Thursday, 13 November 2008

Whisky night

Night shift: Nine calls; one treated on scene; one refused; the others by ambulance.

Stats: 1 eTOH and unwell; 1 Faint; 2 just plain eTOH; 1 Assault with facial injuries; 1 Chest pain; 1 Hypoglycaemic; 1 Back pain; 1 Overdose.

For the first time in my working career I was late signing in. The traffic was diabolical all the way from my home to HQ and it took me two hours to get through it. I don’t like being late and I get very wound up when I am. So, I was tense to begin with.

And just to cheer me up I get a call to a Salvation Army ‘soup kitchen’ to help a 34 year-old Polish alcoholic who thinks he might have a fit. He was agitated and the place was full of people queuing up for dinner. He spoke very little English and a translator told me that he was epileptic, although he had no medicine. At one point his friend ranted at him in Polish and I was told he’d said ‘it’s the drink that’s doing this to you’. Too late for the advice now, I thought.

At no point did he have a fit but the fact that he felt like he was going to have one, combined with his continuing agitation, as well as his insistence that he needed to go to hospital meant that he would do just that. The ambulance arrived just in time because, quite frankly, I’d run out of obs and conversation.

I wasn’t required for a 20 year-old female who’d fainted in the street. I’d gone right past her in the car anyway and by the time I did the loop required to correct my mistake, the ambulance was on top of the job.

In the West End, as the pre-weekend drinkers start to practice for the ‘big one’, two 18 year-olds waited in an alley until I arrived, protected by the doorman of a nearby club and a private medic whose first words to me were ‘they’ve been drinking. She thinks her friend is unconscious and not breathing’. It was a sarcastic remark and the less drunk of the two girls felt insulted by it. ‘That’s just nasty’, she told him.

Her friend lay in a pool of vomit and sputum after helping herself to half a bottle of whisky, according to the sober(ish) one. ‘It was only a small bottle’, she said in defence of their stupidity. They were both too young and too small in stature to down that much spirit without punishment.

The crew arrived and a hospital gown was quickly thrown over the drunk girl before she was taken onto the ambulance. Now, that’s smart thinking.

I don’t see many assaults where a female has harmed a male, so this was an unusual call. The 26 year-old man had allegedly been glassed in the face by his girlfriend (now his ex I think) after some sort of argument or dispute. She’d settled whatever it was by pushing a wine glass into his head, cutting all around his eye as it shattered on his face. The cuts were deep and nasty, one or two of them were still actively bleeding and a spatter of blood lay under a bar stool near the door in testament to his girlfriend’s rage. In my experience women only get that angry when they have been terribly hurt…or maybe she was just insane. Whatever her reason, the police, who were on scene, will more than likely charge her with actual bodily harm (ABH) and she will have a criminal record for the rest of her life. I don’t know if anything or anyone is worth that.

No rest and another call – this time to a train station for a 59 year-old man with chest pain. He was sitting, well slouching badly, on a bench when I saw him. People with chest pain don’t slouch, I can tell you that much for sure and I was unconvinced. However, he claimed to have angina, although he’d forgotten his GTN. He’d been walking around all day with the pain and now it was too much.

I gave him GTN and an aspirin and recorded perfectly normal vital signs. One can ever know for sure, as I’ve said before and he was going to hospital by ambulance BUT when I gave him the GTN spray, he didn’t know what to do with his tongue. If he had his own spray, then surely he’d already taken it more than enough times to know the drill. I had to lift his tongue up for him to administer it. I never have to do that for angina sufferers. Maybe he’d forgotten or maybe he’d never been taught. I gave him the benefit of each doubt.

I got my break after that and watched telly at the station in peace and quiet, which was nice; it felt like being at home, minus the wife and Scruffs of course. But all peace is shattered in time and I was soon off to the next call and it was a genuine emergency.

I was met at the door of the address by a man who told me his neighbour was unresponsive and had been like that for a few hours. I walked in and found him lying in bed, eyes opening to voice but not saying anything back and definitely not 100% there. The call had come in as a '?stroke' but as I started my obs, the neighbour, who checks on his friend regularly, told me he was a diabetic.

‘Oh, I see’, I said. In that instant his demeanour and level of response looked familiar, so I did a quick BM – it was 1.3.

The crew arrived just as I got the reading and we worked together to get the man’s blood glucose up as quickly as possible. I gave him glucose gel but he wasn’t conscious enough to know how to eat it, so I gave him a glucagon injection. We chatted to his neighbour, looked at his medical notes, learned that he was a double-amputee and that his carers had left him like this after attempting to feed him, failing and giving up trying. That’s not something you do with diabetics. Or anyone else you supposedly ‘care’ for.

Over the next twenty minutes he became more alert until he suddenly came on like a light bulb when the glucagon finally kicked in. His BM was improving and by the time we left him, it was a healthy 5.6. There’s no doubt in my mind that his neighbour had saved his life – sometimes just having someone dropping in on you every now and then to check that you are ok is a lifeline. As for the man in the bed; the intransigent Scotsman refused to believe anything was wrong and made it clear he wasn’t going to hospital for man nor beast. So, he didn’t and we left him in the care of his real carer...his friend.

Emotional conflicts and alcohol don’t mix but I expect a grown man to behave with a little more decorum than my next patient, a 25 year-old baby. He collapsed in the street and lay there, surrounded by drunken revellers, refusing to move or respond after his girlfriend dumped him. So the LAS was called in to rescue him from his misery because everyone knows that a Friday night ambulance crew will sympathise with the pseudo-physical nature of a broken heart...especially if it’s compounded by a number of high-strength drinks and a weak disposition.

He lay on the pavement as I attempted to make contact with his brain and he continued to refuse to co-operate when the crew arrived, forcing them to risk their backs and lift him onto the trolley bed. I didn’t expect him to receive a warm welcome at the local hospital.

Towards the tail end of my shift I was sent to an estate for a 30 female with back and chest pain (the chest pain made it a priority call). When I arrived I found the woman writhing on the floor in the hallway of her mum’s flat. Her mother was standing over her and pointed as I came through the doorway. ‘I don’t know what’s wrong with her’, she said. Then she withdrew to a safer distance and I moved into her space to ask the woman what was wrong.

I’ve seen this sort of wriggling, writhing behaviour before and I have to say, at the risk of being accused of professional arrogance, that the ‘patient’ is usually acting up and that there is another reason – a more domestic one – for the behaviour. In this case, however, as time went on and she described the gradual onset of the pain over a few days, during which she tried to cope with it, I became more and more convinced that something wasn’t right with the lady and that her pain was very genuine. She had scored it as 10/10, describing it as ‘sharp’, ‘stabbing’ and starting in her back, radiating through to her chest just below the sternum. She had no DIB and no medical history to explain this. Neither had she suffered any recent trauma.

I'd ruled out pleurisy because her breathing didn't change the pain and there were no other signs to confirm it, so I asked about other things, including her recent C-section birth.

I put her on entonox until the crew arrived and then she was given morphine because there was no way she was going to move from her current position on the floor without screaming out in agony. We gave the drug a few minutes to work and then moved her to the chair. Every now and then she’d cry out in pain as a wave went through her body – the morphine may have taken the edge off it but she was clearly still suffering.

My shift ended with a strange call to a block of flats for a 51 year-old man who was ‘unresponsive’. I was met at the gates by one of his agitated friends and I could see the ambulance coming up the road as I followed him to the flat. Inside there were two more men standing over their friend, who was lying on his back on the floor. He didn’t look well at all; his breathing was shallow and noisy and he looked ashen. It was the look of peri-arrest.

I started checking his vital signs; slow carotid pulse, slow, shallow respirations and completely non-responsive and I asked what had happened. His friends told me that he’d been drinking a lot of whisky tonight but that didn’t convince me and so I looked at his pupils – they were pin-point. ‘Has he taken any drugs tonight?’ I asked. The question is tricky because it makes people react in all sorts of ways – some refuse to answer; some are insulted by the implied accusation and some (usually the guilty ones) will use open terms such as ‘I don’t know’ or ‘I don’t know him/her well enough’. These lads answered with an adamant ‘no’ but changed it to ‘we can’t be sure’ over a period of ten seconds when I asked again.

The crew was now on scene and they started to help me stabilise the man’s airway. His breathing was supported with a bag-valve-mask and narcan was injected into his arm while I got a line in. His breathing didn’t improve much and when I checked his pulse I could feel it slowing down. I re-checked using my probe and it read 38bpm. His sats had been on the floor until he was bagged.

A defib was on him and we were all set for him to suspend at any time the way things were going but a miracle took place (the miracle of narcan as far as I’m concerned) and he suddenly improved, opened his eyes and sat up, startled. Hurrah! He lives.

The man refused to go to hospital and we spent the next half an hour trying to persuade him to do so. He’d denied using any drugs, even though the signs were there. His friends protested his innocence too, citing his fitness and mountain-climbing activities. It’s possible that a ton of whisky had knocked the man out but his rapid recovery was exactly what I would predict after reversing an opioid with narcan, so I left the scene (late again) with a critical mind. Oh, and I removed the cannula from his vein before I went, just in case you were going to write in and be all clever about it.

Be safe.


Anonymous said...

"his carers had left him like this after attempting to feed him, failing and giving up trying"

This is disgraceful and absolutely appalling!!
I've come across some shoddy care workers before but this is ridiculous!

living_with_ba said...

The carers leaving the man remind me of my friend who is also a double amputee and diabetic, I have saved her life more than once, going round to check on her and finding her on the edge of a diabetic coma and having to call an ambulance because her carers have been round and decided that although they're supposed to feed her and give her the insulin, they'd leave it because she ws "asleep"

living_with_ba said...

The carers leaving the man remind me of my friend who is also a double amputee and diabetic, I have saved her life more than once, going round to check on her and finding her on the edge of a diabetic coma and having to call an ambulance because her carers have been round and decided that although they're supposed to feed her and give her the insulin, they'd leave it because she ws "asleep"

BrianW said...

Did you ever find out what was wrong with the 30 female with back and chest pain?

california drug rehab said...

Alcohol made that Polish guy to have a bad temper. Furthermore, alcohol won't do no good especially if there is no moderation in drinking it.