Thursday, 8 March 2012

How to step from the pavement and survive

Naomi the Welsh visited for more punishment, London-style, and helped me on two shifts on the car. I’m in Wales next month to attend a CPD day and I’m due to ride out with her and her colleague whenever I get the time to do so. I’m hoping to learn why our system is so different from everyone else’s in the UK. Meanwhile, however, Naomi continues to learn why we are so fast and efficient when it comes to patient obs and pathway choices.

We start the shift with a call to a 64 year-old female with exacerbated COPD and a history of two MIs. We don't have to do much for her because an ambulance is on scene fairly quickly.

We left the scene of that call to attend a held call for the police. They have a 28 year old female who has accidentally overdosed on her antidepressant medicine. The call has been held for a while, and I guess the cops got fed up waiting, because as we arrived, the patient was being walked out with them - they were going to take her to hospital in their own car.

I had a quick chat with her and decided to take her in my car instead, with the police vehicle following, less one officer, who was now sitting in the back seat with the patient... just in case.

A 39 year-old man was allegedly assaulted outside a pub. He had a lacerated nose, so he wasn't in dire need of a grown-up ambulance. Instead he got us and the FRU, in which he was conveyed to hospital.

This x-ray (permission given to show it) belongs to our next patient. She was drunk, as were her friends, and she managed to step off the shallow kerb in a drunken, uncoordinated way. She basically tried to take a big step forward where there was none to be had. She landed awkwardly and tumbled, tackling her own leg on a twisted descent, into the road... and that's where we found her.

Her friends were all around her but, as is the norm for drunken 'sensible' people, they became a bit of a nuisance, so I asked them to step away and keep away. I'm pretty sure they'd have hauled her to her feet and got her into a cab if one of them hadn't retained a sense of propriety about the situation. He seemed to know, outside the alcohol, that his female friend had a significant injury.

On inspection it was very clear from the start that she'd broken her leg. In how many places and just how badly would not be known until my attention was drawn to that x-ray when we got to hospital with a later patient. What was obvious, however, was the lump of bone protruding under the skin of her shin.

She was in pain but I think the smog of alcohol was taking the edge off it. She still had enough marbles to use entonox to good effect and that's all she was getting until the ambulance arrived and took her away.

I don't doubt that this 25 year-old lady will reconsider her booze intake the next time she's out with the lads.

We were met by a security guard and an angry girlfriend (soon to be ex I should think) when we got on scene to help a flat-out drunken 22 year-old who'd downed a full bottle of whisky after a tiff with his boss. This seems ludicrous but people do the most idiotic things when they get upset.

"He's normally a light drinker", his girlfriend tells me. "But tonight he drank a whole bottle then called me up to get me to collect him. I had to get out of bed to come down here".

The young man was semi-conscious, so I taught Naomi a trick that is not often used in Wales (as I understand); she put a line in and fluids were given in a bolus. Within a few short minutes, the man was awake and fully aware.

Now, there is no clear scientific evidence that IV fluids clear ethanol rapidly, but the studies that have been carried out tend to be weak and suffer from small sample sizes and questionable methodology and I'd argue that, in my experience and probably that of hundreds of London paramedics, giving fluids to unconscious and semi-conscious drunks who are saturated in ethanol, will flush and dilute the problem, leading to a fairly rapid recovery... at least to consciousness if not sobriety. I've done this dozens of times, and even multiple times in one place with two or more patients on the street. To me, there is enough evidence to propose that IV fluids help. At the very least, it's worth a try.

Naomi doesn't get to see enough stupidly drunk people, so she has never witnessed the miracle of a needle, some tubing and a bag of salt water.

At a police station, a 27 year-old man was giving a statement about his recent assault, in which he'd been grabbed and beaten about the face as his iPhone was ripped from his hand, causing another injury on that part of his body. The poor guy was shocked, as you would be. He wasn't seriously hurt, so we took him in the car to hospital. If I were to give advice about this, it would be don't walk around with your iPhone out in the open, especially at night. Mobile phones are the new wallet and some thieves will stop at nothing to get you to relinquish it - some thieves carry knives to ensure that happens. It's simply not worth it.

Our last job was for an 82 year-old man who had leg pain after falling. He'd waited 4 hours for an ambulance. His GP had asked for one and said it needn't hurry. There were no ambulances to send, so we went and got him. He could walk, so we carefully assisted him down his stairs and out to the car. It was a painfully (more for him than us) slow journey but it was our going home job, so we took our time with him. He was rather tall and getting him into the car felt like a folding job.

That was that for the night. No mishaps and only one error. Naomi thinks there is a time called 22:60. She must do because she wrote that on the PRF. It's probably the tea-time hour in the valleys.

Be safe

1 comment:

Anonymous said...

prf forms just love filling them in lol