Ensign Sival: Thumb Medicine
James Scott Schumann
(( Shuttlecraft Halibut ))
Oddas: =/\= Rend assistance to the Ferengi vessel, hopefully this is what it seems like: some sort of misunderstanding. =/\=
Sival: Was that order directed at us, Pilot?
Pilot: No, Doctor. We are about to receive a transport from the Coho. One injured.
Sival: Please assist me at the transport pad. Nurse Pelley, please prepare the bed.
Pelley: Acknowledged, Doctor.
As the nurse worked the controls that automatically extended the bed in the rear of the shuttle, the pilot and Sival stood on either side of the transport pad, ready to catch the incoming arrival.
Sival: Be ready to assess first.
Pelley: Always, Doctor.
Sival was referring to combat medical training. While this wasn’t technically a combat situation, the basic principles still applied. There was a given checklist to be followed, the first of which, ‘contain scene and assess casualties’, was currently underway. The next seven steps would occur in rapid succession, and, if all went well, seamlessly.
Pilot: =/\= Energize. =/\=
With the familiar buzz that ended in a high-pitched whine, Ensign Falt materialized. The pilot caught him under his left shoulder and Sival held him under his right.
Sival: The bed.
As the pilot and Sival walked the Ensign a few steps back, the nurse began reading out his vitals.
Pelley: Heart rate 160. BP 80 over 40. Falling.
They sat the ensign down. Nurse Pelley flashed a bright light in his eyes.
Pelley: Responsive.
Sival: Hemorrhages?
Pelley: Apparent hemorrhage to hand. None other apparent.
Sival: Agreed.
Sival quickly visually inspected the ensign’s hand. It was in bad shape, but there was no significant bleeding at the moment. He had enough time to get him lying down on the bed first before examining it.
Sival: Get his helmet off. Lay him down. Nurse, apply pressure to his wrist, please.
Sival checked his airway. No obstructions, and breathing was normal.
Ensign Falt grunted in pain.
Sival opened the medkit that he had brought aboard with him. He prepped a hypospray himself with five cc of analgine.
Sival: Ensign, I’m giving you a hypo for the pain now.
And Sival did so.
The next steps were for “trained medical professionals,” which was usually a euphemism that meant “there might be blood, so get everyone out of the room.”
Sival: Pilot, I thank you for your assistance, but now please take us back to the Juneau - gently, please.
His patient didn’t need any more rapid accelerations today.
Sival flipped open his tricorder and scanned his torso area for any injuries. None were detected. He handed the tricorder to the nurse.
Sival had already completed four more combat medical tasks - checking for hemorrhages, ensuring an open airway, checking for torso injuries and managing pain.
Now he was going to focus on preventing the patient from going into shock.
Sival carefully lifted up the young man’s forearm, holding midway between the wrist and the elbow, to inspect the ensign’s condition. He saw a torn, blood-soaked EV glove, but not much else.
The glove itself was in bad shape, and Sival didn’t dare remove it yet. Despite any major bleeding apparently having stopped, the Ensign’s blood pressure was still falling. Sival needed to find out why.
Sival: Tricorder.
(( OOC: Star Trek’s version of the magic wand… ))
Nurse Pelley handed him the tricorder. The scan gave him exactly the information that he required without needing to remove the glove and damage the hand further.
The ensign had a compound fracture of the bones in his hand, but this was not what was causing the distress. Somehow, and rather most-unfortunately, Ensign Falt had partially severed his thumb as well.
Sival: Patient has a compound fracture of the metacarpal and partially-amputated pollex.
Sival was closer to tracking down the culprit, but he wasn’t there yet. Normally, when part of the body is severed, the blood vessels contract and close. The blood loss will stop, thus blood pressure will stop dropping as well. But the Ensign’s blood pressure was still falling, suggesting that there was still blood loss occurring, or, worse, something else was contributing to the problem.
Sival thought back to what he had witnessed just moments ago - the Allahayer spiralling around and around in a nauseating blur. Then he thought back to the hypos that Dr. Indobri was preparing earlier that day, spinning around and around in their centrifuge. And that was it! Just as the spinning of the centrifuge separated fluids, so did the spinning of the Allahayer send the body’s blood, almost all of it, to its extremities. The blood would be building up in the vessels where the ensign’s thumb was partially severed, and the pressure would be preventing them from closing.
To test his theory, Sival ever-so-gently pressed just behind the torn area of the glove. A jet of blood spurted out, breaking through the torn fabric, arching up into the air and landing inside the replicator beside them with an audible splurt.
Nurse Pelley slightly gasped.
Sival: Apologies, Nurse. I had a hypothesis, and it was necessary to test it. Do be sure to inform the ground crew about the replicator.
Nurse: Um…. you can also inform them, Doctor.
Sival: Of course, Nurse. The vessels around the traumatized area have not contracted. We need to close them to stabilize Ensign Falt’s condition. Anabolic Protoplaser, please.
The nurse, seemingly a bit more cautious now, or was it Sival’s imagination, handed over the tool. Sival moved it back and forth over Ensign Falt’s hand.
Sival: Sealing the severed blood vessels and purging excess fluid to relieve pressure. Confirm blood pressure is stabilizing.
Nurse: Confirmed, Doctor. BP is now steady at 80 over 40.
Sival: Thank you. Please prepare 10 more cc of analgine.
Sival turned to address his patient, attempting some of his practicised bedside humour.
Sival: Well, Mr. Falt. That was quite a stunt. I had the pleasure of watching some of it myself. But not to worry, not many are able to pull off such an acrobatic maneuver without injuring themselves, so I would say you came out quite good overall.
His remarks didn’t come out as finessed as he had hoped, but Ensign Falt didn’t seem to mind at the moment.
Sival: You have partially severed your thumb. There are a lot of nerves there, so I do not want to do anything more here that might risk potential nerve damage until we get you back in sickbay aboard the Juneau. That means keeping the glove on for the moment. But what I can do is keep you comfortable.
The ensign seemed to mumble something about rebuilding, addressing him as Captain. Sival guessed that he might have been referring to his hand.
Sival: No, I am not captain, yet, but you keep up your positive thinking, Ensign. And do not worry about your hand - we will have it back to normal in no time. For now, I am giving you more pain medicine. It might make you feel slightly more drowsy, however.
Sival administered the drug.
The last two steps of the combat medicine procedure were to prepare the patient for transfer, then actually move the patient. The first of the two steps was easy enough.
Sival: Confirm the patient is ambulatory and ready to transfer to sickbay once we dock at Juneau?
Pelley: Agree, confirmed, Doctor.
Sival: Very well. Pilot, please have a MEDEVAC unit ready to meet us in the shuttlebay to transfer one patient to sickbay.
Pilot: Understood, Doctor.
(( OOC: Tardis sound. Oh, wait. Wrong sim. I mean, Captain Janeway walks into the room. Short time Skip. ))
(( Main Medical, Deck 7, USS Juneau ))
Indobri: What do we have, Doctor?
Sival: Approximately 27-year-old male, human. Presents with compound metacarpal fracture and partially-amputated pollex due to apparent blunt-force trauma, sustained during uncontrolled flight. Sealed vessels to stabilize vitals. Currently at 110 / 70. 15 ccs total of analgine have been administered. Patient conscious, ambulatory, alert and aware.
Indobri: I see. Well Ensign, let’s see about getting that thumb reattached, shall we?
Doctor Indobri anticipated that the ensign’s pain medicine was wearing off, and she administered another hypo.
Falt: Thank you. Is it a complicated surgery?
Sival: It should be quite routine, Ensign. I expect the surgery to run smoothly, although a bit slowly due to the nature of the injury.
Indobri: Well, it shouldn’t take too terribly long. Maybe an hour. Attaching the nerves is going to be the trickiest part.
Sival noticed the concern in the ensign’s eyes. He tried to be reassuring.
Sival: Not to worry, Ensign. Dr. Indobri is among the best.
And she was. Her reputation in emergency medicine had preceded her. Sival had spent weeks reading up on her accomplishments when he had learned that she had been assigned as his CO.
Indobri: Doctor, would you get the surgical kit prepared. We’ll need to make sure we have a dermal regenerator, cellular microsutures, and exoscalpel, a pair of anabolic protoplasers, a sonic separator, and a neural stimulator.
Sival: Yes, Ma’am.
Sival was impressed by the short amount of time it took to prepare the items. Dr. Indobri had arranged her sickbay in such a manner that such tools were readily and easily accessible. Her ER experience was apparent.
Falt: Do you think there will be permanent damage, Doctor Indobri?
Indobri: Well, Mister Falt, I believe we can repair it fully. It hasn’t been too terribly long, and while the damage is severe, it’s not catastrophic.
Falt: Thank you, I appreciate your efforts.
(( OOC: Janeway takes a sip of coffee. 30 minutes elapse. ))
Indobri: Doctor, I need to step back for a moment. Please test the nerve connections for me to ensure they are all properly attached.
Sival: Yes, Doctor.
Falt: I've not seen one of those before, what does it do?
Sival: This device allows me to test if your nerves and muscles respond properly to specific inputs. In essence, to ensure that your thumb will do what your brain tells it to do.
Sival began to attach diodes to each of the nerve endings. As he did so, a new connection appeared on the wall display in front of them. After about fifteen minutes of meticulous work, Sival was ready to test the nerve responses.
He entered commands into the device, which signaled the ensign’s thumb to move and twitch in slight, controlled ways. Each input registered a different, and, thankfully, the proper, neuromuscular response. As he did so, Sival noted the fascination with which Ensign Falt was observing the procedure.
oO Perhaps he would be interested in medic training? Oo
Falt: It's strange watching my thumb move but not being able to feel anything.
Sival saw an opportunity to practice some humor again and hopefully put his patient even more at ease.
Sival: Indeed, Ensign. I imagine it must be an unnerving experience.
oO Was that funny? Hopefully my bedside manner is improving. Oo
Indobri / Falt: Response
Sival: I have finished testing the nerve connections, Doctor. All pathways respond as anticipated. Your work is satisfactory.
From a Vulcan, even a Half-Vulcan, there is no higher praise.
TAG / TBC
Ensign Sival
Medical Officer
USS Juneau, NX-99801
J239808S11