Her Emergency Knight. Alison Roberts

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СКАЧАТЬ use one to splint her forearm, but it didn’t actually hurt too badly anymore and she could wriggle her fingers and even make a fist without causing more than fairly tolerable discomfort. It was a minor injury compared to what the man on the ground had suffered and, as such, it could wait.

      ‘Has he been conscious at all?’ Jennifer stepped around Guy’s feet to get to the other side of their patient. The two-inch heel of her shoe caught between two rocks but she ignored the discomfort the lurching movement provoked. She had obviously collected quite a few sprains and bruises, but hopefully the only broken bone was in her arm. ‘What’s his name?’

      ‘He was alert enough to get out of the plane by himself. He was obviously short of breath and said his ribs hurt, but it took a bit of convincing to get him to sit down while I went back to see about the rest of you. It wasn’t until I’d got Bill out and went back to check that I found him less responsive.’

      He’d still gone back to help Jennifer out of the wreckage, however. She owed both these men the best she had to offer right now.

      ‘Name?’

      ‘Jim Spade. But he hasn’t willingly answered to anything other than “Digger” for as long as I’ve known him.’

      Jennifer leaned close and rubbed a knuckle on the older man’s sternum. ‘Digger! Can you hear me? Open your eyes.’

      The man groaned and his eyes opened briefly. He jerked his head and his hands moved, but any struggle to speak was clearly too much of an effort.

      ‘Breathing’s inadequate,’ Jennifer stated. ‘Do you carry an oxygen cylinder in that bag?’

      ‘No.’

      ‘Bag mask?’

      ‘No.’

      ‘Stethoscope?’

      ‘Yes.’

      ‘Good.’ Jennifer’s tone implied that he had, at last, provided an acceptable answer. She took the item from Guy’s hands and flicked off the leather jacket draped over Digger’s chest. It was only then that she realised why Guy seemed so inappropriately clothed for the cold temperature. He had been wearing this jacket over his polo-type shirt when he had boarded the small plane.

      Digger had a woollen plaid bush shirt on, the buttons of which only opened a short distance.

      ‘Got some shears?’ Jennifer queried.

      ‘Don’t think so.’

      ‘We need this shirt off. I can’t see what’s going on.’

      Guy leaned forward. He gripped the shirt at the base of the neck opening and ripped the heavy fabric apart as easily as if it had been a light cotton.

      ‘Sorry, Digger. It’s about time you treated yourself to a new one anyway.’

      The T-shirt beneath was ripped from the hem upwards and they both stared at the exposed, skinny chest for a moment as they assessed the chest-wall movement. Breathing was rapid and shallow. Then Guy pointed.

      ‘Look at that.’

      ‘Mmm.’ Jennifer gave no sign of being impressed at such rapid recognition of a life-threatening situation. ‘Paradoxical chest-wall motion.’

      As Digger breathed in and his chest wall moved outward, an area on the left side sank inwards. With an inward breath, it bulged outwards. The movement was subtle because of the shallow respirations but that did nothing to diminish its significance. Several ribs had been broken in two or more places, resulting in a section floating free that would seriously compromise breathing.

      Jennifer’s hand had gone straight to the area and she elicited a heavy groan from Digger as she stabilised the flail segment in an inward position.

      ‘We need some towels, or sandbags, or a pillow. And a wide bandage.’ Jennifer looked up to catch Guy’s raised eyebrow and an almost patient expression on his face. OK, so she wasn’t in her emergency department or even the back of a well-equipped ambulance. She could cope.

      ‘We’ll just use his arm as a splint, then. You do have some bandages, don’t you?’

      Having the arm bound to the chest wall to keep the floating ribs in place made the rest of the assessment of Digger’s breathing more awkward, but his respiratory distress seemed to be easing slowly. A faint pink tinge crept back into his skin and his level of consciousness was improving. Opening his eyes, Digger tried to cough but the attempt was weak and broken by an agonised groan.

      ‘Let’s position him on his injured side,’ Jennifer directed, lifting the stethoscope from Digger’s chest. ‘He’s moving air but breath sounds are definitely reduced on the left side. We want to keep his uninjured lung functioning as well as possible.’ She sighed. ‘I wish we had some oxygen. Or at least a bag mask.’

      ‘Welcome to the world of front-line emergency care,’ Guy responded. He gently eased an arm beneath the older man as he spoke, tilting him single-handedly towards his left side. Digger groaned again. ‘Sorry, mate,’ Guy said. ‘We’re just trying to look after you. We’ll get something for that pain as soon as we can.’

      ‘You’ve got morphine?’ Jennifer was pleasantly surprised.

      ‘Only a few ampoules, but it should help for a while.’

      ‘Should be more than enough.’ Jennifer nodded. ‘How long will it take for a rescue helicopter to get to us?’

      She didn’t wait for a response. Her patient’s airway and breathing were under as much control as they could achieve for the moment, and she wanted an assessment of his circulation. Picking up Digger’s wrist, Jennifer felt for a radial pulse. Frowning, she shifted her grip and tried again.

      ‘Barely palpable,’ she announced. ‘Have you got a BP cuff in that kit?’

      ‘No. We don’t have a defibrillator or a 12-lead ECG either.’ Guy was pulling his fleece-lined leather jacket back over Digger’s chest. ‘I’m afraid you’ll have to make do with good old-fashioned estimates. If the radial pulse is palpable, his systolic is at least 80, which is adequate for renal perfusion.’

      ‘Hardly adequate to administer morphine,’ Jennifer countered sharply. ‘And it wasn’t an unreasonable request. Sphygmomanometers hardly cost the earth these days, and many are quite small enough for any first-aid kit. I would have thought you’d use one often enough to make it an essential item even in a remote practice.’

      ‘My first-aid kit happens to be in the back of my four-wheel-drive vehicle and it’s perfectly well equipped, thank you. I keep one in Digger’s plane as backup simply because I often fly with him. The morphine’s not exactly legal with it not being under lock and key, but we needed it once and didn’t have it so we bent the rules.’

      ‘Oh.’ Jennifer didn’t bother to apologise for the incorrect assumption regarding Guy’s medical practice. ‘He’s a friend of yours, then?’

      The smile was fleeting enough to be no more than a ghost. ‘You could say that.’

      ‘Has he got any medical conditions I should know about?’ Jennifer was running her hands over Digger’s body СКАЧАТЬ