Day shift: Ten calls; two taken by car; eight by ambulance.
Stats: 1 Epistaxis; 2 RTC; 1 Head injury; 1 Near faint; 1 SOB; 1 Actual faint; 2 Chest pain; 1 Fall with ? broken nose.
Nosebleeds are not usually emergencies (although I have seen one patient die as he bled out) unless the patient has a particular vulnerability, such as so-called ‘blood thinning drugs’ or high blood pressure, so I usually convey them to hospital myself. My 62 year-old patient was on Warfarin and Aspirin, so fell into the vulnerable category but he had only been bleeding for 30 minutes before I arrived and had no significant clinical signs or symptoms to worry about. The trip was fast and easy for him. I had packed and dressed around the left nostril and this brought an end to his drama.
My first RTC of the day was a motorcycle versus a cycle. The crew was on scene and another call had come in reporting yet another cyclist on the road after being hit, so I freed myself up (this patient had few or no injuries) in case I was needed elsewhere…
…I was but in a police cell for a 30 year-old man who’d deliberately banged his head on the wall, slipped to the floor and pretended to be unconscious. He wouldn’t speak at all but he mumbled convincingly. His mumbles were meant to say ‘I am having a fit’ but he clearly wasn’t. The cops weren’t buying it but they were being cautious. He was known to be violent (a fact they kept from me until I had provided a bit of pain to get a response), so I was suspicious about his motives.
The crew arrived and delivered a bit more pain than I was willing to after the ‘violent’ revelation. He sat upright, opened his lazy eyes and stared with contempt at the paramedic who had cruelly snapped him out of it. I didn’t mind; I wasn’t wimping out, I just had time to play with because he wasn’t going in the car with me.
He continued to play the part and was taken to hospital. I was still unconvinced and later learned that he tried to abscond after lashing out at staff. Told you, didn’t I?
The next RTC involved yet another cyclist and another motorbike – it was obviously day of the Lemming cyclists or day of the demon motorcyclists (they should really wear a badge so that I can tell what kind of day it is). The cyclist and motorcyclist veered toward one another in an attempt to miss each other on the road but ended up sandwiched together... and into the back end of a car they went. The car driver, a lovely lady who helped no end and tried to get me a free coffee but was refused (thanks Costa), was a bit shaken up and even more so when she was read her rights, along with the two competing two-wheeled idiots. She had done absolutely nothing wrong – indeed she was accosted by the two vehicles while her car simply obeyed the law but the police are required to cover all their bases. I felt sorry for her as she sat in the van getting the third degree.
The cyclist had minor scrapes to his leg but because he was the only injured party, he used this as an excuse to get the hell out of there by ambulance. While I was attending to him the two men argued the toss about who was to blame. Meanwhile the poor coffee-cadging woman stood nearby wondering what the hell was going on. Bless her.
A 70 year-old man almost passed out as he wandered an art gallery. It had happened to him before after a run (not bad at his age) but he had no heart problems. His ECG wasn’t normal and his blood pressure remained low so he was taken to hospital.
An interesting chest pain call at a walk-in centre produced a hidden problem that screamed to be diagnosed. The middle-aged man had gone in after a few days of chest pain, followed by progressive weakness and shortness of breath. He was pulling away on inspiration when I got there but he said he felt okay now. His obs were good except for a consistently high BP. His lungs seemed fairly clear, although I detected a small area of possible fluid in there, so I asked the crew to give GTN and nebulise him. This had the effect of reducing his BP and making him feel better about his breathing. The BP reduction wasn’t good enough though and I had already ruled out LVF, so what could it be? His ECG showed a T wave inversion on a lead where normality should be seen, so I had them swapped over to check again and there it was.
We blued him in even though he said he felt much better and a diagnosis was soon given – he had a Pulmonary Embolism. All the signs were there and so I should really have opened my mouth to say it but we are all a little shy of being smart arses to doctors sometimes.
A 60 year-old who fainted in a pub had a high blood pressure too and although she was recovering when I got there, she remained ill-looking to me and the crew, so she went to hospital. I thought it was a bit cruel to send me to a busy pub at lunchtime when I had already asked for a break and was starving. Plates of food were being sent out all around me and I might have stolen something if it wasn’t for my good manners and professionalism. And fear of arrest.
In the pouring rain and howling wind the last thing you want to do is wander around a horrible housing estate trying to find the flat number you need. As usual, the one I wanted was in the very last block, at the very top (no lift) and at the very end of the balcony. It was one number short of the easiest flat to access downstairs on the corner I had come in on.
I huffed and puffed my way up, mainly for effect and through annoyance, to the 65 year-old lady with a history of AF and flutter who’d claimed chest pain. She was on the sofa in the correct pose for ambulance assistance but all her obs were fine. Her pain had gone but the family remained concerned nonetheless. Of she went to hospital – carried down all those wet stairs by the valiant (and I mean that) crew that had also lost themselves in the weather trying to reach us.
Back to that walk-in centre for a 63 year-old man with chest pain and a pacemaker that might not have been pacing at all. He had left arm and shoulder pain but seemed reasonably stable. His pacemaker had been fitted only 6 months ago, so there may be a problem with it.
I conveyed my last patient of the day. She made me late home again but I forgive her. She had been drinking all day and fallen flat on her face, breaking her nose. I asked her why she had been drinking at this time of day (it was entering rush hour) and she said ‘Oh, you know…just because’ and that answered my question. She was depressed or angry about something and it was very likely something to do with the engagement ring on her finger.
She was a type I diabetic and her blood sugar was high. I told her how silly she was and she giggled acceptance of that fact while holding on for dear life to the back seat because she thought the car was spinning and leaning out of the open window preparing to vomit in the street. I asked her to put her head into a clinical waste bag and hold back the tears if she could. She ended up in A&E reception, sitting on a chair with her head so well buried that she looked like she had a yellow plastic bag for a face. She cried anyway.