Wednesday, 13 January 2010

Snow joke

Twinkle, twinkle.

Day shift: Three calls: One assisted-only; two by ambulance.

Stats: 1 Nosebleed; 1 Back pain; 1 ? Flu.

An ambulance shift for me today and the reason we only managed to get three calls covered was that I had an afternoon meeting to attend and that consumed the rest of my day. Oh, and sick Londoners were fewer and further between today as the snow floated onto their pavements yet again.

Epistaxis, or nosebleed, is usually of no consequence and there is no need for concern when it occurs, especially in young people and children (for whom the most likely reason is nose-picking) but when it occurs in the elderly or in anyone where the bleeding is significant, there may be an underlying problem. Posterior expistaxis can be serious and the 39 year-old woman we attended to at work had a familial history of brain haemorrhage; her young sister (in her twenties) died of one and now she was in the ladies toilets with colleagues, nursing a nosebleed that had gone on for more than 30 minutes and which had produced tissue upon tissue of crimson distress. She had lost no more than 100mls of blood but she was clearly worried about what was happening.

We took her to A&E – her vital signs were normal, although her blood pressure could have been a little lower for her age and the bleeding had stopped by the time she reached the hospital. As I said, most nosebleeds are inconsequential and do not require an ambulance but some can’t be ignored.

An 88 year-old man with back pain called us and we climbed five floors, past offices in a narrow building to reach his flat, which was one of five on the roof of the premises. The long-ago fire station had residences at the top and commercial units from then on down so it was very unusual. It also meant that come 5 or 6 o’clock and at weekends, the residents were completely isolated at the top of the building. Our patient was one of them. His flat was tiny, a little untidy and cold. His front room looked like a depot of some kind rather than a living space and although we had climbed a lot of stairs to reach him, he told us he used a lift to get out and about when he could. We used that lift when we left with him – it was a large goods lift, full of junk and bits of rubbish strewn around the floor. To get to it we had to make our way down a flight of stone steps and when we exited we had to snake along a darkened corridor to a fire exit leading into the street. This is how the old man got in and out of his home. We also learned from a worker on the premises that the patient’s own toilet had long since become unusable and that he had to use a facility two floors down from his little hovel.

He had severe back pain and hadn’t been able to get out for weeks to collect his prescription medicines, so his blood pressure (for which he had meds) was high and his general health was not good. This frail old man had finally lost his independence and by his own admission needed support. I spoke to a very kind ‘neighbour’ from one of the companies inside the building and he offered to run daily errands for the man and to ask everyone else to keep an eye out for him. We also completed a vulnerable adult form in the hope that he will get much needed care in the future – he simply can’t continue to live like that.

Our last job took us to a fashion clothing outlet with more security than Buckingham Palace. The place was staffed by well-dressed young people and the goods on sale were spread around as if they needed their own space to breathe. Designer handbags, jeans and shoes were presented without price tickets for the most obvious of reasons and it smelled as if the rich frequented the place more often than the not-so. The 21 year-old member of staff who’d almost fainted and had reportedly suffered chest pain had been panicking because she felt unwell. All our checks were normal and after a long chat and deliberation, she was left to the care of her colleagues and advised to go home and rest. She probably had ‘Flu and that meant a day or so off work. The possibility of those handbag and clutch prices making her sick existed too.

On the way out I suggested that my hi-vis jacket could be ‘souped up’ with designer flair and sold off as something kitsch but current. I got sympathetic looks and nods but no takers.

Be safe.

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