Monday, 29 March 2010

Tail pain

Day shift: Five calls; three by ambulance; two by car

Stats: 1 ? CVA; 1 Back pain; 2 Abdo pains; 1 eTOH (because it’s Monday)

A mystery start to the shift when a call for a 45 year-old man came in and I was tasked to support the motorcycle paramedic who’d just been sent before me. The call had come in describing the patient as ‘can’t wake up, breathing slowly and clammy’.

When I arrived the MC paramedic had been on scene for a few minutes. The man was on his side and breathing slowly. His respirations were shallow and he’d been snoring (airway occlusion by the tongue) when found. He was also very, very sweaty – the whole of his body was bathed in cold perspiration.

With no medical history known, we worked on the basis of a possible hypoglycaemic event but his BM was normal. He’d just gone to sleep, according to the witnesses on scene, so there was no evidence of prior chest pain or a seizure, both of which would also have fitted the bill for his condition. But he was a large man and so his BP may be a clue, however it turned out to be normal too, as did his ECG.

It was reported via his wife on the phone that he’d recently been complaining of chest and left arm pain but when he started to come round, after oxygen was given, he complained only of a headache. I think he may have suffered a neurological insult of some kind but there was no way to rule out other problems and the crew found his BP to be high when they checked it in the ambulance, so maybe something had gone awry in his brain after all.

In one of London’s nicer offices a 47 year-old staff member with a prolapsed and fused vertebral disc was in extreme pain. He had an electrical device fitted which sent impulses down through L5 and the Cauda Equina to resolve this but it had failed a few days ago and now he had uncontrollable pain, despite his diet of Tramadol. This was an awkward one because moving him at all meant giving him pain and he was standing up – propped by his colleagues – when I arrived.

He got Entonox and this helped and when the crew arrived I had managed to get him to sit down on an executive chair, which we rolled out to the lift and downstairs so that he could be put on the trolley bed as flat as he liked. It took us a few delicate minutes but we got there and so did he.

A 24 year-old female with abdo pain presented at an underground station and a motorcycle paramedic kindly offered me up as the driver to take her all of half a mile to A&E, which was packed. The young French woman was likely to sit there in discomfort for a few hours but these days Casualty Departments are a lottery...

...As was emphasised for my next abdominal pain – an 18 year-old who waited in the street for me to do something about her lower abdo pain, probably caused by Cystitis, but for which I had no remedy except to take her to yet another crowded and noisy Emergency Department so that she could sit for hours and wait for someone to ease her pain. Meanwhile, at least two drunken, violent men were sitting in cubicles reserved for ill people.

And finally – the drunk that didn’t get away. He was found sitting in the street ‘unresponsive’ by a passing off-duty police officer (he was appalled at the people he’d seen just step over the man). It took me a wee while to wake him up and establish hat drink was his only demon and then we waited in the rain until an ambulance arrived. He was too big and too drunk for the car... he was also certainly too out of it to go home.

Be safe.

1 comment:

Chris said...

Must've been a new police officer, then! I remember being shocked/appalled by the same thing the first time or two it happened. These days the only shock is when someone who's not an off-duty police officer/paramedic/nurse actually stops to help. Ah, cynicism...