Wednesday, 10 March 2010

Poor little heart

Day shift: Four calls; two by car; two by ambulance.

Stats: 1 Abdo pain; 1 Chest pain; 1 RTC with fracture; 1 Earache.

My Uni Student is out with me for the next few shifts and so I’m observing more than doing for a change. The shift started with a straight-forward car transfer from an underground station, where a 28 year-old woman was suffering abdo pain (period pain).

Then a call came in for an 11 year-old girl at school who had chest pain. Normally a young-person-chest-pain call is actually nothing of the kind but when it’s a child there are implications. We took the call seriously and the update informed us that she had a heart condition and was waiting for a pacemaker to be fitted. I’d already sussed the possibility of her having this kind of problem because I’ve been called to a few in the past and, in my time teaching in schools, I’ve heard of other cases.

The girl was floppy, quiet and looked very frightened. She had that particular look on her face - you normally see it on adults when they are genuinely in trouble and they know it. I couldn’t detect a radial pulse and her pulse rate was very slow – around 45bpm via my sats probe. Typically for a child, her oxygen saturation was high despite her condition.

The ambulance arrived quickly and we moved her by chair into the back of it for an ECG. I’d expected to see a profoundly bradycardic rhythm and, sure enough, she had a slow rate (41bpm) with few P waves and escape complexes randomly spaced in couplets and triplets. Her natural pacemaker wasn’t functioning and her heart was firing slow compensatory impulses from the upper ventricles to stay alive. I think if she’d been older, she’d have had a very short time before her heart gave up. Even at her age, this could be a potentially life-threatening condition.

We got her to hospital rapidly and she was taken into Resus with her worried teachers in tow. She may have to be given an artificial pacemaker to resolve this issue. The poor little girl never uttered a complaint throughout.

A RTC in which a motorcyclist hit a U-turning car (all too common) next and we found him in the middle of the road with police officers trying to control the traffic, although buses and other vehicles were still passing quite close to his feet. I asked for the traffic to be stopped completely to safeguard the patient and ourselves while we assessed him. He was conscious and alert and the only pain he had was in his shoulder. He had a badly fractured collar bone and I discovered later that he’d landed on this when he came off his bike at around 20mph.

He was very reluctant to allow us to examine him properly – this meant cutting away clothing and his biggest fear was that we would cut into his leather jacket. Now, I completely understand how motorcyclists feel about this item of protective clothing because it is very expensive but we can hardly sit a potential spinal patient up and remove it manually. He was more worried about his jacket than his broken bone.

In the end, and with a crew on scene to help, we managed to get the jacket off without butchering it. He could have claimed compensation for it anyway.

The last job of the day was to a 6 year-old girl with earache, neck pain and a sore throat. When we got to her flat she was lying in bed feeling very sorry for herself and I could see why immediately. She had an advanced infection and we were told this was recurrent; ongoing for the past year or so. This recent bout had been treated with antibiotics but they weren’t working and, although the family had asked for more, they had been told the girl was ‘okay’ and didn’t need anything else. This, in my opinion, was nonsense because she had a hugely swollen Submandibular gland, an almost closed pharyngeal space, a high temperature and severe earache. She had all the signs of Chronic Recurrent Otitis Media, a disease that could ultimately destroy her middle ear bones and lead to deafness.

She was awaiting an operation but the family couldn’t specify what she was going to have done – it could be an adenoidectomy, a typanoplasty, myringoplasty or to have a grommet fitted. If she didn’t get help with this, it could develop into a more severe infection – spreading into the bones and causing Mastoiditis or Meningitis, which can be fatal.

We took her and her family in the car to hospital where, hopefully, they will see how urgently she needs treatment to resolve her acute condition.

Be safe.

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