Thursday, 3 June 2010


Day shift: Four calls; all by car.

Stats: 2 RTC’s - both with shoulder injuries; 1 toe injury; 1 ? CVA.

Another sunny day and a warmer one promised today I think. Another day with my student too and I really don’t have to do much because she knows her stuff and is confident and able. We need a couple of tricky jobs to challenge her but the first call is straight-forward. A 37 year-old cyclist slammed into the opening door of a taxi as the passenger attempted to alight. He was thrown off his ride, landing hard on his shoulder. The bone to kerb energy exchange may have broken something but he was stable and willing to go to hospital in the car. It was a ten minute journey by car or a twenty minute wait for an ambulance coming from three miles away. Police were called and stories were recorded but nobody was blaming anyone else; the taxi driver, passenger and patient all agreed it was ‘one of those things’. Wouldn’t it be nice if we operated on that basis more often?

A short convey for a 40 year-old man who cut his toe on the escalator because he was wearing flip-flops (yes, that’s right – an ambulance was called) should have ended in the local walk-in (or in his case, hop-in) centre; instead I got detoured so far away that I took him to A&E instead. There are too many road works going on in too small an area of Central London for safety. We can’t get from A to B quickly any more.

Another cyclist and another shoulder injury when a pedestrian stepped out in front of him, causing him to brake hard and fly over his handlebars. We arrived to find him and the pedestrian chatting amicably. The 37 year-old (are all the cyclists in London the same age today?) was nursing a painful, swollen shoulder and we took him in the car, rather than tie up an ambulance on a busy day like today – I’m sure someone out there, whose mum or dad was having a heart attack at this precise moment, will be grateful for this decision.

A little false alarm led us to a minor shunt between two vehicles that had originally come in as ‘person trapped’ after a car crash. In fact, the poor chap whose car was dinged had arthritis and couldn’t get out of his vehicle, so the panicking public made it a grade A major emergency and had us, an ambulance and quite possibly two or three other vehicles running to rescue him. HEMS had even been put on alert but luckily they didn’t fly the bird - they don't generally turn up for 'arthritic entrapments'.

A very calm looking but obviously scared 50 year-old sat in his office while we checked him out. His vision had become unstable and he walked as if drunk, mostly staggering to the left. He had no headache, no medical history and his obs were normal (although he was initially bradycardic) but his eyes were doing something strange and I struggled to remember the significance of it. Every time his eyes moved across his head, they pulled themselves back to a centre point again as if he couldn’t keep them still – they were like magnetised marbles being pulled one way and then the other. No wonder he felt dizzy and couldn’t see straight.

I knew this could be related to pressure on the optic nerve and therefore possibly the result of a bleed in his brain, so we acted promptly and got him to hospital while he was stable and happy to be taken in the car. Again, we could have waited for an ambulance but there was no need to prolong his experience and he was in the right place within five minutes.

I was going to research this problem and explain it properly in this post but, after long days at work and by the time I typed it out, I found I couldn't be bothered :-)

Be safe.


jkiev1 said...

It's ok after a long days work I think we can all forgive you for not explaining the long and tedious information. You should never feel obligated to explain everything. Though I have to say it does sound interesting and mesmorizing what happened to the mans eyes.

Also for the comment of todays society and blaming everyone else. There is not really anyone to blame for an accident like that just exactly in the wrong place at the wrong time people say. But nice to know there are some civil people around that won't point the finger at every chance they have.

(I think i've been reading too many of your blogs felt obligated to write "be safe" at the end lol)

Aled said...

Hey mate, you've piqued my interest with this one. Was the eye movement similar to a nystagmus - smooth pursuit of the target followed by a saccadic return?


Xf said...


Yes it was but the patient said he didn't suffer from this. His eye problem was new and he was not aware of it; his walk was also abnormal and out of balance.

Aled said...

Was Wallenberg's syndrome what you were thinking?

I have to admit to not being aware of that specific condition before I read up on it, but I'd kinda figured it was some kind of neurological insult. :)


Anonymous said...

My wife has Menieres and suffers regular attacks where she suffers vertigo and walks as though drunk. To help confirm the diagnosis, the consultant performed tests which involved filming my wife's eyeballs after changing the temperature inside her ears. Apparently the way in which her eyes tracked and returned back from tracking, moving objects, helped to reveal the problem as likey Menieres. She is also brachycardic, although I've no idea if that is connected.

becky said...


Im not a medical person but love your blog. The man with the difficulty with blance sounds similar to how I am sometimes. I have menieres disease and find that at times I walk as though Im drunk and my vision is odd and with nystagmus too. menieres causes lots of other problems too this is just one of the thngs that happens to me.

Gordon said...

It doesnt have to be the optic nerve
It could be the 3. or 6. Brain Nerve, maybe a Stroke in the Part of the Brain that supports these Nerves.

Or it is just The symptom of the vertigo, You can put yourself in Nystagmus if you spin yourself on an office chair long enough.

(Sorry for my bad English)


Anonymous said...

I once worked with someone who displayed those symptoms. He'd been getting absent-minded and disinterested in work over some months, then started having minor stumbles. He'd laughed it off as over-work, tiredness and age (he must have been 55-60).

Then he had a bad stumble at work, falling down a flight of stairs a result. I was the first aider and noticed his eyes would smoothly track movement then abruptly jerk back to a centre point. I thought it was something to do with the fall—possibly a head injury—and had an ambulance called.

The man was off work for some weeks, then came in to collect his things when he was retired due to ill-health. When I talked to him, he told me he'd been diagnosed with a degenerative condition—but I can't remember anything other than it being a palsy.

So, not much help I suppose.