Drugs for the hell of it

Five emergencies – all went by ambulance.

If you have an anaphylactic friend who carries an Epipen or Anapen, don’t panic when they tell you they’ve eaten something nasty, like a peanut and they’re swelling up. If you use the injection device too quickly and without calm rehearsal, you’ll waste an opportunity to save their life if things become a little more complicated later on. If they just have a nasty rash and a bit of a puffy face, they’re not yet in danger.

The friends of a 30 year-old female who ‘fainted’ whilst having a reaction was injected twice; once by her friend, who failed to get it right and the adrenaline went to waste, and again by a stranger who happened to know what to do (well, she read the instructions) and managed to get the stuff into the patient’s muscle. The fact is, she didn’t really need either injection and it’s just as well only one of them took effect, as 0.6mg of adrenaline (small dose as it is) may have had the patient’s heart running a wee bit faster than it should while she was intoxicated.

Her BP was high, as expected, but it soon settled down again. She was convinced she was having a life-threatening reaction to something she ate and had instructed her mates to inject her. Neither of her friends was particularly confident about it and one of them repeatedly berated herself for getting caught out – hardly her fault and at least she tried to do the right thing.

Whether the lady in question actually had a reaction is debatable but the Epipen was an extreme measure, given her condition when I arrived – there was no life-threatening airway problem and very little evidence of swelling anywhere. Maybe she panicked.


Another allergic reaction and this time the 28 year-old man was convinced he’d eaten a peanut or a meal with peanut in it but again he looked fine – a little shaken up but alive. There was already an ambulance on scene and I popped my head inside to see if I was needed – I wasn’t, so I left to do my paperwork.

I wonder if there’s an element of panic-stress involved in people with sensitivities combined with alcohol. I’m not presuming that I know how they feel, of course, I just wonder if it’s worth further study. Maybe a moderate alcohol intake increases a person’s fear of allergic reaction or it creates the illusion of symptoms associated with it.


Into a West End casino for a 35 year-old female with chest pain next. She was Russian and couldn’t explain her known congenital heart defect clearly for me to understand what it was and how it could be connected to her recent experience of chest, sub-scapular and left arm pain. I didn’t want to take a chance and when the crew turned up and an ECG was carried out (confirming nothing in particular), I advised her to go to hospital.


A red call that should have been green – ‘chest pain’ had been given for someone with 'shoulder pain'. I queried it but got the usual stock answer; ‘that’s what the caller said’. This wasn’t exactly the case when I got on scene. The patient, who’d dislocated his shoulder while dancing (don’t ask) denied claiming that he had chest pain and the caller, one of his friends, denied it also.

He was a nice lad with gritted teeth (such was his pain) but his mates thought it was hilarious. Dislocations are very painful, especially at large joints, so I sympathised. He’d need morphine because the entonox wasn’t touching it.

Then another surprise when the crew showed up and it wasn’t the LAS. In fact I didn’t even recognise the uniform at first. The St. John Ambulance (SJA) were running on emergency calls tonight apparently – not that I knew anything about it, so it was a bit of a shock to realise that I wouldn’t be handing over to a crew I knew had the same training as me but instead I’d be handing over to three young people with basic ambulance aid knowledge (they told me). They were very nice people but unknown entities on a busy Friday night make me nervous and I’d much rather see one of my own crews arriving to help me out and take over the care of a patient – no offence to the SJA, of course.


The last call of the night, for example – this is when I need professional crews I know and trust. An unknown male was unconscious after taken GHB. The caller had given the wrong address several times and I crawled up and down the road given with the ambulance crew. It was ten minutes before the caller got some of his facts right and we were directed to the far end of the road we were on and it was only by accident that I was waved down by a delivery man who pointed to a window on the third floor of a building I wasn’t going to. A windmill was leaning out of it, so I let the crew know where I was heading and parked up.

The man met me at the gate and led me upstairs. The place reminded me of the grotty house that Steptoe and Son used to live in.

‘We were having sex and he had some kind of fit and then wet himself and fell down’, the man explained nonchalantly as he took me to the very top of the narrow staircase.

It was more than I wanted to know as I lurched into the darkness behind him. I could hear the crew arriving outside, so I wouldn’t be on my own with this guy for too long.

I was led into a dimly lit bedroom, cluttered with rubbish, and I could see no-one else. The man went to the side of the bed and pointed.

‘We’ve both had GHB but not a lot.’

I looked over and saw the patient for the first time. He was lying on his back, eyes glazed, mouth open and the very last breaths were coming out of him as he grunted into oblivion.

I went to his side and opened his airway. I got no response (and I wasn’t expecting any), so I continued with the most basic emergency care...airway and breathing. The crew arrived and I think they were just as taken aback by the sudden drama as the man who’d led me here.

‘Is he alright?’ he asked stupidly.

‘No, he’s not’, I replied sharply.

Although there was a paramedic on the crew, he wasn’t yet registered, so couldn’t carry out all of his skills or give many of his drugs unless supervised, so I was carrying the can alone on this one. I suggested that we move fast and get the patient to the ambulance but we had a problem with the carry chair; it had become damaged and wouldn’t support the patient’s weight safely, so we wre stuck there until a solution could be found.

We were now supporting the man’s breathing with a bag-valve-mask (BVM) and oxygen. An OP airway had gone in without a gag reflex and his pulse was slowing to a crawl. He would arrest soon if we didn’t do something to change the situation.

I looked at his pupils; they were pin-point. I had been told that he’d only taken GHB and cocaine but I was convinced he had taken much more than that.

‘Let’s give him narcan’, I suggested.

He was given 800mcg of the stuff IV and we waited for a response but got nothing. I had called control to request another ambulance and had made it clear that we couldn’t wait but wait we did...for another 30 minutes.

All the while, the man who’d brought me into this crazy situation was pacing about but not looking particularly worried. He’d only met this guy tonight. They’d had drugs to fuel their passion and then sex, during which he’d mistaken his new mate’s heavy, noisy breathing for excitement when, in fact, he’d been having a seizure. It was only when the man had lost bladder control and wet the bed that he’d realised something was amiss and had stopped. If I was in the same situation, I’d be worried sick.

I had broken open the first glass vial of narcan and it had cut my finger through my glove. Now blood was running over my finger underneath and I knew I was risking infection with this job. I decided to intubate the patient, there and then, rather than wait another eternity for the second crew I’d requested, so we moved him onto the bed and I got started but just as my laryngoscope blade left his mouth (I’d scoped the airway but it was too risky to try), his eyelids fluttered. Then the new crew entered the room.

Now we had enough hands to safely remove this patient. His condition changed as a Laryngeal Mask Airway (LMA) was put in his mouth – he began to gag and retch; this meant his level of consciousness was improving. It had taken 1.2mg of narcan but now he was further from danger than he was an hour before. We knew it wouldn’t last and it didn’t - he slumped back into unconsciousness as we carried him downstairs. He was given more narcan during the trip to hospital and taken straight into Resus where his life would be saved.

‘He’s got blood on him’, the doctor said in a worried tone.

‘Yeah, it’s mine’, I told him.

Be safe.