Thursday, 12 August 2010

Torn toes and exploding mucus

A couple of interesting calls this week; one involving a three year-old girl who fell onto her arm and possibly fractured or dislocated a bit of it. Whatever she’d done, there was no way on Earth I was going to get a good look at it because she was screaming her little lungs out, so much so that I could feel my eardrums vibrating. Her mother eventually gave up on the whole idea of me taking her to hospital and it was agreed that they’d bring her in themselves (dad and a sibling were on scene too) if she didn’t move the arm. I saw them in A&E later on – waiting in the x-ray department.

An Australian woman fell down six steps and smashed her face on the concrete when she landed. She was with her husband and friends when I arrived and she was concussed – repeating over and over again ‘what happened?’ as concussed people tend to do. Her facial injury seemed innocuous but she lost consciousness briefly after vomiting and I had to put her into the recovery position to prevent her from aspirating.

Now I needed an ambulance. I had done well so far; conveying all of my patients to hospital without the need to ruin a crew’s day but this was a bit more serious and had to go properly. The crew was with me within a few minutes and the lady, who by now had recovered from her passing out episode, was taken away with her husband. I took the two friends in the car so that they could all be together.

Then a 58 year-old man thought he was ‘choking’ in a museum after swallowing meat (therefore undermining the very act of choking. In fact, his obstruction was low down in his abdomen, at the point where the stomach sphincter, known as the Pylorus, allows the passage of broken-down (not depressed) food into the first part of the intestines. I suspected a physical obstruction at that point and he probably had an ulcer lurking around too because he was projecting mucus into the room every now and then – not acid and not bile – mucus.

Anyway, I lay him down for a proper abdo exam and found the plugged bit of food where I expected to feel it. I massaged the small area around it to check for pain and the lump of stuff moved away. He sat up completely pain-free - no more sense of an obstruction down there and no more mucal explosions from his mouth. He was happy to leave it at that but I asked him to get checked out as soon as possible. Various other problems are associated with this; cancer, Pyloric Stenosis (but that mostly affects children) and ulcers, for example.

Another shoe-based incident occurred at an underground station when a 6 year-old got her toe dragged into the metal teeth of the escalator, resulting in a sliced big toe. She was lucky; I’ve seen much worse and all I had to do was clean it, dress it and take her and her parents back to their hotel to get over the shock of it all, which I'm sure they'll find easy considering the five-star luxury they were staying in for their holiday in London.

Be safe.

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