Sunday, 15 July 2007

Floppy

Eleven emergencies; Two assisted but not conveyed, one running call, one not required and eight taken by ambulance (including the running call). Three cancelled calls and a few quid earned for the LAS through ambulance requests for drunks.

First night of my three-night run and it starts immediately with a 20 year-old male ‘fitting’ at an underground station. He was lying on the platform, surrounded by underground staff and an off-duty nurse and doctor (I don’t know if they were a couple, fellow passengers or were on their way to an ‘off-duty medical professionals’ seminar). There was a crew with me; they arrived on scene just after I did, so there was little point in taking the lead as they would be conveying the patient, so I helped out with the basic obs and treatment.

The man had apparently collapsed and had a fit while waiting for a train – when his BM was checked it was 1.8 so that was probably the reason for his seizure. He was completely out of it and quite combatant so the possibility of him eating anything given to him was slight. We gave him an injection of Glucagon and waited. In the interim we had a quick look in his bag for evidence of diabetes and found his insulin and two bottles of Lucozade. I had already asked a member of staff to get something sweet for him to eat and he returned with a Mars bar (one of those double things that con you into thinking you are eating half the amount of chocolate but you end up eating both bits and therefore it’s the same as eating a giant bar – damn you Mars).

The man was recovering well and ten minutes into his treatment he was able to start chomping down on the chocolate and drinking the Lucozade. I nearly lost my fingers during the chomping phase. He still needed to go to hospital and we helped him out to the ambulance, although he was initially reluctant. He had fitted, so a proper check in A&E was in order, just to be on the safe side.

I went back to the car with Lucozade-sticky gloves and the other half of the Mars bar. He didn’t eat it and he didn’t want it – I asked him twice.

So I ate it.

What? Why are you looking at me like that?

From there I was sent a little further north to a suicidal 20 year-old who had taken an overdose. She hadn’t called; the 999 had been made by someone else who didn’t live at the address. I arrived and knocked on the door. There was no reply. I knocked again - still no reply. I was beginning to think that a bit of breaking and entering was required.

I peered through the letterbox and caught sight of movement and a door opening just in front of me. I shouted “ambulance” into the hallway and a young man jumped from behind the door. He had been in the toilet and was startled by my voice as he came out. He opened the door and gave me a blank look. It was clear he had no idea why I was there.

“Did someone call an ambulance from this address?” I asked

“No, I don’t think so”, he replied


“Is this number 20?” I have to tell you that I began to doubt that this was the right address. I’ve made this mistake a couple of times over the years; misread the number on the screen and gone to the wrong house – or street.

He scooted upstairs while I waited at the door – I didn’t want to be rude and barge in. In a few seconds he was back down, pale as a sheet, with another young man – also quite pale and I was ushered upstairs to a young girl’s bedroom.

The girl was slumped against the wardrobe, empty blister packs and pills scattered around her. She was incoherent and vague, although conscious and breathing, thankfully. I asked her what had happened but I couldn’t make out a single word she said. I only got her name by looking at the label on the pill packets. She had downed two bottles of wine with a cocktail of anti-depressants, sleeping tablets, antibiotics and (ironically) Pro-Plus. Her two friends (they all shared the house together) had no idea that she had done this and that an ambulance had been called. Luckily, she had been on the ‘phone to someone (I’m guessing an ex-boyfriend) and confessed her intentions, so he had made the call for her, although I noticed he remained absent from the scene.

The crew arrived shortly after I began my obs and my colleague found a suicide note, scribbled and almost illegible, on the dresser unit. I hadn’t noticed it but then I was kinda busy propping her up and keeping her awake...and desperately trying to understand her words. The crew had no better luck than me – they couldn’t understand a word she said either.

She was taken to hospital in a hurry (she had ingested over fifty pills) and I watched as the medical team attempted to communicate with her. She had tried this before; she had attempted to slash her wrists. Unfortunately, she had cut way too high up on her arm to have any more of an effect than scarring. She was crying out for something and if only we could hear what she was saying, she might get the help she needs.

Just up the road I attended an assault. A sixteen year-old boy had been set upon by a group of teenagers and kicked, punched and stamped on. I think stamping on someone’s head is the most hateful and disgusting form of assault. It really shows what kind of man (or woman) you are when you need to do that to someone.

He had run home after making the call on his mobile and I arrived to find him sitting with his family in the kitchen of their flat. He had a broken nose, a bloody face and a very clear boot print on his head. It had been a vicious attack and he was lucky to be conscious.

The crew had arrived at the same time as I did, so he was quickly taken to the ambulance for a proper examination. The police showed up as we were walking him out of his flat. He’ll be fine but his bent nose will be a permanent reminder of his violent encounter.

I managed to get back into the West End to witness a gang of up to fifty roller-bladers whooping and singing their way down the middle of the roads around Covent Garden. The first time I saw this lot a few of you educated me about the fact that they are organised and do this regularly – for fun and exercise. It looks fun but I wonder if I will be getting a call to a RTC involving a car and ten ‘bladers’, mown down by a blind and ignorant driver. Or a pedestrian with roller scars on the face and body.

I went into Soho to attend a 35 year-old man who had fallen and cut his hand on glass. In fact, when I got there I discovered that he was a homeless man who had been assaulted (allegedly) and now lay on the pavement with a deep cut on his calf muscle. His ulcer had been ripped open and there was a good deal of blood around – and he was HIV+ (the police on scene told me).

I cautiously dressed the wound and listened to him rant about being set upon for no reason then I called Control and asked them to inform the crew about his HIV status. He was stable and the blood loss wasn’t critical, although it looked dramatic, spilled as it was in large puddles on the pavement, much to the fascination (and disgust) of the passing public.

I ordered up some boiling water from a nearby pub to flush the blood away with (it disinfects and it was all I had to work with) and completed my obs as the patient became less aggressive. Then he refused to go to hospital. I tried several times to persuade him and the police had a go too but he was adamant. He told me that he didn’t care anymore and that he just wanted to crawl into a corner and die. He said his life was worthless now. I couldn’t say anything to make any difference so I gave up the fight to get him to go. I cancelled the ambulance and he got up and staggered off. I left the scene when I had completely cleaned up the blood spills. One day I will see him again.

Off to the east for a hyperventilating female who didn’t need my help and was happy to sit in the ambulance for twenty minutes with her happy friend. She went back to her house (friend in tow) after ‘treatment’. I chatted to them, had a laugh and sat in the car ‘til I was the only one left.

A call for a 62 year-old with chest pain and unstable angina turned out to be a frequent flyer that I hadn’t personally dealt with for some months. I recognised him as soon as he came out of the phone box. He was still on the line with the LAS call taker, so I asked him to come out of the box and told the call-taker that I had arrived and was dealing.

This man is very aggressive and demanding. He had no chest pain and claimed he needed his prescription re-filled. He wanted to be taken to the Royal Free hospital, which is out of my area. He was very loud and in my face for most of the conversation ‘til I cancelled the ambulance and told him to get a bus to the hospital of his choice. He wasn’t happy.

I know I had a short break at some point but I can’t remember it.

Soon enough I was off to a train station for a ‘20 year-old male - unconscious’. I arrived to a lengthy report given to me by a random young man who had helped out when the guy had collapsed. There was also a PCSO present and he tried to give me details as well. I noted the young man was more interested in chatting up the two girlfriends of the unconscious (drunken) man on the ground.

“Thank God you were here to help us”, they said

“That’s okay. I’m like that, I help everyone”, he replied

I thought I was in a B movie.

I waited 30 minutes for an ambulance. It was extremely busy tonight and drunks were not being given priority. The unconscious man was completely out and I had him up on fluids and packaged to go by the time a crew got to me. He was now cold but responsive (a little fluid through the veins will usually wake them up). By the time he was being loaded into the ambulance, he was aware of his situation and embarrassed by it.

During that job my car was attacked by a loony drunkard who decided it wasn’t a good enough ambulance for his fallen comrade. Then he turned on me. The attending PCSO’s made short shrift of moving him along.

Another ‘drunk on a bus’ call – except there were two of them! I went aboard and picked on the smaller of the two but he lashed out at me almost straight away. I avoided a punch to the face by inches. I went over to his mate, who was lying in between the seats on the floor. He was no better. I threatened the smaller guy with the police if they didn’t get off the bus (I had stopped saying please and sir) and this seemed to have an effect. He got up and began to rouse his rather large slumbering mate. They were both Polish (and I wasn’t shocked to hear that) and he told me that his large friend was ex-special forces. Uh-oh.

It took five minutes and a really good kick (from his mate, not me) to get Mr. Special forces up off the floor. He rose to his six foot or so and glared at me as he was led from the bus. I let him have a bit of space. I’m nice like that.

The crew arrived as they left the bus and the police never came.

Meanwhile, in Leicester Square, I was asked to help with a drunken female who had gone off the rails by mixing booze with her antibiotics. She was unwilling to co-operate and vomited frequently in the direction of my boots. Her gang of concerned friends became a real pain as they jostled and harried me about the delay in getting an ambulance to her. I had another half hour wait.

Just after that job, I was sent around the corner (or bend, depending on your perspective) to a hyperventilating man in the midst of a panic attack for no reason other than ‘he is sensitive’. There was a tired looking PC with him and we both sat patiently calming him down until the ambulance arrived and took him away.

My shift ended with a horrible call. A two year-old was having a fit and there were no ambulances available to deal yet, so I was on my own with this one. Usually these things turn out to be nothing more than febrile episodes but not this time.

I couldn’t find the address (it was one of those estates where nothing makes sense) and I asked for the caller to wave out the window or signal somehow. I was told that someone would meet me outside, so I drove in the general direction of the block of flats and saw a large African woman running towards me – with a fitting child in her arms. This, I didn’t need.

I pulled over and immediately took the child from her. I had no choice but to lay the little girl on the back seat of the car and I knew I was going to have to treat her there. This was not good. Never, ever bring your critically ill child to us – we will come to you.

The girl was still fitting and had been for half an hour. There was no ambulance yet and I quickly called Control and asked them to direct the crew to my exact location while the mother stripped off the child’s nappy and clothing at my request. I have to say that I wouldn’t have been as calm as this lady appeared to be. She either didn’t know just how bad things were or she had supreme confidence that I could fix it.

I gave the child rectal diazepam without delay. Her temperature and BM were normal but her sats were plummeting (currently below 85%). I gave her oxygen and thought about my next move, which had to be decisive – there was no time to lose here. She had no medical history for epilepsy, so the cause of her fit was unknown, although I did notice how loose and foul smelling the contents of her soiled nappy were.

As I mulled over the next move (whether to take the child myself or not) the ambulance arrived but not at my location – they were across the street. I grabbed the child and ran to the vehicle before the crew had time to get out. I explained the situation, gave my initial obs and told the paramedic that I had given diazepam. The three of us then got to work in earnest. I put a line in and a second set of obs were completed. Why this child was fitting was still a mystery.

During the second set of obs, she stopped fitting but her breathing became progressively depressed. I was concerned about the effect the diazepam may be having, so I let the crew get on with it and I prepared to follow in the car. Meanwhile, the mother had disappeared back to the flat. She hadn’t asked what was happening and she didn’t seem concerned in my opinion. The crew couldn’t wait for her, so I got her into the back of the car (when I had tracked her down) and took her to hospital, travelling behind the ambulance all the way.

The child had deteriorated when we arrived; the attendant was ‘bagging’ her to support her breathing when the trolley bed was taken out. This concerned me. I followed them into Resus and watched as the paediatric team worked on her, continually supporting her airway and breathing. She was floppy. Her eyes were open but she wasn’t there.

I handed my report over and left to go back to my base station. My shift was ending in 20 minutes but I was in no mood for another ‘routine’ job. I asked the crew who had helped me to let me know how the little girl got on (if she survived or not is what I meant) and gave the paramedic my mobile number. He promised he would let me know the next day.

I went home shattered after that job and I mulled it over all through my ‘sleep’.

I got a call from the paramedic the next day as promised. The little girl pulled through. She had an infection and this had caused the fit. The diazepam had nothing to do with her respiratory change.

Be safe.

9 comments:

Just About Existing said...

quote I got a call from the paramedic the next day as promised. The little girl pulled through. end quote

Thank god for that - and well done :o)

I went all cold when you were describing what had happened in the car. That must of been horrible to witness

JAE xx

petrolhead said...

I'm so glad the child made it. That job must have made you feel good about yourself, and so you should.

Is it easy for you to find out if a patient of yours recovered or not? I imagine it must be hard leaving them and not being able to get any closure. (I hate that expression, but it's the best way to describe it.)

Erik said...

Excellent work with the fitting child! You got the seizure to stop with the diazepam, hopefully before serious permanent damage to her brain occured.

Why is it that most of the really serious incidents seem to happen at the end of a shift? At least for me, most of my critically ill patients seem to arrive when I'm sleep deprived and hungry after 16-24 hours of on-call duty.

BTW, I've enjoyed reading your blog for some time now. I'm a finnish MD, specializing in anesthesiology, aiming for a subspecialty in emergency medicine. I have a deep respect for all paramedics, your skills and attitude save lives every day!

gjmoomin said...

Glad the little girl made it. When people try to put the ambulance service down I just wish they would realise just how competent you guys have to be, swinging from a drunk to a dying child and you have to know what to do and quickly. Congratulations on staying sane.
As always, take care. Gill

caramaena said...

I'm so glad to hear the little girl survived.

Xf said...

erik

Thanks for that. I often wonder what it is about the end of shift phenomenon. Most of my trickiest jobs have been at the end of the shift, likewise when I am tited and just want to go home but I think it has sharpened my skills, so that must be a good thing.

Nice to have you aboard. Thanks for reading!

Xf said...

petrolhead

Thank you. I too was very relieved about this child - that's the second one this year.We don't get much feedback unfortunately, so I had to rely on my collegue and he called me as promised.

Xf said...

Thanks to all of you who commented on the little girl's recovery.

:-)

Matthew said...

Just to let you know, your short shrift link is broken. You need to take a "http//" out from the beginning.