Thursday, 16 April 2009


Day shift: Five calls; all by ambulance.

Stats: 1 Mental Health; 1 Cardiac arrest; 1 DIB; 1 D&V; 1 TB.

Another ambulance shift and my crew mate today was Allan. For the third time in succession we found ourselves with a suspended call. Obviously when we work together people stop breathing.

A screaming 57 year-old psychiatric patient who was on police bail decided he couldn’t move his legs and cops were called to his flat because the neighbours were frightened and concerned by the noise he was making. We went in and found him on a chair in his front room. He complained of having ‘fluid on his face’ and we managed to get him to walk down the stairs to the ambulance unaided, despite his ‘can’t move my legs’ claim.

Throughout the journey he lamented his discomfort and I carried out a FAST check to be sure that nothing was being missed. Although his behaviour was strange and he seemed to have nothing wrong with him apart from a known psychiatric history, I wanted to cover all my bases in case he actually did have a problem. The arm drift check was nonsensical because he deliberately threw both arms down to show me how weak they were.

The cardiac arrest occurred at a hotel. A 25 year-old man had been found not breathing in bed by his 14 year-old sister. Both were visiting London from Ireland and she was sitting on the edge of her bed as the MRU paramedic, who’d arrived first, resuscitated her older sibling on the floor. She had an air of calm about her that shocked me (and everyone else).

As we worked on him, I asked her what had happened and she told me he’d been making strange noises in his sleep, so she’d turned him over to help his breathing. Then, a few hours later when she woke up, she found that he wasn’t breathing at all, so called an ambulance.

After eight minutes of frantic effort (he had been asystolic throughout), we got an output and shortly after that he began to breathe on his own. His diminutive sister had been removed from the room and I’d asked for a WPC to take care of her. She didn’t yet know that we’d saved her brother’s life.

Once we had everything in place and he was stable enough to be moved, we got him down stairs and out of the hotel. I spoke to his sister and told her what was happening but, again, there was no emotion. She behaved as if this was normal.

At hospital (I travelled with the patient and the MRU paramedic; Allan took the girl in our ambulance) I discovered that this wasn’t the first time he’d almost died. I’d already figured out that he must have come in drunk the night before – I can only assume he left his sister at the hotel as he went clubbing (he had an ink stamp on his hand). Then he’d gone to sleep and lost control of his tongue, thus the noisy breathing in the night. He’d vomited and inhaled it, causing his cardiac arrest. Shockingly, the girl told me (and the police) that he’d been taken to hospital a few years before because he’d stopped breathing as the result of aspirating vomit after a boozy night out.

Clearly, he hadn’t learned anything and his parents, who’d been told on the phone what was happening, still trusted him to take care of their young daughter in a strange city without their supervision. Crazy.

An electrical failure on our ambulance brought us to a standstill for a few hours as we swapped vehicles and equipment, and then we were off to a DIB given as a '73 year-old, drinking lots of water – sleepy'. Initially, as the call was coming in, the descriptor read ‘drinking lots, sleepy’ and I thought someone was surely joking because it was a Red call but we arrived to find the lady struggling to breathe, with sats of 56%, swollen ankles and fluid on her lungs. I gave her GTN, a nebuliser and Frusemide and this improved her condition within minutes. We ‘blued’ her in with better sats – not perfect, but better.

Sometimes you wonder if the blue call you made was perhaps bad judgement. It can be embarrassing to cause the fuss only to find that your patient really isn’t as bad as you thought, so the next call for a 43 year-old lady with diarrhoea and vomiting gave me the option of trundling it in or racing it in. I chose racing because when we got there her BP wasn’t behaving; rising then falling all the time. She complained of jaw pain on one side and she’d fainted earlier on. It all seemed a little more difficult to treat than D&V, although I couldn’t yet see a connection.

I had Allan call it in and arrived at resus feeling a little sheepish. I justified my decision with her medical history of hypertension, the fact that she looked very ill, her son’s concern that she’d ‘never been this bad’ and that unstable blood pressure of hers. In the end she was kept there because her BP plummeted soon after we arrived and nobody could figure it out.

Calls to potentially infectious patients are normally given to us with a warning to take proper precautions, which we normally do if we are made aware of them anyway. A call to a 43 year-old man at one of London’s grubbiest hostels, came with a notice that we were to wear masks. The patient had Tuberculosis and was running a temperature.

We didn’t have any face masks on board so planned to play it by ear when we got there but our arrival caused confusion with the staff, who knew nothing of this diagnosis. Now they were at risk.

The man sat in his little bed-sit and denied telling anyone he had TB. In fact he denied calling an ambulance in the first place. The staff member who met us said she wanted rid of him because they couldn’t cope with him but I didn’t see how that was our problem to be honest and I felt that they were using the ambulance service as a means of removing difficult customers.

We took him to hospital anyway – he did have a bit of a temperature – and during the trip I read his paperwork, which had only been given to me when I’d requested it before we set off. I found a note from a specialist communicable diseases department. The man was being investigated for TB after a lung x-ray had revealed abnormalities. Great; now we were back to square one.

The man continued to deny having any health problems, even when I read the letter out to him. A staff member was travelling with us and he had no knowledge of this problem. The fact that the man may have TB should have been highlighted to anyone who was in contact with him. He had a little cough – nothing serious but enough to throw spray around – so I put an oxygen mask on his face until we got to hospital, where a proper face mask was given to him after the nurse, who’d been told the story before I took him inside, decided he was too high a risk.

I went home feeling let down. Someone hadn’t given us the whole story and I still don’t know if I’ve been exposed to TB or not. I’ll find out when I get sick no doubt.

Be safe.


Lizzy said...

Oh, crap!! Fingers crossed for you.

Caroline A said...

That's terrible about the TB, so inconsiderate. You must be really anxious about it. I hope you're okay. I expect you'll be wearing those mask more frequently when swine flue comes to town!

amberly said...

That is awful! I hope you dont get TB. We in the usa have the swine flu going around so there are masks everywhere! good luck!

solongo said...

I have TB and am actually in isolation in hospital right now. I've followed the advice of my doctors throughout, but a number of family, friends and colleagues were exposed to me while I was infectious and have had to be screened. I suspect that your patient truely didn't believe he was ill. I spent a long time thinking that I had either a flu or a mild chest infection, and finding excuses for the symptoms I clearly had. My family reacted the same way until I ended up in A&E. It's hard to take such a serious diagnosis seriously when you don't feel that unwell - and in his case it isn't even confirmed. Of course, that doesn't excuse failing to tell you about the existing concerns.

I hope you aren't too worried about your possible exposure. Frankly, working in London and coming into regular contact with at-risk groups I'm sure you've been exposed before and survived. It's not that infectious and most people carrying it never develop symptoms. But then you probably knew all that.

Xf said...


Thanks for that. You're probably right and I'm not too worried about it to be honest. As you've said, my colleagues and I are exposed to stuff all the time. I'm probably immune to everything on earth!

Take care of yourself and keep well.

Yuki said...

Just to support the notion you're not at high risk: I worked for a time as a nurse on an Infectious Disease ward with a steady stream of pulmonary TB patients. The doctors would happily sit in the isolation rooms with them sans masks on a regular basis.

Their argument revolved around the notion of man-hours of exposure or some such.

Always enjoy reading your blog!