Tuesday, 19 May 2009

Secret diabetic


If this had been done in the UK, the poor doc would probably be in court being sued by someone. They still have a sense of 'do what needs to be done' in Oz and for that I applaud them.

Day shift: Six calls; one assisted-only, three conveyed and two by ambulance.

Stats: 1 Head injury; 1 hypoglycaemia; 1 Amnesia; 1 Nicotine overdose; 1 Sprain ?#; 1 Headache and vomiting.

I’m writing this on my break in an effort to keep up to date. Hopefully, with four nights ahead of me over the weekend, I can keep on top of this writing lark.

So, a 50 year-old Canadian woman tripped on a kerb and landed mostly on her head, where a large bruised bump now resided. She hadn’t been knocked out and when I arrived she was with her family and a white van man who’d very kindly stopped to help out – he stuck around to assist me and I thought that was a nice gesture; he wasn’t in my way and he seemed genuinely keen to do his best, even though his van was being threatened by a lurking (and equally keen) traffic warden.

The lady and her family were on their way to Windsor but now that plan had been changed for a short trip to A&E. I didn’t take her in the car; her age and that massive bump dissuaded me. I found out that she had AF and other medical issues, so it was best to let an ambulance crew take her away. All I had to do was carry two of her relatives in the car to hospital.

She had a couple of stitches put in and went upstairs for a scan later on but I’m sure she’ll be fine – my concern was that her fall hadn’t purely been mechanical.

The next call was for a 30 year-old female who’d been behaving abnormally at work. Her colleagues on scene told me that she wasn’t walking properly and was confused. I found her on the floor but more than willing to sit up – in fact, she didn’t want the fuss at all but she seemed to be drunk. After ruling out alcohol and drugs, I carried out my obs until a crew arrived. I was about to cancel them but as they were on scene, it now seemed logical to have them carry out further checks.

I did a quick BM as the crew chatted with her and as the meter counted down to show the result, my two colleagues and I watched it. Her blood glucose was only 2.4 – she was hypoglycaemic.

She was given Glucogel until we were ready to move her to the ambulance. Every time she stood up, she staggered and lost her balance. She seemed more aware now but her general behaviour was still abnormal, so the crew injected her with Glucagon in the vehicle.

I found out later that she was a diabetic but didn’t want to admit it in front of her colleagues – she told the crew when she was alone with them. Although I understood her embarrassment, I feel she had played a dangerous game and that she may well have ended up unconscious on that floor if not for the quick-thinking of her friends.

Another little mystery call to a hotel next, where a 67 year-old Scottish man had shuffled in and become agitated when he realised he didn’t know where he was. The staff knew he was a resident because he’d checked in the day before and had been taken to hospital for reasons unknown. Now he was up in his room with a staff member and I walked in to confuse him even more.

‘What’s your name?’ I asked.

‘I don’t know’, he said.

‘Where are you now?’

‘I don’t know’.

That was pretty much the basis of the whole conversation.

I got his name from the hotel staff and I did all my checks, none of which showed that he had an immediate problem. He didn’t know where he’d been all night and I was told that he carried a lot of cash around with him, so I wondered if he’d been assaulted and robbed but that didn’t pan out because he still had all his money and he had no injury (that I could see anyway).

I took him to hospital in the car while he mumbled about not knowing anything and how afraid he was. I gave him whatever soothing sympathy he needed until I got to A&E, where the nurses recognised him.

‘What’s wrong with him?’ one of them asked.

‘Amnesia’, I told her.

A grin spread across her face. She obviously didn’t buy it and, to be honest, I was unsure because he’d managed to find his way back to his hotel, regardless of the fact that he didn’t know who or where he was.

I left him in their care, sitting on a chair in Minors; he looked apprehensive. ‘You’re not leaving me, are you?’ he asked worriedly.

Every now and then a call will come in and it’s a piece of cake to deal with – the kind of call that really didn’t need an ambulance but was in that grey area where nobody else will do.

I walked into the reception area of a very posh block of flats near Park Lane and the Concierge took me to the lift.

‘The second floor’, he said.

‘Which flat number?’ I asked as the lift doors began to close.

‘The whole of the second floor’, he replied as they shut in his face.

Now, that is flash.

I stepped out into a huge marble-floored flat and was taken by a family member to a 62 year-old woman who had suffered hyperventilation, shaking and palpitations. She was in bed and looked fully recovered. She beamed a smile at me and I asked her if she felt okay. ‘Yes, I do now’, she said.

She had opened what she thought was a packet of chewing gum and taken one out. As she chewed on it, she began to feel unwell, as described above. Her worried family called NHS Direct who, inevitably, told them to dial 999.

She had never smoked in her life and her body had simply reacted to the nicotine contained in the Nicorette gum she had been eating. For a non-smoker, the gum will cause problems, especially if it is chewed continuously – she had been given a fright but now she was recovering well. All her obs were normal and I left her in the care of her family, who will probably be much more cautious about where they leave their stuff in future.

A 23 year-old German girl stumbled down the last few steps at an underground station and twisted her ankle. She continued her journey until the pain and swelling were too much and she could no longer walk on it. An ambulance was called and a CRU was sent from Frith Street, where he, the MRU paramedic and I had been holed up drinking coffee. I was asked to convey the patient a few minutes after he’d arrived on scene.

Her ankle was hugely swollen and it looked like a grade III sprain or a fractured lateral malleolus (see, I know stuff). She’d have to go to A&E and have an x-ray to confirm one or the other, so we hopped her to the car up three flights of stairs and an escalator. She was tall, so a lot of pressure was placed on my suffering shoulder but it was the most efficient way to get her out of there and an ambulance was an over-the-top response for the injury, which she bore very well considering the discomfort she must have felt.

I wheeled her into casualty after she’d reclined in the back of my car for ten minutes during the trip. She had a history of this kind of injury and she didn’t seem at all surprised that it had happened again. Next time (and there will be one), she will probably stop and get help before it becomes too much for her.

My last patient was a migraine-suffering 56 year-old woman who’d been out for the day with her husband when she began to feel ill. She had the worst headache she’d ever experienced and was vomiting. I take this stuff seriously because at her age and given her history, a major condition can be masked by a known component like migraine. I took her to hospital quickly in the car, husband in tow, and we were there in less than five minutes – it would have been a longer wait for an ambulance. Her vital signs were all normal and she didn’t have any other problems, such as visual impairment. Her FAST check was negative.

She vomited constantly in the car and I considered Vertigo as a possible suspect for her troubles, although she denied ever having it before and the tell-tale dizziness didn’t exist, unless she simply didn’t want to tell me about it. Other, more serious problems, such as tumour, could cause these signs and symptoms.

She was sent to the waiting area, where dozens of people sat or milled about; it was like a Saturday night. She sat on the wheelchair I’d taken her in on, with her husband at her side and she vomited over and over again. I felt very sorry for her and asked the triage nurse if she could see her quickly. I’m sure the other non-vomiting patients wouldn’t mind...

Be safe.


Fiz said...

I have migraine and I hate it. I also hate being sick in public. That poor woman, she has my heart-felt sympathy.

floyd said...

Hi, I am an Aussie! I read your blog! And believe me, Docs wouldn't normally get away with something like that here, but at least this time, it seems as it is all going to be smooth sailing for him, plus I think the mother of the boy would probably cause serious harm to anyone who tried to give the good doc any grief!
Cheers for the great blog!