Tuesday, 19 January 2010

Fracture dancing

Nearly time to go home...

Day shift: Five calls; one assisted-only; two by car and the rest by ambulance.

Stats: 1 Dizzy pregnant person; 1 ?Flu; 1 Chest pain; 1 Diarrhoea not vomiting blood; 1 Sore throat.

I’m going to be interviewed for the programme ‘Bizarre ER’ tomorrow. They want anecdotes to put on the show and I’ll be describing one or two of the strangest call-related stories from either the book or the blog. It's to be aired in April, so I'll keep you posted.

Back in the land of the unwell, a pregnant 37 year-old woman with low blood pressure, recurrent epistaxis and dizziness (probably as a result of her BP), called an ambulance from her place of work. This is a common and almost daily thing for us; there are dizzy, fainting pregnant people all over the place at the moment.

I could have taken her to hospital in the car but an ambulance showed up, so I was spared the journey.

Meningitis is usually diagnosed on the basis of a few key elements; photophobia, non-blanching rash, vomiting, neck pain and headache for example, so it is hard to believe that a GP diagnosed the possibility of a potentially life-threatening condition over the phone on the basis of the Flu-like symptoms that my next patient, a 27 year-old female who lived, quite literally, yards from the hospital had, and told her to make a 999 call for an emergency ambulance. Nobody wants to get these things wrong but surely a more accurate assessment is needed before alarm bells are rung and patients are left wondering if they are heading towards death’s door. For my part I saw only Flu and I may have been wrong to be so hasty about my conclusion but here’s what I saw: sore throat, sore head, aching legs, back ache and neck ache. No vomiting, no rash, no photophobia and no problem when she pushed her chin to her chest (Brunzinski's sign). Oh, and she’d also recently been in contact with people who suffered Flu.

It took one minute to drive her and her partner to hospital using the one-way system around the building. It would have taken them 20 seconds to walk.

Off to court next and a man collapsed complaining of chest pain and lower abdo pain during his trial. This happens a lot. He had no cardiac history but was a kidney stone sufferer, so that explained the abdo pain at least.

I found him sprawled dramatically on the floor with first aiders all around him. He was on oxygen and getting lots of attention and worried looks. I asked him to sit up and relax because he was panicking and I think that’s what was giving him chest tightness. His behaviour was strange and suspect but I went down the line of caution and treated him for cardiac chest pain, even though I felt it wasn’t the case. He got GTN and aspirin. ‘Have you ever had GTN before?’ I asked, showing him the little bottle of red liquid. ‘No, never’, he replied. Then as I prepared to give him a spray I said ‘Open your mouth and lift...’ Before I’d got to the words ‘your tongue’, he’d done it. Usually people have to be shown what to do; a mere description isn’t enough but I hadn’t even finished the sentence, so I knew he’d gone over this routine before.

Then he flopped onto his back and stayed there until physically lifted back upright by the security man. He was playing a game.

The crew eventually got to me (the place is so large that I got lost initially and the crew got lost too) and we carted him off to the ambulance for what turned out to be a very normal ECG and BP check. None of his obs said danger. He had tried to break into a wailing sob while strapped to the chair but didn’t quite make it to the correct octave for convincing sympathy votes to flood in and cruel as I sound, this man was wasting everyone’s time just to get away from court. People do it in immigration offices, police cells and anywhere else where running from your responsibilities is the done thing.

The first aiders here can give oxygen, which is a prescription drug but they have been told not to give aspirin, which is an over-the-counter drug. Apparently their Health & Safety Manager deems aspirin to be a risk and oxygen not. This is ironic in light of recent research indicating that supplementary oxygen given during an MI could lead to further damage but that the risk reduction of secondary clotting gained after taking an aspirin, regardless of the time it takes to work, far outweighs the risk of a stomach ulcer bleed. Some people just bang their heads for the sake of it.

Soon enough, after a coffee and a chin-wag with my MRU and CRU brothers, I was off to see a 34 year-old woman who thought she’d vomited blood after taking laxatives to relieve what she thought was constipation. She purged herself so violently that she went into mild shock as she sat on the loo, causing her to vomit. The vomitus was bright red and she could taste metal in her throat. When I examined her in the first aid room of her workplace, I could find no evidence that she’d thrown up frank blood. There was no red staining in the mouth, on the tongue, lips or teeth and she hadn’t washed her mouth out, so I suggested this: she’d become constipated as a result of the antibiotics (metronidazole), mistakenly taken laxatives and purged unnecessarily causing her body to react by making her sick and the metallic taste was the residue of her antibiotics - the 'blood' was probably the partially digested red salmon she’d eaten earlier.

She was happy with this explanation and calmed down considerably, so I felt I’d done a good job, even if it wasn’t saving a life. I left her at work to relax and recover while she read a copy of my paperwork.

Immediately after this I was sent to a Red2 sore throat south of the river. A motorcycle colleague was on scene and the 25 year-old patient sat waiting at her college for me to taxi her to a very busy A&E for something she could have seen her GP next month about. Ridiculous.

Over the years I have watched hundreds of tourists and visitors taking photographs of the main attraction on Trafalgar Square; Nelson’s Column. Only tonight, whilst watching a few people standing on the steps above the fountains, framing that epitomising picture in their digital screens, did I realise that unless they stood halfway down Whitehall, they’d be photographing the same image – the back of the statue. There’s little point in taking a picture of the back of a human form, real or sculptured, unless the backside is particularly attractive or there is merit in the form from that angle. It amuses me to think that millions of photo’s of the back of Nelson’s body, lit up by spotlights from the nearby rooftops, have been taken and shown to semi-interested friends and relatives around the world. I know Lord Nelson is orientated to look out to sea (or the river Thames at best) but maybe a rotating podium would help to make the image more identifiable when photographed from the only logical place that people tend to go.

And a late(ish) job to end the shift. A Green call for a dancing man who performed a leap of some kind (he was proud of having achieved it and called his partner to let him/her/it know) and landed hard on to his third toe, probably breaking it as a result. So, instead of packing ice onto it, elevating it and hopping home where he could pop into A&E and have it looked at, he had someone dial 999 for an ambulance. As you do.

I dragged my sorry tail up to the studio, which I know very well from many previous jobs of this nature and collected him for hospital. When we arrived the place was packed and he was sent to sit and wait.

Be safe.


Steve said...

Interesting to note the new O2 guidelines, we have been by our COM to carry on giving O2 for ?MI, as an EMT will I be protected under prosecution if it was found that giving the O2 had a detrimental effect on the outcome, after all its my name on the paperwork. I was also told by a DOM to give a stoke patient O2!!!, her name went on the paperwork that time, although I physically put it on, as over perfusion of O2consricts the blood vessels it was the last thing this patient needed.

CrazyNewt said...

RE: o2 Guidelines:

As a First Aider in British Columbia, we are generally told to always use 02 if things are even sort of suspect (this MI thing is news to me, which I'll keep in mind!). As for Aspirin, we are told not to give Aspirin EXCEPT in a suspected MI - the reasoning being we're just First Aiders, and that Aspirin can screw certain things up when the patient gets to hospital.

BUT, we are told specifically to make the patient chew aspirin for an MI. I made sure to put some extra strength Aspirin in my kit for just that reason.

The 02 stuff is news to me, and I'll do some reading about it when I get some free time - always be prepared, and all that jazz!

coyote said...

That's interesting about Nelson's Column. I wonder why people do that when you can get pretty decent up-close shots of Nelson's front (more or less) from at least one location.