Friday, 2 January 2009

Hi's and Lo's

Night shift: Six calls; one left in police care, five by ambulance.

Stats: 1 Hyperglycaemic; 1 Faint; 1 Hypothermia and eTOH; 1Chest pain (non cardiac); 1 eTOH; 1 # ribs.

It’s freezing out there.

I managed to get to the 17th floor of a tall building, courtesy of the guidance of two young girls who had been sent downstairs to wait for me, despite there being enough adults in the flat to do that. So I entered a place that seemed full of kids – they were crawling, running and generally being noisy. Four adults, only one of whom spoke any English, stood over a woman who had been fitting on and off. She’d had a seizure earlier when the first 999 call was made - then it stopped, so I was cancelled. Then she had another and I was sent again. I'd travelled twice the distance to get to the same place.

One of the girls – the oldest at about 12 – took charge of the proceedings and I had to translate everything via this child.

The woman on the sofa was floppy and unwilling to communicate. I was told she spoke no English, so I did all my obs, starting with a BM which I found to be high. My meter simply read ‘HI’ as if to prove the point.

The patient had been diagnosed as anaemic by her GP but she’d been generally unwell for a long time and as I stood waiting for the crew, almost falling over little kids around me, she had another fit. It lasted about a minute and it was clearly not epileptiform in nature. Later on I was able to confirm polydipsia and polyuria - both of which had been ignored for some reason when she saw her doctor - ignored or not queried. This woman was diabetic and was suffering the consequences of a possible misdiagnosis.

The crew arrived a few minutes after she’d recovered and we took her down to the ambulance, where I put fluids up. She had another seizure and then another on her way in to hospital. Astonishingly her English became clear and fluent when she was in between fits – I guess her friends and relatives were wrong.

She continued to have fits at hospital and I left the medical team to sort her out.

Treating a patient in a cramped theatre during a show is not ideal and I found myself squatting on the steps of the balcony trying to make sense of what had happened to a 58 year-old man who’d passed out. The call was given as chest pain but he vehemently denied ever saying that when I spoke to him. The conversation had to be whispered, which I found strange as this was supposed to be an emergency but the play unfolding on stage seemed to have a higher priority than the medical condition of one of the punters. Understandable because you don’t expect them to stop and light up the theatre for a conscious person. I suppose.

The man was unhappy to have his obs carried out – he seemed embarrassed and annoyed by the whole fuss. A first aider on scene was concerned about doing the right thing; he’d just passed his course apparently.

I walked the man out to a quieter area just as the crew came to take over and he was taken to the ambulance where his ECG confirmed my obs on his pulse rate; slow. He had a sinus bradycardia and a low BP, both of which would have caused his collapse but he needed to be checked out because there will be a reason for his slow heart rate. It took the crew a little while to persuade him to go – he wanted to get back to the play. ‘Oh, alright, let’s go then’ he said unhappily. His wife looked fed up.

I was flagged down by a man with a cigarette in his hand on my next call for a 37 year-old who was ‘hyperthermic’. I knew it was unlikely to be the right word, so I assumed it meant hypothermic, given the below-zero conditions outside.

‘He’s hypothermic and he needs to be warmed up’, the smoking man said with a very boozy breath as he leaned in through my slowly descending window.

‘How do you know that?’ I asked.

‘Well, I’m a paramedic’, the man said unconvincingly.

The patient was sitting outside a pub with a tall woman who I’m sure was a man (deep voice, manly features, long dress). He’d been told by the landlord to get lost and I think this was their way of ensuring he left the area.

Sure enough, the thermometer I popped into his ear read ‘LO’, so the smoking man was correct. The ambulance turned up and he was led to warmth and safety, as per recognised procedures.

Later on I set off on a call to a council CCTV control room – a veritable wall of screens – to help a 36 year-old man with chest pain. He apologised again and again for calling an ambulance because he had seen what we have to deal with on his monitors night after night.

His pain was pleuritic, not cardiac. He’d had a cough and chest infection for a while but still struggled into work, so now he was paying the price. He was a large affable man and he apologised all the way to the ambulance. In a world where timewasters and drunks don’t always deserve our attention, it’s very disarming to hear an apology, even when it comes from someone who has no need to say it.

A rude and abusive girl sat outside a night club after her friends were arrested for fighting and breaking a parked van’s window. The crew was on scene with me and we tried and tried to get sense out of her (the call had been given as asthma) but she refused to be nice. The police were also on scene and the officers looked tired of her. We left her there after establishing that she wasn’t a pleasant human being and that, forgive me if I'm wrong, is not a medical condition.

In the late early hours I was called to a 35 year-old man in a tiny hotel room (for which he probably paid a fortune, given that it was in the West End) who was complaining of severe rib pain and DIB as a result of turning over in bed. He had been diagnosed with three fractured ribs, one of which was unstable, after he was beaten up by a drug’s gang (by his own admission). He was pleasant and friendly, shaking my hand when I arrived and when I left him with the crew and bravely allowed me to feel for the offending rib during my exam.

His pain was real enough and he’d need to go to hospital and get his injuries re-assessed so he was taken by the crew and I made my way back to the quiet of my station for the last few minutes before the car was taken over by the next pilot.

Be safe.


Jon Delaunt said...

I feel sorry for the poor first aider in the theatre. I'm willing to bet I trained him as well - I've done loads of the theatres lately. In fairness, they were all very good.

BrianW said...

Hi, I notice you haven't had any comments for this post or the one before, so I thought that this might be a good moment to say that even though I very rarely comment I always read your blog and thoroughly enjoy it. Thank you. Please keep it up and happy new year.

Anonymous said...

having done a lot of theatres with SJA, I can say there own staff hate dealing with anything and often give strange information on a call. Such as calling me down to managers office for twisted ankle to find a female in labor, The play did not even make me jump that much, but laugh a lot so can see why.