Thursday, 6 November 2008

Chest pain walking

Day shift: Ten calls; all by ambulance.

Stats: 1 ?fit; 4 Chest pains (one eTOH, so possibly not); 1 RTC with knee injury; 1 Hypothermia; 1 DIB; 1 Seizure with chest pain; 1 faint.

Off to the Strand before I had a chance to grab a coffee and a homeless man is lying on the pavement, near his usual haunt, after having what his friend described as ‘shaking legs’. His foot is heavily bandaged and the stump shape indicates that is doesn’t exist anymore…or at least his toes don’t. So he’s unstable when he walks anyway. The call was for a male ‘fitting’ but he’s not post ictal and I don’t think he had a seizure. I think he lost his balance and fell down. His leg-shaking was probably the result of the shock of tumbling.

The crew was right behind me and he was taken to hospital where he’ll get a warm bed for a few hours.

I’ve been to the patient I was treating next a few times before. She is a 97 year-old lady who has ongoing problems with chest pain. She is always frustrated when I get to her because she’s fed up of the trouble she’s going through, which I totally empathise with. ‘Can’t someone help me to cope with this?’ she appeals as she is wheeled from her second floor flat in a secure estate. She needs to be somewhere less lonely than this; somewhere with company because I think she misses it, living alone as she does at her age.

I wasn’t required for the 30 year-old man with a cardiac history who was now complaining of chest pain at work. He seemed fine when I saw him with the crew and I’m not sure the call description was accurate.

The first RTC of the morning involved a motorcyclist and a pedal cyclist. One was wearing a helmet because it’s the law and the other, who should have known better, wasn’t…because it isn’t.

The cyclist allegedly shot out of a side street as the motorcyclist pulled away from the traffic lights. Both collided and the cycle was crushed under the heavier machine. Both fell over but only the soft-target cyclist was injured – he had a grazed knee and hands. He was lucky not to lose his life.

If I take ‘pot-shots’ at GP’s I get a lot of stick and much as I have a great respect for the writings of the esteemed Dr. Crippen, I think I might attract his wrath for this next bit BUT when a GP sends a patient with a known cardiac condition out to the waiting room on foot, after he has presented with shortness of breath and a history of being ‘unwell’ for the past few hours, we tend to get a bit annoyed.

The 47 year-old has had an ablation procedure recently for his dodgy pacemaker and now he isn’t doing too well – he is consistently tachycardic at around 140 bpm, has chest pain and is short of breath when moving around. He was offered no oxygen (although that now depends on the saturation levels recorded) and consideration was not given to the fact that it may be safer to leave him where he was (in the doc’s treatment room) until we arrived to take him away…on a chair.

The waiting room was absolutely full of people and this poor guy had to sit on his own, worrying about his condition. He was given a referral letter and told to go back and take a seat until the emergency ambulance arrived. Now, I respectfully suggest that if it was such an emergency, he should have been given greater care than that.

His ECG was unhealthy - he had an irregular heartbeat - and he was taken straight into Resus when the crew took him to hospital. At least someone was taking his condition seriously.

The crew was with me again when we took care of a 70 year-old man with sandals on his blackened feet at a hostel. He was feeling generally unwell and our checks revealed that he had a low BP and hypothermia. A bolus of warmed fluids would start the process of recovering him and he was taken to hospital for more of the same.

A 71 year-old lady began to feel unwell in an art gallery café after lunch. Her friend became so concerned that she called an ambulance. She was very pale and short of breath, even though she had no medical history of significance. The crew was on scene at around the same time, so I spent less than five minutes with her before she was taken away.

It’s rare to meet someone who has survived a cardiac arrest and my next patient had suffered a seizure in front of her friend. She told me she had gone into arrest a few years earlier and the resultant lack of oxygen to her brain left her with some neurological deficit, similar to those of a stroke victim. This interested me and I became more concerned when, after all the usual questions had been asked about her history and the current problem, she told me she had been suffering ‘similar’ chest discomfort to the one she had before, when she had her cardiac arrest. This had been going on for a few days.

The jigsaw of her problem now complete, it was clear she had to go to hospital as soon as possible. The crew was with me now and her ECG confirmed the need to ‘blue’ her in.

Ten pints of lager and a long way from home, so the 65 year-old Irish alcoholic claimed he had chest pain which merited an ambulance. He was in a public building and the staff were worried that he might ‘keel over’ any second. The only keeling he’d be doing, as far as I was concerned, was as a result of too much booze. He’d been out since 6am and it was now 6pm. He’d wandered around until he’d got utterly lost and his first (and only) demand when I arrived was that I take him home – I think this was his reason for feeling chest pain, especially as he didn’t refer to it unless I asked him about it.

His obs revealed that he was hypothermic and so off to hospital he went, telling the crew all about his HGV licence.

I ended the shift with a 30 year-old pregnant female who’d fainted at an underground station – a common occurrence. She was fully recovered when I got to her and the crew was left to complete the assessment I’d begun – she may or may not have opted to travel with them; I’ve supposed in the stats that she did but I was on my way home within twenty minutes, so I don’t know for sure.

Be safe.


MarkUK said...

Taking pot-shots at some GPs is like shooting fish in a barrel. It's just too easy.

A while ago, I had a call to a GP surgery to a woman with DIB. I'm only a First Responder, but I was sent because I have a defibrillator and the GPs' hadn't. (The local crew was already on a call so I could get to the patient quicker.)

On arrival, I was taken into the treatment room to find a very distressed woman looking like death warmed up. The GP told me the patient had pneumonia. She (the GP) had tried walking the patient.

The patient had sats of 83%, according to the GP, and they must have had no O2 as well as no defib.

40 seconds on high-flow oxygen and the patient was looking human again, though still obviously ill. My professional colleagues arrived soon after, so I felt I'd left the patient in good hands.

The most worrying thing is that it's the practice I use!

Feathers said...

Am really commenting to the comment above :) "the most worrying thing is that it's the practice I use!" LOL

Was in A & E led a very interesting life......:) which am now endeavouring to turn right around! (mainly due to circumstances)

The nurse asked my DR stated his name, to which she replied he was lovely she had worked with him in A & E, he has always seemed very knowledgeable and so on. Was reading somewhere else comments about GP's and perhaps they should all work in A & E....which was interesting.

Ethans Mummy said...

its sad that they to dont seem to want to commit.

I took ethan a couple of weeks ago. a child under one with known heart defects and problems history of svt etc
I took him in because he wasnt right, resps very high for him (50 to 60) he was white and cyanotic and and was floppy...very irritable
the gp just sat there and twiddled his thumbs and sent us home - didnt want to commit... turns out he had RSV and was admitted to hospital on o2 by the next day....

And then they complain when i dont go there first?! hello trust issue!! his chd combination is rare so they like to look at him like he is a freek show anyhow so dont really like going - he has open access tp the ward now..

But the thing i really want to say is it wasnt normal for him, if he was doing all this and was happy i would know he was ok..