Friday, 27 November 2009

Madness and mayhem

Here's a photo (taken with permission) of a fightfighter at one of my jobs. I thought my female readers might appreciate it. And he seemed chuffed about it anyway.

Day shift: Six calls; three by car; three by ambulance.


Stats: 1 Fall; 1 Sickle cell crisis; 1 Abdo pain; 1 Hypoglycaemic; 1 Allergic reaction; 1 Festering ulcer.


More car trouble, so the regular vehicle is once again off the road and I am working with the secondary unit, which is no better to be honest. My MDT crashed on the way to my first call, which was to assist a crew who had a 67 year-old lady on the floor after a fall. They needed an extra pair of hands to get her up and onto the trolley bed, so I was happy to help. I had to imagine my way to the location though and did pretty well, considering I’m not a pigeon.

Then south of the river for a 20 year-old with Sickle Cell Crisis; a painful and debilitating condition brought about by the 'sickling' of red bloods cells in the body. When I arrived she was lying on the sofa with her family at hand. She had moderate pain from what I could assess, so I gave her a little bit of Oramorph and that seemed to work. It was my intention to take her to hospital in the car because her legs were unaffected by the crisis but a crew showed up and invalidated my very existence on the ‘Amber Car’.


Then a miracle occurred. A human being with good medical instincts started to task the calls and I solved the mystery of the lady with abdominal pain – the 22 week pregnant 27 year-old at a train station – (that one), by telling her that these things would happen now that she was pregnant and ended up taking her to hospital anyway. She was sent to the waiting area and a large black woman with (possibly) mental health issues sang loudly and incredibly out of tune for me and a few others as she stood outside her cubicle in A&E.

‘Well done, three yeses – you are through to the next round’, I said as I passed by on my way out. I like to stir things up then leave while others have to contend with any chaos that ensues as a result of my meddling.


Then I was asked to check out the condition of a 75 year-old man who’d walked into a chemist and began to ‘behave confused’, according to the pharmacist, who related the story when I arrived. The tall man was standing at a strange angle against a counter with the pharmacist and his assistant propping him up as if he was going to fall. I tried to communicate to the man but all he said was ‘I think I’m ok’ but he didn’t look right at all; very diaphoretic, weak, hardly responding and unsteady on his feet, which is why the next thing I did was virtually force him onto a chair so that I could assess him properly.

I asked the pharmacist if he knew him. ‘Yes, he comes here for his prescriptions’, he told me.

‘What does he take medicines for?’, I enquired.

‘Oh, lots of things’, the pharmacist said. I’m not sure if he thought I was asking him to reveal something covered by the Official Secrets Act, so I asked him to be specific.

‘He has meds for cardiac conditions, high blood pressure and he takes insulin’.

‘Oh’, I said, waiting for the pharmacist to get it, which he didn’t.

I checked the man’s BM and it was 1.1 – now I knew what I was dealing with and I requested an ambulance for backup because if he didn’t recover, I couldn’t take him anywhere in the car.

I injected Glucagon and set up an IV Glucose drip, the way I always do with hypo’s. The crew was with me within five minutes and I got extra hands to help out as the man slowly began to recover. His BM improved to 3.2 by the time I’d set up the Glucose and he was smiling and fully communicative by the time he got into the back of the ambulance. All good, except for one major problem in my view – I teach every pharmacist in London first aid as part of their pre-registration training and they all know that they have a legal duty of care if someone becomes ill in their place of employment but, even though the pharmacist here knew what meds this man was on, he couldn’t work out the problem nor see the solution. This is no criticism against him because he doesn’t have to be trained in first aid but if he has the right drugs (Glucagon), he could give them in order to save a life.

The man’s BM was critically low and this was a potentially serious omission on the part of a professional person, so I think, despite the basic training they receive, more needs to be done to educate pharmacists on the use of this type of drug because it’s so easy to save a life with them. This pharmacists was quite mature, so I doubt I trained him but even those that have had first aid training would probably benefit from a short session on the use of Glucagon, Epipens and possibly Narcan for emergency use. He freely admitted to me that he had no confidence because he'd never actually had to use Glucagon and didn't know how to. I shall think about this...

During this call and just as the crew was taking over from me, I was asked to rush off to another job near the West End. A 25 year-old woman was reacting to something and her throat was ‘itchy’ – she had a very persistent cough too and when I looked inside her mouth I could see her throat swelling slightly. She was in no immediate danger but she’d need an antihistamine and I only offer IV, so I took her in the car. That cough became more and more annoying as we travelled I can tell you. I was tempted to turf her out and let her get the bus.


Back to that train station later on for a drug addict who’d been arrested for (allegedly) shoplifting. His pupils were pin-point and he was trying to fall asleep, so I made a judgment call and decided he’d recently used. His favourite drug is heroin and he looked smacked out on it, although he strenuously denied this when Narcan was mentioned. During his arrest and subsequent hand-cuffing he’d offered the only illness he could think of to avoid the cops and get to the nearest hospital – he had septicaemia. Apparently his groin had a suppurating ulcer on it, no doubt a resident resulting from the constant puncturing of the skin and veins in that area. He offered to let me see it but I declined on the basis that (1) I believed him and (2) I had my dinner to look forward to later on.

When I checked his bag (later in the hospital and at the behest of the police) I found no fewer than 30 unused needles, 5 used needles, paraphernalia and a single condom... for when you get lucky after a good session with heroin I guess.

The bottom of the bag was a lake of filthy liquid from God knew where and floating around as scum was the remnant of some kind of solid food, like a big cake. On first inspection it looked like he had vomited into his bag. Whatever he’d done, the needles were all now filthy – even the wrapped ones – and had to be thrown.

I left him in the care of the police officers guarding his cubicle and walked out to the various off-tune and shouted airs from that mad black woman who was still occupying cubicle 1.

Be safe.

7 comments:

M said...

Why do you have to say 'black woman'? Why can't you just say 'woman'?

8char8 said...

Woohoo fireman :)

Anonymous said...

The condom: for concealing drugs.. somewhere?

Xf said...

M

Why shouldn't I? I am a descriptive writer; I describe what I saw right down to the colour of someone's skin - it helps readers 'see' what I saw. I also mention nationalities incidentally.

Do you feel offended in some way? Do you think it causes offence? Don't you think its this kind of hypersensitivity that has led to our neurosis about everyone else and thus denatured everything we do and say in innocence?

Maybe I should just say 'person' in case I upset someone by being sexist.

I sometimes say 'Scottish' drunk instead of 'Polish' drunk. It doesn't mean all Scots o all Poles are alcoholics, does it?

Anonymous said...

Even if the pharmacist didn't know how to use a glucagon pen, he still could have made him eat a few glucose tablets and by the time of your arrival, the patient would probably have been well again.

Most diabetics know how to handle a hypo themselfs and as long as the patient is conscious, oral glucose (and maybe a slice of bread thereafter) should be enough to get the job done...

CrazyNewt said...

I'm a bit concerned by the pharmacist and the diabetic, myself. I don't know about UK First Aid courses, but in Canada, I know Diabetes is something that is covered, at least at a basic level. And a pharmacist not knowing this info is kind of scary - because they're the ones who are giving product recommendations, after all.

Also, and this has nothing to do with this post, but an earlier post, what does RTC stand for in the UK? In our First Aid courses, RTC is "Rapid Transit Category", and it basically means "This guy needs to get to a hospital RIGHT NOW". You seem to use it only for vehicular collisions. Just curious.

P.S. - Brilliant response to the singer. I do stuff like that myself... so much fun.

Xf said...

Crazynewt

RTC means Road Traffic Collision here.

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