Saturday, 7 March 2009

Obstructions

As the drive towards budget mania increases in the Capital, more and more roads are being carved up for whatever reason and coupled with closures due to demonstrations and protest marches that do nothing significant to alter the course of history in the short term, the result is chaos when we are trying to locate critically ill patients. If one death could be attributed directly to the inconvenience of multiple simultaneous disruptions on a large scale like this I wonder if it would change anything. I highly doubt it.

Day shift: Four calls; all by ambulance.

Stats: 2 Chest pain; 1 EP fit; 1 Hypo fit.


NPC on the first two calls of the day – chest pain.


A call for a collapsed male in the street described the caller as ‘not interested in checking on the patient’ and this always causes problems because details tend to be scant and the whole thing could end with a cardiac arrest or a nonsense call. When I got on scene, the 30 year-old was recovering from a fit and there was a small crowd around him, mostly made up of his friends, so whoever had made the original call had ignored this fact or they had simply shown up coincidentally.

He was epileptic but hadn’t had a seizure for years, so he had to be checked out in hospital but the fuss confused him a lot until his head cleared and he began to understand what had happened. I guess he can be thankful that someone, interested or not, had made the call when he was seen lying on the pavement.


The last call of the shift took me to an estate where a woman had collapsed in her kitchen. The call had been given as ‘not breathing’ but it was a Red2 so there was something in the detail that I didn’t know and as I got near to the scene I was cancelled for a ‘nearer vehicle’, which actually wasn’t true because I was at the bottom of the road and no other ambulance was in sight. This happens a lot because of the way our trigger-happy system runs and its designed to utilise resources in the most efficient way, which isn't always the case.

I was given the job back (somebody with a human brain had obviously seen the problem) and I made my way up the street where a windmill was frantically signalling me. The young man guided me around the back of the block and ran inside one of the flats. I followed with everything I could carry – people seldom behave like he had just done without a good reason.

Inside I found the woman on the floor, fitting. Her crying son had his fingers in her mouth and I told him to take them out.

‘I can’t, she’s biting too hard’, he said.

I could see he was in pain, so I helped him get his digits free by prising the woman’s tonic jaw open as carefully as I could. He fell backwards and regained ownership of his hand. I quickly asked if he was okay but, to be honest, if he wasn’t he’d have to deal with it himself – his mother was in serious trouble.

‘She’s a type one diabetic’, he cried out as his fingers got a cooling under the tap.

That was good information and explained what I was looking at. I checked her BM as she writhed and jerked on the floor – it read ‘LO’.

A motorcycle colleague came in as I prepared to deal with this and I asked him to get Glucagon ready for me. As I waited I cannulated her so that I could give IV glucose. When the meter says ‘LO’ it means low and if we didn’t act quickly her condition could terminate to coma or cardiac arrest.

The Glucagon injection was given but it usually takes time, so she was supplemented with a bolus of 10% glucose. We monitored her vital signs as we waited for a result and continually calmed the family down – there were a few of them and more kept turning up.

Her son had never seen her fit like this before and she had a good record of taking care of herself in the past, so this was unusual and unexpected. The 999 call would have been emotional and confusing, which explains the original ‘not breathing’ statement and why someone at our end was cautious about the category.

A crew had arrived as we were setting up treatment but their vehicle was parked out on the street and had to be brought around the back so that a chair could be delivered…or a stretcher if things didn’t go to plan.

I have a lot of faith in the drugs I use for diabetic emergencies and I was willing her to open her eyes and start recovering. In about five minutes she obliged and within ten she was conscious and more or less alert, although completely confused about what had happened.

On the way down to the floor she had burst her lip on a work surface, so her collapse must have been sudden and without warning – to her and her family. She must have been terrified to wake up with all of us around her and a drip in her arm.

She was wheeled out to the ambulance and her BM had improved to a normal level, so I felt chuffed that we’d brought about such a rapid recovery in someone whose life was certainly on the line. Of all the jobs (all four of them) that I’d gone to today, this was the one that made it worthwhile coming in to work.


Be safe.

3 comments:

Dave said...

4 jobs on dayshift....
That would have been a very quiet day for you.

Good diabetic job.
Sends you home looking forward to coming back the next day.

Regards
Dave

Anonymous said...

I've done 2 jobs like this (sadly to the same guy both times), and it really is amazing the affect that the drugs we give them has.

Just have to watch out for them taking a swing when they come round ;-)

Lucy
Cumbria

Uncle J said...

Re; "more and more roads are being carved up for whatever reason"

At this time of year it is very often because Highways Depts have 'held back' a bit of their budget - just in case of something unexpected.
Now they want to spend it before the end of Financial Year - "use it or lose it".