Thursday, 1 May 2008

Confused clouds

Six Emergencies – all taken by ambulance.

How much rain do we need? Storm flashes and sunshine all day today; the weather just couldn’t make its mind up.

My first call was to a frequent flyer that travels out of his hostel to town and calls ambulances when he gets bored or lonely. The 23 year-old was ‘fitting on a bus’ this time, although he tends to have ‘near-fits’ in the street. He is inoffensive and always apologetic. He didn’t have a fit – he never does but he is known to be epileptic and so he was taken to hospital as usual. I spent ten minutes with him and then chatted with my friend and MRU colleague before heading south west, where another person was fitting.

The 80 year-old had actually just fainted in a hairdressing salon but the customers thought she had been shaking a bit on the floor, so assumed epilepsy – an easy mistake to make. She was a little dizzy and pale when I got to her and the crew, who arrived soon after me, took over, leaving me to my paperwork and the next call.

The rain brings RTCs out in numbers and my first of the tour was to a 20 year-old female who’d been knocked down by a bicycle on a busy main road. She was a tourist and only had a grazed elbow but she cried out in pain every time she was touched, making a proper examination difficult and noisy. Even the crew had a hard time trying to console her; she had a very, very low pain threshold I think.

Then a man with a history of allergies but no definitive diagnosis of anaphylaxis, even though his tongue was as fat as a cow’s. His breathing was normal and he had no problems speaking to me but it was clear he was uncomfortable and needed proper attention to deflate his swollen muscle.

If you get chest pain, don’t ignore it. My next patient - a 28 year-old - did when he experienced it a few days earlier and now he was suffering again but it wasn’t going away. He had been exerting himself, so the angina may be a warning that something isn’t right. The GTN I gave him seemed to reduce the pain considerably and by the time he was in the ambulance having his ECG done, his score had dropped from eight to three. The ECG itself looked normal, apart from deep Q waves on one lead but we never underestimate the body’s ability to regain control during a crisis, so off he went to hospital.

Epilepsy can be triggered by the most mundane things and my last patient was on the floor of a restaurant, with her worried family around her, after having a short seizure as a result of banging her elbow on the wall accidentally. She was vomiting when I arrived and very pale. Even though she was recovering well, she didn’t look fit enough to get up and continue her night out in town, so the crew carried out a complete MOT after my obs and she was taken to hospital to rest until she was safe enough to travel again.

A routine shift with no dramas, thankfully – except for the periodic torrential rain.

Be safe.


miss emma said...

hope you didnt get too soaked xf! are you about in town on saturday afternoon? i will keep an eye for you if you are! hope the bank holiday weekend doesnt bring too many dramas for you!
emma x

Mark UK said...

You said "If you get chest pain, don’t ignore it." and that's so obvious that it shouldn't need saying. However, it can be a little embarassing.

Sunday night I started with a chest pain. I knew what it was (muscular) as I injured my pecs and probably other muscles nearly 20 years ago. I used to get some gyp if I did anything to aggravate the injury but I've been OK for about 2-3 years. This was a bad case of what I'd had before.

I went to work on Monday primed with ibuprofen and also got some co-codamol as suggested by NHS Re-direct. By lunch time the pills weren't working. I was having a hard time breathing as well, so I shipped myself off to A&E.

The receptionist asked what was the problem and I said "I've got pain in my chest but it's not cardiac, it's muscular".

Next thing, I find myself on a cot with no waiting and a lad sticking dots on my chest. (I threatened him with dire consequences if he didn't shave the hairs first!) They also took some bloods, BM, BP and sats. All were OK except my sats were down at 91% - I just couldn't take a proper breath. It was partly the pain and partly the fact that the left side of my chest was stiffening up. Tight boggers didn't give me any O2 though.

Anyway, after three hours and a chest x-ray I was released to the world with a somewhat larger dose of anti-inflamatories and some amoxicillin for the minor chest infection I'd picked up.

Whilst I was there, I saw an ambulance tech I knew. Her first words were "Are you alright then?" (which was a bit silly as I was half-lying on the cot wearing a hospital gown instead of my shirt). She told me that there had just been an arrest (I'd seen a nurse running, so I gathered all was not well). It seems the bloke had brought himself in and had promptly arrested. I suppose that if you are going to arrest, an A&E department is probably the best place.

Anonymous said...


Went to a footballer (aussie rules) who had been tackled andnow had some shoulder pain. This guy was being your stereotypical 20 year old sook. Even the stretcher straps hurt. Anyway, we collared and imobilised with an Oregon spine splint.

Turns out he had a C4 spinal fracture and the pain was neuropathic (that is caused by the nerves being pinched). It is so easy to get caught out in the job.

Regional Para