Saturday, 30 January 2010

Falls, faints and cardiac arrest

Day shift: Five calls; one left on scene; one assisted-only; one by car; two by ambulance.

Stats: 1 Chest pain; 1 Cardiac arrest; 1 Faint; 1 Fractured arm; 1 Eye injury.

Frosty and cold today, with a light dusting of snow. There, that’s the weather done for you.

I’ve been off ill for a few days (I don’t normally do ill) and I was away on a break coincidentally – I went to Centreparcs to write this novel of mine, or at least flesh it out a bit more. I have given myself a deadline – April this year – to complete it and I am finding it hard work to be honest. Now, I know you may think of Centreparcs as a typical corny Brit breakaway but I love the relative peace and quiet, cabin life and the fact that the only traffic you’ll encounter are bicycles with tinkling bells. And that rarest of sounds; something I grew up with but no longer hear as often – children laughing and playing in the background, even at night. It’s as near a Utopia for safe living as you can get in these modern times. Except for the mad ducks, occasional baby deer and rampant squirrels that demand feeding every day at your door!

Back to the real world and my first call is for a 21 year-old French man who is standing on the street with his friend. He is complaining of dizziness and ‘heart pain’ after sniffing Mephedrone, which is a plant food. I’d never heard of it before, so I was sure he was saying Methadone and I drew my conclusions on that basis but his friend, the spokesman, persisted until I got the point. Then he handed me three or four little bags of white powder, there and then on the street while Londoners were getting themselves to work or to the early opening shops. I must have looked like I was buying cocaine from him, so I handed him and his little sweetie bags over to the arriving crew before I got arrested on suspicion of handling a Class A drug with intent to criticise. I should point out that the powder looked like cocaine and that Mephedrone is actually legal in the UK at the moment. I was being sarcastic.

A senior colleague joined me on the car for a few hours so that we could chew the fat about stuff and he attracted a cardiac arrest as soon as we stopped for coffee. The 53 year-old man had collapsed at some point earlier and had been found by his friend, on the toilet floor and not breathing. His girlfriend had seen him, alive and apparently well, just an hour before, so this was a shock to them.

We arrived just ahead of a crew and found the man’s friend compressing his chest in the hallway, where he’d been moved to make things easier. We took over and a motorcycle medic joined us a few minutes later.

Our aggressive resus made no difference to his condition; he’d been asystolic when we arrived and he remained that way, despite drugs and effort. His BM was low at 2.6 and his temperature, which I took on the basis of the way he looked, was reading ‘LO’. The man had been in this state for a while. I’d noticed the discolouration of his skin around the neck and shoulders and thought he may have been gone for an hour or so. So, after a lot of hard work I called it, with the agreement of the team. We weren’t going to be able to bring him back.

I did the paperwork as everyone tidied up and the police arrived for a handover. There was no suspicion here and I learned that the man had a familial history of sudden cardiac death; his father had died that way at a youngish age. It wasn’t until the sister and his nieces arrived that I found out that he’d been complaining of chest pains and DIB recently but had ignored it. He was a drinker and smoker but didn’t do drugs.

I led his sister into the room after warning her about the tube and cannulae, which have to remain in place. She howled and cried over him. ‘Wake up, come back’, she repeated. It was sad to watch but I have somehow become used to the tears of others.

After all the paperwork had been done and a debrief carried out for the sake of a trainee who’d been on the last job – her first ever resuscitation – we were off to a 29 year-old woman who’d fainted and was recovering in a bar. Her husband and family was on scene and she seemed embarrassed by the circus that we brought around her but she needed to be checked thoroughly before we were willing to let her continue her day. She had a restaurant booking and was anxious to get there on time, so after full obs and an ECG that was normal, I drove her and her mother (in-law?) to the venue and she made the scheduled booking time... kind of.

I’d suggested that she was possibly a bit ‘dizzy’ as a person and her husband confirmed that she was, in a nice way of course. She recovered fully by the time she was dropped off and I returned to give her the PRF copy after I’d filled it in. We had been called to a false alarm cardiac arrest in the south but were cancelled on the way, so I managed to get her signature for a non-convey as she was sitting down to eat. That’s how rude I can be.

She must have been happy with the service because she posed for a photograph with us just so she could prove she had been in an ambulance. She’ll be reading this so... try not to faint again on your next visit and reserve another place at the dinner table next time :-)

At Piccadilly Circus a 67 year-old Irish lady and her family waited for us after she’d fallen badly and broken her arm. She’d tripped over raised pavement slabs and sustained a bump to the head too but it was her fracture that concerned me most. Her arm was badly deformed and she needed morphine to control the pain as I immobilised it in a sling for her. I sat in the back of the car with her as my colleague drove us to hospital, where she was taken into Resus for what I’d already warned her would be a bit of 'manipulation' to straighten it. Poor woman.

Another faller, this time a 35 year-old lady, sustained a deep cut above her eye, a broken cheek bone and what looked like Hyphema of her eye. The eyeball itself was also definitely damaged, so much so that when an ambulance arrived I let the crew take her because she’d need to go on blue lights for that injury alone. She was, as you’d expect, very upset and scared about what she’d done to her face, simply as the result of running for a bus in high heeled boots. So, two things to remember here - don't run in high heels and look where you're going if you do.

Be safe.


Anonymous said...

I love centre parcs too.... just so peaceful.


Uncle J said...

The chap with the 'mephedrone' reminds me of a chartacter in 'The Truth' by Terry Pratchett - //One major problem with Mr Tulip is not that he has a drug habit as such, but that he has a tendency to buy and consume anything sold in little bags in an attempt to acquire one,

Isla said...

It's also called Meow Meow, there have been a few articles on it in the press recently trying to get it reclassifed

Zo Zo said...

Centre Parcs...You want to visit Sark! only bikes, horse and carts and a few tractors, no cars, no street lights! The ambulance is a trailer pulled by a tractor, (the trailer is old St. John style ambulance with just the back left no front cab area). Beautiful place!

T44 said...

We get a heck of a lot of Mephedrone in Manchester. It's legal to sell as plant fertiliser, but illegal for human consumption... a funny old thing.

I've experienced all sorts of symptoms (in my patients, not personally) from anxiety attacks, chest pain, vomiting and GCS scores of 3 - simply because of MCAT and alcohol.

Anonymous said...

Expect to see a lot more mephedrone in the coming months. All this stuff like methylone, methylmethcathinone, flouromethcathinone, JWH-018 (synthetic cannabinoid) has been around for a few years but is only properly hitting the streets now I reckon.

MDMA said...

Such an interesting story to read and I enjoyed reading it as well. Keep up the good work.