Tuesday, 3 February 2009

Slush

These boots are made for gripping...

Day shift: Eight calls; all by ambulance.

Stats: 2 Faint; 1 Chest pain; 1 Hypoglycaemic; 1 Asthma attack; 1 EP fit; 1 RTC with Spinal injury; 1 Hypothermia.


Back to normal and I use slush to describe the weather as well as the working calls – not with disrespect of course but as the best descriptive comparison of the last two shifts. With snow, you know what you are getting but slush is a mixture of all kinds of stuff...including contaminants and rubbish.

The snow covers were removed from my car and I slid about a bit but not so much that I couldn’t keep control under 30mph on those icy side streets that still hadn’t been touched by grit or salt.


The fainters are back on line. The first call I received was for a 27 year-old who’d almost passed out in his University Halls of Residence. He’d also claimed chest pain but this was easing as his emotional state relaxed. As I approached the rooms where he lived I noticed various signs that were posted on the walls. One of them pointed in the direction I was heading. It read ‘rubbish’. I hadn’t made a personal judgement yet but I had to smile at the irony of it.


The second call of the morning was also a faint but a crew was on scene for the 20 year-old female who’d passed out in an underground station.


Another chest pain call for a young person turned out to be a bit more interesting than usual. The 24 year-old woman suffered from Wolfe-Parkinson-White Syndrome. She had palpitations and was breathless as she lay on the floor of her boyfriend’s room (again in a Halls of Residence). This condition can quickly convert to a life-threatening VF if not treated but that only happens in rare cases (less than 1%), although at her age she was at higher risk, so it was all taken seriously.

She’d had an ablation treatment for it a few months ago and had seemed fine until today. Her ECG had all the expected waves and forms and there was no evidence of a new problem (no shortened P-R or Delta waves, for those of you inclined to care for the technical stuff) but it would be down to a cardiologist to determine that, so off she went to hospital and straight into Resus.

I felt sorry for her; she’s too young for that kind of problem and it may or may not resolve itself in later life. I could only hope that the former was true in her case.


A 51 year-old lady fell out of her bed and I was sent to her on an assist-only mission. She was a large woman with MS and weakness of the legs as a result. This made my valiant attempt at lifting her on my own rather useless, so I requested another FRU to help me. At this point an ambulance wasn’t really necessary and she wasn’t interested in going to hospital but when I checked her BM as part of my basic obs, I found it to be very low (2.2). I tested her again because she wasn’t diabetic and had no other issues apart from a recurring UTI. The reading was still low. I had to change my mind about the ambulance. Either my properly-calibrated meter was faulty or there was a new problem that needed checking.

When the crew arrived the woman was munching on a chocolate biscuit that I’d given her from her personal stash in the kitchen. I noticed that she also had tubs of sweets and chocolate bars at her bedside. She was obviously a sweetie monster, as we say in the Homeland. I can be one too, I must admit.

This in itself did not make her a candidate for hypoglycaemia because with a high intake of sugar I’d expect to see the opposite if she was developing diabetes but her condition was clearly serious, if taken on face value, and a trip to hospital was now required to sort it out, one way or the other.

Before leaving her flat, I carried out another BM test using my colleague’s meter and the reading was normal (4.4), so there could have been a problem with mine or giving her the biscuit may have been a mistake as it may have skewed the reading, although I’m sure one biscuit wouldn’t cause her glucose level to rise by so much so quickly (within ten minutes of the second check). I was torn between allowing her blood glucose to remain low, thus disallowing any aberrant influence and treating her condition. Clinically, I had to treat her, so the biscuit was given. Oh and the finger I tested on had been cleaned prior to lancing (just in case you leap to any conclusions).


Asthma and hyperventilation can sometimes go hand-in-hand and sorting one out from the other is usually clear-cut but my next patient, a 25 year-old asthmatic who was at work when she suffered an attack, had me making a choice for the benefit of the patient. She was obviously upset and there was a slight wheeze in her chest but I wasn’t entirely convinced that she was having a full-blown attack. Nevertheless, I gave her Salbutamol by nebuliser as a substitute for her non-effective inhaler and this took care of the wheeze and calmed her down. I have seen the psychological effect of this drug many times before and would never advocate its use in an absolutely clear case of over-breathing but there is sometimes a fine line and, again, a clinical decision has to be made on the spot. Peak flow and sats help to make that a simpler task.


The epileptic fit call was to an 18 year-old girl who had a witnessed 2-3 minute seizure at an underground station. A South African paramedic gave me a sterling handover and then promptly disappeared, which is the done thing, when I took over.

The young girl was recovering but told me that she often had more than one fit, so as soon as the crew arrived, she was taken on board. She’d also hurt her ankle, most likely during her fall to the floor, which was seen by one of the station staff members.

I asked her what she did for a living because she'd mentioned going into work tonight. In the din of the station my ears heard her say 'restaurant' and I assumed she was a waitress, being so young, so I said 'you'll be on your feet a lot then', referring to the association between her job and her injured ankle.

I got a peculiar look - nothing more than a bemused glance from her. It was only later, when I asked her to confirm what she did for a living that I realised what I'd done. She worked for an escort agency...


My next call took me back to a road junction I had been to a few days earlier. I'd helped a motorcyclist who'd been knocked off his bike at the exact spot where a man now lay on his back in the filthy slush. He'd been seen to stagger or slip backwards into the road and his head hit a van as it drove past. The van driver didn't know what had happened so continued and disappeared, according to a taxi driver who'd witnessed the whole thing. Now the man was concussed and complaining of severe neck pain; even the slightest touch set him off.

As usual in this area, there was a lot of traffic moving past. I am particularly careful in this area because the vehicles get very close. Once again I found myself on my knees in the middle of the road, holding someone's neck still until backup arrived.

I'd asked for the police but a Camden Guardian was helping out with the traffic for me until they arrived. In the meantime, I spent fifteen minutes with the man, unable to do much else but monitor him until a crew pulled up. By the time he was moved into the ambulance, he had become very cold, despite the blanket I'd put over him. Most of the cold you will feel when lying on the ground will be from below.

I was on scene for an hour and accompanied the ambulance to the hospital, where I sat inside my car doing the necessary paperwork. That's when I was approached by two women who told me that someone had collapsed around the corner and that an ambulance had just gone past him. They thought the crew may not have seen him, so could I do something to help.

I called it in and offered to go and check it out. This would be my last call of the shift.

Around the corner a man was leaning against a railing and swinging his arm in and out as if punching the air. He was fairly young and looked out of his head. A newspaper vendor had called us because she'd been watching him behave bizarrely for the past half hour.

I went up to the man and spoke but he didn't communicate. Instead he swung his arm out towards me several times. At first I thought he was being deliberate but the more he did this, the more convinced I was that it was a repetitive action. He may have taken drugs or there may be another reason for his behaviour.

I waited for five minutes, attempting to get him to speak but his railing-clinging, arm-swinging continued without rest or interruption.

When the crew arrived (three of them - a paramedic and two trainees), we managed to get him into the ambulance and when I jumped aboard a few minutes later he was sitting up and talking. It was a miraculous change in his demeanour but he still wasn't quite right.

'Can I go now', he said, moving towards me at the door.

There was no way to stop him. Our duty of care doesn't extend to the forceful restraint of a person who wants to be left alone but he wasn't 100% and we watched him as he staggered down the road, at one point stalling in the middle of the pavement like a short-circuited robot.

None of us believed he was drunk but drugs were still a possibility. It wasn't until he collapsed in a doorway and became unconscious that we discovered what might be wrong. The crew took the opportunity of getting obs while he was sparked out. I had called the police because we needed to get him into hospital for his own good and while we waited for them, I was told that his temperature was reading below 30 degrees Celsius. In fact, I recall the number 28.7 or thereabouts being used.

Severe hypothermia can bring about odd behaviour, unconsciousness and death. It all fitted with what had been happening and I found it unbelievable that someone like that had become so cold. He may have been on the streets but he didn't look like he was (which is generalising but they do have a certain distinction).

When the police arrived, he was off again and wandering down a busy street, the crew on his tail trying to persuade him to get into the warm. The police officers had to struggle with him when he became aggressive on seeing them. He was eventually cuffed and brought back to the ambulance.

It's all a bit brutal, I know, because the poor man had done nothing illegal but leaving him to wander the streets until he finally died was not an option for any of us.

Be safe.

7 comments:

Jim said...

Do those snow socks actually work?

J

Alan said...

Hi. I've been reading your blog for a couple of months now, and I recently finished your book. I wanted to congratulate you on a great read. Also a thanks; the reason I found your blog originally was due to considering a career with the ambulance service - your writing has been one of the main infulences in making me absolutely certain that is what I want to do with my future.

Alan

Xf said...

Jim

Yep...they do.

Xf said...

Alan

Thank you very much and good luck with it.

theelmbulance said...

Cheers Xf for writing about the Wolffe Parkinson White syndrome, interesting stuff! I'm currently a student Ambulance Officer, and the amount of info I've been able to get from your writing is fantastic. Keep it up!

Medical Student said...

Reading you blog has inspired me to start my own blog as I am a medical student. You can find it here: http://amedicalstudentblog.blogspot.com/ . I haven't put many posts on yet, as I have only just set it up. Good luck in future with your blog, it's very interesting!

ThinkerGoneMad said...

I learned something new today. I am now officially addicted to your blog. Thanks for sharing these stories! :)