Five emergencies; every one of them by ambulance.
A somewhat sleepy and easily agitated 20 month-old boy who’d had a febrile convulsion was my first patient of the night. His worried parents had taken him to their GP when he became hot and unwell. A throat infection was diagnosed and calpol was given to lower his temperature. That was a few hours before he suddenly began fitting; eyes rolling into his head, limbs flailing and stiffening – it didn’t last long, only about 15 seconds Mum told me, but it was enough to cause her to panic.
The little boy had a high temperature, sure enough – 39.1 degrees and another dose of calpol was administered by his father while I watched. I should have taken his BM but he was so upset after the thermometer had been put in his ear that I left that to the crew when they arrived. There was no point in agitating him further or putting the parents through even more stress.
He was taken to hospital for further checks but I’m sure he’ll be discharged in the morning, loaded up with even more paracetamol.
A female feeling faint at a train station next – she was in the ladies toilets and her husband was with her. In fact, including the staff and myself, there were four guys in there and women went about their business without fuss but the hand dryer was getting on my nerves – it was so loud that I couldn’t hear what the patient was telling me, so the loo was cleared of people and closed for the duration.
She suffers from colitis and I suspect she had an intestinal infection, bringing about her abdominal pain, diarrhoea and nausea. She was very weak on her feet, so I sat her down while I carried out my obs. The only remarkable thing I found was that her temperature was sub-normal at 34.8 degrees but I’ve seen this many times when a ‘tummy bug’ is present.
The crew arrived to take her away and as we took her upstairs, I saw the result of my insistence that the dryers be silenced – there was a long queue of desperate-looking women at the entrance.
I don’t mind carrying patients, I really don’t; not when they need to be carried, but my next call, to a 67 year-old man having a panic attack and claiming chest pain, took me to a hostel south of the river where a crew, consisting of two of my friends, were bringing him down three flights of stairs while he moaned and groaned. He had no chest pain, he had back pain but his pain wasn’t agony (his demeanour would have given that away) and he had managed to walk up those stairs earlier. Now he was being carried down on a chair and my colleagues were risking their backs for him. Beyond the call of duty as far as I’m concerned.
An 81 year-old woman bit her tongue and it began to swell up, as you’d expect, but she became uncomfortable with it and, a few hours later, her family called an ambulance, convinced she couldn’t breathe. I arrived with a crew and we found her sitting on a chair in the front room suffering no more than…a swollen tongue. She was a nice lady, though and apologised for the ‘trouble’ she was causing and even though her injury was minor, she may well have been having trouble swallowing and that’s what was interpreted as DIB. She was taken to hospital just in case. It wouldn’t be right to leave her at home if she genuinely believed she was in trouble and no matter who they are, if a patient with minor difficulties shows some understanding of the difference between that and an emergency, we feel less abused.
My shift ended with a call an hour from going home time for a tall, gangly 40 year-old Somali man ‘fitting on a bus’. He was lying face down in the aisle and a witness told me that he had been kicking his feet around. Hardly a seizure and more likely to cause me harm if he decided to do it again while I was hovering over him. In I went then, to wake him up, and it took a lot of shaking and shouting to convince him to open his eyes. I was, of course, very wary about his movements after my recent experience, but he seemed passive enough and you can usually tell if you’re in danger in the first few seconds.
I got him to sit up and then, with the help of the bus driver (which was unusual), he was put on a seat so that I could carry out my obs and continue my questions.
I got nothing out of him for a while and all of his obs were fine, except for his racing pulse, so I asked him about alcohol and drugs.
‘Have you been drinking tonight?’
He nods and grumbles something.
‘Have you taken any drugs?’
Again, he nods.
I wasn’t really convinced because he really didn’t look the type and I was happy to believe he was just drunk. He had a huge chunk of his right cranium missing and the indentation was very pronounced, so I assumed he had suffered some kind of war injury, accident or had been operated on. It was possible his brain wasn’t intact and that he had, indeed, had a fit.
When the crew arrived, and after ten minutes on oxygen, he became more responsive and confirmed that he had just been drinking – no drugs. He had downed ten bottles of Guinness and that was a surprise. What was a Somali Muslim man doing drinking Guinness? Drinking at all, in fact?
He was taken to the land of the free (healthcare) for his own good.