Friday, 11 June 2010

Head injury

Night shift: Five calls; one assisted-only; one no trace; three by ambulance.

Stats: 1 panic attack; 1 assault with fractured base of skull; 1 fall with head injury; 1 nosebleed.

World Cup nights ahead of me and no student tonight or tomorrow, so I’ll be working for my salary.

The Friday night started with a hyperventilating, panicky 22 year-old who was convinced (as were her work colleagues) that she having an asthma attack. She’d used her inhaler earlier and then gone to work without it – never advisable – only to collapse in a heap with fast breathing and a ‘burning’ feeling in her throat. The recent chest infection she’d had may have something to do with that but I wasn’t going to give her Salbutamol; she didn’t need it – her lungs were clear and her whole demeanour screamed panic.

The crew calmed her down and she was set free into the warm evening air... and back to work.

Immediately after this call I was sent to the rescue of a homeless man who told concerned strangers he was hungry. I was greeted by two guilty-faced women who apologised profusely for 'wasting our time' because the man got up and walked off without a nod or thanks. It wasn’t food he needed – it was manners.

Then, after a short rest, a 30 year-old man was found in an alley with serious a head injury and I was tasked to assist the crew and another FRU pilot already on scene. He was on the ‘scoop’ with a collar in place when I arrived but his condition was dire – blood was pouring from his ear and a large, bloody lump had formed on the back of his head. His nose was broken and blood leaked from that too. He was stable enough though but we knew that wouldn’t last long, so we got him into the ambulance and away to a Major Trauma Unit quickly. Oxygen was all he needed initially and as long as he was breathing and had a decent blood pressure, he would survive the trip.

Allegedly he’d been hit hard in the face and fallen onto the ground with such force that his skull had cracked. The extent of the damage was unknown and only a scan would reveal that. On the way to hospital fresh blood poured from his nose and his blood pressure began to change, as did the nature of his pulse. Significant changes in his behaviour would soon follow and I knew we’d have a combative patient on our hands soon. HEMS was busy and there were no Delta Alpha doctors to spare, so we ran with it and got him into Resus, stable and still conscious but it was touch and go, literally.

To prove that sometimes assumption is an evil thing my next patient, a 79 year-old man who fell at a train station, demonstrated lucidity even though he looked and behaved drunk. In fact, the call had been given as ‘fall, head injury, intoxicated’ but the man had discharged himself from hospital earlier – he was being treated for cancer and was receiving morphine for pain. He told me he was fed up and signed himself out against medical advice.

He had capacity, that much was sure and he denied drinking at all. This was confirmed when I called his sister and she told me he reacted to morphine this way – he would look very drunk and be unable to walk straight or talk without a slur in his speech. I accepted this and managed to persuade him, with the help of an Urgent Care crew, to go to an alternative hospital to the one he’d just left.

He had a minor bump to his head but was not fit enough to go home, so it was a battle to argue the point against his Irish stubborn refusals and his adamant counter-arguments, all of which were sensibly thought out. ‘Look Scottie’, he said, ‘I’m not long for this world and I’ve had a good innings, so I’d rather have the pain than the morphine because I hate the stuff’. How could I argue?

He was a decent, well-spoken man with a great sense of humour in the face of his deteriorating condition and he knew how he wanted to spend the rest of his life. I respected that and I hope he does whatever he wants to do until cancer finally catches up with him. I wish him good luck because that’s all he wishes everyone else.

Not all nosebleeds (epistaxis) are emergencies but my last patient of the shift, a 72 year-old man for whom I was tasked in my last five minutes of duty time (tsk!), was taking Warfarin and had suffered a cardiac arrest a year ago, so his was a special case.

By the time I arrived, he’d been bleeding for 20 minutes but it had stopped. All I had to do was dress it as a precaution and wait for the ambulance to take him away.

Be safe.


Japhia said...

May the man with cancer, live his last days with those that love him and where he feels loved. That's all I can really say for him. I feel touched by his decision to deal with the pain instead of looking like a drunk though.


Anonymous said...

Reading about the 79 year old with cancer brought tears to my eyes. - Nina