Night shift: Eleven calls; one false alarm, ten by ambulance.
Stats: 2 Collapsed ? cause; 1 Croup; 1 eTOH; 1 ? Drug overdose; 1 DIB; 1 Hypoglycaemia; 1 Chest pain; 1 RTC with ? # wrist.
Two and half hours to change a light bulb… that’s the answer. I waited for a minor repair to the car before being shipped off miles away to another area for a tail light, then it was business as usual for a night shift.
A crew was already on scene for a female who’d collapsed on a rail station concourse. She was laying curled up and refused to communicate with anyone, despite her obvious consciousness (her eyelids were flickering a lot). Then she suddenly broke out of her mood, grabbed my legs and wrapped herself around my lower half, crying out for her mother. She wouldn’t let go for some time and I wondered if she’d had some kind of emotional crisis, or perhaps had been robbed or assaulted – her behaviour was strange.
For another 30 minutes she kept mostly silent – even in the back of the ambulance when a female police officer was requested to talk to her (just in case that would help). She wrote down bits and pieces of information but otherwise refused to tell us why she was causing the fuss.
In the end, and with the crew exasperated by her stupidity, she was taken to hospital. I heard later on that she was told to leave after saying that her only problem was that her boyfriend had left her. This was a grown woman with issues.
Croup is characterised by a ‘barking’ cough and affects children at a young age. When I arrived at the home of a 7 year-old girl with such a cough, I recognised it immediately, as did the crew who heard her from the street. She had a history of ‘viral cough’, according to her parents, who’d had the foresight to put her in a steamy bathroom to ease it, but this was a bit worse than a tickly cough and she’d need to be seen at hospital.
Teenage drunks are becoming more and more common. My next call was for a 15 year-old who’d had too much to drink and who’d been found collapsed and unconscious in the toilet of a McDonald’s restaurant. Police were on scene and a crew was already there, so I wasn’t really required, except to assist. The girl’s mother had been called and she’d apparently told the police that her daughter ‘doesn’t usually drink a lot’. There was no anger or embarrassment in the statement.
Unfortunately her pride and joy was leaving the place with her trousers undone, vomit on her clothes and in her hair and the ‘floppy doll’ look in an ambulance carry chair. If only she could be sent video footage to cherish for years to come.
A call to an unconscious male at a pub provoked a rather over-the-top response for my request for police assistance when the man began to thrash out at me after I’d attempted to get him to wake up. He was slumped over a table in a quiet bar but I was told he hadn’t had a lot to drink, so I guessed he was homeless or very, very tired. I wasn’t in the mood for any aggression tonight, so after a few near-misses from his flailing fists I called for extra hands. For some reason, despite my answer to the standard question ‘do you want urgent police?’ being no and a further explanation to Control that I was okay but just needed cops in to help me control him, I was sent half the Met.
At least six police officers, including two armed cops, filed in to the bar, doubling its popularity – if they hadn’t been on duty the barman would have broken into a song.
Luckily, I needed at least three of them because when we woke the man up again, he lashed out even more. He was big and fairly strong, so it took a bit of effort and shouting (from the police) to keep him in check while I figured out what his problem was. As he slipped back into a deep sleep, I looked at his pupils – they were pin-point. This can mean nothing of course but given his demeanour it was best to delegate an option, so when the crew arrived I gave him IM Narcan. Within five minutes he was wide awake, abusive, aggressive and being dragged down the stairs to the waiting ambulance.
It always amazes me to see the clutter and untidiness of other people’s homes. I don’t mean general disorganisation – I’m talking about real trashy piled-on-high rubbish and as I struggled to get into the basement flat of my next patient, a 62 year-old woman with DIB, my bags knocked books and magazines onto the floor. I thought there was little chance of getting a chair in if we needed it (which we did) but somehow the crew managed to squeeze around the blockade. The woman wasn’t having any difficulty breathing anyway – she just said she did. She was quite rude at times; one of those well-spoken types that feel we are simply servants.
Hypoglycaemic patients are not a major issue for me and I have my own routine for treating them, especially if they are still conscious but difficult to manage. A call to a 50 year-old man who’d become semi-conscious when his blood sugar dropped to 1.3 (on my meter), meant I was struggling to keep him still as he periodically sat up, cried out and pulled away from me and the two people with him. Placing an IV line wasn’t going to happen until I had help, so I started him off with Glucagon but the crew arrived as I was about to give it. Things didn’t change with him though. He’d settled down a little but I’d been with him a few minutes now and he didn’t stay still for long, so I continued with the IM injection, giving only half – the dark room and stupid little syringe had combined to make me think all of the liquid had been drawn when it hadn’t – still, some was better than none and it would be in his system while I tried to get a line in.
Predictably, he struggled hard as I tried to put a cannula in and it was soon torn out of his vein as my colleague set up the 10% Glucose line I’d be putting in. Another half bolus of Glucagon would have been a good idea, especially if getting IV access was going to prove impossible. He needed to mobilise his own glucose if I couldn’t give him any of mine.
In the end, a second cannula went in and I managed to stick it in place long enough for 150ml of Glucose to run into his bloodstream. He recovered within a minute with an improved BM of 3.9 and from then on was completely manageable.
A MOP called an ambulance for a homeless man who had requested one for his chest pain. The MOP was cynical about it all and seemed to know what he was talking about; his handover was professional, so I figured he was a doctor or a nurse…or a medic. The man on the bridge just wanted a place to sleep and the crew obliged.
‘I just want checking out’, said the 49 year-old woman as she leaned against her kitchen table. She had suffered a panic attack earlier on and now had chest pain – well, it was more numbness down her arm, she admitted. She had no medical history of significance but I think depression was on the menu.
I wasn’t required for the ‘unconscious’ male on my next call because he wasn’t. The police were on scene and the not conscious man was walking away into the sunrise.
And again I wasn’t required for the 21 year-old female who collapsed for some unknown reason (her boyfriend probably left her), so this was another NPC.
I assisted a crew with a 43 year-old man who came off his motorcycle after colliding with a car on a bridge. There was a temporary traffic light system operating, allowing only one lane to run at a time but a private taxi driver chose to ignore his red signal and ploughed into the poor bloke, throwing him off his machine at speed. Now he was being collared and boarded for the ride to hospital. By the time I had finished my paperwork, the sun was up and I was going home.