Saturday, 27 September 2008

Ending it all

Night shift: Five calls; one false alarm; one dead on scene; three by ambulance.

Stats: 1 MI; 1 Suicide; 2 Chest pains.

An 82 year-old man with chest pain and DIB, a history of type II diabetes and heart failure probably had a UTI – he hadn’t urinated for three days and his condition was complicated by the fact that he was now having an MI. His ECG was textbook and the training crew that arrived to take him away had their first lesson in treating the obvious when they were told about it by their Supervisor.

I wasn’t required to do anything on the next call and the crew on scene simply completed the necessary ‘life extinct’ paperwork as I left. The 30 year-old had apparently committed suicide in the hostel where he stayed. He’d blocked the door to his room with a barrier of furniture and killed himself in the toilet, where his body was found by staff, lying on the floor at the side of the toilet bowl. Water surrounded him and he had had a head injury, which was probably sustained when he fell. The likely cause was an overdose but the police and Coroner would be left to work all that out – there was nothing we could do to help him and, with all the effort he’d put into his demise, it was unlikely he could be saved even if he’d been found earlier.

The water on the floor and the towels used to seal the gap between the bottom of the toilet door and the floor had served some purpose but I don’t know what it was – he certainly hadn’t drowned.

A false alarm (or not) next for a ‘person in the river’. Someone had been fished out dead earlier in the evening and now another man or woman had jumped in to drown. Despite a search by the river police and rescue boats, no-one was found. I stood on the bridge, looking over into the water alongside a few of my colleagues but it all came to nothing as we were told to stand down after a while.

Chest pain isn’t always cardiac-related and right-sided pain makes that possibility less likely, so my 58 year-old patient, whose BM and BP were both on the high side, may have been suffering from a pulmonary embolism. His ECG showed bradycardia and he was uncomfortable. He was given oxygen, monitored and taken to hospital.

On the other hand, chest pain in the absence of any clinical signs whatsoever can mean something and nothing. My last patient was 25 years-old and she insisted that she had severe chest pains, even though her vital signs were all good and her ECG was normal. I thought she may be making a drama out of it and it got her the night off work but I don’t want to be too quick to judge such things because every now and then you get calls like this – seemingly for nothing but they turn out to be significant. I still doubted her though, I have to say.
Be safe.

1 comment:

emma said...

From now on, I'm going to take all chest pain calls seriously (I'm a call taker). I'm 20 years old and I had chest pain and kept blacking out. I went to my GP who did an ECG, and he said he's never seen one quite like it! I ended up spending 3 days in hospital with heart block (2nd degree, Mobitz type 1 for the medics) which I didn't know young people could get!
I used to be a bit cynical if I took a call for say a 25yof with chest pain, and joke to my colleagues that they knew how to play the system, but now I take them deadly seriously.