Thursday, 7 February 2008

And tonight's illness is...

Eight calls – one declined aid and everyone else went to hospital by ambulance.

The shift started with the first of a run of chest pain calls. Sometimes calls are coincidental all night long - seizures, falls, and chest pains. It's almost as if a committee meets up to decide what type of emergency is going to dominate for the day. 'Let's get all the chest pain calls done tonight' they would say...I imagine.

A sturdy 98 year-old with chest pain actually had muscular pain associated with a strain after she reached down to pick something up. The crew had arrived on scene at the same time, so we went up to the flat together. Her carer told us that she was in some pain earlier in the day but that it got worse every time she moved. She finally gave up after bending over and getting punished for it, so she sat down in her chair and let her carer call us out to check on her condition. We found her to be alert and with good vitals - her only problem was a 'stitch-like' pain in her ribcage. I hope that's all I have to complain about when I'm pushing a hundred.

A call for a 75 year-old male who had fallen in the street, sustaining a hand and leg injury, took me north and out of my area, where I found an incontinent drunken man sitting against a wall being helped by a couple who had been passing by.'We just found him collapsed on the ground. He isn't making any sense and I think he's broken his leg', the male passer-by said, although I felt his handover was a little dramatic. He and his lady friend hovered helplessly over me while I got on with the basics.

‘What’s your name?’ I asked. I used a loud clear voice because the man was wearing at least one hearing aid.

It’s possible the passer-by had mistaken his deafness for confusion. Maybe he thought the old guy was having a stroke. As for his 'broken leg', I couldn't see any evidence of that. The man was in no pain and had no visible problems with his limbs. In any case, how awkward a drunken tumble would he need to have to break his leg so easily? And before you all start shouting osteoporosis, the lack of pain...any pain...led me to believe that he was just sitting down and too drunk to get up. His walking stick was next to him, so he was never steady on his feet sober, never mind in this state.

Nevertheless, cautious as I need to be, I checked what I could for any sign of a change in normal brain function. Alcohol can imitate a stroke and vice versa, so I wasn’t hedging any bets and would wait for the crew to fully assess him in the warm ambulance. The smell, even in the cold night, was beginning to overwhelm me as I crouched close to him.

I thanked the couple for their help, using the standard ambulance service ‘Your help is no longer required and you can go away now’ tone. It usually works first time but for persistent helpful people, it may need to be repeated with a twist.

‘You can get on with your evening now, thank you’, I said diplomatically. It's my version of 'there's nothing to see here'.

The old man reached out to shake their hands and thank them but they didn’t venture to take up the offer, preferring to smile and nod acknowledgement instead.

‘Are you sure I can leave him with you?’, asked the man who thinks everyone has broken their legs after falling.

I know what he meant but the tone had that ‘you don’t look like you can cope alone’ colour to it and I objected inside. Outside I smiled.

‘Of course you can’, I said. I hoped my teeth weren’t clenched. I didn’t want to offend.

After my initial checks I asked him to try and stand up. He managed to get to his feet with a lot of help from me and as I was hoisting him up, a woman stopped and asked if she could help. A very kind gesture, I know, but how much trouble am I in if I look as if I am struggling to lift a 5 foot 5 inch 75 year-old off the ground? I suppose the kind lady was only thinking of my back and I was thinking of hers, so I politely declined and thanked her for the offer. I won’t allow MOPS to help with lifting if I can avoid it – they generally aren’t trained and it’s not worth the potential injury they can sustain. Unfortunately, that’s our job and we cop it if it goes awry.

The crew turned up and took him away after a ten minute wait during which I pinned him to the wall in an effort to keep him on his feet. He was far too drunk to walk anywhere. A straight line would have been a universal challenge. How he got this far from the pub was a mystery. Maybe he flew on the wings of the Red Bull fairy.

My second chest pain call was for a 62 year-old man in a Soho restaurant. He had just started his meal with a gang of work colleagues when a shooting pain cut across his chest, sternum to axilla. He had suffered this type of pain before but had been cleared by the hospital of any cardiac problems. It looked like he had experienced a transient muscular problem because by the time I arrived, which was a mere three minutes after the call was made, he had completely recovered.

The crew arrived a few minutes after me and he was taken to the ambulance for an ECG. This showed an irregular heartbeat, which in itself can mean nothing but in conjunction with chest pain and his recent history, it was worth further investigation, regardless of his previous check up. The paramedic offered to take him to hospital but he declined. 'I think I'll pass', he said. I think he was scared but he was taking a bit of a risk with his health.

It's worth noting that he had just finished his starter and if you are going to pay London prices to eat out, you best get chest pain after the meal has been completely eaten. Maybe that’s why he declined and went back into the restaurant. As a Scot, I can see his point of view.

This call was followed swiftly by another chest pain. A 47 year-old man developed crushing central chest pain whilst playing bridge with his friends. Again, the crew were with me on scene and again, the man's pain had subsided by the time we arrived. He looked well enough but his friends confirmed that he had become very pale and sweaty when the pain struck. He had no cardiac history, just high blood pressure, but he had been taken to hospital before for chest pain - nothing had been found. This would be his second trip for the same problem.

Chest pain again...a 36 year-old woman with no previous cardiac history and a clean bill of health was lying on her sofa, husband at her side, when I went into her flat. She explained how the pain had been with her all day. She pointed mainly to her upper abdomen and told me she had taken Gaviscon but this hadn't worked (people often mistake cardiac pain for indigestion). Whether or not this was simply a gastric problem remained to be seen but her colour and demeanour suggested it probably was. She had no breathing problems and she was able to move without too much discomfort.

The crew arrived as I got on with my obs and she was taken to hospital once I had completed them.

Bending over to pick something up provoked yet another 999 chest pain call. I arrived at the little basement flat after cautiously entering the building in the dead of night. I had received an alert on my screen which stated that this was a 'high risk address'. I contacted Control to establish whether it was or not and I was told that the information was inaccurate, so I pressed on but when I got there the place was a bit dodgy looking and the basement flat across from my patient's looked like a drug den – metal shutter over the door glass, damaged locks...that sort of thing. At first I thought this was the flat I was to enter but my patient’s was across the hall.

The door was ajar and I could hear nothing inside, so I knocked and waited for a voice. I always assess the threat by the tone of the answering voice; if it is male or sounds edgy, I will go very slowly. If it is female (and I know this smacks of sexism but I am playing the odds) and sounds even, then I am more confident about entering. Either way, I will always leave the front door open and look around for other people inside. Sounds paranoid, I know, but it has kept me safe so far.

‘In here’, the even-sounding female voice shouted.

The 46 year-old woman inside had bent over to pick something up when she felt something tighten across her chest. At first she described it as feeling a ‘crack’, like a muscle had gone but then, as I examined her, she gave a more accurate description. Her heart was racing; she was tachy at around 220 bpm. Then her pulse slowed right down to 36 bpm – quite a dramatic change in tempo. She was understandably anxious about this and I was concerned that her heart could become unstable and the rhythm would convert to something more dangerous, like VF. I was pretty sure she was suffering from paroxysmal atrial tachycardia (PAT) but without a proper 12 lead ECG, I couldn’t confirm anything.

The crew arrived when I had finished my basic obs and her heart rate had stabilised and was back to normal, although she still had a niggling pain in her neck. I handed over and she was taken to hospital. Her ECG had looked fairly normal but then, without the physical manifestation of PAT, there would be little or no evidence of it on the strip anyway. We had to catch it while it was there.

Three hours passed in the early hours and the 999 ocean was calm. In between hoax calls (yes, our regular nutcase is still making them – three tonight) which were cancelled before I moved, I managed to get some rest. I think we were short on ambulances tonight because I had been running out of area frequently.

As the nightclubs started throwing people out, I received a call for a 20 year-old female with a head injury after a fall. Her heavily bloodied and almost hysterical body was walked over to the car by a group of people, including a police officer, as soon as I arrived. The waving from the windmills had been frantic enough to alert me to the possibility that she wasn't just another drunken woman who had toppled over, courtesy of alcohol. She wasn't too drunk at all, in fact

Her head had been covered in a dressing which was placed by the club's first aider but there was a lot of blood coming from an area to the back of her skull which had not been covered properly. Instead, the poor first aider was pressing blue paper towel into it to stem the flow. This was sticking to her hair and the congealed stuff when I removed it to have a look. Unfortunately, the lack of good light meant I couldn't see where the blood was coming from, so I wrapped another dressing around the area in the hope that I was on target.

Meanwhile, the young girl was sobbing and rocking back and forth, wondering what had happened to her world. Apparently she was dancing on a bench seat inside the club, lost her balance and landed on the uncovered concrete floor, using her head to break her fall. I went in to see the place when the crew arrived and took her off my hands. Apart from the video screens and the bar, the place was pretty Spartan and looked like it had been put together with only one thing in mind - profit. Certainly not comfort. Hard seating and hard flooring is hardly empathetic to human bones.

She may have been knocked out because she couldn't remember what happened and this seemed to upset her even more. The female crew had a calming effect on her though and by the time she was driven off, the crying had stopped and was replaced by quiet resignation and the odd sob.

I raced off to my next (and last) call an hour before I was due to go home. It was for an 83 year-old lady who had fallen and hurt her ribs. The crew were on scene and decamping from their ambulance and the old lady walked herself out to meet them, so I wasn’t required. I set off for my base station but got diverted to a call over four miles away – well out of my area. I queried it but got a stern response. Yes, I was the nearest vehicle to it. Sometimes you get made to feel guilty just for wanting to get home on time.

I sped off and got within two streets of the call when I was cancelled down. Great. If it wasn’t for the light traffic, I would have been late getting back but I managed to ‘clock out’ on time.

If I am to face a busy, drunken Thursday night then I will need a decent sleep. That’s fair, isn’t it?

Be safe.

5 comments:

Dani said...

what or who are MOPS?

and i hope you had a good sleep. weather is supposed to hold tonight

Xf said...

dani

MOPS - Member of Public

If you get stuck on any term I use, I have put full explanations on the link in the left hand bar.

I'm still a bit tired. Thanks for the weather update :-)

Anonymous said...

XF,

I don't think youre paranoid or edgy being cautious at a scene. This job has the potential to be dangerous, and people are the most unpredictable hazard we face. Nothing is more dangerous than a scared or angry person. I never let anyone lock the door behind me, always look around to see who else is around and won't tolerate dogs. So far I've gone home after every shift.

Regional Para

Xf said...

regional para

Sorry for the delay in replying. Thanks for your comment and empathy. Hopefully your caution will keep you safe in this job.

Japhia said...

Just wondering if a MOP offers to help will an ambo/paramedic ever say yes?

Or is it just full of potential law suits?

Japhia