Thursday, 26 March 2009

Labradors are thick

If warnings have no consequences, the result is always the same.

Day shift: Five calls; all taken by car.

Stats: 1 Epistaxis; 1 Testicular pain; 1 Abdo pain; 1 eTOH; 1 Allergic reaction.

Another nosebleed start to my day. An Italian man stood in his kitchen with his wife and a large, fat chocolate Labrador, as he bled into tissues. The sink was covered in blood and many more crimson tissues lay inside it. He’d been bleeding for over an hour and couldn’t get it to stop.

The man had a cardiac history and was on anti-coagulant drugs but he’d been able to stop the bleeding when it had happened before. He was due to see an ear-nose-throat specialist about his recurrent epistaxis.

As the chunky dog attempted to jump up at me (unfortunately he was too fat to get his two front paws very far off the floor) I packed the patient’s nostril and swathed his nose in a dressing. That seemed to do the trick and I got him ready for the short car journey to hospital.

As we left the house (his wife accompanied us) he told me how much he loved his dog but that it was ‘thick’...'lovely but thick', he said. I agreed that the friendly mutt was thick in terms of its waistline but I couldn’t comment on its intelligence as I hadn’t had a conversation with it.

On the way to hospital, through ever-slowing rush-hour traffic, the man began to cough and splutter as blood leaked into his throat and through the dressing. I advised Control that I would be pushing through the traffic on lights because I didn’t want my patient to pass out in the back of the car and that got me to A&E within three minutes (it may have taken ten or fifteen otherwise).

A 42 year-old chef had an acute onset of testicular pain which radiated into his groin and perineum. He’d had this before but his GP had diagnosed nothing, so he was left to wait for the next attack, which was now.

I found him on the floor in agony, bent double and cupping his scrotum with his hand, just like you do when you are hit there with a football...or a boot. If you are a female reader, please refer to any manual on the pain of childbirth and get back to me on this.

I asked him if it was similar to the pain you get when kicked there and he shrugged his shoulders. Every other male in the room knew what I was talking about but he, apparently, had never been hit there in his life. I found that strange. Even a light tap to the area can produce agonising pain for a short time...every boy knows this.

Anyway, there he was on the floor and I had to get him up, walk him out and put him on entonox before he finally calmed down. He had no medical problems and denied any recent traumatic event. My guess at the time was testicular torsion but my cursory exam of the area couldn’t conclude on that theory as it’s an internal problem.

Remember when you were growing up and all sorts of aches and pains plagued your body until somebody used the phrase ‘growing pains’ and it seemed logical? My next call was for a 13 year-old girl with chest pain and I knew I was running to an inaccurate call description, either in symptom or age. The young French-speaking teen was in an art gallery with her teacher. She was sitting on the floor, chatting away and looking healthy. I used my minimal French to start communication with her until I ran out of steam (and the French language) and had to refer to her English teacher for translation.

The girl had muscular pains of a general nature – not chest pains. Her earlier hyperventilation had produced other symptoms and that’s what prompted the emergency call. I suggested growing pains because she was very tall for her age and looked like she was heading for over 6 feet in height when she stopped developing. Her muscles must be under a lot of stress as they stretch to catch up.

I took them both to hospital in the car. You can never be too sure with these things I guess.

A drunken homeless man broke into a ‘secure’ television news centre and I was sent to get him out. He had somehow snuck in and settled down on the toilet in the executive loos, much to the consternation of the suited managers as they came and went. Security tried to deal with him but he demanded an ambulance.

He was slumped on the loo seat with a sandwich on the floor beneath him; laid there like a loyal puppy at his feet – a bacon and lettuce puppy. I woke him up and he told me he had ‘ligament pain’ so needed to be in hospital. I cancelled the ambulance and decided to take him myself. He was smelly and generally unclean but the trip would only take ten minutes and the options were limited – he could go by ambulance and waste tax-payer’s money or I could simply take him outside and leave him but he’d generate another call for sure. The police could come and collect him but, apart from trespassing, he’d done nothing wrong. So, the only viable option was to take him to a place of safety - still a waste of tax money but cheaper than an ambulance and crew.

During the trip (which lasted forever because of the traffic), he mumbled to himself. Sometimes he spoke to me but I didn’t really listen to him; I was keeping a wary eye on him in case he decided to misbehave and the smell was blurring my focus. So the journey dragged on and all I could hear eventually was mumble, mumble, mumble...snore! The cheeky git was asleep and it took me ages to wake him up and get him out of the car when I got to A&E.

A late job (again) for a 19 year-old girl who was having an allergic reaction in the street. Her friend was with her and, although they were both going to hospital in the car, their boss didn’t believe them, preferring to think they were skiving for the night. He’d called to find out what they were doing and when the situation was explained to him (I’d even offered to speak to him myself but he wasn't interested), he was more concerned about losing a client. I guess in today’s economic climate that’s understandable but the girl’s skin was covered in an urticarial rash – there was no way she could work behind a bar like that.

She had an Epipen but knew not to use it unless her airway was threatened, which it wasn’t, so I scooted her off to A&E for the necessary antihistamine she’d require. Unfortunately (and this has happened to her before) by the time we got there, she didn’t look as if she needed anything – her rash was disappearing. She and her friend had to sit in the crowded waiting area. They’d be there for hours and probably not get anything more than the evidence they needed to convince their mean boss that she was actually unwell.

Be safe.

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