Have you every worked Trauma?  If not  Trauma patients tend to walk in to even the lowest acuity Emergency Rooms (ER).  From shootings, painful accidents, drownings, and many other low-frequency high acuity scenarios these patients will show up when you least expect them.  Although these could be a high frequency occurance at Level 1 trauma Centers.

Recently at a local hospital; there was a patient that suffered a chainsaw injury.  Now, this can be life-threatening for sure as it has high RPMs and made for cutting hard objects like trees.  It wouldn’t be hard for a chainsaw to easily cut off a limb, cut down to artery or muscle, and even decapitate someone.

This patient came in via personal vehicle.  The patient was found lying in the back seat covered in blood holding his neck.  This patient was accompanied by three other individuals that were workers.  Due to a mild language barrier, it was difficult to find out quickly what happened. The first thought is did he cut deep and any arterial vessels involved and or spine?  The patient was assisted out of the car with multiple personnel controlling C Spine.  A makeshift pressure bandage was applied with a C-Collar and the patient was placed on the arriving stretcher.  Once the patient made it to the back of the ER where the Trauma bay was he was greeted by an army of staff.  The staff was interested due to all the blood and the Charge Nurse informing the Doctor on that the patient had a chainsaw to the neck injury.  This type of injury had not been seen at that ER and obviously fascinated the staff.

The patient was placed in a room and immediately the nurses did what they do best…  They cut the patients clothes off with ER LIFE® ONE SHEAR™s heavy duty trauma shears to assess the patient better and began to hook the patient up to the monitor and start IVs.  Once the wound was assessed by the MD and blood was sent off to the lab; the patient was off to Radiology.  The patient had many CTs done and an Angiogram to check for bleeding due to the injury.  The patient was lucky and missed all major vessel and organs.  This turned out to be a flesh wound that was dirty and needed clean out and closure in the Operating Room.

Later that day the story came out of how the accident went down.  The patient stated that he was on his knees trying to cut a large log when the chainsaw jammed.  After Jamming; he tried to pry it out.  He then attempted to back it up and restart.  His friend behind him helped pull and restarted the saw.  Little did they know that the blade was partially broken.  When the patient tried to start it the chainsaw had so much torque he lost control and the chain snapped at high tension.  The patient lost control due to the torque and hit his neck and the remaining chain hit his friend in the bicep.  The friend also went to the OR due to arterial bleed and muscle involvement.  The patient said all he remembered was a lough snap and his neck was cut.

Findings:

• Alert and Oriented
• The left side of the neck had a visual opening of skin showing trachea and neck muscles
• Dark Blood (the good kind)
• No arterial blood/ bright ejection or pulsation noted.
• PT had sensation and was able to talk
• GCS 15

Testing was done:

•  2 large bore IV inserted
• Lab test was done including the type and screen for possible transfusion
• Fluids started IVF
• Serial CT exams are done
• Neck area cleaned and covered to help maintain from infections.
• OR surgeon called and Patient prepped for OR immediately

Outcome:

• The patient did well
• The patient had neck cleaned out and closed in the OR
• Abx treatment course administered per surgeon and admitting provider
• The patient was discharged home and did well

Prevention:

1. Properly oiled chainsaw blades
2. When the chainsaw torque kicked and didn’t seem to move the patient should have been more cautious
3. The patient was not using a chain upper guard rail protector
4. Maintenance all equipment frequently
5. Wear protective goggles
6. Wear properly fitting clothing (no loose-fitting garments as they can get stuck in saws mechanisms)

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Alright, guys,  we have all seen it.  That patient comes into triage and says I got something stuck.  The triage Nurse reply is usually stuck where?  Followed by the patient whisper….. in my butthole.  This usually requires great hidden laughter and professionalism by the Nurse.  Only the most skilled can pull this one off.

What happens when a person puts a foreign body in their rectum?

• The item becomes hard to retrieve
• Embarrassment sets in
• Abdominal pain
• Peristalsis which causes contracting of muscles and the item goes further up the colon.  Eventually needing surgical removal.

How do you prevent this?

1. Don’t put anything in your rectum
2. Only use rectal approved devices with the appropriate attachments and or strapons
3. Tie a string on it.  Come on, if you can’t put a string to pull to get it out then at least put a handle on it.

Diagnostics

• Xray Imaging
• Digital palpation
• Other US/ CT may help but are not the most typical

Items Commonly Misplaced and lost

• Vibrators/ Dildos
• Buttplugs
• Toothbrushes
• Golfballs
• Toys
• Lightbulb
• Various vegetables
• Utensils
• Squirt Bottles
• etc.