A mistake while gutting a deer
Caused the blood to appear
Despite all my reading
It’s hard to stop bleeding
Surgery’s not my career
The patient involved gave me permission to write about him.
His knife slipped while he field dressed the doe he shot Friday morning, the blade went about and inch and a half (3 cm) into his right thigh. He pulled it out, and it bled vigorously and he came to the hospital for stitches.
The Nurse Practitioner on duty in the ER tried local pressure to stop the bleeding, which didn’t work. She asked me to step away from the clinic to give her a hand.
The wound itself, about an inch long, filled up with blood as I watched it. I tried a pressure dressing with 4×4’s and an ace bandage for 30 minutes.
Dark red blood continued to well up.
I am not a surgeon, and every time I thought I could be one I witnessed horrendous complications in the hands of competent men and women, who pulled the chestnuts from the fire every time, even if they sweated to do so. I gave up decades ago on my fantasies of surgical practice. I do OK on skin, but I don’t like to go deeper than that.
I know what to do when I don’t know: call someone who knows more. I phoned the hospital of the patient’s choice and asked for the trauma surgeon on call. Of course I my communication got shunted to the emergency doctor.
The conversation passed between us with one good idea exchanged. “I’d just elevate it and put ice on.”
Elevate? Sure, a great idea: use gravity as an ally. Ice? I just took the Advanced Trauma Live Support (ATLS) course; one of the scenarios had to do with a young patient bleeding profusely from a thigh wound. Applying pressure slows bleeding, it doesn’t always stop it, neither does ice, and I didn’t want to send a bleeding patient home.
The patient’s cut, outside my comfort zone for treatment, didn’t justify transporting the patient to a surgeon.
I gathered my breath and decided that whatever else I can or can’t do, I could anesthetize the wound and irrigate it.
I used five millilitres of 1% Lidocaine with epinephrine, a medication that constricts blood vessels and slows bleeding. I injected as I advanced the 1 1/2 inch needle to the hub. When the red river slowed to a trickle I could see a significant bleeder, right at the skin edge. I clamped it with a hemostat and tied it off with 3-0 chromic, and the bleeding stopped.
By then I’d spoken with a real surgeon, who advised against closing a wound containing contaminated by deer fat and clothing fibers.
I relieved the patient when I announced I wouldn’t be sending him by ambulance to a different ER and a surgeon.
But we talked a lot about deer hunting.