Friday, 7 November 2008

A mixed bag

Day shift: Seven calls; one conveyed in the car; six by ambulance.

Stats: 1 Hyperglycaemic; 1 eTOH fit; 1 Abod pain; 1 Asthma; 2 Allergic reactions; 1 Head injury.

I arrived shortly before the crew to deal with a 77 year-old man with ‘diabetic problems’ who was lying on the floor ‘unable to move’. As usual the location was at the top of the stairs, four floors up and there was no lift. If I didn’t keep myself fit, I’d have been more flushed than he was when I got to the top. Luckily, I gave away only a few rasped breaths as I dropped all my bags on the kitchen floor.

The man was lying face down on the floor and his wife told me he’d been there all night. ‘No I haven’t’, he denied as I approached.

He couldn’t remember how he got to the floor and I waited for the crew before moving him, so that gave me time to check his BM. He is insulin dependent and had been out the night before drinking, although he swore he had downed only two pints. His BM was high but not critical.

The crew and I turned him over, sat him up then moved him onto a kitchen chair for a more human approach to his treatment. He was an affable character in complete denial about his circumstances. His wife said that she’d left him sitting in the kitchen after he’d been brought home by friends feeling ill the night before. She had gone to bed, probably unimpressed with him and he’d been found on his face in the morning. She spoke and looked like a woman resigned to her fate.

We completed our obs and advised him to go to hospital because he had no memory of what had happened during the night. He’d been incontinent and was confused at times. He agreed and was taken to the ambulance after a long, slow walk down the steep stairs of his block of flats.

He is an ex-professional footballer and he certainly didn’t look his age, which must be thanks to his fitness in youth and, I suppose, a good set of genes. I suspected, as did my colleagues, that he drank a few more pints than he admitted to in front of his wife.

A 50 year-old Polish man who refused to speak to us had an eTOH fit at a bus stop in Oxford Street. Passers-by stopped to help him and when I arrived he was sitting up on the pavement. I don’t know if he spoke no English or if he was still a little confused after his seizure but he complied and went with the crew to hospital when they arrived to take care of him.

Then a call to an underground station for a 33 year-old woman who’d collapsed on the platform after leaving her train because she didn’t feel well. At first she didn’t speak to me either and rolled about on the floor clutching her abdomen as soon as I introduced myself, something the police and staff on scene said she hadn’t been doing until that moment. During my initial obs a train pulled in and spilled out its contents. Most of the hurrying commuters went around us but one lady insisted on stepping over me and my equipment so that she could cut a route through and save two seconds on her journey. It was a very selfish and thoughtless thing to do and I reacted by telling her that I didn’t appreciate her actions. She ignored me, of course but the police weren’t too impressed with her either and I think they may have had a word if we hadn’t been pre-occupied with the patient.

This was a strange one because the lady on the ground had no medical history and only began to speak when the crew arrived and she was aboard the ambulance. She was sleepy and every now and again weepy too. She wouldn’t give us a reason for her behaviour and we found, as I had earlier, that her pulse was consistently slow at around 49 – 50 bpm.

This Scottish lady only cheered up once when I was there but broke down again during the trip to hospital. I suspect that she’d taken something in the morning prior to leaving home (she was due to go to a job interview) and the drug, whatever it was, was affecting her pulse rate…but not her blood pressure, which remained within normal limits.

A 45 year-old man lay on the floor of his office with colleagues crowded around him after suffering an allergic reaction to his medicine. He had a rash and his blood pressure was low, so he fainted when put on the chair by the crew.

Another allergic reaction, this time at a YMCA and a 43 year-old man broke out in a global erythemic rash after eating sardines for lunch. The rash was inside his mouth too, so, even though there was no swelling and no DIB, it was a good idea to have him checked out in hospital.

There was no ambulance available for the 4 year-old boy who'd fallen on his head at school and was now vomiting. He was with his mum and a few worried looking members of school staff when I arrived. He was behaving just like a 4 year-old does when he's had an accident; he was quiet, moody and hugging mum every now and again for reassurance. Other than that, he seemed absolutely fine and THAT is an important point.

I studied the faces of the school staff present and realised they were a bit on edge. The boy had fallen and smacked his head off the ground. Then he'd got up and been taken care of - monitored for a while. There was no visible injury and he did not display any sign or complain of any symptom associated with his recent fall. He was fully conscious, fully mobile and fully able to integrate back into his normal school day. Until he vomited, that is.

A teacher told me he became tired and vomited in class. His mother was called and he was monitored. He vomited again an hour later and mum arrived as the ambulance was being called. Then I showed up and spent twenty minutes in his company. The boy was fine but he'd go to hospital now just to rule out any nasty surprises. I decided to take him and his mother in the car rather than wait any longer for an ambulance which, given his emotional fragility, may have been too upsetting for him anyway. That the only reason I made that decision.

I reassured the school staff that everything they had done was correct. They were seriously worried because of THIS nonsense, which I will elaborate on in a separate post soon.

As I discussed this story with the boy's mother, she agreed that all some people want to do is blame someone. Blaming school staff is just too easy and it's time to STOP it.

The boy will be checked out in hospital and monitored but there will probably be no x-ray or scan carried out. He will go back home, go to sleep to get over his trauma and then go back to school with a story for his friends. That's it. Very rarely does it turn out any other way.

Finally, a call for an asthmatic 19 year-old Portuguese woman who had only arrived in the UK a few weeks ago and had yet to register with a GP or get meds. There were no ambulances available because we were being run ragged, so I made the long trip south to see her. She had waited 20 minutes and when I arrived she was outside her home, wheezing and suffering SOB. She was so desperate for help that she climbed into the back of my car as soon as I pulled up.

I gave her Salbutamol and was fully prepared to take her to hospital myself if there was going to be a longer delay but the crew turned up minutes later and by that time her condition had improved significantly.

Be safe.


Kelly said...

I saw that story on the news this week and it came to mind before you'd even linked to it. I'm interested to hear what you think because I thought it sounded like a really unfortunate consequence of a small bash to the head.

Anonymous said...

Head injuries can be really weird. I had a serious fall when I was young, and was concussed. Apparently I did not loose consciousness, but I can not remember anything from about 15min before the fall, to 24 hours later. But other than a tendency towards depression (which I may have had before anyway)and the odd habit of asking myself what day it is, (which I kept asking after the fall)then I seem to have been either lucky, or perhaps even more people have injuries that cause no problems and I am unlucky!

Tony F

Faraaz said...

Probs the woman rolling on the floor took a beta-blocker!