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The Accident Part 3

Rating:; Genre=Fiction; Pages=5; Characters=9,779;
Chapter 3Treatment

Dr. Peters decided to stabilize the girl, Beth's, neck by using cervical traction. A nurse handed him a cotton-padded halter that he fitted onto her head. One strap went behind her neck, the other went under the chin, they were joined together above the head by a metal spreader bar that kept the straps from pressing against the ears. The thin nylon rope that was attached to the bar was then run up along the bed and through a pulley attached to an upright at the head of the bed. Ten pounds of sand filled bags were then attached to the rope so that a steady pull would be exerted on her neck to keep it from rolling around until a brace could be fitted.

Once the cervical spine had been immobilized, the nurse could put the gas mask on the patient for the general anesthetic. In order to insert the pins for the femoral traction, several incisions needed to be made on the leg. As the anesthesiologist monitored his patients condition, other nurses prepped the leg for surgery by swabbing the leg with anti-bacterial soap, and by placing green surgical covers over the areas that would not be operated on. When the EKG read a steady, anesthetized, heart rate, Dr. Peters made the first incision near the knee. The incision, which was only about a half-inch wide, went all the way down to the bone. A similar incision was made on the exact opposite side of the leg. Dr. Peters then took a cordless Black & Decker drill and drilled a 3mm hole all the way through the bone. The nurses who were attending the operation used a suction machine to get the bone chips out of the opened wound.

A nurse brought over a 6" piece of metal in a stainless steel tray. Dr. Peters took the thin metal bar with a pair of pliers and prepared to hammer it into the hole he had just drilled. The knee had previously been secured in a special holder that was designed for just such an operation. When the bar had been hammered all the way through, Dr. Peters handed over the task of closing the wound to one of the resident doctors. Then he moved onto the ankle pin, which was easier because the cut needed was not as deep.

While the doctors had been inserting the pins, nurses had been attaching pulleys to the overhead trapeze at various places. There were also about 50 pounds of sand weights ready to be attached to the femoral traction system. Dr. Peters tied the ropes to the spreader straps that had been attached to the pins. The spreader straps were basically the same as the cervical ones were, just a lot smaller. The ropes were then run up through the pulley system until they all hung at the foot of the bed. Hooks were tied to the ends, and the weights were hung from them. Each weight was carefully balanced so that the bones in femur were pulled back into alignment. The leg was also placed on what is called a Thomas Splint, which is used with traction to support the lower leg and to keep it at the right angle, but without interfering with the tractive force.

Dr. Peter's stood back and admired his work. He and the resident doctor had done an exceptional job of inserting the pins, and now the x-rays showed a perfect alignment. Enough self-admiration, he told himself, there's more work to be done.

He moved on to the problem with the shoulder. The thumb would best be treated by casting, he decided, but the humerus would need to have traction for a few days so that the bones would heal in alignment. As the casting materials were brought over to the bed, he told the resident to put a splint on the left pinkie finger. The resident decided on using a nylon wrist splint and an Alumifoam splint that the finger would be taped to.

As the resident immobilized the patients finger, Dr. Peters started the casting process on the thumb. He would be making a short arm thumb spica. He first took a piece of 3" stockinette and pulled it down the arm, with a few extra inches at each end. Next he took a roll of synthetic cotton padding and evenly wrapped the thumb, palm, wrist, and forearm. The padding was about three layers thick everywhere. After smoothing the padding with his hands to get out any wrinkles, Dr. Peters took a roll of pink 2" fiberglass casting tape and began to wrap the thumb. The cast was carefully wound around the wrist and the thumb, and was molded carefully so it would match the curvature of the arm perfectly, with the wrist in neutral supponation. When the first layer was done, the leftover stockinette was pulled back over the cast, and another layer of tape was put on.

As the cast was drying, Dr. Peters checked what the nurse had brought over for the humoral traction. He would be using skin traction since it would only be on for a couple of days, and pins would cause more problems than they would solve. He had two spreader bars, the rope and weights, two strips of moleskin, and a roll of non-compressive gauze. When the short arm cast had dried enough that it would not deform when handled, he started to wrap the upper arm near the elbow with one of the strips of moleskin. The moleskin was not actually wrapped, it just made a loop outside the elbow that the spreader bar would be attached to. The non-compressive gauze was used to hold the moleskin in place. He wrapped the other piece onto the wrist, around the cast, so that the loop formed about four inches above the tips of the fingers. The spreader bars were then attached and the ropes were run through pulleys to weights that reduced the fracture. The traction that pulled vertically ran to an overhead pulley, but the one that pulled the arm away from the shoulder had to run through a side-pulley before it could be run through the overhead system. A nurse had attached the arm to the bed earlier, expecting the need for it. As the traction pulled on the bones, it also popped the shoulder back into place.

Dr. Peters sighed as he took the x-rays to see how the humerus was lining up. The procedure was already over an hour in, and he still had to do the tibia and fibula, and the hip fracture. He started on the broken leg by reviewing the x-rays. They were clean breaks, and he would thankfully not need to operate. He had decided at the beginning to use a hip spica cast that would run from the toes of the left leg up to just below the breasts.

The first piece of stockinette was pulled up the leg. Like in the thumb spica, several inches were left at each end. Four inch wide synthetic cotton padding was then wrapped all around the leg. The knee was held at about 30 degrees off straight when the casting began. Four and five inch rolls of pink fiberglass tape were used for the cast. The doctor made the cast just like a regular long leg cast, except that the extra stockinette at the top was not folded back into the cast, it would be used for the torso portion that would be applied next.

The nurses had prepared their patient for the torso casting by lifting her up and placing her shoulders and the now-cured leg cast on padded wooden blocks. This left enough room under the patient's body for the casting tape and padding to be passed under, because of the traction that had already been applied it was impossible to use tubular stockinette to encase the torso. Dr. Peters decided to just use the padding, but to make it extra thick so that the fiberglass would not stick to the skin. A roll of six inch padding was used, it covered from just below the patient's breasts all the way down to cover the extra stockinette from the leg cast. It was trimmed and folded to fit around the crotch area for bathroom needs, and extra padding was placed on the illiac crests so that pressure sores would not develop on the hips.

The casting tape was then applied to the now fluffy white body. Dr. Peters decided to start at the chest, and work his way down to the legs. After laying down a base layer along the ribs, he took a roll of 4" tape and joined the body cast to the leg cast. The leg was held at an angle so that the lower leg was horizontal and at the same height as the other leg. The area around the crotch was covered with a specially designed plastic liner that would make cleaning the cast and skin much easier. That plastic was held in place with more casting tape. The plastic also made it easier to form around the buttocks and crotch because it made smooth angles that the casting tape had troubles making. The cast was then reinforced back up along the torso, and the padding at the top was folded back and held in place with tape to get a comfortable edge.

Dr. Peters stood back and looked at his work. The girl now had on cervical traction, femoral skeletal traction, shoulder skin traction, a short arm thumb spica, and a single leg hip spica cast. She also, though it seemed insignificant in relation to the rest of the immobilization, an aluminum finger splint on her pinky finger.

The nurses removed all the rest of the accessories that had helped with the surgery and the patient was settled directly onto the bed. Dr. Peters decided to take one more set of x-rays to make sure that everything had been done correctly. After adjusting a few of the weights, he was happy with the treatment. He signaled the head nurse that he was done here, and that the patient could be taken to the Post-Op room for recovery from the anesthesia.

Dr. Peters cleaned up and headed home to his family for a late dinner. His daughter was on the last day of her freshman year at the high school, and had given her final presentation earlier in the day. The thought of his daughter being in an accident like the girl he had just treated brought tears to his eyes. He hoped he would never have to see his children hurt, not even a scratch.

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