Monday, 17 March 2008

Faulty circulation

Eleven emergencies – two assisted-only, all the others went by ambulance.

A 3 day-old premature baby was fitting and her young parents were, understandably, worried sick about her. She had been born three weeks before her time and was sent home with her mum and dad as soon as she had been checked over and judged fit for life in the outside world by the doctors. Now she was coping with a minor infection and had probably suffered a minor febrile convulsion, although nobody had witnessed this and her mum’s description of what took place didn’t fit the bill. The baby had simply been shaking or shivering on the bed. Mum was seriously worried because this ‘wasn’t like her at all’ but I wondered how much she actually knew after only three days of being with her child. The crew were happy to take them to hospital though and off they went. At least she would have the weight of thinking the worst taken from her inexperienced shoulders.

My MDT was playing up tonight and some of the calls I received were not getting through to my car’s system – this was slowing me down as I struggled to get to where I needed to go with the basic information required until the stupid screen lit up with everything I should have been given before I set off; very frustrating.

I climbed a long way up a spiral staircase inside a theatre to reach an 18 year-old male who had suddenly collapsed during the show. I was a bit hot when I got to the top and I found the crew already attending to the young man, so I wasn’t really needed. I climbed all the way back down and out into the cold air, which for once was refreshing.

An embarrassed bus driver tried to explain to me that he had tried everything to wake up the slumbering drunken male that now resided on the back seat of his bus. The 20 year-old opened his eyes as soon as I prodded him. The best approach with all of these ‘drunk on a bus’ calls is to weigh up the sleeper before you wake him because there is a very real danger that he won’t be pleased and will lash out at you with a fist, a foot or a weapon before you have time to step back and get clear. I always keep my feet alert for an instant decision to back off. This time, however, Mr. Sleepy-Head yawned, stretched and walked off the bus with no fuss at all.

The bus driver had been telling a couple of women who happened to be standing at the bus stop how hard it had been to get the man to wake up. Apparently, he had thumped hard on the outside window, just where he had laid his head but to no avail. He hadn’t actually gone up to him and touched him.

Just to compound his blushes, despite my call to Control to cancel other resources, the ambulance screamed in, followed closely by one police vehicle, then another. We don’t usually get this kind of back-up for these calls, so I was a bit surprised at the party we had gathered. The sleeping drunk was long gone. Probably on another bus by now.

In a restaurant in W1, an 86 year-old man had fainted. I was called to go and treat him and he was still quite out of it when I arrived a few minutes after the event. The man had a history of heart bypass surgery and now looked very pale and shaky. He obviously wasn’t well and the crew showed up within a minute of me to take him and his wife to hospital. I asked him how he felt and said ‘very sleepy’.

A 31 year-old female with learning difficulties dialled 999 for chest pains which were in fact abdominal pains. I reminded her over and over again that what she was pointing to as her chest was her belly but she just didn’t get it and I gave up trying after a dozen attempts. ‘Can you look at my heart?’ she asked me. Her description of the pain and my obs suggested nothing more than indigestion but she would still have to go to hospital, just in case. I left it to the crew to carry out the rest of the obs, including an ECG, if that was their decision. The pain had gone before I got there and based on what she told me, I suspect she may have passed wind and that was the cure.

On my way back from that call, I got another which took me to the Euston Road for a RTC involving a motorcycle and a car but it was cancelled just as I approached. I got another call instead, taking me past the incident and south for a distance. I watched as another FRU pulled out just in front of me to attend the RTC and I couldn’t believe that the proximity had been an issue with FRED. As I past, I could see that my colleague was having a tricky time trying to keep the patient stable, as well as deal with a very dangerous traffic situation – cars and buses were passing very close to her. I stopped, got out and quickly asked her if she needed my help. She thought I had been tasked to this call but I told her I was on another. Obviously, she was happy for me to stay so I went to the car and called Control to explain that I was required to assist on this RTC. There were no police on scene yet and the first thing that needed to be done was to make the area safe.

I used the car as a block against traffic invading the treatment area and I asked people who had gathered around to go away (please). Then I helped my colleague sort out the patient, who was a young man with a head injury – not life-threatening but still nasty. His helmet had come off when he was hit by the car and now his bike was lying crushed under the wheel of the offending vehicle. He was very lucky not to be there in its place.

I spent twenty minutes on scene assisting my colleague and the ambulance crew when they arrived, then I made my way back to the station for a cuppa but that plan was thwarted the minute I poured the water into the cup. I was off to a 24 year-old male who was unconscious and not alert which as an ironic mix of terms to say the least. He was, of course, drunk. He lay in a shop doorway, surrounded by seven or eight very loud Chinese friends. They thought it was all a joke. The drunken man was alert and had only collapsed in a heap because he was too inebriated to stand up. This, he thought, was justification for dialling 999. I was fuming inside and I lectured him and his friends about whether there was a genuine need for an ambulance here but they couldn’t care less.

‘Do you think you need to go to hospital?’ I asked the man on the ground.

‘Yes, I do. I’ll pay anything, if that’s what it takes. I’m very ill.’ He slurred.

The crew had as much patience for this as I did tonight but they simply asked him if he wanted to go to hospital. He said yes and they duly obliged. To me, it was a simple head and brick wall scenario. If I had my way, he would have gone home with his mates in a taxi.

I still get Red1 calls for ‘life status questionable’ incidents where there is absolutely nothing to rush there for, but like my colleagues, I won’t risk presumption in case one day I’m wrong. Usually, I’m not and the call is inaccurate and purely the fault of whoever made it in the first place. This one was an assault. The man had minor facial injuries and didn’t even want to go to hospital. He was outside a pub, so I’m guessing someone saw the fight and dialled 999 in such a state of panic that they couldn’t even give proper details, thus the Red1 alarm.

An epileptic on a bus next. He was stuck in the narrow walkway between the seats near the back of the vehicle, so it was an awkward job. Luckily, he had stopped fitting and was post ictal. He told me he might have another, however, so getting him out and into an ambulance was a priority. I didn’t fancy trying to deal with his next seizure in the position he was in now. There were a few people around; bus staff and police, so I had to make adjustments to the spectators as the crew arrived. There was no room for them to manoeuvre otherwise. When the area was cleared, the patient was lifted into a chair and taken away to hospital.

In the early hours of the morning, near the end of the shift, I received a call to a 19 year-old male who was having an allergic reaction to his medicine. I arrived to find the man shivering in a chair and looking unwell. His friends were with him and they told me that he had brought medicine for a cold back from India where he had been recently and that he had started reacting to it. He had an erythemic rash but his airway seemed safe. His BP was a concern, however; it was consistently low – sometimes very low. When the crew arrived and we got him into the ambulance, we pondered this situation some more and I noticed that his feet were a little swollen and very red. I considered the possibility that the reaction was causing fluid pooling in his peripheries, which would explain his low BP. His legs were raised but this didn’t help much, so I set up fluids and asked the crew to give him adrenaline, which would reverse the effects of histamine and nitric oxide and cause vasoconstriction, which in turn would raise his BP. This seemed to work because by the time he reached hospital, the redness in his feet had completely gone and there was no swelling. His condition had generally improved. At first, the crew were unsure of my request to use Adrenaline but there doesn’t have to be an airway compromise for anaphylaxis to cause problems; circulatory collapse alone can kill, so it was a judgment call.

I ended my shift with a 21 year-old female who was fitting but I didn’t treat her because the crew was on scene and I wasn’t required. That suited me ‘cos I all I wanted to do was go home.

Be safe.


Anonymous said...


I'm just curious, did you consider the use of chlorphenamine for this patient as I admit I would not have thought to give adrenaline for this patient.


Xf said...


We give Chlorphenamine secondary to adrenaline, so it was my first line drug but the patient was hypotensive and that condition may have been made worse by giving him it without initially checking his low BP.