The Magic of Christmas by Sarah Morgan

up.’
    â€˜Will do.’ Jane hurried over to the phone and Lara stepped a little closer so that she could watch Christian do the FAST test.
    He placed the transducer on the patient’s abdomen, just above the pubic bone, and studied the screen, a frown on his face. ‘Penny?You can’t see from over there—come closer. I’m looking for free intraperitoneal fluid—fluid collects in the pouch of Douglas and you can visualise that with the scan.’ He paused for a moment, staring at the screen with total concentration. ‘It’s negative but that doesn’t exclude intra-abdominal injury.’
    The anaesthetist adjusted the oxygen flow and glanced at the monitor. ‘They don’t like having patients this unstable in the angio suite, Christian. It’s not a good place to resuscitate a patient.’
    â€˜Interventional angio is the best way to stop the bleeding.’ Cool and unflustered, Christianchecked a set of blood results and shook his head. ‘Give her FFP and cryoprecipitate. Let’s take a look at that X-ray, Maria.’
    â€˜I have it here.’
    He studied the screen. ‘Well, that’s fairly obvious, isn’t it? Penny? Take a look at this X-ray.’
    Lara recorded the patient’s observations again and glanced towards the screen, hoping that Penny would spot whatever it was she was supposed to spot.
    The girl needed a boost to her confidence.
    â€˜She has an antero-posterior compression fracture.’ Penny leaned closer to the screen and touched it with her finger. ‘It’s causing separation of the pubic symphysis and widening of both sacroiliac joints.’
    Lara breathed a sigh of relief and slipped her pen back into her pocket.
    â€˜Well done.’ Christian nodded. ‘Also known as an “open-book” fracture. Significant opening of the sacroiliac joints is associated with tearing of the major blood vessels that overlie the joint. So what we’re looking at here is potential for serious vascular damage.’
    â€˜And major blood loss.’ Lara grimaced as she looked at the blood-pressure reading. ‘Christian?’
    â€˜I’ve seen it.’
    Penny frowned. ‘But the X-ray doesn’t look that bad.’
    Lara handed Christian a set of results. ‘With every pelvic fracture it’s important to think about the mechanism of injury because the damage on the X-ray may not actually reflect the degree to which the bones were separated during the actual injury. So you need to be alert for major soft-tissue damage.’
    Christian scanned the results. ‘I want to take her straight to angio. Everything else can wait.’
    Derek adjusted the oxygen. ‘You don’t want to examine her back?’
    â€˜That can wait, too. I don’t want to risk dislodging the clot in her pelvis.’
    Lara watched him, envying the ease and confidence with which he tackled every case that came his way. In two months, working alongside him in the ED, she’d never seen him remotely rattled and she loved working with him.
    â€˜Penny, what do you know about interventional radiology?’
    â€˜Very little,’ the junior doctor admitted frankly, and he gave a nod.
    â€˜Perhaps you should go along and observe.’
    â€˜Oh, yes, please.’ She nodded immediately and then fell silent as one of the nurses drew his attention to the monitor.
    â€˜Her blood pressure is dropping into her boots.’
    They worked swiftly, using the rapid infuser to push blood into the critically ill patient.
    â€˜Her pressure is coming up a little.’ Christian looked at Lara. ‘Let’s do another FAST test, just in case things have changed.’
    He performed the test, satisfied himself that interventional angiography offered the best chance for the patient and the team transferred her to the angio suite.
    Left alone in Resus, Lara started clearing up and restocking, ready for the next