called over the chaos that had assumed the Sickbay. There were only two surgical-based positions in the surgical room, one of which was apparently occupied by one of the older doctors and the patient he was currently assisting. “Most of the injuries should be curable with our technology, but some will require surgical procedure to assist in the healing of their wounds, specifically severe puncture and osteogenic issues. So, three stages of severity should be enough to classify the injuries.” She motioned towards the surgical room, as she stood within the main reception, where several of the biobeds, she could only assume, were taken to see to the injuries. “Take three other medical officials to assist you, Doctor!” She added, having to raise her generally soft voice, again, to make certain he wasn’t doing the triage on his own.

Dr. T’Aria
CMO

“I’m a PA, but thanks for the raise!” he yelled back and ran to the open surgical suite. “You you and you get in here!” he yelled at three Ensigns who were looked to be in a state of shock. “Listen up. This is a conveyor belt. You.” and pointed at one Deltan nurse. “You are triage. Get all the ones who need surgical attention tagged and ready to go. Once I yell clear, you have thirty seconds to get the next patient in. Got it?” and he began the decontamination protocols on the surgical suite. “You.” and he slapped a Vulcan on the shoulder. “You are prep. Once they are in, you prep them for surgery and tell me everything we are dealing with according to the latest scans.” As the decontamination protocols finished, Kane put on clean gloves and a gown. “You are surgical assistant.” he said to the remaining human Ensign. “I say it, you hand it. Simple, right?” The Ensign began gowning up as the first patient came in.

Kane, Tac/Med

“PA or not, you are still a doctor!” T’Aria have only that as a response, before shifting her attention back to the Captain. After all, he was her prime focus and the triage could be manned by any officer with a sense of the difference between a broken bone and a torn ligament.

Dr. T’Aria

Kane used the surgical suite to remove a piece of bulkhead from the first patient’s chest. Fortunately for her, it had been stopped by the woman’s ribs and didn’t puncture a lung, so the repair was done quickly. Once the wound was closed and the patient was stable and antibiotics had been ordered, Kane looked at the nurse had put in charge of triage and said “Ok, next one in. Let’s go let’s go let’s go, people. Move move move. ” and he switched out his surgical gear for a clean set. “What have we got next?” he asked as the patient, a conscious Vulcan, was brought in with an open leg wound and a tourniquet around his upper thigh. Kane knew from that that an artery had been damaged. “Ok. Transfusion set up and ready to go. Type and crosscheck. Clean that wound and let’s get some dressings in here.” and he looked at the patient. “When did they put the tourniquet on?” The Vulcan, as steady and emotionless as he could manage under the circumstances, said “Approximately fifteen minutes ago, Doctor. It was applied by -” and Kane cut him off “Shut up, don’t care.” and he looked at the surgical assistant. “10cc anetrizine, and monitor respirations.” and he looked back at the patient. “You’re going night-night now. See you in a bit.” and he watched the scans as the anesthetic was administered and the patient went under.

Kane, Tac/Med

It took about half an hour, but Kane managed to repair the artery and seal off the surrounding veins and capillaries that had been severed. Once that was done, he put in an order for antibiotics to stave off any infection and sealed the wound closed. “Ok, get him out of here. Monitor vitals and BP for the next twelve hours . Any drop, notify me or the CMO immediately.” and he pulled off the surgical gear he wore and looked around the room. He didn’t see the nurse he put in charge of triage, and he did-not-silently-at-all curse. Spying the CMO, he yelled “Doc! I’m clear. Surgical suite is open! Who who we got left that needs attention?!”

Kane, Tac / Med

“We have a few Ensigns who have maintained severe lacerations to their arms, chests and legs. If you can get a Nurse to do so, have them clean the wounds and fix the lacerations via dermal regenerator and have them give the patient an NSAID.” She glanced up from where she had been tending to another Officer, an older Andorian who had internal bleeding. “As for you, there is a young Human male; Lt. (JG) Kitzober, sustained a concussion, punctured lungs, and bruised ribs. I would prefer you take over for Nurse Rodriquez, as our other doctors are busied and you are most qualified.”

Dr. T’Aria
CMO

Kane simply nodded and grabbed another set of surgical gear and yelled “Rodriquez! Get him in here now!” and he looked at this surgical assistant. “Prep a chest tube and thoracic suction.” He finished gowning just as Kitzober was being brought in. Kane turned and looked at the vitals. “BP dropping, pulse rate accelerated, and shallow breathing.” and he examined the patient. He had multiple lacerations across his face and chest, and two deep wounds to his left side that extruded frothy blood every time he took a breath. “Chest tube.” Kane said and took the device that was handed to him. Using a scalpel, he cut a small incision between two lower ribs and inserted the tube. Feeling some resistance, he knew he had reached the pleura. With a firm thrust, there was a soft ‘pop’ as the tube pierced the sac. Immediately, blood began to pour out of Kitzober’s chest cavity. “Prep transfusion. Now.” Kane said through gritted teeth. This was a precarious balancing act. He had to remove the pooled blood from the patient’s chest cavity so he could breathe, but not too much or risk losing the patient. He also couldn’t start the transfusion until he could find the source of the internal bleeding. He activated the surgical scanner, and once the patient could take a full breath put a clamp on the chest tube to slow the drainage of blood. He looked at the scanner and his jaw clenched. “Doc! I’m gonna need you on this one! Right now!” and he spun the viewer so she could see what he saw as she gowned up.

The Doctor quickly handed the said patient over to another man, leaving to get herself gowned and prepped to assist in the surgery. Watching the viewer as she made her way over, she didn’t bother asking any questions regarding the current procedures, instead, she got straight to work. “Do you have anticoagulants on hands, to inhibit any blood clotting that might form in response to the excessive bleeding from the ptient’s Chest cavity?”

Multiple metal fragments had punctured not just his lungs, but also tore a hole in his pericardium and sat with their razor-sharp edges almost directly against his heart. The pieces were slivers of metal, tiny and lethal. Any attempt to remove them would run the risk of pushing the others into the heart and killing the patient. Kane looked at his surgical assistant and said “Go prep for bypass.” and the nurse took off to get the necessary equipment.

Kane, Tac / Med

“If using a CABG, we could potentially remove the shrapnel from his lungs; depending on where the metal went in, we could attempt to remove the metal from the outside, using retrieval surgery to remove the metal from his chest to inhibit it from reaching his heart. If we have the cavity opened, where the heart can be visibly seen, one of us can be watching for the shrapnel moving to his heart, via scans or physical observation, while the other carefully extracts the metal from the entry point.” She didn’t doubt that this would be, if utilized, far more difficult than it sounded. “If we are careful, we might be able to remove a few pieces of the metal.” She glanced back in the direction of the nurse, to see if they had returned with the equipment for the Caronary Artery Bypass, which would allow for them to return proper blood flow, to the heart.

Turning back to the patient, she studied the scans that informed of the metal within the heart. “We could even attempt a magnetic retrieval, to lessen the risk of forcing the shrapnel down into his heart, as a result of the invasive surgery tapping them in the wrong direction. This, however, would have to be done while the heart is being stopped, in case of the fact that the magnetic pulse could potentially alter the function of the heart. In any event,” She was saying all of this while moving around the retrieve several instruments that could potentially become vital to them, “We would have to seal the wounds from both ends, preventing any other foreign bodies from reaching the heart, that way.” It was a basic idea which they could begin to work off of and adapt, in case of need. Of course, she was fully aware that the shrapnel might be too dangerous to extract, on that prospect, they would have to seal the puncture, regardless, to inhibit the further spread of the shrapnel to the heart.

Dr. T’Aria
CMO

“Anti-coagulants already administered to prevent clots in the lungs. Chest tube is draining the excess fluids and we have transfusion running.” and he leaned in to look more closely at the shrapnel. Using a gloved finger, he pointed at the view screen. “See here? This is my concern. These pieces are so small, we would have to pull each one, cauterize, and so forth. But every time his heart beats, they move closer. We can bypass, but that still won’t help us address the fact this guy has so many pinholes in him, I know we aren’t gonna find them all. I can crack the chest and give us access, but with the amount of blood he is losing and the rate those things are moving… I dunno. Its gonna have to be your call: We crack the chest and remove, risking bleed out and heart lacerations. Or we try to magnetize what we can and hope it doesn’t cause cardiac arrest. Either way… this guy’s heart is gonna stop. And I don’t know if we can get it safe to start again.”

Kane, Tac / Med

“Risking ventricular fibrillation would be better than risking the loss of blood, for he would likely be quicker to be lost, if the blood pools within He lungs and causes the patient to suffocate within it. If he is already bleeding extensively, we cannot risk the possibility of completely obstructing his chances, but causing more bleeding. The pieces are minuscule, as you remarked, thus a magnetic pulse would be out best chance at retrieving majority of the pieces, the pinholes can be mended with a tissue regenerator, if we can catch the incisions from the metal, before they begin to gush.” It was also a far less cruel way to die, than to be drowning in your own blood.

Inhibiting a sigh, the Doctor bit the inside of her cheek, a subconscious habit she had when she was thinking. “Let us go with the magnetic pulse route. There is a higher chance of sustaining life, in such a manner.” If they could avoid blood clotting, erratic pulses and any miscalculated moves, then they could have a chance of this patient surviving, even if logic told her otherwise. “Prepare the machinery,” T’Aria glanced at the same Ensign who had retrieved the bypass equipment.

Dr. T’Aria
CMO.

As the nurse brought over the necessary equipment, Kane activated the tissue regenerator and began closing up what bleeds he could without disturbing the shrapnel. As he worked, he asked without looking up “Do we know what kind of metal that is? If we get the frequency wrong, we might end up shoving them away rather than keeping them in place.”

Kane, Tac / Med

“Judging by the place where the patient had sustained injury, I would assume duranium alloy.” She picked up a tricorder, pausing in her efforts to be assisting in the tissue regeneration of another laceration, she ran a quick scan to identify the type of shrapnel which made up the pieces of metal within his body.

Dr. T’Aria
CMO

“Do we know where he was in Engineering?” and then he swore loudly. “He’s going into a-fib! Get me a crash kit and defibrillator!” and he looked at T’Aria “Shrapnel moved, punctured the pericardium. He’s bleeding out.”

Kane, Tac / Med

One of the nurses frantically left to retrieve a cardiostimulator and the crash kit. T’Aria withheld a calm exterior, despite sound far more rushed. “The pericardial puncture would be the source of the bleeding; we need to inhibit the bleeding, but the defibrillator is already a pulse of energy, which will increase chances of heart failure or blood clotting,” She was moving about as she spoke, “It might be best to remove the largest pieces of shrapnel, surgically, without the presence of a magnetic force, which might counteract the stimulation from the defibrillator,” She retrieved different surgical tools, as to prepare for it, in case Solomon couldn’t come up with something better. “If we can remove the larger pieces from the pericardium, we might be able to seal the membrane wall, enough to obstruct the internal bleeding enough for us to deal with the smaller pieces.” This was stated, the moment the Ensign came back with the defibrillator. Which were handed to Kane.

Dr. T’Aria
CMO

OOC: Fixing error.
Trin

Kane looked at the CMO and said “We have to go in.” and his head whipped around to the nurses assisting. “Full surgical isolation fields up. Laser scalpel and rib spreader, now!” and he grabbed the needed tools from T’Aria and then the rib spreader from the nurse. “Ok, Doc. Get him on bypass while I crack the chest. Once in, I’ll go for the shrapnel next to the heart and you work on sealing the pulmonary bleeding and punctures. Work for you?” he asked as he began marking an incision on the patient’s sternum.

Kane, Tac/ Med

“Already on it, Doctor.” The Vulcan informed, blandly. Once the proper incision was made in the chest, she quickly worked to get the patient on bypass, so they wouldn’t be risking too many further issues with the heart itself, beyond the noted shrapnel moving down through the thin membrane and liquid of the pericardium. Once the artery was blocked, successfully, she quickly moved around the other side of the surgical table, glancing up at the patient’s vitals. “Heartbeat steadily decreasing, doctor.” She remarked, which was a calmer way of saying: ‘Okay, we need to work faster before we lose him!’ Or something like that.

Grabbing a regenerator and the tools to assist in the removal of the larger shrapnel in his pulmonary system, she wasted no time in carefully beginning the removal. Both doctors were in an incredibly precarious situation.. one wrong move, and this man would die.

Dr. T’Aria
CMO

Kane worked smoothly but quickly getting the chest opened and exposing the heart and lungs. As T’Aria began working on the pulmonary trauma, Kane set to work on the shrapnel near the heart. For several minutes, he said nothing. He heard T’Aria’s warning about the Ensign’s heart rate, but his only acknowledgement was to scowl. He grasped the piece of metal and slowly enlarged the tear in the plural sac and began pulling the shrapnel from it’s position resting so close to the young man’s heart. As he did so, he made sure that he caused no more damage to the surrounding tissue. Once the shrapnel was removed, he began trying to repair the plural sac as quickly as he could. The faster he worked, the slower the heart beat. “Adrenaline, .5 cc’s!” he said through gritted teeth and clenched jaw. The assistant injected the compound into the IV, and the heart steadied momentarily, sped up… and then stopped altogether. “GODD IT!” he yelled, and grasped the heart with his right hand and began squeezing and releasing, squeezing and releasing. “Cardiac arrest! He’s lost too much blood! Get the defib on him, NOW*!” and Kane glanced up at the readouts on the bio-monitor. BP was flat, no pulse, blood oxygen at 12% and falling… even if they managed to bring him back, the young man would have severe and permanent brain damage. Still massaging the heart, Kane looked at the CMO; his jaw working overtime as he ground his teeth together in anger and frustration. “Even if we can salvage the heart, pulmonary function is nil. His brain is starved for O2, and probably damaged beyond repair. Do you want me to keep going or do you want me to call it?” he said as he kept massaging the failed organ.

Kane, Tac / Med

T’Aria stopped in her tracks, turning her attention to Kane. A decision had to be made in a split-second time frame, otherwise they would lose him, regardless of their attempts. Briskly, she ran over the possibilities regarding any further attempts to save the patient’s life. Recognizing the patient would have to deal with severe trauma to the brain, resulting in lesser ability to function, possibly speech impairment and other issues, which may end his career in Starfleet and cause him to deal with depression and anxiety among other mental instabilities, T’Aria knew it would be inhumane to make someone suffer through that. Despite the undeniable hardship that came with losing a patient, they could not force anyone to live such a dreadful life, to spear themselves, as doctors. “Let him go,” despite everything going through her head, her words came out in a bland, monotonous huff. It was as if she didn’t care, when that was simply the antithesis notation of her true emotions. “To save him would only risk severe brain trauma, in which we would be saving a man only to give him hell, for the remainder of his life.”

Dr. T’Aria
CMO

Kane nodded and looked down and stopped massaging the heart. He looked up at the readouts and watched as the respiration and brain waves slowly faded into nothing. “Note time of death. Close up and prepare for storage.” Kane said calmly, professionally. He looked down at his bloody hands for a moment. “I think you made the right call, Doc.” but then he looked up at her with a fire in his eyes and a calm in his voice that made the nurse assisting him take a step back. “Just so you know, Doctor. When we finish here I’m going to go find Loring, you know… the guy that put these stupid engines in and then blew the ship all to hell?… yeah, I’m gonna go find him and I’m going to punch him in the face.” and he looked down at the deceased Ensign. “This is all on him.” and he took a deep breath and slowly exhaled. “Just wanted to let you know that I will probably be in the brig once we get all this handled.” and he then turned to the nurse. “Get this suite decontaminated and surgery ready in five minutes.” and he looked out over the medical bay. “Looks like walking wounded from here on. I’m gonna clean up and start on getting these people back on duty as quick as possible.”

Kane, Tac/Med

T’Aria assisted the nurse in cleaning the body, and preparing it for storage, so that he would be able to Rest In Peace quicker, as opposed to being worked on for a leisure frame of time, by a single, young nurse. While Kane mentioned the correct decision having been made, T’Aria wasn’t certain if she agreed. As a doctor, specifically a Vulcan doctor, she had a tendency to run over situations as many times possible, to ensure whether or not the proper efforts had been made and they went to the lengths, to do what they could for the patient. Perhaps it was a flaw, perhaps it was a form of articulation. Whatever it was, it offered a distraction from the truth. Yes, quite odd that a Vulcan, of all people, would mule over a distraction.

“Do not be a fool, Doctor Kane.” T’Aria spoke up, after giving the Nurse brief orders regarding what needed to be done. “We operate under an oath, Doctor. An oath that states we are here to assist in the healing process, to ensure the prevention of disease and to treat our patients with the same warmth and sympathy as they deserve. We cure, Mister Kane, we do not inflict pain.” Contrary to popular belief, it was not the Hippocratic Oath that said to ‘Do no harm,’ but its values did match that phrase.

“With that being said, you appear to understand the consequences of your behavior. I simply encourage you to act with your head— and do not attack in favour of the lost life of another.” She knew she could not stop him, but that didn’t mean she wasn’t going to emphasize logic.

Stepping past him, when her name was called to assist in another manner, she stood by his shoulder, close enough to his height to not have to glance up, too much. When she spoke, her words were simple, “Be logical, Doctor. Not all problems can be solved with our fists. Evolution gave us a tongue, for a purpose.” Saying no more, she went to degown and decontaminate anything obtained by the surgery, prior to heading to the doctor requiring her assistance.

Dr. T’Aria
CMO