Sunday, 16 May 2010

Foreign language

Day shift: Eight calls; six by ambulance; one by car; one no trace.

Stats: 1 short of breath; 2 head injuries; 1 TIA; 1 vomiting; 1 cardiac arrhythmia; 1 invisible o/d; 1 probable o/d.

Before I’d managed to grab some breakfast I got a call for a homeless man who was suffering shortness of breath. He had a bad cough and this was probably the foundation of his troubles but I took him to hospital because many of these individuals have health problems that simply get ignored or overlooked.

Lying on the pavement in broad daylight, near a small dark pool of blood, was an alcoholic Polish man who’d either fallen or been hit by someone. It took me several attempts to wake him up but he was passive enough when he stirred - I was on my own with him for a few minutes until a crew arrived to help me.

A broken bottle lay in the car park area of a nearby estate and dots of blood led from it to where I found him but he denied being assaulted when the police arrived to ask him what had happened. He was a known alcoholic and epileptic, so I guess he may have just fitted somewhere and the broken bottle was coincidental. The crew took him off to hospital, whatever the cause of his head injury – he’d need to have it closed.

Almost as if a mirror of the day before had been brought up for me, I was off to a man ‘asking for a doctor’ but not giving any reason. He’d walked into a public place and seemed fine for an hour but when someone started to speak to him he was coming out with nonsense. When I arrived he was replying with whole sentences that sounded almost mathematical. He could clearly understand me but his brain was picking up alternative words for his mouth and his language was impossible to translate. It was clear to me that he’d had a neurological – possibly a TIA. His FAST, apart from speech, was negative but I had no history because he couldn’t tell me anything.

When the crew arrived I asked one of them to use the patient’s mobile to contact someone and get details of who he was and what might be wrong with him but during that process the patient began to make sense. Suddenly he was replying in plain English. This is what happens with TIA’s and it's what took place yesterday at the train station. Recovery is no guarantee of stability and often TIAs are precursors, sooner or later, to full-blown strokes, so he was going to hospital.

When he was able to communicate properly he told us that he’d had a TIA before and this clinched it. He was also hypertensive at over 190 systolic. His ECG was anomalous; left axis deviation, wide QRS complexes, deep q waves, T wave inversions in all chest leads and very tall R waves. These anomalies are seen with early-onset MI, so I wasn’t sure whether we were looking at another problem – he had no chest pain.

He was ‘blued’ in, as is required and by the time he got there he was losing the ability to speak properly again. This deteriorated in Resus and it was clear he was having another TIA. At least he was in the right place at the right time.

Jumping on your bed and smacking your head on the bedstead is not usually a reason for calling an ambulance – unless you are a student and you think your friend is about to die as a result. The 24 year-old girl had nothing more than a scratch on her temple after flinging herself on the bed and missing it entirely. ‘She was going to faint’, said her friend when I explained that the wound was minor. This was me being told just how seriously I should take the 999 call. The likelihood of this injury becoming a major issue when it gets to hospital is slim to nil; thus I will see her sitting in the waiting area later on... probably hours later on. A crew took her away because this was given as Red – ‘not alert after falling’. There you go - that's me told.

In a very posh hotel a French lady vomited in her bed as her friend looked on helplessly. She was suffering the effects of a viral infection I would guess; she had a high temperature (39c) and was tachycardic (pulse rate 129). She wanted to blame food poisoning and it can’t be ruled out but my money (none of which I will actually pary with if proved wrong) is on a virus. The crew came to take her away for confirmation and I chatted at length to one of the Hotel's security people about becoming a paramedic.

And continuing with the theme of fast heart rates, a 24 year-old woman collapsed in the street after feeling dizzy and faint. As she sat on the pavement in the rain, I asked her a few questions and got the bottom of the problem – she had SVT; a heart condition that causes fast and sometimes dangerous arrhythmia. She’d had an operation to destroy the aberrant cells responsible and to help her pacemaker get its act together but now she was experiencing another rapid heart rate episode. Almost as soon as the ambulance arrived, her pulse settled and her heart rate normalised. This is called a paroxysmal SVT and it may just be the result of her adjusting pacemaker or it could mean the operation, called ablation, hasn’t been successful.

An off-duty nurse (allegedly) called 999 to report a drug overdose lying in the street in Soho, so I went to investigate. The caller (the nurse) refused to go near the patient or to stay on scene. This, I think, is suspect. Medical professional have a duty of care and if he/she didn’t want to go and check the patient’s status, he/she shouldn’t have bothered identifying themselves in the first place.

I trundled around in the rain, with blue lights on and apparently nowhere to go, searching for the elusive ‘man on ground’. Rain-sheltering folk and diners were bemused and confused at my 2mph crawl up and down and then again from end to end in a bid to ensure that I didn’t miss anyone. I called the search off after a thorough tour in which even I got bored. I have to assume that the ‘overdose’ had got wet, got up and got himself somewhere dry. Somebody with sense at last.

And finally, as they say... off to a local and well known hostel to sit on the floor and chat with a 35 year-old man who was depressed and so took 12 Codeine tablets (he claimed) with alcohol. He lost his girlfriend to drugs recently and simply doesn’t know how to cope. In a ‘there for the grace of God’ frame of mind, I talked to him at length but he got no BS from me and I didn’t try to patronise him. He was genuinely depressed and so, as soon as the crew arrived, off he went for help. I honestly felt for him.

Be safe.

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