Sunday, 23 November 2008

Bad starts and funny bones

Day shift: Eight calls; one false alarm; one declined; six by ambulance.

Stats: 1 Knee injury; 1 RTC with minor facial injuries; 1 cardiac arrest; 1 sprained ankle; one faint; 1 fall ?cardiac; 1 fall with knee injury.

I’m doing my usual couple of shifts on an ambulance, so I have a crew mate each day and, for the first time in a while, I’m enjoying the change. Ambulance calls are much more varied; I never go to Green category calls in the FRU and I don’t do patient transfers. I also get to spend more time with my patients and that’s often the most satisfying part of the job.

My first shift is with Dave – I’ve never worked with him before but I have known him for a few years – he’s a thoroughly nice chap and totally professional.

We had a routine kind of start to our day with a 30 year-old Spanish woman who stumbled whilst running up stairs at work. She got a banged knee for her trouble and now she could barely walk on it. It was more than likely just bruised but knocks to the knees can be very painful, so I empathised with her misery and we took her to hospital.

This was followed by a 9 year-old girl who was on her way to school when she stepped out in front of a cyclist as he sped along the road. She ended up with cuts to her cheek, mouth, nose and hands. The handlebars of the bike struck her across the face and she was obviously upset. Her father had to be dragged out of bed to come to her aid when other family members called him. He was calm enough about it all but he told me that cyclists were notorious for speeding along that particular road, despite the fact that children use the route to get to and from school.

Some calls just aren’t what you expect or want in the early morning. A man had collapsed and was ‘unresponsive’ in McDonalds. We know the particular restaurant well and we know the locals who visit it, so our assumption was simple; it was a known alcoholic or drug user who’d lost himself on the floor. We would go in, wake him up and walk back out with him, arm in arm no doubt.

We walked in and I got to the man on the floor first. He wasn’t known to me and the staff members present weren’t too worried about him. A customer had a lot more concern on his face – he was the one who tried to get him to respond with no luck.

The man was on his back and he wasn’t breathing. I felt for a Carotid pulse and got a very weak, thready impulse against my fingers. He was peri-arrest.

As the equipment began to gather around his body, he arrested and his ECG showed asystole.

Nobody knew the man and there was no indication of anything untoward when he walked in. He sat down and then fell down by all accounts. The witness, who continued to help us as we started working on him, said that he’d gone to the toilet but there was no real historical information to help us work out what may have caused his sudden demise.

I asked the McD’s manager to call 999 and request a second crew (this is normal practice) and off he went. We continued to go through the sequence of actions needed to save the man’s life; CPR, drugs and more CPR but his rhythm didn’t change and no shocks were given.

The crew arrived but seemed completely surprised by what they were seeing. The paramedic told me that they had been given this as a ‘second patient’, so they thought they were simply coming to assist with another casualty. Right from the start, the verbal communication of what was going on in that restaurant was inaccurate. I even had to request that they clear everyone from the basement area because people were still munching their breakfast buns as we jumped up and down on the man’s chest. Then I had to ask for the cheery music to be switched off because a) I couldn’t hear the defib above it and b) it was entirely inappropriate and was cheering nobody up.

If you are a McD employee, please do a first aid course and learn how to relay messages. No offence if you are already switched on but it is all about communication.

We stayed on scene trying to stabilise the patient but nothing changed, so we blued him in and the work continued in Resus. Unfortunately, he was pronounced after twenty minutes and still nobody knew why he’d gone. He was only in his forties.

Green calls can wait a while before any help arrives and our next patient, a 19 year-old Danish girl had to endure two hours with a badly sprained ankle at the hotel in which she works. A heavy drawer cabinet was being pushed past her but the clumsy maintenance man failed to realise that an obstruction to his path was the young lady’s foot, so he pushed harder to clear it. She twisted herself to get free of it and damaged her joint in the process.

We arrived to find her sitting, leg raised, behind reception. She wanted to go by taxi but the hotel management decided an ambulance would be better. Not really…she would have been in A&E faster by cab.

She was a pleasant, chatty girl with excellent English and a love of texting that kept her pre-occupied during the journey to hospital. Opposable Thumb Psychosis I call it.

Comical calls are few and far between and the 999 request for a cancer patient who was not answering his door and was seen in bed not moving by a worried neighbour turned out to be one of those things. A MRU colleague was on scene with police and the door was being forced. The patient could apparently be seen in bed through a little window but he cared not for the commotion outside his door…apparently. When the door broke I went into the bedroom and approached the bed. A quilt was wrapped in a roll and I braced myself for the purple body it contained. Then I lifted it and saw…the sheet underneath. The bed was empty. Nobody was home and now the poor guy was going to return home to a smashed door. The police would inform him and he’d get a replacement but it would be a shock.

The shaken and very pale neighbour waited outside and fully expected us to come out shaking our heads in that ‘there’s noting we can do for him’ way but the shakes were contrary to his fears and we quickly reassured him that he’d done the right thing. Even I was convinced up to a point.

A 73 year-old lady declined to go to hospital when she fainted three times in a busy department store. ‘I’ve been fainting all my life’ she told me. We did all the necessary checks and pronounced her fit and well. She’d fainted, got up too fast, fell down again and repeated that action once more for the benefit of the worried staff who were lovely with her throughout.

Another elderly fainter was an 81 year-old man who tripped in the street, fell, was helped up and then passed out further down the road. He had a head injury and was confused about what had happened, although he had a clear memory of the events leading up to it. His ECG revealed a possible heart block and that would certainly explain the falls. We took him to hospital and his wife joined him a few minutes after we arrived. She looked resigned because, although he had told me this had never happened before, she told me that it had…several times.

Last call of the day and it was a cyclist who fell off her bike. She had a painful leg and when I examined it the bone seemed to be protruding. In fact, when I touched the area it clicked back into place and she got instant pain relief. She told me that this bone had done the same thing before but the location of her ‘loose bone’ was high up on her tibia, near the knee. Unless she was born with a deformity or the bone has been broken for a while, the movement was quite unnatural.

By the time we arrived in hospital the pain was virtually gone but she still couldn’t put weight on it. Good idea not to, I think.

Be safe.


Anonymous said...

In Central London I'd be surprise if anybody in a McD spoke English, let alone gave a damn.
Thus making communication a complete nightmare

BenefitScroungingScum said...

Re lady cyclist-that kind of 'loose jointedness' is a typical symptom of either Ehlers Danlos Syndrome or more likely in someone that active Hypermobility Syndrome which is relatively common but very poorly diagnosed.
Bendy Girl

Jo said...

Question - in my most recent first aid course, we were told that if the patient wasn't breathing, unless it was a drowning, we should assume no pulse and start CPR (i.e. saving time checking for a pulse, and avoiding the possible misdiagnosis of feeling one's own heartbeat instead of the patient's). In a similar situation to this one, would doing heart massage harm the patient?

mac said...

The patient would do one of two things, 1)Tell you to get off or 2)Remain unco. No real harm would come to the patient, they would just have a very sore chest!

Anonymous said...

Its a ear since my last first aid course but id always check for a pulse, nearly before checking for breathing. Breathing is very easy to miss, not so easy with the pulse, if you dive into cpr without pulswe check you could do a fair bit of damage.

AnalogueAndy said...

Re the McD's sudden death, presumably there'll be a PM and an inquest. Do you get called to give evidence? Or if not do you ever get told the outcome (i.e. get an explanation)?

I'd only just passed my first aid course at work when I was called to someone in a similar state (no breathing, v weak pulse), got her 'back' but she eventually died later the same day.

(Boy did that 10 minutes before you lot turned up seem a long time!).

Turned out she had some kind of undiagnosed congenital defect. I cracked a rib doing the CPR apparently. My memory is vague but IIRC there was an inquest and I was asked to provide a written statement.


Anonymous said...

Andy - it's not uncommon to crack a few ribs. It's less the actual rib breaking, and more the cartilage popping. There are some who say that CPR isn't being "done right" unless you crack a few.

My Pt certainly popped a few when I did it.