Wednesday, 8 April 2009

Twitch in time

Early shift: Six calls; one hoax, the rest by ambulance.

Stats: 1 Head injury; 1 ? TIA; 1 ? # Femur; 1 Hyperglycaemic with AF; 1 Heart failure.

This is my pool shift week on ambulances and I attended on both shifts. Before our MDT failed and we had to wait just over an hour for a repair, we were called to a 36 year-old woman who had discharged herself from hospital after being admitted the night before with a head injury. She had jumped from a moving taxi and had been diagnosed, after a scan, with a brain contusion.

Now she was at home, lying in bed and complaining very loudly about her headache and ‘pain all over’. Her obs were normal but given the circumstances and recent diagnosis, it was best to get her back to hospital.

During the journey, she moaned and cried relentlessly but most of her discomfort seemed to be hidden underneath something else – self pity I think. While I booked her in and my crew mate stood by the trolley bed, she cried even more loudly and looked around to see if anyone was paying attention to her.

One of the nurses recognised her and I was given the full story. She’d hailed a taxi to get home but refused to pay the fare, so the driver drove her towards the nearest police station with the intention of turning her over to the cops. Not being one to stick around and explain herself, she opened the cab door and threw herself onto the road. Obviously, the cabbie had forgotten to lock the doors.

She was taken to hospital and spent a few hours there before discharging herself soon after one of the nurses caught her with crack cocaine in her possession, which neatly explains why she took such drastic action in the taxi.

An 86 year-old man got off a train with his wife and suddenly felt dizzy. His wife said that he had developed an unequal smile and she was concerned that he was having a stroke. He had a history of CABG and a valve replacement ten years earlier, so there was a need for caution here but his FAST check was negative and he appeared to have no facial droop when I examined him.

Every time an advertisement campaign is launched for a particular medical emergency, we see more and more false alarms, which use up resources of course. The latest campaign is for stroke.

We took the man and his wife to hospital – better safe than sorry. He may have had a TIA but he may have just got up out of his seat too quickly.

A 65 year-old man fell in the street and several people helped him to his feet again. He continued his walk and made it to his local drop-in centre at a church, where he gets his lunch. He sat down and couldn’t get up again. His thigh was very painful and he found that moving it was excruciating, so an ambulance was called and we arrived within a few minutes.

I examined his leg as he sat in the chair and I could feel a distinct lump a few inches below his hip. I asked him to remove everything from his pocket, just in case I was making a mistake but it was still there. I knew I’d need to have a proper look at his leg, so we carefully moved him onto a trolley bed and wheeled him out to the ambulance.

Inside the ambulance, I helped him remove his trousers and his injury was obvious. A large bruised, swollen lump on his thigh muscle indicated (at least the possibility) of a fracture. A bruised muscle probably wouldn’t have caused such pain or immobility and at his age bones tend to be less able to survive the energy of a fall, even from standing.

If he had a fractured femur and it remained stable, he would be fine but if it moved too much, he could bleed a lot and the injury could become life threatening, so we put a splint on the leg and got him to hospital for an x-ray.

The next call looked like a hoax ‘callbox, unknown problem, caller hung up’. When school kids are on holiday this is how a few of them entertain themselves. Obviously, we had to go and investigate the call and, not surprisingly, there was nobody on scene to worry about.

A strange call to an 87 year-old Cypriot woman who had developed facial twitching that could be timed almost to the second. Every 22 minutes precisely, she would turn her head to the left, stare at nothing, and her face (on that side) would spasm. This would last for up to a minute then she would be back to normal. I wasn’t sure at first and doubted the accuracy of her grand-daughter’s statement but she’d been timing it until we arrived, so I waited as I carried out my obs, for the next event.

The lady’s BM was high – the meter read ‘over 33.3’ so this was a significant factor because there was the possibility that her hyperglycaemia could be causing Epilepsia Partialis Continua (EPC). When all the obs were done and time was just about up, I checked my watch and as the 22nd minute rolled on, my patient’s head turned to the left and a facial tick developed. It lasted about 20 seconds.

On the way to hospital it happened again and I discovered AF on her ECG; something that I couldn’t connect with the event I was witnessing but that could put her in jeopardy if I was correct about the insulin depletion.

I left her and her family at the hospital and was unable to go back and find out what the actual diagnosis was, so I'm hoping for input from them at some point.

Our last call was to a 92 year-old woman with heart failure and the swollen ankles to go with it. Her GP had ordered an ambulance after her ankles had become much worse overnight but the lady sat in her chair watching telly in her sheltered accommodation flat and adamantly refused to believe she had any medical need to go to hospital. ‘I don’t know what all this fuss is about’, she said to me. ‘I’m nearly a hundred you know’.

I find it fascinating that women (and I’m generalising) spend a huge chunk of their lives keeping their age a secret until they are so old that it’s pointless and they start telling everyone, whether they ask or not. Men will tell you which war they fought in.

Be safe.


Katie said...

Interesting post...I've been writing my dissertation and desperatly been waiting for an update on your blog to distract me...

I totally agree about the age nan spent about 6 years saying "I'm nearly 90, you know?". It was like her aim in old age...she was active and lived on the 1st floor of a flat with no lift and still got out and about without a walking aid. She died of a stroke not long after turning 90..!

Anonymous said...

your book was brilliant stuart! I've just ordered your new one as I finish my A-Levels and start my degree in september - and I can't wait!! Our placements are with London.
did you enjoy your training and how hard was the degree??
Ps. I agree with the age bit - i think it's a pride thing?!