Monday, 5 February 2007

The sad and the strange

A routine (but never run-of-the-mill) few shifts. Early starts, which I prefer, with a few decent spells of sunshine. It was sunny enough and warm enough on Saturday for the tourists to come back and flood Central London. It was extremely busy and it felt like Spring had arrived - in February! That's global warming for you.

I dealt with a number of varied calls over the weekend. A elderly skater who fell hard on the ice and broke his humerus. He was with his grand-son and this was one of the things they did together. It was a significant break and the mid-shaft of his upper arm kept 'wobbling' around when he moved. I told him it was probably best not to move and he agreed.

The humerus is the upper arm bone and we tend to call the extremity, at the elbow, the 'funny bone' but there is nothing funny about breaking it. It can be extremely painful and dangerous; nerves, muscles and large blood vessels can be involved. I was asked to assist a PTS (Patient Transport) crew that had been assigned. They had tried using entonox for the pain but it hadn't touched it, so I offered him morphine, which he gladly accepted. The drug had some effect but he was still in pain and moving him, with his now immobilised arm, was tricky. His grand-son, meanwhile, was enjoying the drama!

Earlier on I attended a bus vs. pedestrian in which the young man sustained a deep head wound when the bus hit him as he was stepping from the pavement. He was Italian and was probably looking the wrong way when he stepped out. Or not looking at all. He was also complaining of chest pain and a witness stated that he had fallen hard onto the pavement after the fight with the bus. This may have caused a chest injury and it was entirely possible, given that his pain became increasingly worse and widespread, especially on breathing, that he had developed a punctured lung (pneumothorax). A broken rib is all it takes sometimes. The condition isn't necessarily life-threatening but can develop into a more complicated problem if left unchecked, so he was rapidly transported to hospital - no staying, no playing.

A drunk with a great deal more confusion and disability than would be expected prompted a call for a possible CVA (stroke) and I did my best to communicate with him but the alcohol, or the intracranial pressure, was working against me and all I got was slurred English, which sounds like heavy Scottish and since I have been down here so long I find it difficult to translate either!

A strange RTC in which the casualty lay in the middle of a busy roundabout, complaining of a thigh injury. Witnesses, including the driver of the car who knocked him off his bike, say the collision speed was no more than 10 or 15 miles an hour and that he had not made contact with the car at all. Initially, he wouldn't even speak to the crew on scene and only started chatting when he was being treated. He got the whole nine yards: collar, blocks, scoop but I have my doubts about whether he will benefit from it.

Old people who have sad stories always bring a tear to my eye. An elderly gentleman had called us because he had chest pain. It turns out he has a chest infection and is alone. He told me that his wife had died late last year. They had been married for over 5o years. He told me he missed her terribly. I was thinking that, in my experience, the elderly don't tend to hang around too long after losing a significant part of their lives. Even a chest infection would be a good excuse to follow a loved one. I'm willing to bet that those of you who work with the elderly have seen this too.

Then Mr. Swollen Tongue (not his actual name) presents himself to me after calling 999 for 'allergic reaction'. Sure enough his tongue is swollen and sure enough he has a letter from hospital listing his meds for an allergy to a specific drug he was taking but there is no emergency protocol for him and he is homeless and shivering and hungry, so he needs to go to hospital for those things at least because no-one else gives a damn about him. The crew turn up and oblige because they are nice people and they care.

I think I saw a rare case of dystonic reaction, where the muscles become tense and uncontrollable as a result of a reaction to (usually) medicines or drugs. The man was lying on his bed with his toes curling inward (first thing I noticed) and a certain overall rigidity about his body. If he stood up, which I asked him to do, his back arched abnormally as if he was about to dive into a pool for Olympic points. It is a strange problem and I have only ever seen two or three cases. I gave him a little bit of Diazepam and he relaxed. His rapid heart rate also began to settle and off he went to hospital. I didn't go in with him so I don't know for sure that my diagnosis (or opinion if you prefer) was correct but he was treated and conveyed appropriately and that's good enough for me.

There's a guy who walks through Leicester Square and Covent Garden doing a particular dance routine. He carries a long stick and he will march forward a few steps, stop, turn around, point his stick in front of him and then continue a few more steps. He stops, spins, walks backwards and then points with his stick over and over again. It's his routine and although everyone stares at him as he passes, he is generally left alone. I have seen him four or five times now and his eccentric behaviour always makes me smile. People like that are not mad and they are not a problem. People like him are on this Earth to ensure that we never forget that life is not that bad and shouldn't be taken too seriously all the time. If I get one smile out of my day then I'm perfectly happy.

Haven't heard from anyone, except by email, for a few entries. Let me know if there is a problem with this new commenting system. Otherwise, why aren't you talking?

Be safe.


mitch said...

lurking but still checking in daily

Anonymous said...


im a lurker.

ZebedeeZBD said...

Because we're too busy listening?

Xf said...

Fair enough.

Anonymous said...

hi big man.
check in most days but beleive this is the first comment i've left. Great blog. I'm halfway through my probation year at one of the busiest stations north o the border. Loving the job and enjoying your posts from London town. Glad to know i'm not alone with the, aherm, "swally-heids"! Keep up the good work fella.


gjmoomin said...

Reading avidly as ever, but also too knackered to bother with the rigmarole of commenting! Those of us who work with the elderly agree with your observations whole heartedly. I left work very late on saturday thinking nursing stinks and old age sucks, guess I didn't have my smile moment of the day. I can usually find one (even if its crude as nurses tend to be- given the job) Enough! Take care. Keep smiling. Keep writing Please. Gill

Xf said...

Thanks Yorkie. Nice to hear from you. I think my blog is rare in that more people seem to read it than comment but that's ok as long as I haven't become boring!

Good luck with your career. This is a great job to do, whatever some may tell you.

Xf said...

Gill. Sorry to hear you have had a crap day. I'm with you on that too, I have had a few less than good moments on my last few shifts.

Keep smiling. If I can, so can you.


Anonymous said...

I check in with your blog every day. I'm about to start (two weeks time) with an ambulance service in Australia as a student ambulance officer.

ecparamedic said...

I think our local chap with the dystonic reactions died a while ago, a very strange and frightening affliction.

I've been having problems posting on 'Blogger' sites, my password is continually rejected. I see I now have the 'other' option now, obviously if you can read this, it worked.


caramaena said...

I'm not certain about your blog, but I have had problems getting into the comments on some of my other favourite blogs in the past two weeks. Then others I could get into the comments but after trying to leave a comment it would give an error.

It seems to be ok now but I didn't bother commenting on a lot of posts for a while.

Petrolhead said...

I'm also a lurker, but I love your blog! I'm becoming addicted, so you'll probably hear more from me. :-D

olivia said...

I'm a lurker, but love your blog and check it every day! Please keep writing.

Anonymous said...

Still reading with interest here! Ochil5

Anonymous said...

Hello Mr Paramedic! I read your blog every couple of days as I have done from day one!! Keep 'em coming please!!

Fooyum :-)

Gix said...

Just found this site. have read it with interest. I to work in the pre hospital field. Perhaps this being a small world we'll bump into each other one day.

Xf said...

Thanks to you all. Nice to know you are all still out there. Some of the regular names are missing so I hope everyone is ok.

I have to tell you all that I am going to be very careful about what I say when I write because I need to respect the feelings of my colleagues. This shouldn't affect my view but it means less detail in some cases I'm afraid. I hope you understand.

Anonymous said...

Still here and enjoying your blog tho' have had to time ration my internetting recently due to work.

Unlike you I hate early starts. I am an owl forced to work as a lark which plays merry hell with my body clock.


Anonymous said...

About dystonic reactions -- as a nurse who once worked on a psychiatric unit some time ago (I'm retired now) -- I remember giving patients Benadryl 50mg IM when they suffered from this affliction, usually as a result of taking psychotropic medication. Benadryl (or any antihistamine, I assume) worked like a charm, I guess because the dystonia is an allergic reaction to psych meds. Just thought you'd like to know. I enjoy your post.

Xf said...


Thanks for the information.

Unfortunately, we are given no tools to deal with this affliction. All we can do, as you have read, is treat what we see and what we are led to believe is going on. This was reported as epilepsy and he was being treated with diazepam, so that's what I chose to also worked because it relaxed the spasm. I can see your point though.

Shame we can't be given more specific treatment guidelines for this problem but we aren't.