Friday, 31 August 2007

Something and nothing

I wanted to go to this but I couldn't find it...

Ten emergencies. One taken to work by request, one assisted-only and eight taken by ambulance to hospital.

An early call for a 34 year-old man who had fainted and made his way to a hospital when he recovered. The hospital has no A&E department, so I was asked to attend and I found him sitting in the reception area looking very pale and tired. He had no significant medical history but he hadn't completely got over passing out and still felt dizzy whenever he stood up.

The crew arrived soon after I had started my obs and he was taken to another hospital for further investigation.

My next call, for a 25 year-old female with dizziness and chest tightness was easy - there was a crew on scene when I arrived, so I wasn't required.

Another faint, this time a 33 year-old female who was on her way to work when she collapsed at a tube station. She had fully recovered by the time I got to her and she insisted that she didn't need to go to hospital. She hadn't been sleeping well and was packed to go on a weekend break after work, so she was probably just exhausted. I gave her a lift to work and she seemed right as rain when she got out of the car, wheeling her suitcase along the road to her office.

A local job at an address just around the corner (literally) from a hospital next. A 50 year-old male had called to say he had collapsed outside his flat. After that there was no communication with him; he wouldn't answer his 'phone. Calls like this can be nonsense or they can turn out to be serious, so the crew and I stood outside the locked street door and buzzed every flat until we got an answer.

'London Ambulance, can you let us in please?'

'No', said the woman's voice

'We have an emergency call to this building and need to get in'

Nothing. Then a click. She had hung up.

We tried that buzzer again and again while we waited for the key holder to arrive but the woman refused to reply. She wouldn't even come to her window to look out onto the street and verify who we were!

Eventually, we gained entry when the key holder (who arrived without his key) let us in using a free code. A woman from the same department arrived just as we let ourselves in and made our way to the lift - fully equipped for a possible resuscitation.

'Do you know this man?' I asked the woman

'Yes, he has health issues', she replied

I thought I recognised the tone of her answer.

'Is he an alcoholic?' I ventured

'I think so’, she said

I could almost predict what we were going to see from then on.

The lift shuddered to the relevant floor and the doors opened. We could all smell the booze. We walked to the corridor where the flat was located and he was lying on the floor outside his flat, unlit cigarette in hand and cans of lager strewn around him. He was the perfect patient.

'What's wrong with you?' we asked when we got close

'I'm locked out' he replied

I left the crew to deal with him and made my way back. The lift door had a child's boot print on the doors, almost as if s/he had walked up the length of it. 'Spiderkid, Spiderkid....'

Paying your taxes means you can rely on a swift and altogether over-the-top response if you give the wrong details to the call taker. My next patient was a 54 year-old female who had called us claiming chest pain. She was at work and we descended on her in full force; me, the motorcycle response unit and an ambulance crew. Turns out she had back pain. Not chest pain, back pain. Even I find it embarrassing when we overload a job like that.

A young panicky male next. He was at work too but for some reason collapsed in a heap of emotional hyperventilation before his day had even started. I had to extract him from his cuddling colleagues to calm him down - he was soaking up too much sympathy. He recovered in the ambulance and went back into work. He had done it before and he will do it again.

The next call reminded me never to be complacent about patients, regardless of how they look and act. A 45 year-old male with severe DIB outside a hostel had me reeling a little from the smell of him. He was not well toilet trained and had been sleeping in his own filth for days. He stood outside the building gasping for air and, incidentally, gasping on a cigarette. He begged for something to help him breathe but he refused to put his fag out, so I couldn't give him oxygen.

He had been hit by a car the previous week and sustained a shoulder injury. He had been discharged from hospital and limped around for days doing drugs and smoking cigarettes (and not washing at all). Now he was struggling to breathe and he wasn't acting. He stopped smoking after my tenth request, which was firmer than the previous nine. He chucked the ciggie, staggered forward and complained of a sharp pain in his chest. His colour wasn't good but then it's difficult to assess with someone whose lifestyle drains energy from every cell in their body.

The ambulance arrived as I gave him that much needed oxygen and he was transferred on shaky legs and a walking stick as swiftly as physically possible. A proper check was carried out and he was taken to hospital, which was literally one minute along the road. His sats had never improved above the high 80's without oxygen, so we were taking him seriously, despite all appearances.

I left the hospital as soon as the crew delivered the patient because I had another call to attend but I learned later that he had been diagnosed as having a pulmonary embolism (PE) - a potentially life-threatening problem. It probably developed after his accident; it could have sat in one of his large veins as a thrombus before tearing off into his circulation (embolism) until it found an artery too narrow to squeeze through. By chance, that happened to be an artery in his lung (pulmonary). Thank God for two lungs then, eh?

A 23 year-old female who was reportedly suffering a panic attack and had pins and needles in her arms may in fact have been having an allergic reaction. She had a swollen tongue and a rash developing on her neck. She scratched her way through my initial obs as she sat in the staff office of a tube station - she was also tearful and very worried about 'not being able to breathe properly'. Needless to say she was taken to hospital quickly - just in case.

After a lull I visited a 12 year-old boy with severe physical disabilities that I had treated three years ago. He is prone to epileptic fits and the last one I dealt with was extreme - he needed airway support all the way to hospital. This time his fitting was bad but his airway was patent. He recognised me through the seizure and was able to communicate with his eyes. I gave him a top up of diazepam (his mother had already given him some but with no effect) and when the crew arrived we bundled him out of the house and into the ambulance. I grabbed his favourite soft toy for him but it got left behind somehow in the mad dash to move him before he deteriorated. Poor mite.

Finally, a 48 year-old female who fainted twice in quick succession. The call originally came through as a single fainting episode in a bar and it was cancelled because she recovered on scene. However, I received it again because she had fainted a second time.

When I got on scene, she was recovering but very pale and unsure. Her BP was lousy, so I got her to lie down while I tested it again in a supine position - it had improved to around normal. The woman had no relevant medical history and she had been very tired and stressed recently but I was concerned that I may be missing something, given her age, her BP and her propensity for multiple faints. She was continually hypotensive when upright, so it was prudent to keep her flat and I asked for an ECG to be carried out when the crew arrived.

Her ECG seemed to be normal but her BP continued to stay low whenever she was upright. She went to hospital and I hope she recovered without further drama. It was probably nothing more than the effect of a combination of stress and lack of sleep but I'm not willing to testify to that.

Be safe.


Robin said...

Yes, very funny! Just like the Secret Nuclear Bunker one.....
I do wonder though exactly what a camouflage exhibition would look like!! I suppose I have until the 18th November to find out :o)

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