Sunday, 1 March 2009

Anti-social behaviour

Day shift: Seven calls; one assisted-only; the rest by ambulance.

Stats: 1 Head injury with memory loss; 1 DOAB; 1 Anaphylaxis; 1 Panic Attack; 1 Collapse ? cause; 1 Hypoglycaemia; 1 Head injury post assault.

I’ve posted this retrospectively because I forgot to do it on time, sorry.

The head injury was old; he’d been seen at hospital and given the all-clear but I went to the underground station where he’d asked for an ambulance because he claimed to have memory loss. The fact that he was drunk blind-sided my conviction to be honest. I was in the middle of a training ride-out for a colleague who wants to get onto the FRU unit and this was a diversion, so I handed the patient over to the crew when they arrived and continued the session for another hour.

When I was back on I was sent to a DOAB. A Polish man was asleep at the back of a bus and he refused to go at first. It took a few minutes and a lot of persuasion with threats of police attendance before he finally gave in and left. This call had come in with the descriptor ‘sitting with head in back’. I thought I might be seeing my first decapitated drunk on a bus.

A female with anaphylaxis had an acute reaction to something she ate at lunch and walked herself into a local medical centre for treatment. I was called and found her sitting in one of the rooms with her friend and a nurse, who had started her off on antihistamines. I gave her a shot of adrenaline because her throat was swelling up and she didn’t take kindly to it. She felt unwell and shaky but that’s what the hormone does sometimes, so I waited for the event to pass and it did. By that time the crew had arrived.

If you go to Madame Tussauds and you are of a nervous disposition, try to avoid the Chamber of Horrors. We get lots of calls to panic-stricken youngsters who come out of there. The 20 year-old French girl I was called to was hyperventilating after her experience and all she needed was fresh air and reassurance…and advice about not going near scary things made of wax.

My NPC was a woman who collapsed in the middle of a zebra crossing – a crew was on scene.

A very distressed diabetic with low blood glucose sat in the ticket booth of an underground station as I explained to her that the BM reading I had taken was 1.4. ‘No, that can’t be right’, she cried but her behaviour was typical of a hypoglycaemic and her emotional state, coupled with confusion and the fact that she had collapsed earlier meant that glucose would be a good idea there and then but she refused the Gel I offered and I gave her an IM injection of Glucagon, which did the trick within ten minutes. She eventually ate some of the Gel too and her BM rose to just below normal by the time the crew took her away, still crying and shouting out.

As I neared the end of my shift and sat outside my station ready to unpack, I got a late call for an unconscious person outside a pub, so I made the usual assumption and headed out thinking that it would be a drunk and therefore a fairly quick turnaround call - but it wasn’t.

The man lay on the ground with an off-duty doctor attending to him. The pub was packed and it was rush hour, so there was a lot of confusion. When I got to him I was told that he’d been assaulted and hit on the head, which had bled onto the pavement. He had a wound and a large bump at the front of his head and he didn’t respond at all, except to move automatically every now and then.

I checked his pupils and they were okay initially but as I progressed into my obs I found that his BP was high and his pupils became larger. He also began to posture decorticately and at that point I decided HEMS was needed, so I called it in as the doctor took care of him for a few seconds.

Over the next twenty minutes or so two MRU’s, an ambulance crew and the HEMS team showed up and helped me get to work on him. The road was closed off on one side and the police detained everyone in the pub because the man’s condition was serious and I had told the cops earlier that I judged it to be life-threatening.

The story of how he landed there became clearer too. Allegedly, he’d been taking other people’s drinks and generally bothering the pub customers until one of them got fed up and pushed him out of the way. He tumbled over a table, landed hard onto his head and that was that – he didn’t get up again.

His posturing became more severe but he spoke at one point when the oxygen kicked in, however that was only temporary and the HEMS doctor decide to RSI him there on the pavement. It took a few attempts to intubate him once he was put to sleep but eventually he was taken away to the nearest neuro centre.

This man looked like he’d been in trouble all his life – he had the scars and tattoos to testify to that. He had obviously bitten off more than he could chew with one person and it had cost him dearly. I understand from a colleague that he died in hospital later on.

Be safe.


Pablo said...

She didn't like the epi? Strange. You would think she would be thrilled to have something that was saving her life.

Guess you can't make everyone happy

Anonymous said...

Thats sad :( That man with the head injury...