Friday, 26 March 2010

Everyone's falling down

Day shift: Seven calls; one assisted-only; one declined; one no-trace; one went home; three by ambulance.

Stats: 1 Hypo fit; 1 Faint; 1 ? eTOH fit; 1 NPC; 1 Seizure; 1 Tired person.

After a quiet start I was sent to a train station to deal with a seizure. The 45 year-old man was on the ground and a member of staff and a passing MOP first aider were on scene with him. The first thing I noticed was that he was clutching a handful of little sugar bags, so a BM was carried out straight away. The ambulance crew was on scene with me and we got him into the vehicle within a few minutes. He was recovering but still very vague and confused, so he was going to hospital despite the fact that his BM was normal, as were his other obs. Nevertheless the seizure had been witnessed and it’s entirely possible that he managed to get some sugar into his system just prior to falling down – a bolted horse as it were. This would have meant a rapid increase in his blood glucose level during and post fit, giving that normal reading in the face of his obviously recent hypoglycaemic state.

A frightened Romanian woman with an inconsistent story next – the 25 year-old collapsed on an underground train and an off-duty PCSO attended to her as she recovered from her faint. She was lugging a huge case with her and this was next to her when I arrived and found her inside the station office, where she’d been taken after her event.

During our chat she seemed very nervous and would not make eye contact, even with the female PCSO who was with her. Maybe it was the fact that she was being bombarded with questions and medical tests after falling down (maybe in Romania they just leave people on the floor to get on with it) or maybe something significant had happened to her. She was young and vulnerable travelling around with a whole load of luggage and very little English – that can attract the more unsavoury characters from the rotten woodwork, so I just wanted to ensure there was nothing amiss before I left her.

She didn’t want to go to hospital and her vitals were normal. She had no medical history and, apart from a dehydrated lip, she looked healthy enough. But she’d told us she was travelling in to the UK for the first time. Then she changed her story and said she was living with her boyfriend and had worked in London for the past two years. Her English markedly improved and now she was speaking in paragraphs instead of little one-liners.

The British Transport Police arrived to help out and to arrange translation via Language Line and by the time we’d asked the same questions over and over, it was well established that, 1. She could speak English perfectly well, 2. She didn’t want to go to hospital and 3. She was probably hiding something but nobody was going to find out what.

Now, it may well be that whatever she was keeping close to her chest was her own business and that’s fine. She could also have been scared looking because we were standing over her and that’s intimidating if you don’t know how things work here and her language block may have simply been the result of that fear. I’m sure my rubbish French would be non-existent in similar circumstances and some personal issues that I may have will be of no concern to the police or anyone else but me. I just wanted to know, as did the others, that she was ok and we weren’t missing something important.

Seizures are usually easy to recognise but every now and then we will be sent to individuals who are ‘fitting’ but have full control of their muscles and appear to know what they are doing. They don’t lose bladder control and they are completely lucid in between these events. Medically, it’s possible to have such seizures but on many occasions the individual is play-acting. Alcoholics tend to do this and many of our visiting alcoholics use it as a means to get into hospital. So I was skeptical about the seven seizures my next patient, a 33 year-old alcoholic man with HIV, HepB and HepC, who collapsed just outside the clinic he visits. I found him on the pavement with medical staff around him. He’d already had three fits and he had another two while I was dealing with him. I can’t afford to be negative about their authenticity but my gut instinct and experience with hundreds of epileptics and fitting alcoholics had me looking at this side-on.

It was only when a passing police officer showed up to help and stuck around that the man appeared to desist. He didn’t have any problems at all while the cop was there and then, when in the ambulance and away from the officer, he had a further couple of fits – he literally attempted to throw himself off the trolley bed, almost causing injury to my colleagues who were holding him down.

When he was lucid, he asked for one thing only... and he asked politely. ‘Can I have a beer please?’

Then a phantom stabbing took me north and the police were already on scene with a crew. The stabbing had supposedly happened at a College but after an area search and lots of denials about who had called, we all went back to our start positions.

Following rapidly on that job’s heels was an abdo pain but I couldn’t get the people inside the address to help because nobody knew where the patient was. Another FRU paramedic turned up and I handed over to her before we were told that the patient, a 25 year-old female, was in another building somewhere else on the road. I went to help out in case the call, which was Red, turned out to be a cardiac arrest but it wasn’t. The woman was chatting to the other paramedic when I popped my head around the door.

Off to another fitting call and this time the man was on the floor of a busy store restaurant. He had a history of brain tumour and had fitted once before but today he had two in a row. His daughter was graduating later on but they would all miss the ceremony (including the daughter) for the sake of their loved one. He was post ictal and when he fully recovered he declined to go to hospital. I gave my usual advice but it was clear he was not for turning, so I got my signature and he got a copy.

His wife had told me they were advised not to bother if he had seizures and just to monitor him but I felt his medication may not be working effectively if he was having multiple seizures and now I was concerned about him going home, which is where they were headed, and having another fit on the way. I took them all in the car to the nearest taxi rank and let them get on with their day.

A last-minute call for a ‘not alert’ 25 year-old female turned out to be an alert but not-willing-to-talk female. She was tired and hadn’t slept for a while. She tried again and again to go to sleep as I sat with her attempting to get sense. Then the crew arrived and I handed her over to them. I went home late and she was taken to hospital for some sleep.

Be safe.

No comments: