Friday, 16 May 2008

Losing battles

Seven calls; one refused, one conveyed in the car, one pronounced dead on arrival and the others by ambulance.

The first hour of the shift, early morning and I’m just waking up after a cup of coffee but the dead and dying care not for my creature comforts. A 60 year-old female is unconscious and not breathing. It’s a Red1 and my update tells me that ‘CPR is in progress’. I get on scene first and run to the flat in question. A nervous, drawn man greets me at the door; ‘I think my wife’s dead’, he says with high emotion. I walk in to find her lying face up on the bedroom floor. CPR is not in progress.

The room is very small and cluttered, making life difficult for me and I could tell it was going to be an awkward job when the others arrived to help. I set up the AED after carrying out my basic checks, although it was obvious she was in cardiac arrest. No shock is given because she is asystolic and her heart is receiving nothing from her brain. She looks like she’s been dead a while but I can’t be sure; she’s still warm and flaccid, so I start CPR.

The crew arrive as I begin and they quickly fall into the well-rehearsed and well-practised routine for this situation. We work on her for twenty minutes in that crowded little place and her husband looks over our shoulders from the hallway. I can see grief and acceptance of the inevitable on his face but I still tell him we’ll do all we can and that she can’t feel anything we’re doing to her. I may be lying when I tell people the last part.

I give all the drugs I need to and we decide to continue all the way to hospital. Her BM is low and it drops throughout the effort, despite Glucose. She’s had cancer and her Liver may be affected by it, so it’s possible that organ failure was the primary cause of her arrest.

Another crew turned up half-way through and now we plan to get her out of the room and into the ambulance. It will be an awkward, heavy lift-and-carry all the way down the stairs, so a scoop stretcher is used and four people – one at each ‘corner’ – have to bear the weight. At times, I think she's going to slip off onto the stairs as we heave and balance on each step.

CPR is still in progress and we continue our care in the ambulance – I give more drugs and she is being aggressively resuscitated. Twice the AED reports that a shock is to be delivered and twice it cancels – she’s not coming back.

They try for another ten minutes in Resus but the towel is thrown and they call it.

The husband didn’t come with us – he told us he’d be along later. I wondered why he would want to stay away. If she’d come back, even for a short while, he may have been able to hear her voice for the last time. He’d gone to sleep with her and woken up the next day to find her lifeless beside him. I wonder what they said to each other before they went to sleep.

It took me almost an hour to clean up and replace my stock after that call. Luckily, there was no need for me to go back and get my car because one of my colleagues volunteered to drive it to the hospital while I stayed in the back of the ambulance. Once I’d freshened up again, I was off to a male ‘fitting’ at a building site. The 17 year-old was post ictal; very confused, pale and sweaty when I arrived and a CRU colleague was treating him. A crew was on scene shortly after I arrived but I thought it prudent to get IV access, so I put a cannula in his arm just in case. His BP was very low and hadn’t come back up after his seizure – he may have needed fluids.

Traffic has been very bad this week and my next call, to a 36 year-old male, diagnosed with peritonitis and having abdominal pains, had to be conveyed in the car. No ambulances were available and even if there was one nearby, it would have taken forever for it to get where I was, so I called Control and let them know I could take this one myself. He was stable and agreed to be taken by me rather than wait for another vehicle.

A 46 year-old chambermaid (do we still use that term?) had been vomiting and suffering from diarrhoea for three days but only just decided, during work, to call an ambulance, so I was sent to check her out. Although she said she was vomiting ‘all the time’, at no point during my twenty minutes with her prior to the ambulance arriving, did she demonstrate this. Quite frankly, she could have walked or taken a taxi to hospital because it was just across the river.

Into the West End for a 20 year-old who called from a phone box complaining of chest pain. Cardiac pain is unlikely (not impossible) at that age, so I didn’t think I'd be treating him for an MI. He walked to the car when I arrived and told me that he had pains in both sides of his chest when he breathed – especially when he breathed in. He had a history of bronchitis and asthma and when I listened to his chest, a slight wheeze and a bit of a rub was evident. I put him on a neb in the back of the car while I waited for the ambulance.

I waited for half an hour and in that time, I learned the young man’s life story. He seemed plausible and likeable but there was an edge to him that made some of what he told me untrue – he said he was doing a degree in physics, which I though was admirable. He was chasing a career in forensics – again, commendable.

The crew turned up and took him away and later on I was told that he was a drug addict, living in a hostel. I am quite gullible sometimes – ask anyone who knows me.

My MDT refused to show me the next call, even though my service mobile had beeped to warn me that one was coming, so I took the details the old fashioned way over the radio and planned my route to the job using a map, instead of the navigation system. This takes a few minutes (as it always did in the old days) and by the time I got on scene, an ambulance and MRU were already there. No need for me then.

A bus allegedly knocked a cyclist off his bike and he sustained a graze to his leg – nothing more. He refused an ambulance when offered one by the bus driver and his manager, so the manager wrote ‘no injury’ on his report form. When the cyclist saw this, he changed his mind and demanded an ambulance, so I was sent. The incident had taken place more than thirty minutes before.

When I arrived, all I got was an earful from the patient. He complained about the bus driver’s behaviour and about how he’d tried to kill him. I stayed neutral. I asked him if he wanted to go to hospital and he said no. I called the police because someone had to deal with this and it wasn’t a medical matter. I positioned myself away from the grazed-leg man and waited for the police while I got on with my paperwork. My MRU friend showed up to assist, although within a short time he too was positioned out of complaint-range of the man with a bemused look on his face.

I was due to go home and I’d had enough of the patient’s moaning, so I took my leave and left him to work it out with the police…if they ever arrived.

Earlier, as I drove to the peritonitis patient, I saw a cyclist standing in the middle of a busy road, attacking a car with his helmet. He bashed it on the roof and window of the driver’s side again and again, shouting expletives as he did so. He may well have had a genuine reason for being angry at the driver – maybe he’d been cut up and bumped by him – but a grown man should never lose his temper to the point where he behaves like Basil Fawlty in broad daylight!

Be safe.


Anonymous said...

I sometimes wander what my father will do if he finds my mother dead in bed..

She had a stroke a few years back and collapsed at 2am on the way to the toilet, instead of calling an ambulance or their GP, he put her back to bed, and they called their GP at 8am - didn't want to disturb him.
He arrives on scene in 12 minutes ( bear in mind, they live out in the country and its a 20 min journey on an empty road normally), mum then refuses to go to hospital on a Saturday, on the pretext its the weekend and they won't do anything - yes maybe for a cut finger, but not a CVA

Eventually she agrees to be admitted on the Tuesday - the GP doesn't like the Consultant in service on the Monday... aaaaaaaaargh

Luckily it was a clot, rather than a bleed and she could still talk/swallow/eat.

You couldn't make things up like this if you tried

Anonymous said...

Made me chuckle! I now have images of a cyclist declaring he's going to give a car 'a damn good thrashing!'

northern nurse said...

Just out of interest, do all your crews use AEDs? We're having a bit of a local debate at the moment (albeit in an in-hospital environment) about AEDs vs manual defibs - the manuals seem to be coming out on top in all the crit care areas, and with all the "experienced" defib-trained staff, whereas obviously on the rehab wards where nobody's seen an arrest in donkeys years, any kind of defibrillation by the ward staff seems a bit of an alien concept!

Xf said...

northern nurse

Yes, all our crews carry FR2 AEDs, although we can use them in manual mode if we need to. We also have the bigger, heavier Lifepack 12's but it would be difficult to carry one them into every job.