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‘Such as?’

Bryony looked again, determined not to miss anything. ‘The trachea is deviated to the right. The aortic outline is blurred and the aortic knuckle is obliterated.’

‘What else?’

‘It’s cloudy.’ She peered closer at the X-ray. ‘I haven’t seen that before. Is it a haemothorax?’

‘Full marks.’ He gave her a lazy smile but his eyes glittered with admiration. ‘She has a right-sided haemothorax caused by a traumatic rupture of the thoracic aorta, which is currently contained. In this case we can see it clearly on the X-ray, but not always.’

Bryony looked at him and felt her heart thud harder. The patient was lucky to be alive. ‘So what happens now?’

‘She needs urgent surgical repair. In the meantime, we need to give fluid cautiously, otherwise the adventitia could rupture and she’ll have a fatal haemorrhage.’

‘So presumably we also need to give her good pain relief so that her blood pressure doesn’t go up?’

His eyes rested on her shiny blonde hair and he shook his head solemnly. ‘Amazing.’

She poked her tongue out discreetly and he gave her a sexy smile that made her knees wobble.

Fortunately, at that moment the surgeons walked into the room and provided a distraction. They all conferred, agreeing to take the woman to Theatre right away for surgical repair.

‘So what exactly do they do?’ Bryony asked Jack after the woman had been safely handed over to the surgeons and they were left to deal with the debris in Resus.

‘Depends.’ He ripped off his gloves and dropped them into the bin. ‘They’ll attempt a surgical repair.’

‘And if they can’t repair it?’

‘Then they’ll do a vascular graft.’

Bryony helped Nicky to clean the trolley. ‘But what made you suspect an aortic rupture? I always thought patients died at the scene of the accident.’

‘Well, if they’re alive it basically suggests a partial injury,’ he told her. ‘It’s often hard to diagnose on X-ray. A widened mediastinum doesn’t necessarily indicate an abnormality. But in her case there were other classic chest X-ray signs and she had clinical signs too. The neck haematoma, asymmetric BP and chest pain.’

‘And if the X-ray hadn’t been clear?’

‘I would have talked to the consultant radiologist and we would have done a multi-slice CT scan. It’s worth finding out as much as you can about the details of the accident. The paramedic told us her car had been hit on the driver’s side. A significant number of blunt traumatic aortic ruptures are caused by side impact.’

Bryony stared at him in fascination. ‘What’s the pathology?’

‘Basically a sudden deceleration such as a fall from a height or an RTA allows the mobile parts of the aorta to keep moving. It usually tears where the aorta is tethered to the pulmonary vein—’

‘The ligamentum arteriosum,’ Bryony intervened, and he rolled his eyes.

‘If there’s one thing I can’t stand, it’s a brainy blonde,’ he drawled, and she clucked sympathetically.

‘If I’m threatening your ego then just let me know.’

‘My ego is shivering,’ he assured her, his blue eyes twinkling as looked down at her. ‘What do you get when you give a blonde a penny for her thoughts?’

‘Change,’ Bryony said immediately, tilting her head to one side. ‘Why is a man like a vintage wine?’

Jack’s eyes narrowed and his mouth twitched. ‘Go on…’

‘Because they all start out like grapes,’ Bryony said cheerfully, ‘and it’s a woman’s job to tread all over them and keep them in the dark until they mature into something you’d like to have dinner with.’

Nicky gave a snort of amusement from the corner of the room and Jack grinned.

‘That’s shockingly sexist, Blondie.’