Saturday, November 17, 2012

Trauma # 4027: The 13 Year Old Sheep Herder

Trauma patient 4027 was a 13 year old boy that was simply in the wrong place at the wrong time. He was with his uncle herding sheep when he was caught in the middle of a combat engagement. Initially, he was taken to the local Afghan hospital by his uncle. His injuries were so severe that it became obvious that he would die without the intervention of the 691st FST. We agreed to accept him, and he arrived by ambulance to our facility at about 5:00pm - almost 5 hours after his injury. 

When he arrived it was clear to us that he was in bad shape. His color was terrible and he was essentially unresponsive. I put him to sleep and placed a breathing tube within five minutes of his arrival. We placed a central line and arterial line and began infusing blood in as fast as we could. Within 30 minutes of his arrival, he was in the operating room.

This is moments after his arrival. The patient arrived in the prone position. It was clear from the beginning that he was seriously injured.

Dr. Yoder

The picture below is a good illustration of what a typical ATLS resuscitation looks like. The surgeon (Dr. Yoder) is positioned on the patient's left with the CRNA (me) at the head of the bed. There is a medic on each side of the bed. A recorder, seen at the foot of the bed, documents everything for posterity. It looks chaotic, but it is in fact highly orchestrated.

Trauma resuscitation: Controlled chaos.

The patient post surgery. If you look closely you can see blood coming out of the patient's breathing tube. He sustained a serious lung injury. Both sides of his chest cavity were filled with blood.


This is the deceptively small entrance wound. The projectile that entered this child's chest cavity did a significant amount of damage.

Without a doubt, the vast majority of children in Afghanistan live an incredibly difficult life. Most live in a constant state of malnutrition. The illiteracy rate for boys is somewhere in the 85% range. The illiteracy rate for girls is an even more appalling 94%. Child labor is almost ubiquitous. Unlike the United Sates, violence inflicted upon children is not an anomaly in Afghanistan. The sad truth is that generation after generation of Afghans have lived this harsh existence. It's an almost inconceivable reality, but sadly, it is their reality.

MAJ Randall D. Moore, CRNA
691st Forward Surgical Team
FOB Sharana, Afghanistan

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