Wednesday, 2 April 2008

Where are the conscious people?

Nine emergencies; two assisted-only, one declined and seven by ambulance.

My first call, to a 70 year-old ‘unconscious’ on a bus, turned out to be the usual case of booze + warmth = deep sleep but with a twist. This time, the man was waiting for me to arrive so that he could accuse the driver of swearing at him and threatening him, all of which was denied, of course, by the busman.

He was also play-acting a bit and several times while I was talking to him; mainly asking him how he was going to get home, he fell into a staring stupor. I could tell he was faking it; he even snapped himself into an upright position after one of these episodes and said ‘I’m back!’ Bravo.

I walked him off the bus and over to a bench. A young girl was waiting for her boyfriend on the seat and I took my elderly patient over to sit next to her while I asked Control if there was an ambulance coming. He chatted to the girl and she seemed bemused by his attention. He told her all about his army days and how long he’d served his country. I was relieved because, much as I admire an old soldier, I had already heard this and he would have repeated it all ad nauseum if I’d let him.

He was vulnerable and a little childish, so when the ambulance finally arrived, he was coaxed in and taken to hospital.

I only had to assist with the next patient – an MRU was on scene and the woman had just fainted at an underground station – happens all the time.

Another assist-only; this time a call for a 50 year=old man who was ‘unconscious’ in an amusement arcade. Neither the police officer on scene nor I were amused, however, to find a drunken Polish man slumped on the floor in a corner. Apparently, every time someone approached him to ask if he was okay, or what the hell he was doing there in the first place, he simply said ‘ambulance’. I truly believe there is a course being run somewhere in Eastern Europe where people like this are taught to call us for a free bed/meal/drink/punch-up.

He was bodily dragged out of the place and summarily thrown into the street by the fed-up (and totally understood) policeman.

A 53 year-old sleep apnoea sufferer with DIB was my next patient. His flat was so cramped and tight that I had to squeeze through obstructions just to get to him and I’m not fat at all. There was probably no more than a foot of space to get through in order to reach him as he sat on his sofa. It was going to be impossible for the crew to wheel him out in the chair, so I hoped he had no chest pain.

He was short of breath for sure but his vital signs were normal and he had no pain whatsoever. He just seemed uncomfortable and it may be that his current condition was predisposed by his diagnosed medical history.

The crew and I arrived simultaneously at an address given for a 24 year-old female who was unconscious on the toilet. Unfortunately, the address given was wrong and we spent ten minutes looking around the basement flats belonging to people who had no idea why we had been called to them. It was late into the night and many of them were trying to sleep as we noisily searched for our patient.

The neighbour, who’d actually called us, drew our attention to the error when he spotted our vehicles outside but further down the road than they should have been. We followed him to his flat (the correct address) and to his apparently unconscious girlfriend. He was one of those panicky types.

‘Come quickly, there’s not much time’, he said in his stricken voice. I thought the drama was unnecessary but I guess if you’re unused to trouble in your life, every small thing that happens is a major event.

She was lying on her back on the bathroom floor. She was conscious and smiley. She was also totally unaware of why we had been called.

‘You fainted on the toilet’, her boyfriend told her.

‘Did I?’ she replied, unconvinced.

‘Look, I’ll demo for you’, the boyfriend said. Then he sat on the loo and went through her exact movements (excuse the pun), including the part where her eyes rolled up to the ceiling. It was highly amusing to watch and he was very sincere about getting the facts right.

She lay there while my colleague chatted to her about her health. All the while, she remained calm and strangely unconcerned about where she was. Her boyfriend seemed more inclined to panic on her behalf.

‘You’re lying on the toilet floor’, he said.

‘Am I really?’

‘Yes’.

‘Well, that’s strange.’

If she didn’t look like a perfectly intelligent, sensible type, I would have suspected alcohol, drugs or mental illness...or all three. I left the crew to it and got on with my paperwork.

A call to a pub next for a 40 year-old female, ‘unconscious’. It was early in the morning and the pub was closed – there were only a few drinkers left inside, including my patient and her drunken Glaswegian accomplice. He greeted me and slurred the details of how she ended up flopped in her chair.

‘She was fine a minute ago, then she just went on me’, he explained. The concept was easy to follow because he said it loud and repeated it over and over again as only a hardened alcoholic could.

I checked her over and found that she was non-responsive and had pin-point pupils; therein lay the possible answer.

‘Has she taken drugs tonight?’ I asked. This question is usually followed by gasps of disbelief/horror and complete denial by all around, lest they be tainted by the same affliction. Telling them you’re not the police and you couldn’t care less about their filthy habits makes no difference, so the question itself needs to made in a demanding tone, like ‘if you don’t tell me the truth, she may die’ but not said like that, if you follow me.

‘Right, let’s get her on the floor then’, I said, expecting and not getting any help until I held her above the chair long enough for the penny to drop. ‘Just take the chair away from underneath her’, I said, repeating the instruction five times before it was finally carried out. I lay her on her back and checked her pupils again. This had a dramatic affect on her Glaswegian friend; he began crying and shouting out ‘Aw, hen don’t leave me...come back, wake up!’ (Incidentally, we call all women HEN and all men SON, or JIMMY...even if that’s not their name – we are strange fruit indeed).

‘Why are you crying?’ I asked him, ‘there’s nothing wrong with her’, I said, ‘how long have you known this lady?’

‘All day’, he replied.

Maybe in drunk-land, the time for deep and meaningful relationships to develop is much, much shorter.

I had to assume she’d taken something and after sticking her on oxygen and carrying out my obs, including a BM to rule out anything more obvious, I began to cannulate her for narcan. The crew arrived just as I started the process and, miraculously, she began to stir when the needle entered her vein. A few moments later and after more stimulus was applied, she opened her eyes to object.

The crew then spent twenty minutes debating with her about going to hospital. She didn’t want to and the paramedic tried to explain that, as she’d suddenly become unconscious and that she’d taken something (which she didn’t deny but was cagey about), it was best she got checked out.

‘I don’t need to go to hospital’, she said, glaring at the female paramedic.

‘But you were unconscious, why was that?’

‘I was just happy’, she cackled.

Needless to say, she didn’t go and wasted enough time (and tax money) to shorten our collective tempers.

A Red1 for a 25 year-old male ‘unconscious, not moving at all’ was nothing more than a drunken Chinese man, slumped in a doorway in Soho at three in the morning. He wouldn’t speak or comply with any instruction given, so he had to be lifted and practically carried into the ambulance, where he continued to be a deaf mute (don’t worry, he wasn’t because genuine deaf mutes will attempt to communicate that fact to us – I’m heading off the inevitable emails and comments for that description).

A call for a 37 year-old man who was fitting at a bus stop led me south and to a place where the mad people gather, judging by the lunatic Somali man who was gesturing, shouting and throwing things around in the street when I arrived behind the ambulance. At five in the morning, he had loads of energy and when he approached the car and stared into my window, I had to use sign language to persuade him that I wasn’t interested in speaking to him. The crew were dealing with the fitting man, who wasn’t fitting at all and so I left the scene with the madman running across the road in front of buses in my rear-view mirror.

Just before I went home, a call for a 43 year-old man with chest pain came through and I was sent to the City, to a primary school, where the caretaker and his family were gathered, waiting for me. He was on the sofa, complaining of central chest pain, radiating to his back and down his right arm (sometimes it’s the right arm, not the left). He had no cardiac, or significant medical history and this was his first encounter with chest pain, so he was very worried, as was his teenage daughter and his wife. His dog, a lovely English Mastiff, lay in its cage unconcerned.

I gave him aspirin and GTN and within a few minutes, his pain score was lower and he seemed to be relaxing a bit, although he complained of ‘feeling weird’ and having a headache.

‘Oh, that’s the GTN, I’m afraid. The oxygen will clear your headache soon’, I told him.

The crew were on scene now and they took him to the ambulance for an ECG, which was fairly unremarkable, except for a few minor anomalies which may or may not have had relevance – a fascicular block perhaps, although without axis deviation, it was an unconfirmed possibility.

Now it was time to go home and end my third night in a row. One more to go.

Be safe.

9 comments:

miss emma said...

great post as usual! hope your last night shift goes okay without too many drunks to deal with!
Emma

Fiz said...

So do I! I really admire you,Xf. I could never do your job, especially when most of your calls are about self-induced "illness" coupled with stupidity!

Staff Nurse M said...

Another great post! Have the LAS ever considered using the "booze bus" idea. I believe this was trialed in Norwich for the care of drunk (sorry "emotionally tired [.sic]" people.

Given the amount of drunks, surly better to have a safe haven rather then tying up ambulance and A&E department.

elmblog said...

Hehe, I got a chuckle out of the girl lying on the toilet floor, totally oblivious of her position and the fuss she created. Strange, Interesting...and a change from the usual!

Xf said...

Staff nurse e

I think LAS invented the idea. We have been using it for the past three years, as far as I know - it was the brainchild of Brian Hayes, one from the paramedics from my station.

We use a PTS vehicle, crewed with a tech or para and a PTS driver with blue light training. They go around picking up all the drunks in town and depositing them at St. Thomas' Hospital.

Unfortunately, budget restraints mean we can only run it at peak times...like Christmas and New Year!

gimlet said...

No specific comment about this particular post (although I did laugh out loud at the "all day" quote), but your blog is one of those I read regularly and I thought it was time to say thank you, I really enjoy it! Please keep it up.

Anonymous said...

XF,

Do you wonder why you do it. It seems you rarely get to use your medical training.
I used to work in the city but the time wasters and frequent flyers drove me nuts.
Where I work now we only get 1.5 jobs /24hrs (we're on call for 96 hours straight) which isn't really enough but they are almost all real. My last job was a 1 hour extraction of a spinal shock patient from a car that had collided with a truck, my second spinal with neuro deficit for the year.

We're looking for paramedics in the antipodes. Maybe you'd like the weather too :-)

Xf said...

gimlet

Thanks :-)

Xf said...

anon

Sadly, I have been thinking seriously about leaving the UK, probably in the next few years...