A young woman was screaming and writhing on the stretcher.
Jack took one look at her shortened right leg, the foot rotated almost completely sideways, and knew this patient was going straight to surgery. Jack quickly cut away her clothes, to reveal impacted hip fracture, her thigh bone rammed into the socket by the force of her knees hitting the car's dashboard. Just looking her grotesquely deformed leg made him queasy.
"Morphine?" the nurse asked.
He nodded. "Give her as much as she needs. She's in a world of hurt. Type and cross six units. And get an orthopod in here as as -- "
"Dr. McCallum, stat, X-ray. Dr. McCallum, stat, X-ray." Jack glanced up in alarm. Debbie Haning He ran out of the room.
He found Debbie lying on the X-ray table, hovered over by the ER nurse and the technician.
"We'd just finished doing the spine and skull films," said the tech, "and we couldn't wake her up. She doesn't even respond to pain."
"How long's she been out?"
"I don't know. She was lying on the table ten, fifteen minutes before we noticed she wasn't talking to us anymore."
"Did you get the CT scan done?"
"Computer's down. It should be up and running in a few hours." Jack flashed a penlight in Debbie's eyes and felt his stomach go into a sickening free fall. Her left pupil was dilated and unreactive.
"Show me the films," he said.
"C-spine's already up on the light box." Jack swiftly moved into the next room and eyed the X rays clipped to the backlit viewing box. He saw no fractures on the films, her cervical spine was stable. He yanked down the neck and replaced them with the skull X rays. At first glance he saw nothing immediately obvious. Then his gaze focused on an almost imperceptible line tracing across the left temporal bone. It was subtle it looked like a pin scratch on the film. A fracture.
Had the fracture torn the left middle meningeal artery? That would cause bleeding inside her cranium. As the blood accumulated and pressure built up, the brain would be squeezed. It explained rapid deterioration of her mental status and the blown pupil.