Thursday, 5 March 2009

Slow hearts

Day shift: Nine calls; all by ambulance.

Stats: 1 Birth imminent; 1 Burns; 1 Headache; 1 Nosebleed; 1 Heart problem; 1 Back pain; 1 Fall; 2 Bradycardia.

Over the two ambulance shifts I did there were many calls and I have selected a few of them here.

I almost had to deliver a baby in the back of the vehicle when a pregnant woman called for an ambulance after a PV bleed and contractions began in the early morning. I asked her not to push if she could help it but her urges were stronger than my suggestion and by the time we arrived at Maternity and put her into a delivery room, the baby’s head was appearing. Phew!

This woman had six other children so why she didn’t prepare herself better and arrange transport to hospital is a mystery. Her husband was there and I believe they had a car. The hospital was only a mile up the road.

A call to a police station for a well known protestor who’d burned his hands badly while putting a fire out – the fire was alight on another protestor’s body after he’d doused himself with petrol and set it alight. He’d saved the man’s life but he had been arrested afterwards for another incident and now he was in his cell complaining about police brutality while the skin on his hands peeled to the raw flesh. I put a saline-soaked dressing on the worst of the pair but it was all too late and he’d have to fumble with them until they healed.

Nosebleed calls are rarely emergencies but people tend to panic. We went to a school where a member of staff had this problem but it had been going on (on and off) for 24 hours, so she was concerned and frightened. It certainly bled actively and I put a nose dressing on around her head to control it before we took her to hospital.

I listened to a heart-wrenching story told to me by an elderly lady whose heart was giving her trouble – her ECG was all over the place and as we travelled to hospital she talked about the war and about how her late husband had fought in France, only to lose his leg after a mortar hit his unit, killing the sergeant. She said his life was never the same and he slipped into a serious depression which lasted until he died in the mid ‘90’s. I felt sorry for her because she had supported him all that time and I felt sorry for him because I understood how his pride had probably suffered when he couldn’t play normally with his kids or do the jobs he wanted to do.

I never tire of hearing stories like this and there are lots of people out there who have them…these are individuals who have seen and experienced things beyond our imaginations and for whom the youth of today (for the most part) have little or no regard.

Entonox alone is not always effective for severe back pain, so I gave my next patient, who’d fallen backwards over an office chair, morphine to supplement the gas. Even that didn’t completely reduce his discomfort. We arrived to find him ‘frozen’ in position on another swivel chair but he had to be moved carefully to the trolley bed, so it was important to make sure at least some of his agony was relieved and I think a small reduction was achieved in time. By the time we reached A&E he was getting more comfortable.

An 83 year-old woman stumbled in the street and it was called in as a ?stroke. There was a motorcycle colleague on scene when we pulled up and the lady gently shook my hand when the handover began. She had no injuries and didn’t look like she had suffered a CVA but her tongue was protruding at an odd angle on one side of her mouth, so I could see how that might have been misconstrued by the public. She was taking amitriptyline, which has side effects….

I tried to get a car arranged to take her home because she didn’t want to go to hospital but I was defeated by the pressure we are currently under, so I looked for an excuse to take her to a place of safety (hospital). Her BM was high(ish) at 10, so that was enough to prompt me to persuade her to go, even if the obvious side effects of her drug were there for all to see.

This lovely old lady had nobody in her life at all – she got two visits a week at her sheltered housing accommodation from a carer but for the rest of the time she was alone, so she visited the Salvation Army hall, which was miles away from where she lived, in order to get food and company. She carried a shopping bag with her and I noticed that it was empty. She had been on her way to get tinned stuff when her legs had given way – she didn’t complete her objective, so she’d be going home after her stay in hospital empty-handed.

Two patients with a bradycardic ECG next – the first was at a walk-in clinic and he was normally fit and well, although he told me of several incidences in which he’d felt chest pain and a feeling of being ‘out of body’. His pulse rate was consistently slow at around 45bpm, so we got him into Resus. Nothing was found to explain it.

The next brady call was for an elderly woman who’d collapsed and vomited (a lot) in a theatre. The musical was still going on and we had to work in the dark while three vocalists belted out a song from the show. The audience were oblivious and we found ourselves whispering to a woman who was not alert and at one point convinced us she was about to arrest.

The lift out of the auditorium was awkward and we had to go all the way around the back of the building to get to the ambulance. She vomited again and this time the stuff was all over her, the chair and our clothing – especially my crew mate's. I was working with a student paramedic and he is no fan of puke apparently. He’d never seen so much, he told me later. He'll need to get used to it.

In the ambulance she vomited again several times, which kept us busy and the smell was beginning to overpower us. Her ECG showed a slow heart rate with several anomalies on the graph. She was becoming more alert now but her condition was likely to deteriorate without warning. Again, her heart rate didn’t increase beyond the low 50’s for the entire time we were dealing with her but its possible that her violent and almost constant vomiting had produced this effect.

We returned to the station at the end of the shift and spent 30 minutes cleaning the ambulance but, despite our best efforts, the vehicle still had traces of sick inside it and the smell just wouldn’t go away, so I took it off the road and scheduled it for deep cleaning. I don’t think the next crew would have appreciated taking over a truck in that state.

Be safe.


Fiz said...

Stuart, you really are a hero. The reason the pregnant woman did nothing is the lumpen prolertariat don't plan ahead, they let things happen. I don't envy you getting that poor woman out of the theatre - they are such rat-run corridors - especially with her being so spectacularly ill ( I don't handle vomit situations too well!).

Anonymous said...

I am 27 years old and i grew up in a rest home. As a community cardiac nurse a large part of my job is dealing with older people. And it is my favourite bit of it. I get really annoyed when people patronise them , do they forget that these people have seen a lot in their lifetime?

Jess said...

oh i am so glad your student doesnt like vomit as it makes me feel like il be able to actually be a paramedic and get over my fear of sickness. I never used to mind sick and I was the one that had to look after the ones that got too drunk at parties, but i just cant do that anymore after i was continuously ill and in hospital for a while. I know it seems silly but i thought i wouldnt be able to be a paramedic if i didnt like sick (quite alot of the job involves vomit, im sure), but i should be able to get over it if your student could put up with alot of sick.
Keep up the blogs! I enjoy reading about your heroics!