Thursday, 25 February 2010

Red, red whine

Day shift: Seven calls; two assisted-only; three by car; two by ambulance.

Stats: 1 Back pain; 1 Palpitations; 1 Unwell alcoholic; 1 Lacerated hand; 1 Near faint and panic attack; 1 Faint; 1 Cut above eye.

The first call was a Red simply because the caller told us the patient was ‘not alert’. This is one of the vaguest and most confusing things to ask a MOP – ‘Is the patient alert?’ What kind of response do you really expect from most of the population, especially if they are not English-speaking? The 33 year-old man had slipped on a newly washed floor (the wet floor signs were up) and fallen onto his back, like that clumsy and obviously very blind woman on the TV claim-for-blame shark ad. He now had a tender coccyx (as you would) and the pain was radiating to his pelvis and upper leg. This is what happens when you land on it hard – it gets bruised.

The man was fit and well and there was no reason to believe he had anything more than a minor injury – yet it was given a Red2 on the basis of his ‘not alert’ status. And yes, I know, you can fracture your coccyx and it’s painful but it’s not life threatening. This category is reserved for immediately life-threatening or at least potentially-so calls. Even if ‘not alert’ in the absence of a head injury, would this be such a call? Does smashing you tail bones on a hard floor from standing constitute a near-death experience? Is the brain somehow directly connected to the tail?

This call became a resource-drain simply because the guy on the floor said things like ‘I can’t move my leg’ and ‘it’s really painful’. But he scored his pain at less than 5/10 and he stood and walked, with support. In fact, after a breakfast of Entonox, he declined his trip to hospital and hobbled right back into work. I’m just glad he’s tax payer.

Next, a 23 year-old described as having ‘chest pain’ was actually experiencing palpitations. She had a one-year history of Lupus (SLE), so any organ can be affected if she has a ‘flare’ and in this case, her heart seems to be involved. The disease is degenerative and if her heart is being affected adversely this is not a good thing for her future health.

She was stable enough when I arrived; no chest pain, just that fluttery feeling when your heart is racing. The crew arrived a few minutes after me and we took her out of the crowded and very noisy hotel reception (it’s a large tourist hotel...mainly for young people) and into the quiet ambulance for further tests and a trip to hospital.

As I ran to yet another Red call, this time for a 41 year-old Polish alcoholic resident at a hostel who was having ‘breathing problems’ that didn’t exist, I heard a call come in for a cardiac arrest. An 18-month-old child and another child had been involved in a road traffic incident. This is why we have the colour red in our system.

The man sat in his grotty, litter-decorated room, panting and puffing as if he’d just run a Marathon. He complained bitterly about not feeling well and being sick after telling me he hadn’t eaten for two days and had just been drinking cider and cheap white lightning. ‘Well, no wonder’, I said, suggesting the obvious but, as usual, there was no acceptance of a pre-written fate – no acknowledgement of something brought upon himself. It’s a disease they say. It’s a state of mind eventually, I say. Smoking can be beaten with determination and will-power and so can an addiction to alcohol – it’s all about what it’s worth to an individual to stop.

I took him to hospital myself and once in the back of the car his theatrical breathing stopped (not his breathing per se of course) and his ‘vomiting’, in which he’d been up-chucking gobs of plaster-looking phlegm into a small bucket (and sometimes out of his third floor window when the mood took him), ceased instantly, even though I had provided him with a perfectly good yellow clinical waste bag for his pretender-to-the-throne vomitus.

He was actually relaxed by the time we got to hospital and I’d like to think that my calming manner had influenced his mood but no, like almost all of these individuals, their purpose for going to hospital is to get into an environment where they can be ‘cured’ of any immediate problem that interferes with their drinking routine. On the way out of his room, he tried to light a cigarette – so his ‘breathing problem’ was of no significance to him as long as I was there because his attitude was pretty much that I would clean up any consequence for him.

On a building site, three storeys up where a hard hat is required if you want to keep your skull intact, a 55 year-old man was handling a hoisted RSJ when it got caught and then slid into his hand when it was freed. This heavy piece of steel sliced into the joint of his hand, at the point where the metacarpals meet the fingers, ripping it open and probably breaking the bone there. A cycle colleague was on scene and had already dressed the wound, which had stopped bleeding. I was asked to take him to hospital in the car, rather than an ambulance, which is fair enough.

He was a good-humoured man and the three of us managed to have a smile and a joke or two before I took him to A&E. The pain in his hand was bearable, he told me and he didn’t want analgesia for it – but then he didn’t know he would be waiting for two hours in hospital before being seen – poor bloke.

A Red call for a ? Stroke at a museum turned out to be a near-faint that converted into a panic attack with hyperventilation and clawed fingers (this occasionally happens). The whole ‘can’t feel my fingers’ triggered an emergency call for a suspected CVA but the lady was embarrassed by the fuss that had been caused and sat munching on a bread roll as I completed all the obs I needed to confirm that she didn’t need to go to hospital if she really didn’t want to. She got the usual three offer deal but, sensibly, declined.

Another patient who declined was the 85 year-old female who fainted for ‘ten minutes’ according to her friend. That to me is a wee bit more than a faint, which is generally defined as being less than a minute and I advised her to consider going to hospital. She was very strong-willed about seeing he GP rather than going into A&E and so I did all I could on scene as she recovered fully from her dark spell. Her ECG looked a little long and slow in the P-R interval department and her pulse stepped up in pace from slow to normal. Her BP remained lowish for her age (115 systolic) but she insisted this was normal for her and that she regularly played tennis to keep it that way (pulse and blood pressure of an ageing athlete then).

Before going to see this lady and her friends at a well-known restaurant, I had travelled to a train station for a man claiming back pain after admitting to having cirrhosis of the liver through drinking. He was already being attended to by a crew so I was redeployed for this patient. The call went from Red to Green in a short few seconds. When it’s red for an 85 year-old ‘collapsed’ that’s a genuine worry; when it goes green again, all things have to be considered.

So, she got to sign my PRF and she was given three opportunities to go to hospital. She seemed fine but I made her promise me she’d see her GP immediately. She told me she would but after her next scheduled tennis game.

My peddling friend (cycle paramedic) was given a call in Oxford Street and I sensed a perfect job for getting home on time. Sorry but sometimes it’s about finishing on time, unless someone’s life is at risk of course. In this case, a 50 year-old woman had walked into a glass door in a department store, cutting her eye and landing on her backside when she fell. She had a small laceration above her eye and hadn’t been knocked out... in fact, she had no other injury at all, so I drove up there, collected her and got her to A&E, with her husband, who had shown up in support, giving me ten minutes of paperwork and ‘filing’ to do before finishing my tour of earlies.
Next up... the dreaded weekend nights.

Be safe.

1 comment:

Anonymous said...

"Is the brain somehow directly connected to the tail?"

Was this gentleman a politician by chance? If so, one could be concerned about a possible brain injury given the location of the pain.