The Grind: Chapter 16

📊 Global Attending Consensus

The team voted to: 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.

"Barrett can wait," Mitch growls, slamming the wall phone into its receiver. Hayley instantly abandons the defibrillator at Bed 2, sprinting across the bloody linoleum. The cathinone overdose in Bed 1 is a thrashing, naked nightmare, his right arm spraying a bright, rhythmic arc of arterial blood across the room. "Farmboy! Pin his shoulders!" Hayley barks. Daniel throws his massive Nebraska frame over the man's chest, taking a brutal headbutt to the collarbone but holding the patient down. Hayley draws 400mg of Ketamine and drives the needle straight into the man's exposed lateral thigh. Mitch slides in through the shattered safety glass, whipping a CAT tourniquet high and tight around the patient's right bicep. He cranks the windlass until the mechanical click echoes over the screams, and the arterial geyser abruptly stops. Ten seconds later, the dissociative sledgehammer drops. The patient goes entirely flaccid.

A rare, ten-second wind-off settles over the trauma pod. Mitch leans against the Broselow cart, picking a shard of safety glass out of his forearm. "Next time triage complains about wait times, tell them we have an open-door policy," he deadpans, flicking the glass into the biohazard bin. Daniel is panting, brushing fine glass dust off his scrubs, while Donna silently hands Hayley a wet towel to wipe the arterial spray from her face. "I thought the psychiatric ward was supposed to be on the fifth floor," Daniel mutters. "Every floor is the psych ward if you wait long enough," Hayley replies, her voice flat, savoring the brief drop in her heart rate.

The illusion of peace shatters. Bed 2's monitor shrieks as the electrical burn's sustained Ventricular Tachycardia begins to decompensate. His blood pressure plummets from 75/40 to a dismal 55/30, the waveform flattening out. The cooked myocardium is failing. Simultaneously, Bed 3 violently thrashes against his bedrails. "My back! It's tearing!" the 65-year-old dissection patient screams. Donna checks the arterial line. "Nicardipine is maxed at fifteen milligrams an hour, but his pressure is spiking! Two-hundred-and-ten over one-ten!" The sheer pain is driving a sympathetic surge, overpowering the drip and actively unzipping his aorta down to his renal arteries.

The trauma bay is redlining. Bed 2 requires immediate synchronized cardioversion and an Amiodarone load before the V-Tach degrades into terminal V-Fib. Bed 3 needs a secondary, heavy-hitting antihypertensive—like Clevidipine—plus Fentanyl for the pain, and an immediate physical transport to the CT scanner before Dr. Barrett in CT Surgery will even consider opening an OR. Bed 1 is temporized but requires a vascular consult. With Donna trapped mixing new drips, Mitch and Hayley have to split the senior hands. They can't be in the scanner and on the defibrillator at the same time.

What are your orders, Doctor?

Mitch physically escorts Bed 3 to the CT scanner to secure the imaging for CT Surgery, leaving Hayley and Daniel to execute the synchronized cardioversion and Amiodarone load on Bed 2.

Execute Option 1

Mitch and Hayley double-team Bed 2's failing V-Tach to perform the cardioversion, forcing Daniel to independently push Clevidipine and escort the unzipping Bed 3 to the CT scanner alone.

Execute Option 2

Hayley delegates Bed 2's cardioversion entirely to Daniel, while she and Mitch aggressively push Clevidipine and Fentanyl on Bed 3 to break the sympathetic surge before attempting CT transport.

Execute Option 3

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