Tuesday, 13 July 2010

Crazy Postie

Day shift: Four calls; two left on scene; one by ambulance; one by car.

Stats: 1 Renal pain; 1 ?CVA; 1 hypoglycaemic; 1 ? # big toe.

Not the best start to the shift when I was sent to a possible kidney stone / UTI at a sorting office. The employee was in the toilet with his shirt off for some reason. His trousers were loose at his waist and he wore no underwear. This very bizarre person was ranting and puffing as he dealt with his 8/10 pain and he stomped around being extremely unhelpful; something I understood with pain, so I can forgive it.

I couldn’t get through to Control and this is happening more and more now that I am just another resource among many; it meant I couldn’t find out if an ambulance was available for this patient because I could predict his behaviour if I took him in the car and I wasn’t sure I wanted to risk it. After a long period of trying I gave up and decided he’d get morphine and a drive to hospital – I couldn’t just sit there and ignore his pain and need for treatment.

When I got to hospital he kicked off – shouting, swearing and lashing out at me when I tried to guide him safely into A&E. ‘You are attacking me and I don’t like being grabbed’, he said. This guy was bigger than me and I did no more than lift him up from the ground when he threw himself down and attempt to steer him towards the A&E entrance. He was having none of it and his aggression escalated until finally I shepherded him in to the department, where he continued to raise his voice and stamp around like a child.

When the dust settled he apologised for his behaviour and, as I said, I held no grudge because pain can create a monster from the gentlest person – not that I knew him enough one way or the other. When I got back to the car I discovered that my finger had been torn open, either during the attempt to lift him up or when he swung at me. Now I have a plaster and a war wound.

On the pier, at the Embankment, a 73 year-old man collapsed after losing the use of one leg. The staff took good care of him and called an ambulance and I was sent to investigate. I asked for a vehicle to be sent because, regardless of the low category and minor details given, he was not a well man. He was diaphoretic, confused at times and had a positive FAST with left sided weakness – the side he’d lost the use of his leg on. He was nauseous but not vomiting.

His two young grandchildren were with him and he was more concerned about their welfare than his own, so I made sure they were chaperoned and when the crew arrived we got him on board and comfortable – that included giving him Metoclopramide to ease the nausea and take the strain off his ICP (retching will increase it and if he’s bleeding this will cause more damage). Oxygen was delivered and he was blued in to a Hyper Acute Stroke Unit (HASU) for definitive treatment. His grand-kids remained calm throughout.

The consultant at a dental hospital decided that twenty five spoonfuls of glucose in water would bring a hypoglycaemic diabetic, who’s BM was 3.4, back to the land of normal blood sugar. It did a wee bit more than that - it elevated his serum glucose to 19.1 and climbing. Usually, when IV glucose is given by us, we put no more than 50ml into the bloodstream and wait for a result, cautiously evading the possibility of raising blood sugar too quickly and inducing hyperglycaemia. With some care a hypo can be turned into a happy 4.0 and then a sandwich or biscuit will keep it there.

The two dental nurses who were given the dosage (followed by a sandwich) were embarrassed by the new BM reading, which shot up in less than an hour and I advised that, should there be a next time, they may want to consider just five spoons in a glass of water (25ml) - and patience.

We can’t do much for a possible broken toe, so Mr 35 year-old broken big toe from Colombia got his poorly Hallux wrapped to splint and a thumbs up for luck. He wanted to get home after falling down a few steps at a language school and damaging his foot digit. The staff at wherever he is learning the language packed him off to the train station first aid room because they didn’t have a first aider, either on duty at the time or in existence... my money’s on the latter.

His toe was probably only bruised; I’ve seen a lot worse being sent into the waiting room after an x-ray and advice to ‘keep it elevated and take paracetamol’. The same advice I gave him in fact.

Be safe.


Japhia said...

Just a random post,

At work we get a few paramedics come through each day and I always seem to pay special attention to them and take time to ask them if they were starting/finishing their shift and if they were finishing how was their shift.

So there was a paramedic that came through last week at about 6am and I asked how his shift had been and he was very pleased as he hadn't had a call in after midnight so he just spent his shift sleeping.

I never realised how quiet nights can be for you all, or should I say how busy they can become.

Keep up the good work :)


Uncle John said...

Interesting headline in Sunday Telegraph - 31/07/10-

"Controversial targets for ambulance response times could be axed following a Government review of 999 calls."
[ http://tinyurl.com/37wgben ]

"John Heyworth, president of the College of Emergency Medicine said: "Time targets in general can work to improve patient care, but we know that not all do.
"Where there is evidence they work we would want them kept and improved, but in the cases where they cause dysfunction, and cause more problems than they solve, we would be supportive of changes".
He said ambulance crews were under "relentless" pressure to hit the targets affecting millions of patients, which made it difficult for them to focus on those who needed the most urgent help."