Wednesday, 15 April 2009

Phantom family

Day shift: Seven calls; all by ambulance.

Stats: 1 Unwell adult; 1 Chest pain; 1 Back pain; 1 RTC; 1 Head injury and ? fracture; 1 Seizure; 1 Suicidal.

I worked on an ambulance today and my crew mate was a friend from my own little station. The day was eventful but fairly routine.

Being pregnant may cause side effects. My first patient today, a 32 year-old who claimed she couldn’t eat or walk and was dizzy made a dramatic attempt to increase the speed at which she could be delivered care when she discovered she’d be waiting for a few hours with everyone else at hospital because her condition was simply connected to being pregnant. She wobbled on her legs and cried out that she was ‘feeling bad’ when the nurse directed her to the reception area of A&E, rather than put her straight into a cubicle for treatment.

At a train station, not far from the local hospital, a 79 year-old woman developed chest pain as she pulled her cases along the concourse on her way to the train. An ECG confirmed Left Bundle Branch Block (LBBB) and we took her directly to the Cath Lab, where an occlusion in one of her coronary arteries was found. She had no previous history and her angina had given us the opportunity to save her from something more dramatic and possibly life-threatening later on.

Then a strange story from a man with back pain. He twisted the muscles in his lower back as he attempted to avoid a car which was allegedly trying to run him over in the street. Apparently, the driver chased him in an attempt to cause harm – the reason for this eluded the patient. It might have been a case of road rage but trying to mow a pedestrian down because he or she has annoyed you isn’t the done thing. It’s illegal I think.

After the confrontation he went home but his back began to give him problems and so we were called to take him to hospital. While we were there a taxi driver ran into A&E asking for help. He had a passenger on board who was having a TIA. I went to assist and the poor lady was slumped on the floor. This was her third TIA in as many months and she was taken into Resus for investigation.

A slightly over-the-top response for an elderly man who was hit by a motorcyclist in the West End next. The man lay on the ground with a head and leg injury as two MRU’s, two ambulances and one FRU descended upon him. A training crew was left to deal with it – the man wasn’t badly hurt and the crew needed the practice.

Fractures to the Humerus are potentially limb-threatening, given that it is a large bone and contains major blood vessels and nerves, so our 65 year-old patient, who’d fallen and crashed into a wall on the way down was treated with great care. She had a minor head injury but it was the arm that caused most concern to me. ‘It feels like its floating’ she said as she described it to me.

Although there was no obvious sign of a break in the upper arm, the way she was holding it, the manner in which she fell and her floating arm description made it very possible that she’d seriously damaged it.

Myoclonic seizures consist of muscular twitching and rigidity – there is no full-blown clonic-tonic event but it is still a type of fit nonetheless. A 45 year-old man who was attending an out-patient clinic for HIV patients lay on the bed in the medical room, refusing to speak and sporadically jerking his upper limbs as if he had no control over them. He had no history of seizures but he was a Methadone user and its likely he was withdrawing. He wouldn’t confirm or deny anything and it took us a long time to get him to come with us to hospital.

On the way into the ambulance he had another event; stiffening up then jerking violently, mainly in the upper torso. The hospital was just behind the medical centre, so it took us a minute or so to get him into A&E for checks. He still wouldn’t talk to anyone and the doctor was left attempting to get the same information that I had tried to obtain. There were clearly other issues here.

The last call of the shift was to a 45 year-old male who had called from a phone box threatening suicide. He then told the call-taker that he had a knife, so we were asked to be careful.

The police were already on scene when we arrived and were struggling with him as he was dragged from the box and forced to the ground. A quick search of him and the phone box revealed that he had no weapon on him. The cops had received the call initially because drivers had been swerving to avoid him as he ran into the busy road nearby.

‘My wife and kids have died and you lot don’t care’, he shouted as the police restrained him and we all pondered what to do with him. He is a known paranoid schitzophrenic and had no physical illness, so no need for hospital but the police were reluctant to take him and I tried to think of a plan. None of the local psychiatric units would have him, so, after about an hour of his ranting, swearing and threatening, I agreed to take him to hospital and try to persuade the doctors that he was a danger to himself – thus a place of safety was appropriate.

When we got to hospital (with a couple of cops on board), the A&E staff were, understandably, confused about why he was there but I managed to get them to see our side of it and they accepted him.

He was still going on about his lost wife and kids and how the world didn’t seem to care about his troubles as I booked him in. During that process I discovered that he wasn’t married and had no kids.

Be safe.

1 comment:

Hugh said...

i think i may have swine flu - i read your blogs rss feed as The Pandemics Diary