Memoirs of an Emergency Nurse by Elizabeth Nicholl Page B

paramedic s were waiting so they could retrieve their spinal board, a hard thick plastic board that was rigid and offer ed maximum support and spine alignment when spinal injuries were indicated . With so many staff still in the resuscitation room , we again performed the log roll movement on J ohn so that his back and neck could be assessed properly by the doctor.
    The paramedic at John's head gave the command . “Is everyone ready? Roll after three…. . One , two, three, roll . ”
    The doctor felt down John's spine from top to bottom . Jo hn said nothing hurt until the doctor pressed on L4, where there was a large swelling . John was able to feel both legs and wiggle his feet about ; however , he was experienc ing pins and needles in his right leg .
    We pulled the spinal board out from beneath him and he was laid on the emergency trolley. He had no neck pain but due to the mechanics of his fall , the doctor wanted to err on the side of cautio n and wait for x-rays of his neck before removing the collar. I began recording observations on the patient ; blood pressure and pulse while the doctor assessed his injuries . John was talking and indicating where it hurt . He stated that he was still in a lot of pain and therefore the doctor ordered another 5mg of morphine. I grabbed a 10ml syringe and a white drawing up needle and proceeded to check out a 10mg vial of morphine from our controlled drug book . I snapped a plastic vial of 10ml of saline and drew up 9ml . I placed this to one side and , with my thumb and first finger , held the top of a pear - shaped glass vial and snapped off the top . I the n drew up the 1 ml of morphine into my 9ml of saline, making it 10ml. I added an orange morphine sticker and I locked up the rest o f it up. I took the syringe to the doctor and while he was administering it, I asked J ohn what had happened .
    He had been up three lengths of ladder and was on a roof when he lost his footing and fell onto his left side . H e didn’t lose consciousness at the scene but he couldn’t move his left shoulder at all . No relatives knew that he was here, so I asked who he would like to contact . He gave me his sister’s number and I got through to her the second time I tried.
    All John wanted to do was sleep . He kept asking for more painkillers and if we could put him to sleep . The doctor gave him the 10mg of morphine slowly as a bolus dose and I monitored him. Initially , the doctor suspected that J ohn had dislocated his shoulder and had a probable compound fracture, a broken bone that pierces the skin to his left elbow . H owever , preliminary x-rays done in the resuscitation room couldn’t rule out a fracture of his spine and more accurate x-rays had to be done in radiology . The doctor and I packed up John ’ s x-rays, notes and morphine; I made the observation machine portable by taking it off its stand and attaching it to the side of the bed , and then I pushed John’s trolley around to radiology. Many series of x-rays were requested and it took half an hour for the films to be processed and looked at by the doctor .
    I stayed with John throughout his trauma x-rays series, just nipping behind the lead shield when each x-ray was taken and I talked him through the whole process . Once the x-rays had been completed, one of the radiographer assistants helped me push the trolley back around to emergency. John remained flat on the trolley with his head taped down . He had to wait for the doctor to be free to review his x-rays before he could change position . Luckily , after two hours of constant treatment and numerous x-rays, the emergency doctor could see no fractures in John’s neck and gave the go ahead to remove his collar and head blocks . However , the orthopaedic consultant needed to review John as he did have fractures elsewhere . John was still in pain and another 10mg of morphine was given to him after his x-rays .
    The orthopaedic consultant had just come back from holiday and was