Sunday, 28 February 2010

Stop the cavalry

I found this article from 2001 during a bit of research - things haven't changed much.

Night shift: Six calls; one left at home; two by car; one by police van; two by ambulance.

Stats: 1 Dislocated elbow; 1 ? Drug overdose; 1 Chest pain; 2 EP fit; 1 eTOH.

One of the best dislocated elbows I’ve ever seen presented itself on my first call of the night after a 25 year-old Brazilian woman fell down the escalator at a tube station. Her heavy case fell and she tried to stop it but ended up following it down a few steps. Her arm did the job of stopping her vertical journey but it cost her the complete dislocation of her humerus from the radius and ulna so that it stuck out latero-posteriorly and looked like someone had just twisted it in an attempt to remove the lower arm. This type of dislocation is extremely rare.

Amazingly, she didn’t complain at all and told me it was ‘out of place’ when I examined her – yes, it was and the underground staff attending were amazed at the sight when I finally revealed it once layer upon layer of clothing had been carefully removed. She had a good distal pulse and a healthy capillary refill, so she went in the car, with a stable sling in place. Her routine will be x-ray, morphine and manual and probably aggressive reduction of the joint.

Oxford Street next for a 35 year-old female who apparently left a taxi to get money from a cashpoint but found herself without transport when the driver, who obviously got impatient or just didn’t like the look of her, threw her bags out and drove off. So, she collapsed in the street and MOPs gathered around her as she ‘behaved strangely’ - like she was having a fit.

A crew was with me when I arrived and I could see that, although she responded to pain, she was unwilling or unable to stay awake. Her pupils were tiny and her respirations were slow and shallow. On the ambulance she was given 800mcg of Narcan and her sleep continued, except when she had mini-fits of consciousness that made her flail around and lose bowel control.

She went to Resus and complained bitterly about having to take her top off, so she ran around the room making a nuisance of herself. Soon enough, I thought, she’ll fall down and go to sleep again.

At a train station a 49 year-old man had chest pain and a recent cardiac history with angioplasty, so when he told me he had unresolved pain despite GTN and aspirin, he got morphine to help. He threatened to collapse there and then but I think he was more anxious about the possibility of having a heart attack than the actual event taking place – his ECG said no but he went to hospital by ambulance.

After a break and a wasted journey out to a ‘vomiting with closing airway’, I got a call to an epileptic having a seizure. The crew arrived and together we headed up many, many flights of stairs – ignoring the lift for some strange reason - to the top floor, where we wheezed and panted as the 23 year-old woman’s mother explained that her daughter had been fitting irregularly and unpredictably recently and this latest episode worried her.

She was trying to sleep it off in bed when I rudely interrupted her rest and started my obs – she was looking normal except for a fast pulse, which is to be expected and then I handed over and left her to the crew so that a decision could be made about what should be done. She was left at home because I was still outside when the crew appeared patient-less and empty-chaired.

In the wee small hours a man was seen lying on the pavement ‘not moving’ and I went to check it out, asking that no ambulance be sent because the area I was heading to is notorious for this kind of sleeper – drink or drugs... or both. The police were on scene and two officers were helping the young man to his feet. Initially he was sluggish, sleepy and uncommunicative but a few minutes into the routine questioning carried out by the cops he reeled on one of them and was forcibly taken to a wall, pinned against it and handcuffed for his attitude.

I was about to put him into the car when this happened and of course I changed my mind. He would be travelling in a police van to hospital for what may or may not have been a drug-induced problem. On arrival, however, he sparked up and admitted to being a diagnosed depressive and drinker. ‘Why were you lying in the street?’ I asked. ‘That’s what I do’, he said.

He had been shopping and had a little bag containing tobacco, a can of soft drink and a can of dog food – hopefully for a dog and not himself. He was probably a waste of A&E time but it was quiet in the department and he hadn’t given the police an address to take him home to, so there really was no option. In the end I think he lied about his name and was generally cagey about where he lived because he just doesn’t like authority.

There’s nothing like causing a bit of trouble at 5.15 in the morning, so when a call for a ‘fit’ came in and I was sent to Horseguards I discovered that it was a soldier on the morning parade that had collapsed. Unfortunately, soldiers and horses were out in the dark, standing to attention amid the sounds of bugles and police motorcycles were controlling early traffic, including myself until I explained that I had to go in to attend this patient. Then I had to U-turn with an ambulance in tow, in front of the arriving royal car, stopping it in its tracks, to get through the gates and into the courtyard of Horseguards Parade.

We were ordered into a corner so that the royal dignitary could drive through on his way to inspect the soldiers and then a medic explained that he’d taken care of the patient and that it was nothing more than a stomach ache. An officer came over and introduced himself as the regimental doctor, saying much the same thing – the soldier was fine and we weren’t required. I have to say I felt very unwelcome and in the way. They’d already held up the parade because of us arriving, so I sensed they just wanted shot of us.

Once out of the area, I parked up to do the paperwork but another call came in about the soldier. This time I was to go around the back, to the parade ground itself. Police ushered me to a patrol car, inside which was seated a young Guardsman, in full uniform and great coat. He explained that he was epileptic and had fitted during the parade. He also told me that his medication was being ‘weaned’ off him. Now, I can’t understand this because epilepsy is something you can’t be weaned off – it’s not a bad habit. Having his drug cut in half meant he was bound to have a seizure as far as I’m concerned.

What struck me as emotive, however, was the story behind his condition. This tall 28-year-old Sergeant had been on patrol in Iraq when his squad was hit by an RPG, killing two of his comrades instantly, right in front of him. He sustained a head injury and this led to his epilepsy, which had been controlled by Epilim until now.

I found the whole thing worrying but, as an ex-army medic, I understood the politics of army life and sometimes things aren’t cut and dried. Sometimes you risk your life and get kicked in the face when you’ve survived.

He was an amiable man, very polite and determined to get on with his life – he has a plan for his family’s future and that’s something he can concentrate on while he copes with his condition.

Be safe.


Deborah said...

the poor soldier - I wonder what has happened to him?

Anonymous said...

Hi :)
to Deborah that commented above. I'm his wife, thank you for your sympathy! He is now doing alot better and has been put back onto his medication. I never understood why they took him off it! x