Sunday, 7 December 2008

Clear blue eyes

Day shift: Six calls; six by ambulance.

Stats: 1 DIB; 1 Unwell adult; 1 Collapse ? cause; 1EP fit; 1 Fall with head injury; 1 ? Pneumothorax.

My suspicious mind is telling me that the heating in our little station has been programmed so that we don’t hang around too long inside and get out there on area cover because it’s warmer in the vehicles. I’m wrong, I’m sure but you just never know these days.

A quiet Sunday but a couple of early calls to keep me awake, starting with a run up to Great Ormond Street Hospital (GOSH) for a 28 year-old Indian lady who’s suffering SOB. She was given an inhaler by her GP but left it at home; she has a child in the hospital and has been staying in the parent’s accommodation block.

A doctor and the nursing staff are taking good care of her as she sits in the treatment room, wheezing slightly. She has an obvious tracheal tug but there’s no effort on her face; she’s just quietly having breathing difficulties. Her husband is there and he speaks English, so together we try to solve the problem.

She’s never had this problem before in her life – not before she arrived in the UK a year ago. I figure it’s either a cold-air or stress induced thing. There is nothing more worrying than having a child in hospital; especially intensive care and this weather can be no good for lungs acclimatised to a milder environment. Even though it gets cold in The Punjab; I’m told it never gets so damp.

She settles down with a nebuliser and I wait almost 30 minutes for the troops to arrive and take her away – the shift has just changed and I am taking point until a crew has completed their VDI and equipment checks.

When they arrive the patient is already much better and off the oxygen. She is still tachycardic at 130bpm and is quite scared of the prospect of going to another hospital – she looks like a frightened, vulnerable child.

Another frightened, vulnerable person was my 83 year-old patient on the next call. She had claimed chest pain but didn’t have a cardiac problem at all. When I arrived and knocked on her door, she didn’t answer, so I pushed the door open, almost expecting to see her collapsed on the floor of her hallway. She was shuffling towards me, apologising for being so slow. The she started to cry.

She had recently been diagnosed with a chest infection and woke up this morning so weak that she could barely wash her face. She was clearly an independent woman who was upset by this sudden deterioration in autonomy. It comes to us all eventually.

I’d barely begun my obs when the crew arrived; I’d been busy consoling her and getting the information I needed from her. I carried out a FAST check and it was negative – my feeling was that she had become run-down by the infection. This poor, frail old lady just needed reassurance and some company.

I left her to the crew and she seemed to be perking up a bit. They’d take her to hospital and she’d get the care and attention she needed I’m sure.

A 50 year-old man was found lying in the street by an off-duty nurse from a local Health Centre. When I arrived a MRU was on scene and, from a distance as I approached, it looked like he was resuscitating. The man was conscious but not responding at all. He had his eyes open but didn’t react to anything we said or did. He lay in the wet road while we waited for an ambulance and did all we could to keep him warm and safe.

His obs were normal but his collapse and subsequent behaviour suggested a possible CVA – a FAST check would have been impossible without his compliance and that wasn’t forthcoming.

When the crew arrived and took him on board his condition hadn’t changed.

A call in Oxford Street had me starting at Centrepoint and slowly working my way along until I got to the correct location. It had come in as a fitting at the Tottenham Court Road end but the details changed again and again as I looked for a windmill or anything that would be a clue to where I needed to be. It was very frustrating; I have no crew mate to look out and guide me, so it’s very dangerous doing the driving and the looking on a busy road like that. Eventually, someone got the details to me and I was heading for Regent Street in fact. Call connect has a lot to answer for.

The 20 year-old had dropped in the middle of the road without warning and was seen to fit for a few minutes. He was lifted to safety by MOPs who were around him at the time. His mother and family had walked ahead of him so didn’t know what had happened until they turned round to see where he was. It was a shock to all of them; he had no medical conditions and had never had fit before in his life.

The street was crowded and the road was busy, so it was a dangerous area to hang around in. The crew arrived soon after me and I was able to expedite a quick removal into the back of the ambulance. He was very post ictal and reluctant to allow obs to be carried out on him at first but as he recovered he became more human again.

His sisters were crying at the roadside, so they needed reassurance. I took one of them and the patient’s step-father in the car so that they could all join him in hospital. They had travelled into London to go shopping but hadn’t even got their credit cards warmed up when this incident ended their day.

Next, a 23 year-old man had his movie spoiled by left-sided pain which he could no longer bear after putting up with it for a few days. His girlfriend was with him and when I arrived I saw that a CRU colleague was on scene. We both entered the screen area and attempted to get a history and obs as ‘Zak and Miri make a porno’ played in the background. The meagre audience weren’t put off but I’m sure they must have felt cheated somehow as we practically shouted at the patient in the back row in order to be heard.

After we’d established a non-cardiac origin for the pain, he was moved out into the doorway and sat down on a chair. I listened to his chest but I’d already reached a conclusion based on his height and frame; he was 6ft tall and quite skinny. He’d told us he was lifting heavy objects before the pain began and that it was worse when he breathed in. He possibly had a spontaneous pneumothorax.

To be safe, he was taken to the ambulance where an ECG was carried out. I didn’t stick around with the crew to find out one way or the other; I had a chat with my CRU friend instead – you don’t get much chance to chin-wag in between calls as a solo – it was therapeutic.

I ended my shift with an easy one – a 77 year-old lady fell backwards on an underground escalator when the man in front lost his balance and fell onto her. She was waiting for me in the station office and, as usual, the staff was taking good care of her. She was badly shaken but, apart from a bump to the back of her head, relatively unhurt.

I examined her eyes and noticed that they were in very good order for her age; clear and without a hint of cataract or opacity. I think it made her day when I mentioned that to her. I left out the ‘for your age’ part of course.

Be safe.

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