Wednesday, 15 August 2007

Mechanisms

Twelve emergencies; one assist-only, two refused and nine taken by ambulance.

Mechanisms. I’ve used the word many times throughout this diary. The word describes the causes for injury. For example, if someone falls 20 feet onto concrete, the mechanisms for injury include the height, the landing surface (and its ability to absorb energy) and the person’s body and state of health, among other things. If you were to show a REAL interest and it was relevant, you might also look at objects on the way down, the weather and other things that may influence injury but we rarely have time to be that scientific about it.

Medical emergencies also have mechanisms; the pills a person takes or doesn’t take, the state of a person’s heart when they have chest pain, etc. Every tell-tale sign or symptom is a lead to a potential mechanism.

My first call of the day was to a 33 year-old man who had come off his bicycle at speed while going downhill. A wall had abruptly stopped him and he had gone over the top of his handlebars at around 30 mph. Now he was sitting on a step outside his home with a friend a few hours after the incident. He had decided it wasn’t worth an ambulance at the time and had simply hobbled home.

His main complaint was that he felt dizzy and faint. He also had severe pain in his shoulder and ribs on the same side (the side he had landed on). He had a tender spot on his cervical spine at the level of his mid-neck. His breathing was rapid and his BP was low. He hadn’t been knocked out and there was no visible bleeding. The mechanisms, however, suggested a possible neck injury, a possible fracture to his upper arm and ribs and the possibility of an internal bleed. So, he was treated for all of those.

I asked him to lie flat on the ground (which helped him feel less faint) and held his head so that he couldn’t move his neck. The ambulance arrived at that moment and I explained the situation to the crew. The man was immobilised on an orthopaedic stretcher (a scoop) and taken to hospital for further investigation. His mate was left behind wondering what the hell had just happened.

My next call was to a 20 year-old female with a history of anaemia who now felt dizzy and complained of her ‘throat swelling’. I couldn’t work out whether she had eaten something and was now having a mild reaction or she was relating two different problems to me; her anaemia-induced dizziness and the fact that she had reacted to something. When I carried out my obs, she seemed absolutely fine and had no history for anaphylaxis. The call had come in as a ‘DIB’ but she was having no difficulty with her breathing at all.

She was taken to hospital anyway. If she had reacted to something it was possible she could relapse.

Choking children present one of the worst scenarios for us. This call was for a one year-old boy who was ‘choking and vomiting’. I arrived with the ambulance at my heels and we all entered a small, dimly-lit flat together. Inside a woman was sitting with a child in her arms. He looked perfectly happy and was active and playful. I asked if this was the child who was choking and she said 'yes'.

On the bed, there was a little mound of vomited food and an benign object that caused the whole panic in the first place. It was a large, badly cut piece of apple. Apples are notorious for causing choking in small children, they get stuck in their little windpipes and are difficult to get back out again. In this case, the child had vomited in distress and the apple core had been forced out with the pressure.

I checked the child over and could find no reason to take him to hospital; he had cleared the obstruction himself and was now fully recovered. I asked the mum if she was happy to keep him at home and she said she was.

‘Can I still feed him?’ she asked

‘Well, yes but I wouldn’t advise anything but liquids at the moment.’ I replied

Let’s not tempt fate, eh?

I was sent to an underground station for a 32 year-old man who had collapsed and was vomiting. He was, of course, extremely drunk. He was taking a cocktail of drugs for gout and back problems, none of which deterred him from downing as much alcohol as his body could possibly hold – ‘I think I’m an alcoholic’, he said apologetically. I agreed with him.

The crew arrived and a chair was wheeled out for him.

Meanwhile, the beautiful people of London were hurrying past us in their suits and dresses, on their way to happier places where people don’t lie in their own vomit until well after chucking out time. The man painted a pathetic picture of his future history and everyone passing him knew it, judging by the looks of pity and disgust he was receiving...or maybe they were looking at the men in green.

No break yet and off to see a 27 year-old male suffering abdominal pains at home. He had a history of Hep B and was complaining of a burning pain in his stomach. It could have been an isolated gastric problem and nothing more but he had taken an antacid with no relief and had not vomited or experienced heartburn prior to it. His medical history meant that he could suffer all sorts of complications arising from liver disease and there was a palpable lump on his abdomen, directly above that organ, so he went to hospital for further investigation.

I got back to my home station for a cuppa and a short rest before being sent up north for a 25 year-old man who had allegedly been pushed down a flight of stairs by the doormen at a club. I couldn’t find the place because I had an approximate location on my navigation system, so I tail-gated a police van that I felt sure was running to the same call. Of course, I ran the risk of ending up miles from the job but I was willing to take it. Luckily, they pulled up in front of the club I was heading to.

There was an ambulance already on scene and I wasn’t required. The young man was conscious, alert and appeared to have no significant injury, regardless of the fact (which couldn’t be proven) that he had been pushed down stairs.

Back in Leicester Square I found myself hovering over yet another drunken female who had vomited all over her clothes and for whom all glamour and excitement of the evening out had evaporated. She was in a mess but insisted she was alright. A police officer stood over her and was ‘guarding’ her when I arrived. She had a low temperature and a low BM (although she wasn’t known to be diabetic) but this combination is common when too much alcohol is taken.

The crew arrived and swept her off the pavement and into the ambulance. She would spend the night in hospital, vomiting and crying about the injustice of it all.

My next call, immediately after this one, was to a collapsed female. I was being directed to a bus stop at the Aldwych. This strangely shaped road runs straight until you get toward The Strand, where it becomes an arch before straightening out again. It reminds me of an aneurysm.

There are a LOT of bus stops in this road and, although I was given the bus stop number, I couldn’t see it for...buses. So, I had to crawl from one to the other. Then I was waved down by a young lad who was sitting with a seemingly collapsed person next to him. He was holding this person up. I stopped, got out of the car and approached him but he gave me a stupid grin that warned me I had been set up.

‘Did you call an ambulance?’ I said

‘No, but my mate is drunk’, he replied

‘Why did you wave at me to stop?’

‘I was just saying hello’

Arrgh!!!

So, I started the whole search all over again until I met up with the assigned ambulance crew and we searched together. Eventually, a windmill directed us to a collapsed woman, lying in her own vomit. She had been drinking all night and couldn’t get home without falling down. Her ‘friends’ had abandoned her to this fate.

A noisy basement club in Soho next for a 19 year-old pregnant girl who fainted. The noise and heat were incredible in the pits of this place, so I wasn’t surprised she had passed out. She refused to go to hospital and promised me she would see her GP in the morning. She signed my form and I watched her make her way home with her boyfriend.

I stopped at a shop to get something to eat and was accosted by a lunatic who demanded I call the police or he was going to beat people up. He was threatening two of the staff from the shop I had entered. He seemed to mean business, so I asked for police to attend and waited in case he decided to make real his threat. In the end, he was all talk and no action. The police arrived and calmed him down.

I got a break after this and made my way to sanity and a cup of coffee (and a sandwich...and chocolate). There was nobody else on station; it’s still busy out there and the ambulance crews are working flat out, mainly to recover the human detritus produced by alcohol.

My next call was for a 30 year-old male with ‘cuts to arms and neck, ? cause’. It was an amber, so I had plenty of time to get there but when I arrived I found a young man collapsed on the floor of a petrol station with two very obvious and very deep stab wounds to his arm. He also had nicks in his neck where attempts had been made to stab him in the throat. One of the fingers of his hand had been sliced open, probably as he tried to defend himself, and he had a bloody mouth, where he had been punched or kicked.

He was stable at the moment and his obs were normal but he said that he had been attacked by two or three men at a club and couldn’t remember what happened. He had probably been knocked out, so there was always the possibility of hidden injuries, including a head injury. Young people tend to cope well with injury until the last possible moment, and then their compensatory mechanisms fail. I wasn’t prepared to take that risk with him, so when the crew arrived, I had him ‘blued’ into hospital.

A rude 26 year-old next – she stormed off as I tried to help her in the early hours of the morning. Her boyfriend had called an ambulance because she had collapsed in a drunken heap at a train station. She wasn’t happy with him but took it out on me instead. She didn’t care a jot who I was, what I represented or why I was there.

My shift ended with a ‘not required’ when I arrived on scene for an 82 year-old with DIB. The crew were there and I could go home, so I did.

Be safe.

14 comments:

John said...

Hyperglycaemia after drinking is common? In hospital, I think I've only seen hypoglycaemia from drinking, as the alcohol suppresses the liver and prevents it from releasing glycogen...

Xf said...

John

Oops! Her BM was low, not high...duly amended and well spotted!

PeskyResponder said...

Nice to know, I personally would have thought drinking would have caused 'Hyper' due to the high sugar content of most alcoholic drinks.

I still find it amazing how many shouts you get per shift.
I have been on 3rd manning shifts where we have only had 2 shouts in 1 shift!

Garth Marenghi said...

"there was a palpable lump on his left abdomen, directly above that organ"

whoops posted on wrong thread, right one now, which organ are you referring to here?

Xf said...

peskyresponder

LAS is the busiest ambulance service, so ten to twelve calls per shift is not unusual.

Some drunken patients present with HYPERglycaemia but their glucose levels depend on whether they ate before drinking. If you drink on an empty stomach, your body cannot release stored sugar for you when levels drop (alcohol inhibits the mechanism)

Xf said...

garth

His liver.

Anonymous said...

"LAS is the busiest service"

Being busy is a relative term. Although the service I work for (NEAS) has less calls per shift, we have significantly less vehicles and staff with which to respond. We also average 10-14 jobs per shift from my station, per vehicle.

Anonymous said...

I've sent a link for your blog to the Prime Ministers office, to illustrate the damage alcohol is doing to society. Maybe he'll read your blog? Maybe he'll take some action? Hmm.

Xf said...

anonymous1

I wasn't blowing the LAS trumpet but it is the busiest ambulance service in the world (in the FREE public sector) with over a million and a half calls per year.

Obviously, other services can be just as busy in relative terms - that statistic may just mean that LAS cops all the rubbish stuff!

:-)

Xf said...

anonymous2

Thanks but I have a feeling I won't be hearing from Mr Brown in the near future about this problem. Your heart is in the right place though...

Anonymous said...

Good blog this.
Now, apropos of nothing really, just a need to share something with a wider, similar minded bunch out there, I would like to relate briefly the following 2 items which highlight to me the obscure and sometimes bizarre way that some people make an assimilation of a situation and then come out with a completely inappropriate statement, people who are intelligent and maybe should think before they speak!
1) A colleague recently attended a light aircraft crash (engine failure at 50ft) from which survived a consultant orthopaedic surgeon. He had a severe scalp wound and partial debridement of his skull. He was sitting in a nearby helicopter(on the ground). My colleague approached to make an assessment and the injured consultant orthopod stated: "I think may have a fractured lumbar vertebrae! But I'm not going to be put on a longboard though, I'll be ok, I can walk!"
He was put on a board and collared, needless to say.

2) A trainee technician I had been mentoring was making an assessment of a patient found in a collapsed state in a hospital carpark at night. The patient was wearing pyjamas, the trousers of which were around his ankles. He had a urinary catheter in-situ and a partially empty bag of fluid was attached to his left arm. I heard the trainee, as part of her questioning, say to the patient, "Are you visiting someone"?

Maybe they weren't thinking.

nuff said?

Anonymous said...

Liver?? On the left abdomen?? I've just checked with the British Liver Trust (sometimes one can doubt ones own certainty) and it is mainly on the right side of the abdomen with the upper lateral surface just below the diaphragm centrally

Dont let Crippen get you!

Xf said...

anonymous

The word LEFT should not even have been in the paragraph! This is the problem with 'live' writing, expecially after shiftwork, the eye can miss problems even when it is staring right at them.

As for Dr. Crippen, I'm sure as a seasoned blogger, he understands how easy it is to make mistakes!

Thanks though, 'cos without sharp-eyed critics I'd look like I haven't got a clue.

Incidentally, when editing for the book I found dozens of little spelling errors, omissions and additions. Writing so much in a short period is obviously easier said than done.

PeskyResponder said...

xf,
thanks for clearing that up for me.
I wish I could come and 3rd man for a couple of days with LAS!
I assume you dont have responders up there?