Sunday, 30 December 2007

Last Christmas

Eight emergency calls. One dead on scene, the others went by ambulance.

I thought my first call of the shift was going to be a suspended patient. It was for a 37 year-old male with ‘blood coming from mouth, not waking up’. I asked Control if an ambulance was on its way because I had literally just got into work and had virtually no time to complete my checks.

‘If this is a suspended, I’ll need a crew there as soon as possible’, I said.

Somehow, this became translated as ‘the patient is now suspended’ because that’s the message the ambulance crew received on their MDT moments later. The communication problem was exacerbated even further when I got on scene, couldn’t find the exact address (it was one of those streets where the numbers, both odd and even, were spread randomly around), and called Control for a more precise location. Unfortunately nobody answered my call and as I poodled around looking for the house, a woman waved at me from her doorstep. By the time Control had got back to me I was out of the car and in the house, so the ‘nothing heard’ message would probably have confirmed the fact that, to them, the patient was suspended.

He wasn’t, however. The woman led me to the basement bedroom and pointed him out.

‘I tried and tried to wake him but he won’t respond at all’, she told me.

I called his name once and he opened his eyes.

There was a little blood stained saliva on the pillow next to him and he was certainly very confused looking. I think he might have had a fit and bitten his tongue in the process. Even though he had no history of epilepsy, something neurological had happened here.

He was difficult to work with initially because he was still post ictal, so he didn’t comply with my attempt to get obs and he couldn’t answer questions properly. He didn’t know where he was or who his wife was at first but after five minutes he began to recognize her. By the time my colleagues arrived (weighed down with everything they needed for a resus), he was recovering.

We got his wife to dress him and he brought himself upstairs to the waiting ambulance. He was back to his normal self, according to his spouse. He certainly looked a whole lot better than when I first saw him.

I can understand her fear when she heard him gasp for air and then couldn’t wake him up. He needs to be checked out to discover what might have taken place and to prevent the possibility of a more serious episode later on.

I was sent to Hyde Park Corner for the next call, a 30 year-old man with a head injury after falling, but the location was wrong. I should have been at Speaker’s Corner, which is at the other end of Park Lane. The ambulance was with me at the wrong place too and we carried out an area search before the correct location was given. I think a tourist had called it in, thus the confusion. Luckily, despite our delay of ten minutes or more, the man only had a minor bump and cut after slipping on wet stairs.

I arrived with the crew from the Speaker’s Corner job at the next call – a 60 year-old man with heart problems. I recognised him when I went into the restaurant where he was sitting with my colleagues. He had genuine cardiac problems but I vaguely remembered taking him to hospital and he was discharged very soon afterwards – nothing was wrong with him. Still, this wasn’t my call, so I pointed out the fact that his face rang a bell and left the crew to get on with it. They blued him in after looking at his ECG – apparently it was problematic.

On my way back to the station I was called to an 80 year-old who was fitting on a bus. He had collapsed suddenly outside and his friend and other bystanders had hauled him onto the floor of the bus for his own safety when he started to have a seizure. Not something I would recommend but I guess they were reacting instinctively. The man was breathing abnormally when I got to him. He was clearly having some kind of neuro event.

The crew arrived within a few minutes and I was preparing to insert an OP airway (he was on oxygen now). There was now enough of us to stabilise him properly. I couldn’t open his mouth because his jaw was clenched shut, so we kept things basic – oxygen and IV access; the latter proved difficult because he became very combative. Now all we had to do was plan a way off the bus.

We had no choice but to support him and ‘walk’ him off the lower deck and onto the waiting trolley bed. Then we got him into the ambulance. Within a few minutes and just as the crew was about to leave, he had another seizure. He became stiff and his breathing stopped for at least a minute. His back arched and his jaw clenched even tighter than before. It took a shot of diazepam to get him to settle down again. Epilepsy wasn’t being ruled out here, regardless of his negative medical history and the drug would calm him down enough to restore breathing and make him easier to manage en route to hospital.

Once he was settled again, I left the crew alone and the patient was ‘blued in’ to hospital.

A quick rest at the station then a call to a 45 year-old man with chest pain and DIB. He actually had abdominal pain and had taken Gaviscon, thinking it would go away but it didn’t. He wasn’t the type to complain easily and it was the staff at his workplace that had insisted on calling an ambulance, otherwise he would probably have continued taking Gaviscon until he died of a heart attack, if indeed that was what was going on. His ECG was abnormal and he didn’t look very well, so I would be reluctant to second-guess this one. He went to hospital on that basis.

Then a 36 year-old female ‘in and out of counsciousness’ who had fainted at a tube station. She was recovering when I arrived, although once again the sales crowds had slowed me down and it took me longer than usual to get to her. The crew took over after five minutes and I left them with her.

In the early evening I got a call out of my area for a 51 year-old male ‘not breathing’. My MDT crashed just as I took the call but I navigated my own way there while it re-booted. None of the details were available to me until I was near the scene. I read the screen and it stated ‘caller believes patient is beyond help’. This usually means they have been dead for a long time. Death is obvious to everyone in some cases.

A neighbour had called the police to the man’s flat because she hadn’t seen him since Christmas Day. She couldn’t get an answer when she hammered on his door either, so the police broke in and he was found dead in his toilet. I walked in to find the crew just coming out of the room. I went in to see for myself and it was indeed an obvious death. He was folded over on his knees, head on the floor. He had just gone to the loo by the look of things and had suddenly toppled onto the floor dead. The blood from his mouth was dark and smelled bad, so he probably died from ruptured gastric varices. It’s common enough for those with liver disease, especially as a result of alcoholism. Indeed, the patient’s front room seemed to bear his dependency out – there were lager cans strewn around and very little else. Absolutely no food in the fridge.

I left the scene and the crew stayed behind to complete the paperwork. A small group of neighbours and curious residents had gathered near the flat to see what was happening. Inside, an alcoholic man with no food and two televisions had seen his last Christmas.

A final call to the police office on Piccadilly Circus for a 7 year-old boy who had fainted. Highly unusual at that age, I thought. Surely the age had been misheard?

When I got there I found a family and a sick young boy waiting for me. He was eleven, not seven. Still unusual though.

He was complaining of abdominal pain and had suffered this for a while. His GP had checked him and tested him for the possibility of appendicitis but this proved not to be the case. So, he was told it was just cramps and that was that. The fact that he had collapsed several times as a result of the pain hadn’t been enough to warrant a more thorough investigation of the cause and now here he was, hundreds of miles from home with his family in London, passing out in the street.

He was very pale and lethargic and his pain seemed confined mainly to his right lower abdomen (thus the appendix link) but I wasn’t going to postulate because only two thirds of children suspected of having appendicitis actually do. Clearly his GP knew this and hadn’t made a decision about it. The trouble was that his acute condition might develop into a life-threatening emergency at any time.

The crew took him and his mum to hospital and I followed with his dad and brother in the car. That took me close enough to my base station for me to get home on time, which, I hope you understand, is an important thing for me to achieve after a shift like this.

Be safe.

3 comments:

DJM said...

Hi,

Just signed up so I can comment on your blog.

Read the book and I really enjoyed it. Great stuff.

Doug

Xf said...

djm

thanks...keep reading

Mental101 said...

Hi,

Just reading through the posts and it just stuck me as odd that you look through the fridge of someone who is dead? What are you looking for food that can't be wasted? On a serious note though why is that. My theory is so you can get an idea of what he lived like so you have a better idea of how he died.

I can understand it if the person is alive as incase you want to do a vulnerable person report etc.

Thanks