The Grind: Chapter 15

📊 Global Attending Consensus

The team voted to: Mitch takes Bed 3 to aggressively manage the aortic dissection and fight Cardiothoracic Surgery for an OR bed, forcing Hayley to rapidly RSI the burn patient in Bed 2 before the airway completely closes.

"Rate control before pressure control!" Mitch barks, stepping aggressively to the head of Bed 3. "If we drop his pressure first, the reflex tachycardia will shear his aorta completely in half. Donna, push a five-hundred microgram per kilo Esmolol bolus, then start the drip!" Across the pod, Hayley is already moving on the electrical burn in Bed 2. "Farmboy, I need Etomidate and one-point-two per kilo of Rocuronium! No Succinylcholine! The electrical current cooked his muscles; if we use Sux, his potassium will spike and he'll code!" Daniel's trembling hands slam the non-depolarizing paralytic into the IV. Hayley slides the Glidescope in. The monitor shows the vocal cords swollen into blistered, unrecognizable mounds of edematous tissue. With a sharp, calculated twist of her wrist, she forces a 7.0 endotracheal tube through the narrowing opening just as it seals shut. "Tube's in. Bag him."

The blaring monitors momentarily settle into a rhythmic, manageable hum. Mitch wipes a bead of sweat from his forehead with the back of his wrist, watching Bed 3's heart rate drop from 115 to 65. "Nice catch on the Roc, Carter," Mitch mutters, his voice flat but carrying a rare, heavy ounce of veteran respect. He grabs the wall phone to page Cardiothoracic Surgery. Daniel leans his massive frame against the Broselow cart, his hands finally stopping their violent tremor. "I thought electrical burns were mostly just superficial skin damage," the Nebraska native breathes out, staring at the charred lineman. "Only if you're a toaster, Farmboy," Mitch deadpans, pressing the phone to his ear. "In humans, it cooks the myocardium."

As if on cue, Bed 2's monitor shrieks. The isolated PVCs suddenly string together into a terrifying, wide-complex sawtooth wave. Sustained Ventricular Tachycardia. The lineman's blood pressure plummets to 75/40, but he still has a weak carotid pulse. "He's in V-Tach!" Hayley yells, ripping open the defibrillator pads. "I need the machine in sync mode, two-hundred joules!" Simultaneously, the phone in Mitch's hand clicks. Dr. Clay Barrett, CT Surgery, speaks with an infuriating, aristocratic drawl. "I don't do blind exploratory thoracotomies for back pain, Mitch. I don't care about your asymmetric pressures. Get a CTA of the chest, or lose my number." Mitch glares at the receiver. Bed 3's pressure is still 185/95; moving the paraplegic man to the CT scanner right now is a near-guaranteed death sentence, but Barrett won't cut without the imaging.

Before Mitch can curse Barrett out, a deafening crash violently interrupts the trauma pod. The heavy glass double doors separating the ER from the waiting room shatter completely. The synthetic-cathinone overdose patient, completely naked and covered in safety glass, bursts through the threshold, having overpowered the security guards. He violently thrashes, screaming incoherently, and collapses directly onto the empty Bed 1. A massive, jagged shard of glass has lacerated his right brachial artery, spraying a rhythmic, bright red arc of arterial blood across the linoleum. Mitch is trapped on the phone with a demanding surgeon, Bed 2 requires immediate synchronized cardioversion, and Bed 1 is actively bleeding out while thrashing in a drug-induced psychosis.

What are your orders, Doctor?

Mitch yields to CT Surgery, physically escorting the fragile Bed 3 to the CT scanner to get the required imaging, leaving Hayley to cardiovert Bed 2's V-Tach alone while Daniel attempts to tourniquet and chemically sedate the thrashing psych patient in Bed 1.

Execute Option 1

Mitch aggressively ignores CT Surgery, staying in the bay to push Nicardipine for Bed 3's blood pressure, forcing Hayley and Daniel to physically tackle and tourniquet the violent psych patient in Bed 1 while Bed 2's V-Tach is temporarily temporized with an Amiodarone drip.

Execute Option 2

Mitch and Hayley immediately pivot to Bed 1 to execute a rapid chemical takedown and arterial clamping of the violent psych patient, intentionally delaying Bed 2's cardioversion and Bed 3's CT scan, accepting the massive risk of both cardiac and aortic collapse.

Execute Option 3

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