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Thursday, June 5, 2008

The Pez Dispenser...Gaping Neck Wound

At around 11:00 a.m. on Sunday, we were called to an Evangelical church in the middle of a predominantly black neighborhood, for an injury/laceration. When we arrived, we knew we had a real emergency because we were being waved in by other firefighters.... acting like third base coaches in a baseball game, waving in the winning run of the decisive game in the world series (it's rare to see fellow firefighters get that excited about something). Our second indicator that we had a significant injury was the reactions of the black, Evangelical worshippers, who are already a very dramatic group of people, were now in a complete panic, strewing their bodies about the chapel, praying and chanting. Our final indicator that something was seriously wrong was the solid trail of blood, running up the steps of the church, straight down the middle of the aisle, terminating just in front of the pulpit of the church, where we saw a 30 y/o HM, drench in blood, surrounded by a pool of blood, kneeling down, and holding a drenched trauma dressing to his neck.

According to the patient's girlfriend...since the patient wasn't in a story-telling mood...this guy was attempting to commit suicide, by cutting his own neck. Normally, this is a surefire, no frills way of getting the job done, as seen in Quentin Tarantino movies, where people die quickly of lacerations to the neck while painting the room with blood spraying from their necks. Well...this guy lacked the vital knowledge that, in order to make this method of suicide work successfully, you need to make sure you cut one or both of the carotid arteries. He somehow cut everything except the carotid arteries. He cut through his trachea and esophagus, but he missed the arteries. You see,... he cut deep rather than wide. There was a lot of blood, but it was all from veins and capillaries, rather than arteries...it was oozing, rather than spraying.

If you're going to kill yourself by cutting your neck open, ALWAYS START AT THE CAROTID ARTERIES, not at the front of your Adam's Apple (find your carotid arteries by touching two fingers to your neck, just to the sides of your trachea, until you feel the pulsating arteries). The chances are, if you start at your Adam's Apple, you'll give up before you get to your carotid arteries, due to pain, blood loss, difficulties breathing, blood aspiration, or general discomfort. Also, ALWAYS USE THE SHARPEST KNIFE AVAILABLE. Maybe this guy was using some sort of butter knife or similarly inferior blade, and he ended up having to saw his neck open, rather than gently slicing his neck open. I would recommend using a Wustof bread-cutting knife; it's long, sharp, and it's serrated, which would help get through some of those tough (cartilage-y) spots. I don't know what made this guy stop sawing open his own neck before getting to his carotid arteries...he wasn't in a story-telling mood...but just before he carved open his carotid arteries, he suddenly acquired the will to live.

He got in the car with his girlfriend, and she drove him to the nearest Evangelical church, of course. They were in the middle of singing praises to the lord, speaking in tongues, and rolling on the ground, overcome with the Holy Ghost, when this guy came staggering up the aisle, holding his gaping neck wound with two hands (the international sign for 'I just sawed my neck open'), and leaving a trail of blood on the carpet.

We removed the trauma dressing to take a look (partly for business reasons, partly for entertainment reasons), and we quickly re-applied the trauma dressing, when we saw that his neck had become a horror film, and it was still generously disseminating blood. We threw the guy onto the stretcher and quickly hauled him to the nearest Level 1 trauma facility.

While enroute, the patient kept losing consciousness, and every time he would lose consciousness, he would allow his head to fall backwards, which would expose the MASSIVE wound in the guy's neck, making him look like a giant Pez Dispenser. It was interesting that whenever his head was forward, he would breath through his mouth, but when his head fell backward, he would breath through his neck-hole. Breathing was not exactly easy, since blood was running down his trachea, into his lungs, causing him to gurgle on blood and occasionally cough up the blood (sort of...through his new mouth in his neck).

When we got to the hospital, he was taken straight to the operating room. The patient was almost completely unconscious at this point, and the doctors had applied a topical anesthetic. For the first time, I actually felt a little nauseous, when the doctors started probing his massive neck hole with their whole hands...almost like a little kid would crudely pull open a half-broken pinata to see if there's any candy left inside.

Overall, the patient was in pretty good condition, and the doctors thought they could put this dude's neck back together again. This was probably the most ambitious, failed suicide attempt I had ever seen.

19 comments:

Matt M said...

Suicide - Getting It Right the First Time, a title that several EMs have discussed, still hasn't come out. You could ad a few tips.

Crusty, I heard on Houston Public Radio yesterday about a new Emergency Services program where, if you don't need an ambulance they won't send an ambulance. If you need a prescription refill, or if your back hurts for the last two weeks, or your thumb nail is all black, a Trained Nurse will discuss with you the best way to take care of your needs, if you happen to call 911.

What do you think of that?

Crusty said...

Funny you should say that about suicide...I'm working on that blog post right now.

Yeah...I heard about that thing in Houston...it seems like a step in the right direction. These 911 ambulance calls definitely need to be screened a little better.

Stretcher Jockey said...

Holy Sicilian Neckties Batman!

Gertrude said...

awesome neck wound. I always get the failed suicide attempts that are " I took too many benadryl". Nobody tries to cut their head off on my watch! My last post is about patient " conditioning." I think you would get a kick out of it.

MonkeyGirl said...

Niiiice.

Evil Lunch Lady said...

Geez................

Drama>Trauma said...

It is so rare to see a good effort suicide attempt anymore.. I am jealous.. I usually just get the psych med ODs.. 50 gm charcoal and home they go.. I would have paid to be in that OR.

ndenunz said...

This reminds me of story from many years ago. A young girl came in the emergency room who had attempted suicide by cutting her jugular vein. A surgeon came and sewed up the vein. Instead of admitting her to his service he wanted her admitted to medicine because she had a "psychiatric problem".

Yours truly got stuck with her.

EE said...

I'm naseous now, thank you.

Esmeralda S. said...

You R a sick evil individual. I can't beleive they allow this disgusting crap on the internet. How could you talk like that bout some1 who wanted to kill hiself. Suicide is horrible and lots of people feel like doing it sometimes. How does an ambulance driver make fun of someone who wants to kill hiself. Thats just sad. If i knew of a way to get the governmnet to shut down this sick website I would. How can someone like you even drive an ambulance. I hope to Jesus in heaven that you never come to my house when I call for the ambulance. I had to call the ambulance three times already for my kidney problems and i never had a rude sick ambulance driver like you. I hope you cut you're neck with a Wustoff bread knife then we will all laugh at you.

idahokat said...

The only 51-50 attempts I ever to pick up were OD's. That's just classic, and your description of him being a "pez dispenser" - hahahahahaahaha Thank you!

CRD said...

So, Esmeralda s., you think it is sick to make fun of someone attempting suicide, but yet you encourage another to do so. Hmmm...

knitalot3 said...

Esmeralda s., perhaps you shouldn't read this blog if it offends you. That will teach 'em!!

Very high on the gory meter for us non-medical folk.

Thanks.

Gertrude said...

Hard to take anyone seriously who can't form a complete sentence. Or spell or punctuate properly. Poor poor Esmeralda can't type with out speaking in text message lingo. What's with "Hiself"? I mean come on.

HollyB said...

Hey, Esmy...
1st...polish [as in learn and practice...not pole-ish] your English language skills, Chica.
2nd... This is a place for an Emergency Medic to tell the stories about the NON-tragedy stories he sees. He blows off a little steam here so he CAN be a caring guy when it COUNTS.

UNTWIST your Vickies. Get off the Cross, Honey. Use that wood to build a bridge and get the Fuck over it!

Intubate Em!!! said...

Love it!!! You are so descripitive, I can just see it!!! I would love to be there as they were trying to figure out how to put in an airway! Orally or just straight through the trachea?!?!

medical assistant said...

that was quite a different case, but you handled well. congrats

Anonymous said...

A PEZ DISPENSER, BWAAHAAAAAAAAA!!!
BREATHING THROUGH THE MOUTH IN HIS NECK.
WHAT BEAUTIFUL PROSE YOU WRITE.

ESMERALDA, GET OVER YOURSELF. IF YOU'VE CALLED AN AMBULANCE 3 TIMES FOR "KIDNEY PROBLEMS" YOU'RE PART OF THE PROBLEM. SHUT UP AND MAYBE YOU CAN LEARN SOMETHING FROM THE SUICIDE LESSONS CONTAINED HEREIN.

Anonymous said...

wusthoff bread knives kick ass...and are goddamn sharp too.

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