Friday, 22 January 2010

Unexpected dramas on a routine night

Night shift: Nine calls; two treated on scene; three by car; one false alarm and three by ambulance.

Stats: 1 Head injury; 1 Hypoglycaemic; 3 eTOH; 1 Not hypothermic child; 2 Assaulted (same call); 1 Panic attack disguised as DIB; 1 DOAB (assaulted)

The first call took me to a block of luxury apartments and the man on the door just stood there without indicating to me at all. This was originally a Red1 because the patient was unconscious and nobody knew if he was breathing but it was downgraded slightly when someone eventually informed us that he was conscious again but was bleeding badly. For that reason, as I passed the location looking for a ‘building site’, I would have expected a bit of urgency from the member of staff waiting for me.

A woman appeared as I went in and the ambulance crew pulled up – she was visibly upset and led me up to one of the upper floors, where in darkness and on extremely slippery flooring (some kind of oil or wax had been used to treat it), I found an agitated man in a suit. He’d bled badly onto the floor and had severe facial injuries, including what looked like a fractured orbit and maxilla but his behaviour intimated other, potentially life threatening injuries – he may have been bleeding into his skull. He thrashed about and tore the collar off as we tried to keep him still. There was no way he was going to let us immobilise him and the fight would cause him more injury, so we decided to get him out of there as soon as possible and by whatever means was safe for him. We were working in what amounted to a pitch black ice rink.

I’d asked for a Delta Alpha (BASICS doctor) to attend in case he needed to be calmed down for transport to the nearest neuro hospital and he arrived as we tried to settle the patient down in the ambulance.

Meanwhile, the poor woman who’d come to me and told me what had happened explained in more detail what had taken place up in that black hole of a room. The man was an estate agent and she was the potential client, ready to fork out thousands a month for this place but when he discovered the lights weren’t working as he showed her around, he told her to stay put then went forward and tripped up on a step, falling very hard onto his face, according to the woman. He’d lost consciousness and she was left wondering what the hell had happened. You couldn’t see your hand in front of your face without a torch, so she much have been petrified as the man began to make ‘bad’ breathing noises.

A member of staff arrived but told her to stay there while he went to make the call for an ambulance – she couldn’t do anything and no first aid kit was brought to her. The man lay on the floor regaining consciousness but bleeding all over the wood from multiple wounds to his face. She stood by him and didn’t know how to help. Then she was forceed to come and get me because the useless doorman was, well...useless.

When the man went to hospital, I took the lady in the car so that she could be with him. She wanted to know that he would be okay and she kindly called his sister so that she could join him in Resus. I felt very sorry for her because she’d gone through a lot of drama and seen a lot of blood for someone who just wanted to look at a pricey piece of property. I doubt she’ll rent it now.

Then as pizza was ordered and began to get cold, Sod showed up and stuck his oar in, so off I went to a private hospital where the prices are so high they don’t even tag the dead, for a 63 year-old woman having a hypo. The qualified nursing staff on scene didn't seem to know what to do for this and I found the lady sitting on a chair next to her bed-bound post-op husband. She was confused and I was told her BM was ‘one point something’ but when I checked it was actually 3.5 and the health care professionals there could easily have just fed her a couple of biscuits to solve the problem. And that’s all I did; she got orange juice and biscuits and within ten minutes she was right as rain.

After another set of checks and a round of toast (for her, not me - I had cold pizza waiting in the car), I left her to it and everyone was happy, including the hospital nurses of course. Nobody died on their watch.

Friday night kicked in post-pizza and the next call for a 38 year-old male ‘fitting’ was going to be a non-starter and I knew it. The location gave the game away because it’s where our local Russian and Polish community alcoholics gather and fall down. A crew was on scene and they signalled the waste of resources I had become, so I popped my head in to make sure he was what I imagined he’d be (he was) and then I left.

No sooner had I made my way north when a call from the south had me turn tail for a 25 year-old male who’d been found drunk and with a head injury by a police officer. He’d been attempting to urinate and in his stuporous state had fallen onto the wall, splitting his eyebrow open. By the time I arrived, he had a nice clean dressing on his head, courtesy of the copper but he pulled it off contemptuously as I explained that he’d need to go to hospital. He spoke very little English and expected me to dial his partner’s number so that he/she/it could come and collect him but I declined on the basis that I wasn’t that kind of public servant and I didn’t fancy becoming embroiled in an even more complex language barrier conversation while the rain dropped on my head. I already had a soaking sock, courtesy of a split in the sole of one of my boots and water had seeped through and possibly blood from the earlier head injury, so I wasn’t comfortable standing in a puddle any longer than I needed to.

Eventually, the cop and I managed to get him into the car and I took him to A&E. He tore his dressing off for the second time and I left it alone. He refused to have any obs done on him and was stubborn about everything except following me to where he needed to be.

One 5ml spoon of calpol and one 5ml spoon of children’s Neurofen won’t cause a massive core temperature drop to hypothermia. A woman whose 5 year-old child was recovering from a chest infection took her axillar temperature using an oral thermometer and got various wild readings. She got 38c and thought her daughter was going to develop a fever, so she gave her the meds, then she took another temperature and got 34.5c, which is unlikely. Fearing she’d given her kid an overdose into hypothermia, she called an ambulance but luckily common sense prevailed and I went there to check it out before all the alarm bells went off.

Sure enough, the little girl was fine. She had a normal temperature and was showing no signs whatsoever of dying until she’d reached a ripe old age. I gave mum some advice about temperature taking and that was that.

A 22 year-old drunken girl was left in an alley by her workmates, who then called her boyfriend to inform him that she was ‘in no fit state to get home’ and when he found he she was sitting in a pool of her own vomit, alone and very vulnerable in the small hours behind the bins in an alleyway. He will, no doubt, have words about this reckless abandonment with her so-called friends.

She’d been drinking steadily and had the usual ‘I haven’t had many’ excuse which didn’t impress me at all. Her boyfriend thought she may have been drugged because she was quite wired (but apparently she always acted like she was on drugs), so I asked her if I could check her pupils, ‘look up for me’, I said and she squinted as if in pain and said ‘if I look at you I’ll throw up’. That hurt deeply. No, really, it did.

Anyway, I took her and her boyfriend to A&E where she told me she would have a hysterectomy if I got her a puppy. I couldn’t make the connection until the conversation I had with her earlier flashed back; the one where I had asked if she was currently on her period and she said ‘yes’. So, I told her that she was likely to feel the effect of alcohol much more acutely as a result. I guess she’d rather be able to have a good drink and survive with a little dog than have kids and stay sober.

I left her with her head in a sick bowl and her boyfriend sitting beside her. No puppies were harmed in the writing of this post.

One of those double-ups next when I am asked to go to a man with an eye injury and arrive to find the police on scene with two men who’ve been assaulted by a little gang of thugs. The 19 and 20 year-old Lithuanians were out enjoying themselves when they were set upon with fists and bottles. One of them had an eye injury caused by an aggressive elbow and the other had an incision to his chin and a head injury caused by a bottle which broke on impact. They were stable enough to go in the car and a police officer accompanied them.

I left the next place smelling of cigarettes because the patient had just finished a ciggie at home prior to my arrival on the basis that she was having emergency 999-style difficulty in breathing (DIB). Her grand-daughter indicated to me (by use of the world known hand gesture) that she had been drinking tonight and I walked in to a room full of smoke and booze, where her adult daughter and a 4 year-old girl, who was the great-grand-daughter and, thankfully, did not smoke at present, (although I’m sure her lungs would tell a different tale if they were asked, such was the indifference shown to her health in this household), were present.

I had to ask each of the grown-ups in the room to put their cigarettes out because I was using oxygen. I know this is a contentious issue and that smokers believe they have the right to continue puffing away in their own homes but I could barely stand the atmosphere in there and I couldn’t fathom why the patient was sitting wheezing at me when she knew her next cigarette was only a few minutes away. It was 4am and this was no way to show a small child how to live.

The patient had a long and chequered medical history but tonight she was just panicking and putting on a show for her family after having had a disagreement with them. I tried her on Salbutamol because she needed a little but she reacted as if it was burning her lungs. This was despite the fact that she had inhalers around her and a redundant compressor nebuliser sitting on a table. She was a fool to herself and I knew I’d get nowhere with her. She refused an ambulance and she refused to leave the fags alone for a few hours. So I left and the family went straight back to smoking and bickering about whatever they felt like as the small girl watched.

Tonight’s drunk on a bus was unusual because I had to call an ambulance for him. He was lying on the back seat, as they always are – drunk of course but also sporting a heavily battered and bloodied face. He’d clearly been set upon and the driver told me that he’d boarded the bus looking like that earlier on.

He was reluctant to let me help him and threw his arms around a little, so I thought it best lto eave him alone and get some backup. A few minutes later and two police officers were helping him off the bus – he didn’t do anything for me or the crew when they arrived but he recognised the cops and complied.

He told us that he’d been attacked by four men in south London but he hadn’t been robbed (all his belongings were on him). His fist was swollen and cut as if he’d been giving as good as he got and he had a tell-tale pattern mark across the back of his ear, left either by a sliding boot or a belt buckle. My money's on belt buckle.

The cops could do little with him because he wasn’t making much sense and, although a head injury can be masked by alcohol, I think we were looking at the effects of the latter rather than the former.

Be safe.


Sarah said...

Out of interest, are the private hospital nurse more likely to be agency or less qualified? They sound a bit dim!

Anonymous said...

dude, i do the same shit as you in a different part of the country. i must say, its good to read your words, it reads like the reality that it is, i can almost see myself, looking, talking, thinking and feeling. brutal dude. brutal. :)