# I held a guys brain in my hand!



## PapaBear434 (Jun 17, 2009)

Well, a small piece of it, anyway.  I will preface this with a warning, that some people may find my gallows humor a bit of a put off and gross.  But assuming we are all EMT's and Medics here, I think we should be ok.  I also warn, however, that I ramble.  I guess I feel like chatting.

Got my first gunshot wound ever yesterday.  Self inflicted with a 9mm to the temple.  The guy did it while his 17 year old daughter was having a pool party out back.  We get there about five minutes after the fire crew did, who were all basics.  I am shock/trauma, and I was running with a medic for my EMT-I quals.  

So, we show up, get the guy in the back.  I got to start the IV and prepare for RSI while we wait for the nearest additional ALS to show.  The guy was still breathing on his own, though we had to continuously suction out the airway.  He hit his temporal artery, and was inconsiderate enough to squirt everywhere.  

We actually had to do a conscious sedation in order to drop the tube, though at that point the other actual medics arrived and I volunteered to drive (as the lowest trained person there, I figured I would be better served getting us to the hospital and letting the medics do their thing.)  

After all was said and done, it took us almost two hours to decon the truck and gear.  There was blood on the walls, floor, ceiling, monitor...  On the "trampoline" under the lifting back of the stretcher, in a very large collected pool of fluid, I found a meatball sized chunk of what looked like ground turkey-burger.  I picked it up (gloved hand, obviously) and couldn't believe what I was holding.  I just hope it wasn't a part that he needed, and instead just housed his phone number, the 1999 Chicago Bulls starting roster, or something else unimportant like that.  

It was surprisingly spongy.  Not that I played with it or anything disrespectful like that, but it was just one of those moments that made me stop and go "Whoa."

In the end, the guy is still alive, though it's safe to say he's probably not having a very good day today.  Full entry and exit wound, temple of both sides, and a large hunk of brain tissue currently being immolated somewhere downtown.  Though, I suppose for someone to get to the state to put a Smith and Wesson to his head and pull the trigger, he must have had a couple bad days in a row before hand.  He was moaning and groaning down the tube by the time we dropped him off at the ER, and he was listed as "critical but stable" this morning (or said so on the news, anyway), but it remains to be seen how much of the same person he's going to be when and if he ever comes to.

Just wanted to share my first experience with a head trauma this severe.  Up until now, the worst I had was a skull fracture with minimal trauma.  It was weird, though, how ok I was with it.  I never got grossed out, never freaked out, and even the 25+ year medic that I was working with said she had never seen someone so calm during a major trauma like that.  Afterwards, I cleaned up the mess, deconned the truck (bleach got all over my brand new pants and made them all tie-dye, dang it!) and I went right to eating my turkey-bacon club I bought moments before the call came in.  

And yet today, I was eating a sandwich in my kitchen when I noticed a small corner of my bread had a tiny spore of mold on it, and I about got sick while I spit repeatedly into the trash can.   Go figure.


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## medichopeful (Jun 18, 2009)

PapaBear434 said:


> And yet today, I was eating a sandwich in my kitchen when I noticed a small corner of my bread had a tiny spore of mold on it, and I about got sick while I spit repeatedly into the trash can.   Go figure.



LOL.  Many food-related things make me feel gross too.  There are very few other things that make me feel like crap (gruesomeness wise...)


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## willbeflight (Jun 21, 2009)

Wow!  That is quite a story.  I know it isn't at all funny, but the way you worded it is priceless!  Glad you made it through with such a calm demeanor about you!  

Pay attention to the bread next time!!


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## WannaBeFlight (Jun 23, 2009)

NICE!!!! That one you will never forget. Have a good one!


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## mycrofft (Jun 24, 2009)

*Sorry about that. Welcome to the club.*

My exposure was by kneeling and putting my stuff down in a poorly-lit situation and had to wash it out of my uniform and off the jump kit.
Hang in there, PM if you want to talk more about it.


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## captainbeatty (Aug 6, 2009)

My first exposure was at a motorcycle vs tree accident. Our assistant chief at the time(not an EMT) was on the scene and said it looked bad.we went down the embankment where the two victims were.( This was in the mid '80s before all the bsi equipment was standard issue). The first victim's head was off-center, as well as all four extremities were obviously broken, so I blacktagged him, and went to the other victim. As he was face down, we logrolled him on this back. I felt something cold and wet on my hands, and thought," Oh, great, vomit." Wrong! After we got a light on him, we saw his face was literally flattened by the tree, and  brain matter was everywhere.Another doa. At this time, our rescue truck arrived, and I told the squad to come in quiet, as they were not needed. To finish the story, a rookie on the rescue thought he saw the victim wwith the neck fracture move, so he started cpr.With every compression, blood shot out of the victim's mouth about six inches, and you could heat the sternum hit the backbone. Under our protocol at the time, once cpr was started, we had to transport the victim, no matter what, so he got a code three trip to the ER, where the doctor pronounced him dead while still in the squad. At the postmortum exam, the M E found almost every bone in his body was broken. Not a pleasant call.


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## NEMed2 (Aug 6, 2009)

I still find it strange that I can run the bloodly, :censored::censored::censored::censored:ty, gross calls without even thinking about it and then be grossed out when I accidently eat food with mold on it.  Guess its just one of those things.

Great job on the call.  I'm sure that both your partner and the other crew were impressed.


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## usafmedic45 (Aug 11, 2009)

> Not that I played with it or anything disrespectful like that, but it was just one of those moments that made me stop and go "Whoa."



Hey, after watching a forensic pathologist hold the severed head of the pilot from a crashed small plane balanced on his hand while he recited the soliloquy from _Hamlet_, there are few things I view as blatantly disrespectful in comparison.  

As far as it being a "whoa" moment, it definitely is.


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## BuddingEMT (Aug 11, 2009)

captainbeatty said:


> My first exposure was at a motorcycle vs tree accident. Our assistant chief at the time(not an EMT) was on the scene and said it looked bad.we went down the embankment where the two victims were.( This was in the mid '80s before all the bsi equipment was standard issue). The first victim's head was off-center, as well as all four extremities were obviously broken, so I blacktagged him, and went to the other victim. As he was face down, we logrolled him on this back. I felt something cold and wet on my hands, and thought," Oh, great, vomit." Wrong! After we got a light on him, we saw his face was literally flattened by the tree, and  brain matter was everywhere.Another doa. At this time, our rescue truck arrived, and I told the squad to come in quiet, as they were not needed. To finish the story, a rookie on the rescue thought he saw the victim wwith the neck fracture move, so he started cpr.With every compression, blood shot out of the victim's mouth about six inches, and you could heat the sternum hit the backbone. Under our protocol at the time, once cpr was started, we had to transport the victim, no matter what, so he got a code three trip to the ER, where the doctor pronounced him dead while still in the squad. At the postmortum exam, the M E found almost every bone in his body was broken. Not a pleasant call.



Sounds messy. I haven't seen something this bad yet, but then again, I haven't been in EMS very long.


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## mct601 (Aug 12, 2009)

Don't get me wrong, that story is pretty horrible. A dad basically shot himself while his daughter had friends over, so I'm sure they were exposed to it, and now have to deal with that horrible situation.


but damnit I laughed at the wording lol. I hope I can be as calm when I get into the field when freshly exposed to things such as that.


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## SanDiegoEmt7 (Aug 12, 2009)

usafmedic45 said:


> Hey, after watching a forensic pathologist hold the severed head of the pilot from a crashed small plane balanced on his hand while he recited the soliloquy from _Hamlet_, there are few things I view as blatantly disrespectful in comparison.
> 
> As far as it being a "whoa" moment, it definitely is.



That's downright horrible.

On a side note:  also made me realize that even after reading hamlet 2-3 times for different classes, I still can't remember that damn soliloquy.:wacko:


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## Smash (Aug 22, 2009)

PapaBear434 said:


> So, we show up, get the guy in the back.  I got to start the IV and prepare for RSI while we wait for the nearest additional ALS to show.  The guy was still breathing on his own, though we had to continuously suction out the airway.  He hit his temporal artery, and was inconsiderate enough to squirt everywhere.
> 
> We actually had to do a conscious sedation in order to drop the tube, though at that point the other actual medics arrived and I volunteered to drive (as the lowest trained person there, I figured I would be better served getting us to the hospital and letting the medics do their thing.)



Brains are quite nice crumbed and deep fried.  Not sure about human brains, but still.

Do you mind if I ask something about the call/treatment?  I realise that this is not the right part of the forums, but I'm curious.

You state (above that you help set up for RSI, but then state that you had to do 'conscious sedation' to drop the tube.  I'm just wondering why you would set up to RSI and not do it, then sedate a head injured patient to intubate.

I'm also curious as to why the patient was 'groaning up the tube' when you got to hospital?  Surely ongoing sedation and paralysis is called for to maintain the tube in this setting (and minimize secondary brain injury)

Finally, did you give the brain back?  He might have need it later.  Maybe you could pop it in a bag and post it back to him.


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## Jeremy89 (Aug 27, 2009)

*I held a man's heart in my hand... and it was still beating!!*

Sorry to hijack this thread, but I wanted to share a similar story.  I edited the "dumbed down" version for the general public, but some wording may still seem like that, so bear with me.

I work at a Level I trauma center in Phoenix, and I heard we had a trauma code coming in- car vs pedestrian.  We normally have 2 trauma nurses on staff- one does everything, one charts, leaving 0 left for compressions. As a tech in the ER, I don't really go to trauma too often, but when I went back upstairs from lunch, I decided to stop in and see what was up.

The paramedics from Phoenix Fire had intubated him in the field, but they weren't able to get an IV.  The respiratory therapist was ventilating him at the head of the bed, and one of the trauma surgeons was doing compressions.  I put on my gloves and gown (you could imagine it gets pretty messy) and took over compressions.  Finally, we got an arterial line in his leg and after a round of Sodium Bicarbonate and Epinephrine, we got a pulse back.  The nurse asked me to go to the ER and open another code cart to get Vasopressin out of it.

I came back and the respiratory therapist asked me to bag for him while he called another therapist over to get an Arterial Blood Gas. The trauma surgeon then took a scalpel and was performing a Thoracotomy- aka "cracking the chest" on TV. haha  (http://www.trauma.org/index.php/main/article/361/print - WARNING: GRAPHIC!!) 

He cut along a rib beneath the heart, inserted a metal jack-like instrument, and cranked it and opened the chest up to expose the heart and left lung.  He was feeling for a rupture in the Aorta.  You could see the lung inflate as RT bagged him.  Sure enough, it was "transected", and he had lost a great amount of blood.  At this point we had lost a pulse again, but the trauma surgeon decided we had done enough, and called out the time of death.

Afterwards, we were using it as a learning experience- he said we should take a look because this is likely the only time we'd ever see this.  People were looking, feeling and touching everything.  I came up, put some gloves on, and felt around.  I was very familiar with this from my anatomy class, but the cadavers used were older- this man couldn't have been more than 45.  I held his heart in my hand.  He was still in PEA.  I felt the heart muscle contract in my hand- I held a beating heart!!!

It still amazes me and I will never forget that day as long as I live.  Because of this experience, I am about 150% sure I'm going to be a trauma nurse.  Now don't get me wrong, it's not like that everyday, but its stories like this that make me love my job.  A life was lost that day, but the learning that took place from this experience signified a new generation of doctors and nurses that are ready to help people.  Perhaps one day there will be a way to help people that are unfortunate as this man, but for now, we just work with what we can.


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## Akulahawk (Aug 27, 2009)

My first GSW (and so far only) GSW to the head was a guy who shot himself in his right temple with a small caliber handgun, probably .25 ACP. I forget the specifics of his vitals and such, but he was responsive to pain, minimally to verbal stimuli. GCS was right at 8. There was a nice, defined entrance wound with powder burn to his right temple, his right eye was basically gone, and his left eye was protruding about 1/3 way out. There was no exit wound. Aside from his head, from the neck down, the secondary physical exam was quite unremarkable. I believe he was in his 50's. 

He still had a patent airway on his own. He wouldn't take a tube and at the time, that medical system had no means to sedate or do RSI. I doubt they have that ability now. When we got to the ER, he was RSI'd and confirmed by x-ray. The bullet was visible on the x-ray... it was lodged behind his left eye. The last I'd heard about him was that he was in surgery... I imagine he might have survived, but given the likely wound track, his mental capacity would likely have been quite diminished. 

I'm actually not bothered by the memory of him at all. This thread reminded me of him though.


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## Akulahawk (Aug 27, 2009)

I've seen a couple thoracotomies... it's definitely different seeing the anatomy in younger patients than it is with the typical cadavers. Never got to hold a heart in PEA though... I just got to observe. 

The description of a transcected aorta is consistent with the likely kinematics at impact.


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## HokieEMT (Sep 3, 2009)

Now Im second party to this call, but I feel like I got a pretty good breakdown of the call.

This was at least 12-15 years ago because it was when my dad was still in the FD.  There was this married couple that had seperated for the time being and the husband decided to call her up to try and "patch" things up.  Well as their driving down this road in our first due he starts beating her with a baseball bat and knocks her unconcious.  Now this road ends in a T intersection which has a huge embankment on the other side.  She wakes up and starts fighting the wheel from him and they end up blowing through the intersection and fly over the embankement.  The problem is that from the road you can not see the other side of it. Oh and its July in Maryland.

Two days later a horseback riding group pass by and see the car overturned so they call 911.  The first arriving engine is from our adjoing district because the accident happened in their first due.  They approach the car and bust one of the windows.  Its now that they discover the inside of the car is covered in flys, maggots, and the like as well as a gruesome odor.  The odor is so bad that they had to go back and put on their SCBA.  By this time they have put out the Working Rescue dispatch so they get our Squad 483, Engine 481, Medic 485, Medic 203, and EMS 6 (the career supervisor for our area).  They end up having to cut apart the car just to get him out, which they think is the only occupant.  He's DRT and its when they get close to him to take him out that they hear "Help."  The wife is stuck underneath him and it all messed up.  She has all kinds of insects all over her and maggots coming out of her nose and mouth and wounds.  The maggots are what kept her alive.  Supposedly she was in the hospital for almost 6 months recovering.  She cam by my dad's station to thank them and all and they could tell she wouldnt be the same in the head for the rest of her life.


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## RescueYou (Sep 8, 2009)

That call seemed pretty sucky. :-/

But I remember a burn incident where the guy had been in a fire and had horrible 2nd and 3rd degree burns all over his body. You could see flesh of all colors - pink, red, black, etc... That didn't bother me. But when we got back to the station, I sat back down at the table to finish picking (I wasn't really going to eat it...only covered it with a paper towel) my 1/2 eaten watermelon slice from before the call and, being as the picnic table was outside in the bay, there were flies around it. I took one look at the fleshy colored watermelon and ran to the trashcan and just puked. I couldn't eat watermelon for 3yrs after that.


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