Sunday, 21 December 2008
'OK then let's get some shoes on and we'll pop you over to the hospital.'
Her boyfriend came with us and sat holding her hand on the way. I was busy doing more obs and filling in the paper work. The rash had now started to subside although her eyes were still really puffy and her top lip still swollen. I constantly checked to make sure her breathing was OK and that her tongue wasn't swelling. All was well until we pulled into the road leading to the hospital. Her boyfriend grabbed my arm and said that he thought she was struggling to breath. I asked her and sure enough her chest was getting tight and she was complaining of a feeling like there was a lump in her throat. I put her on some O2 and quickly administered 500mcg of adrenaline 1:1000 intramuscularly. I didn't have time to give any Hydrocortisone so I left that to the hospital. By the time we got into the dept her breathing was now easier.
Saturday, 20 December 2008
Sunday, 14 December 2008
Sunday was busy as usual. The moment the shift started , at 06.30, we were straight out on our first job. We had been called to a nursing home about 7 miles away for a Cat A haemorrhage/lacerations call. The only extra info was that the patient had been vomiting blood, also known as hemetemisis. We were met by an oriental nurse who showed us where the patient was. I seem to remember repeatedly asking her 'what's wrong with the patient?' only to be ignored. That really gets my back up. In the room we find a male in his 70's lying on the bed. Another member of staff was in the room tidying up. The patient had vomited up what the staff described as looking like 'coffee grounds'. That is an indicator that the patient could have been suffering from a G.I bleed. I asked if there was a lot of vomit and they said yes but unfortunately the staff had stripped the bed and disposed of the sheets. We could have at least gauged how much blood he had lost. He had a good radial pulse although a little on the rapid side which gave me a quick indication of what his circulatory status was. If an adult has a good palpable radial pulse it tells us that their estimated systolic blood pressure is above 90, therefore an adequate blood supply able to keep the vital organs perfused. We got the patient on to the vehicle and did some more obs. His O2 saturations were a little low and his pulse was around 125 however his blood pressure was an acceptable 128/76. A few minutes into the journey I retook his BP and it had dropped to 77/44. He then started to vomit more of the coffee ground liquid. I quickly swapped his O2 mask for a vomit bowl and cleaned him up. As we were on a straight piece of road I decided to pop in a cannula and run some IV Hartmans to boost his BP and maintain it at around 90. He had 500ml in total. Because I had pre alerted the hospital we were greeted on our arrival and ushered into the resus room.
While I was filling out my paper work an Irish Dr came over to speak to me and asked what had happened.
'I know I shouldn't say this but it was a job to speak to some one who actually spoke English in this nursing home!' I said. 'It was a real struggle to get any history out of them.'
'Don't worry about it, I always believe you should say exactly what you think.' came his reply.
'RIGHT my friend'. boomed the DR to the patient. 'Let's get some blood out of your arm and find out what's going on!'
We also had a lady who slipped on an icy path right next door to the Fire Station we use as a response post. Unusually there wasn't a vehicle there so we responded from about 8 miles away.
She had an obvious fracture/dislocation to her wrist. The fact that it was bent like a dinner fork and unusually rotated 180 degrees in the opposite direction kind of gave it away. She was clearly in agony and was a little pale & dizzy. She pleaded for some pain relief but couldn't get on with the Entonox. I said that the only other pain relief we had was the sort we give through a drip to which she replied 'Please give me something!'
When I said that it was Morphine she said 'Ooh I can't have Morphine it makes me sick!'
'But you're not actually allergic it are you.'
'No but I was ever so sick after I had it last time after I had an operation.'
'Some people can be quite sick anyway after an operation.' I said
'Well I've had lot's of operations and never been sick before.'
'Well I can give you an anti sickness drug before I give the Morphine and if I give it nice and slow (which we do anyway!) that should prevent you from feeling sick.'
She declined but soon changed her mind as the pain was clearly became unbearable. She had 10mg of Metoclopramide and 2 x 2.5mg doses of Morphine which helped considerably.
A call came in for someone who had fallen from a horse and as we were sat at the hospital we were the closest. It was about 5 miles west of the city. We received updates en route which stated that the woman was in her twenties and had fallen from a horse, she had apparent back and chest injuries. We pulled up on the side of the road and were met by a young girl , she said that our patient was about 100 metres along this country path. More like half a bloody mile! It took us ages to get to her and to top it all the path consisted of mud only. My trousers and boots were filthy. On the floor was quite a large woman covered in, yep you guessed it, coats. She still had her safety helmet on and looked uncomfortable. Not surprising really considering it was bloody brass monkeys (freezing), wet and muddy that day. Her horse was tied up to the fence close by and was being calmed by another woman. We quickly assessed the woman on the floor and established that she was short of breath, had significant pain and bruising to her left chest & epigastric region (this is just below where the breast bone ends). She was also complaining of some thoracic back pain (in the middle of the back). She had good air entry but I was reluctant to give her Entonox for pain due to the fact that if she did have a collapsed lung then I would cause it become worse. We put her on some O2 and then out with some more Morphine . Without being rude she was a large girl but only needed 5mg to make her comfortable. We have to be careful when giving Morphine to chest injuries because it can cause respiratory depression which in turn will worsen hypoxia if we are not on top of our game. On the other hand this girl's pain was inhibiting her breathing and by me administering some Morphine eased her pain thus enabling her to take deeper breaths, avoiding hypoxia. However prior to giving her the pain relief I had to get a line into her hand but her previously calm horse started to get a bit skittish. There was a brief moment when the horse 'neighed at 150 decibels' and raised it's front legs. Although not in immediate striking distance it wouldn't of taken much for it to get loose. I very nearly crapped myself!!
My crew mate had done nearly the equivalent of a half marathon getting various bits of kit from the ambulance. For a split second I nearly even felt sorry for him. Naaaa. He gets paid enough, ha ha. From the start it was a chopper job but out of four possible options none were available. Our two HEMS choppers were both on trauma jobs and the Police/Ambulance combo chopper was grounded due to an equipment upgrade, even the neighbouring ambulance service's helicopter was busy on a trauma job. There were no other ambulances available so we ended up getting Fire & Rescue to assist us carrying the girl out to the vehicle. We only needed a few extra bods but two Fire appliances turned up, one from our county and another from the next county. Before they arrived my crew mate went to the road to wait for them and while I was waiting I had a little bet with myself. I bet they come walking up the path with their helmets on. Sure enough through the trees I saw all these yellow helmets. I shook my head. Joking aside they were a great help.
Another proper job.
Saturday, 13 December 2008
'Er we haven't had our second break yet and if we do have to go on stand-by somewhere can it be somewhere with facilities!'
'Roger, sorry about that, I pushed the wrong button, you can RTB (Return to base)'
'Roger, will do'.
So off we went. Stayed on base for a while but copped a job at 18.10. We where on a 18.30 finish with no one else on base. As Dick Dastardly would say 'Drat and Double Drat!!!'
It came through as a sick person and that he had been to the hospital earlier.
'Right let's get him on board and go' said my crew mate.
We were on scene within minutes and went inside. A lady directed us into the living room where a young man in his early thirties was lying on the sofa not looking too clever. On the other side of the room was a baby asleep in a small chair and another child was quietly playing. It transpired that this chap had been to the hospital earlier with chest pain, had x-rays, bloods and an ECG. He was discharged with anti-biotics and pain killers-diagnosed with a chest infection. Well he may have had 'just' a chest infection then but now it was bit more serious. He was pale, breathless, pulse of 140 (which was barely palpable), blood pressure of 100 systolic and had a tympanic temperature of 40.8. I quickly exposed his chest and abdomen to check for any signs of a bacterial rash, although more common in children and adolescents, I didn't want to miss anything. No rash.
Now on the vehicle we repeated his obs. His pulse oximetry read 89% on air and his blood pressure was still low. We did a 12 lead ECG which looked fine but he was still complaining of severe chest pain. We gave him high flow oxygen, cannulated & took bloods, IV Metoclopramide, IV Morphine and in total a litre of IV fluids. Despite the IV fluids his blood pressure and pulse remained the same although he did say that he felt considerably better by the time we delivered him to the hospital.
I handed over to one of the A/E nurses and before we could off load him onto one of their trolleys the DR who had seen him earlier came over. He looked worried, may be he was thinking of what he may have missed. I briefly explained our findings to the DR, bid fairwell to our patient and booked him in at reception.
A late job but I didn't mind as it was a worth while job. I found out later that he was admitted to a medical ward.
Even at a time like this there is shed loads of overtime and I am taking full advantage of it, after all I need the money. Don't we all! Not only is christmas as expensive as ever but I've also got to pay for my wife's New York trip. I don't mind though, she deserves a break. Which reminds me I may be getting some video clips of FDNY because a couple from my local station have just been to the 'Big Apple'. Watch this space.
My timesheet looked odd, it showed mainly annual leave and overtime with only a hand full of rota'd hours. You see I get 277.5 hours annual leave but up until recently had only taken 44! I was politely informed by our scheduling dept to 'Hurry up and book my leave or have it allocated for me'. I've now done this but because we get a fair amount of time off any way I decided to book some overtime shifts.........................on days that I was on annual leave. Loads a money!!
Tuesday, 9 December 2008
Our friend's sister and husband lost their 2 and a half year old little girl under tragic circumstances two weeks ago. Her funeral was yesterday. I couldn't bare loosing any of my children and wouldn't know how to carry on. To think we were all at a birthday party only two days before, celebrating. If only it had happened there, I know I could have made a difference.
God Bless Little One
Monday, 24 November 2008
'She's my sister-in-law and she has taken 60 of these.' as she hands me an empty packet of solpadol.
n.b we were initially informed that the drug was Tramadol although it wasn't
'She is having problems with her husband and I'm really worried about her!'
'OK let's go in and see her shall we.' I say
Inside I'm gobsmacked at the size of it all, beautiful wooden floors and the sweeping stair case and the kitchen, well my wife would have a field day. Inside the open planned kitchen there is a woman lying semi-conscious on the sofa. To cut a long story short she appears to have taken all the solpadol (solpadol is an opiate containing Paracetamol and codeine) and is showing signs of an opiate OD such as pin point pupils, decreased respiration's and reduced conscious level. We treat her with O2 and IV Narcan which does the job and take her to hospital. What we later learned was that at the end of the road and at the exact time of
our job there was a car accident. A local teenager had pulled out of a junction on the busy dual carriage way and had been struck by a van travelling at high speed. She was in cardiac arrest. A couple of crews and the air ambulance attended and despite bi-lateral chest drains and every thing else that goes with a serious trauma job she died.
A sad tragedy had occurred with in a stones throw of where we were. Even if we were there as it happened there would have been nothing that we could have done to save her. It's still horrible to think that someone died right under our noses.
Sunday, 23 November 2008
'Yeah man he's only done 20 quids worth of gear and drank some beers, that's all' said one of his mates.
Out with the BVM and an OPA (oral airway), his pupils were pinpoint (a classic sign of opiate OD) and even in the moonlight he looked pale. As I started to ventilate I asked my crew mate (who is a trainee) to get out the drugs bag and give 800mcg naloxone/narcan via intra-muscular injections, one in each arm. It's funny because only earlier I was talking to him about what skills he has used so far and what did he need to get signed off. Although he had given Glucagen IM in the past he didn't get it signed as this was before the new policy had come into effect. The new policy being that all trainees now need to be signed off (twice) as competent at administering drugs via IM injection, this was his chance.
At this point the police turned up and quickly arrested his mates, why I don't know.
With a good patent airway the next step was to administer the narcan. My crew mate did well and pushed 400 mcg into each arm. I carried on ventilating him for a good few minutes but nothing was happening, he was still not breathing. I opted for a tube and attempted intubation there and then but as I got through the cords he gave a massive cough so I withdrew the tube. I reassessed his airway and breathing but still nothing so I swapped positions with my crew mate so he could practice his BVM technique. Next step was to give more narcan but first I needed to get IV access which can be pretty tricky in IV drug users. Not in this case, the patient had cracking veins so I popped in a 20 g pinky and gave another 800mcg of narcan. Within about 30 seconds he was back in the land of the living. A life saved.
He was no bother on the way to hospital which makes a change! Most of the time when you have ruined a heroin addicts hit/fix they usually moan like hell but not this guy, he was nice as pie and happily came to hospital to be checked over.
It's now 03.30 am and I'm tired. Must try and get some sleep. I'm not holding my breath though!
Friday, 21 November 2008
'Come on we've got a red call!'
Now, I'm not great at waking up at the best of times. The night shift had been pretty quiet and we were lucky enough to have had about 4 hours sleep on base.
I manage to haul myself up and make my way to the vehicle. On the mobile data terminal (MDT) the message reads 'Lights and sirens response, SOB, GP advises patient will need oxygen.' From that I knew that it was a Dr's red call but what I didn't know was whether a DR had actually visited or not. Probably not. We usually get updates of the job en-route but didn't get anything extra.
When we arrive on scene about 5.5 miles away we see that the front door is open so make our way over. Inside there is a lady, about 70, who was really struggling to breath. You didn't need a stethoscope to listen to her chest as the wheezing was so loud. I still had a quick listen so I could detect/rule out a pneumothorax (collapsed lung). Her air entry was equal with a pronounced bilateral expiratory wheeze so straight on with the high flow oxygen while my crew mate was moving the vehicle.
On board I gave her a Salbutamol nebuliser which only provided mild relief so after about 5 mins I gave her another, this time we added Atrovent (Ipratropium Bromide). Her peak flow was only 150 (her normal was around 350 which in itself is pretty poor), O2 saturation's was 90% with a pulse rate initially running at 110 bpm. I decided to cannulate her and administer 200mg of Hydrocortisone. She knew exactly what we were doing as she was an ex nurse and repeatedly kept thanking us for what we were doing even though she wasn't out of the woods yet.
It all started around 2 am when she was woken from her sleep with severe breathing difficulties so she decided to contact the out of hours GP. The GP obviously heard her breathing on the phone and called us.
By the time we reached hospital her O2 saturation's were 98% and her pulse rate had come down to an acceptable 90 bpm although she was still a bit wheezy. We were greeted by a DR and 2 nurses who took my hand over as we transferred the patient to the hospital trolley. As I turned round another nurse came into the cubicle with a tray with 2 vials of hydrocortisone drawn up into syringes and bloods tubes.
'What do you want them for? I've done all that.' I said.
'Have you?' said the nurse.
'Yep, I did say when I gave the pre alert.'
'Oh OK I didn't know. I'll get rid of them them, thanks for that.' she said.
Our patient is now doing much better and after doing an arterial blood gas the DR looks at a loss as to what to do next. He wanders off and starts to write some notes while the nurses get on with repeating some obs. Our patient thanks us and we wearily make our way back to the vehicle hoping to get back to base for a bit more shut eye.
After a week of doing nothing of any significance it was nice to have a proper job just to remind us of why we are here.....................even if it was at 4 am!
Wednesday, 19 November 2008
We were called to a care home for an unconscious female. She was in bed, unresponsive, malnourished, dehydrated and no heavier than 5 stone in a wet raincoat.
'How long has she been like this then?' I said knowing full well that this wasn't something that had suddenly happened.
'Don't know, I've only just started my shift and I don't know much about this lady.' came the reply.
'Really' I thought to my self.
It amazing how many times we get the same old story, no-one knows anything about the patient, they've just come on shift or 'it isn't me that usually looks after her.'
No-one seems to know!
This lady is poorly sick and needs to be in hospital. She is severely dehydrated with barely palpable radial pulses. She is also hypoglycemic (although not diabetic). She needs some fluids and IV glucose. One attempt and that's it. This was before we had the
EZ-IO (http://www.vidacare.com/ez-io/index.html) We're in! A 22g bluey in her hand. 50ml of glucose and a bit of fluid en route. She starts to stir.
Overworked, understaffed, don't know this, don't know that. We've heard it all before. There is no excuse to allow patients to get like this.
Monday, 17 November 2008
I was working on the RRV when I got a call, 'Rollover, 1 female trapped'. Everything was being sent including the air ambulance, basically every man and his dog.
The accident is on an S bend and road is slippery after some light rain. Within minutes I was there. The usual helpful member of the public was there directing traffic, he gets every where that bloke! Before I pulled up I spotted the windmills, these are those people that think that we are blind and have a need to stand at the scene waving frantically. Perhaps they think we have got multiple incidents along the same stretch of road and need to wave us down in case we drive by. Funny old thing the car on it's side gives it away! Never mind.
I grab my kit, analyse the scene for hazards and quickly check to make sure there aren't any other casualties that have been ejected from the vehicle. There are 4 people gathered at the side of the overturned car and one kneeling by the boot.
'There's some one in the car', says someone. 'We didn't want to move her just in case.'
As I lift up the boot hatch I am confronted with a wriggling mass of coats and bags.
'Can I get out now?' a voice says.
'Hold on.' As I crawl inside. 'Are you hurt?'
'Any neck or back pain, did you hit your head, seat belt worn?'
No, no and yes were the replies.
'Well let's get you out then.' I said.
'Yes please' said the woman.
Before I get her out I call up control and ask for just one vehicle to attend and to cancel the air ambulance and fire & rescue. Although standing down fire & rescue in this country is pretty much impossible.
I have to detach the back seat and slide it out and then remove the coats and bags that are now only partially covering the woman. As I guide her out I am deafened by the sirens of the approaching ambulance. As it pulls up the trainee tech driving turns them off, her crew mate gives her a filthy look and shakes his head. I thought she parked it on my head they were that load! Never mind she'll learn.
The woman is now out and is unharmed so we put her on board the ambulance to have a proper look at her. The crew move the vehicle down the road so it is out of the way. While I'm talking to the Police two fire appliances turn up.
'She's out mate.' I say to the watch commander.
He turns to his colleague from the other fire truck and waves him goodbye. He walks off looking disappointed.
'Right, we'll make the car safe then.' he says.
The woman is being checked over in the ambulance so I pop over to see if the crew need anything. The woman is fine and doesn't need to go to hospital. I then make myself available for calls.
I got another call to the same spot on Thursday this week for a car on it's side, again non-injury. We have been to a lot RTAs on this stretch of road with most incidents thankfully being only minor injuries. Although 4 lads in one car were killed not that long ago at the same spot.
Saturday, 15 November 2008
Some more pics from my trip to Richmond. The FD dropped in and told us about their role in prehospital care with RAA. One thing I found amazing is this; Like us in the UK, RAA have a response standard, theirs is 8 mins 59 seconds. But the only thing that stops the clock in Richmond is an ALS ambulance, that's a vehicle with at least one crew member who is a Paramedic. If a fire truck or a RAA field supervisor or BLS ambulance turns up first with in this time it doesn't count. Irrespective if they save a life it still doesn't count. Another thing I found astounding is that Richmond's population size is very similar to that of Southampton in the UK but in Richmond they have 20 fire stations and that RAA put out on average 16-18 ambulance crews daily and about 8 crews at night. This doesn't include the rescue volunteer squads dotted about the city. I know for a fact that there aren't that many fire stations in Southampton and that South Central Ambulance probably don't put out that many ambulance crews during the day.
Richmond FD have a few nationally registered paramedics as firefighters and the FD work closely with RAA.
Thursday, 13 November 2008
Wednesday, 12 November 2008
Once we managed to prize her hands from the steering wheel we checked her over, she was fine. She managed to take out a brand new wooden fence. So new in fact the council workers were just packing away their tools. Didn't they laugh.......................not! Oh well at least I know my £1500 annual council tax money is being put to good use.
Non-injury, sign here!
" There has been a number of incidents nationally involving housing association properties where tenants who are suspected users or suppliers of drugs are secreting DIRTY NEEDLES with in the bottom corner of light switches.
The needle is placed in between the rocker switch and the front plate, meaning that any person attempting to turn the lights on is likely to get a needle stick injury to the finger."
Unbelievable. So to my fellow emergency workers across the land, BEWARE!
After the 'Big Ben' style door bell stopped ringing the door opened and we were face to face with an overweight male in his fifties. 'Quick come this way' he said as he ushered us in. 'Are you all right?' I said to him, he was ever so wheezy and sounded like he was having an asthma attack, In fact I nearly gave him a nebuliser there and then on the spot. 'No I'm fine, it's my wife. Come up here, quickly please.' he replied.
It seemed to take ages to climb the enormous sweeping staircase. The patient was sat on the edge of her bed and was crying. As she looked up we could see the frustration in her eyes. It wasn't the fact that she couldn't speak it was more that what ever she said made no sense. We managed to find out that she suffered from high blood pressure and was taking tablets for it. After doing her temperature and sugar level we moved on to her BP which was 146/78, nothing remarkable there then. As she was symptomatic we popped her on some oxygen.
She still needed to go to A/E and within a few minutes we were on our way. Her husband, whose wheeze had now calmed down, came with us. The patient had been on O2 for around 5 minutes when her speech started to become clearer, it was no longer garbled. A few more minutes and it was getting better, by the time we were at A/E it was back to normal. As we unloaded her on the trolley her husband was leaping around shouting 'Hallelujah, she's cured! You boys are wonderful, you've cured her!' and he was repeating this up and down the corridor. I kept expecting James Brown to pop up and shout 'Can I get a Witness, amen'. With what we were presented with we queried a TIA (transient ischaemic attack, a sort of angina of the brain), did some obs and gave O2. That was it! But the husband thought we were miracle workers. A little while later the grateful husband came up to us and asked if we thought it was definitely a TIA but all we could say was that he should let the Drs run their tests to confirm it. He was more interested in our opinions than those of the Drs.
He was over the moon that his wife was doing well.
A TIA is sometimes called a 'mini stroke' and it is where there is a brief interruption in the blood supply or temporary blockage of a blood vessel in the brain. Patients usually recover within 24 hours but if patients have lots of these it is just a matter of time before they have a full on stroke. Patients with high blood pressure and/or an irregular heart rate (known as AF or atrial fibrillation) are particularly susceptible.
Sunday, 9 November 2008
Thursday, 30 October 2008
The last week hasn't been exactly busy or exciting but at least I have attended a small amount of needy patients. There has been the usual mix of drunk and overdose patients with a sprinkling of regular fallers for good measure.
After attending a couple of patients suffering from MI's (heart attacks) I have become a little fed up, I mean they didn't even have the decency to have an MI that I could Thrombolyse! I don't know, some people eh.
One of the better jobs I went to was a guy in his 30's who thought it might be a good idea to start weight training again...............................at home. The job came in as a GP admission (urgent journey) stating that the patient had back pain. His initially sympathetic partner briefed us about what had happened and showed us the GP's letter. I say initially sympathetic because soon after we arrived and started giving him Entonox she thought he was a bit of a light weight and was playing on his pain. She then started comparing his back pain to 'man flu'. By this point we were all laughing, even the patient. However he was clearly in genuine agony. The GP had queried a prolapsed disc and had refered the patient to the orthopaedic surgeons. His partner said that she had started exercising recently and had joined the local gym, he on the other hand opted for a bit of DIY weight training and put his back out soon after starting. Two Drs had visited over the course of the evening and had given the patient a whole array of pain killers including Diazepam, Paracetamol, Ibuprofen, codeine and even a 100 mg Tramadol injection. In fact the patient was convinced that the Dr must have injected him with water as it had absolutely no effect. He was also surprised that the Dr didn't have any Entonox.
It was time to move him on to the carry chair and get him down stairs. The Entonox was doing the trick up to this point but when he moved, the air turned blue. After a back breaking carry down the stairs we got him on to the vehicle. Back on the Entonox but this time it wasn't as effective so I asked if he wanted anything stronger, I already knew what the reply was going to be. I started with 5mg of Morphine which just started to take the edge off but gave him another 5mg which made him a lot more comfortable. The last thing he needed was to be bounced about in agony on the way into hospital. I think his partner was especially impressed when we, including the patient, said to her that women simply don't understand what us men have to go through. She rolled her eyes and laughed. Good job, nice couple.
Tuesday, 21 October 2008
9 calls today:
1. PR (rectal) bleed, elderly male who happened to be a DR. Lost a considerable amount of blood and was still loosing some. He ended up being infused with blood. Poorly patient. It's not every day you can say you've cannulated a DR!
2. On the way to a standby post we got a Dr's urgent admission into a local community hospital but when we arrived the patient wasn't ready. We passed the call back to control and were told to carry on to the original standby post. Bahh
3. After watching Bondi Rescue on SKY we were given a 999 from the psych unit to the A/E.
4. Before we got on scene we overheard a call for a cardiac arrest so we were passed that call. There was a Technician responder on scene who stood us down as the patient was deceased.
5. Another cardiac arrest call but this was just to lend our ECG monitor to another crew as their machine wouldn't print out a trace. They went and got a spare machine afterwards.
6. Homeless guy with apparent chest pain, more like intoxicated but due to a couple of other contributing factors he needed to go to A/E.
7. Fall in the street, female who was on Warfarin (blood thinning meds) was rushing around town trying to sort out her last minute holiday details when she tripped hitting her head. Patients on Warfarin who hit their head, whether they cut it or not, need to go to hospital due to the internal bleeding risks.
8. Chest pain, young girl at work who became unwell with chest pains but we put it down to one of three things, gastric as bringing her knees to her chest eased the discomfort, possible chest infection brewing as her temp was slightly elevated or anxiety. It was a sharp pain and was causing her a lot of discomfort, enough to make her cry.
9. The Icing on the cake! Transfer up to the big smoke 'London'. A trauma patient needing pelvic surgery and we were the only available vehicle. We had 2 1/2 hours to go and knew we would be late. He was on a morphine PCA pump but had to have it disconnected for some reason. He was ok for pain relief on the journey and didn't need any morphine from me which was surprising. I only finished 3 hours after my shift ended but at least I get paid for 21 3/4 hours! Every cloud and all that. One good thing though, my dinner was in the oven when I got in and it tasted bloody great.
Friday, 17 October 2008
Update on my last 2 night shifts.
Wednesday: 5 patients.
1. Passed as a stroke but was a diabetic having a hypo. We weren't needed as their was a RRV Technician on scene who had given a Glucagen injection. We hung around for a little while just in case the patient needed some IV glucose. She didn't so off we went.
2. Fall, assistance call only.
3. Unconscious, female in a care home. Very pale and blue around the mouth. Her blood pressure was also low and she had a history of chest infections and heart failure
4. Psych/suicide, female who was intoxicated and decided that it might be fun to slash her arm and belly with razor blades. We cleaned her up but she declined hospital. She went off with friends who were going to look after her and take her to the DRs in the morning. They weren't best pleased that she wasn't going to hospital. What can you do? If someone is alert and orientated they have the right to refuse.
5. Chest pain, male in his 30's who had an episode of chest pain. After wasting over 20 minutes deciding whether or niot he wanted to come with us he declined, opting for a lift with a mate. All he was worried about was how he was going to get back from the hospital! I doubt he was having a heart attack, his ECG looked fine and he was too well looking. Anyway he had similar episodes in the past with nothing found and was due a scan.
Thursday: 6 patients.
1. GP admission, suicidal male and at risk of self harm. This was a paranoid schizophrenic that I later learned had a history of violence and assaulting staff! This information wasn't relayed to us with me finding it out by reading the GP letter & notes. I was pissed off to say the least. To top it all the GP failed to refer the patient to the right dept which kept us hanging around at the hospital for ages. The patient was as good as gold and asked me not speak to him on the way in. Fine by me!
2. Fall, elderly female who fell in the morning and now had severe right sided back pain. TLC and a little diesel to get to the hospital.
3. Abdo pain, female with severe abdo pains, occasional chest pain, sob and looking pretty poorly. It all started of with vomiting earlier that evening. Her ECG was horrendous and she was in lots of pain. I managed to get a little bluey into the back of her hand and sort out her pain with some GTN & Morphine. She refused to take any Aspirin. After being seen in resus we moved her down to the coronary care unit where I gave her the rest of the Morphine as her pain started to return. This saved the staff a job as I already had it with me and they didn't need to go to the drugs cupboard and draw it all up. My suspicions of a heart attack were right. Her ECG showed Left bundle branch block (LBBB) and as she had no apparent cardiac history I assumed that this was a new cardiac event. The problem with LBBB is that it basically blocks the view of the left side of the heart making it a bit more tricky to diagnose a heart attack. A proper job!
4. Fall, regular dementia patient with very minor abrasions, the staff admittedly panicked on this one. We left him there.
5. Fall, intoxicated female who fell with someone landing on her arm. This was an obvious dislocated elbow. I screwed my face up like a bull dog chewing a wasp and said to my self 'Shit, that's gotta hurt.' I gave her 10mg of Morphine with gas & air which completely knocked her out for the journey. We have to be extremely careful when administering Morphine to patients that are under the influence of alcohol as they can both depress the central nervous system and lead to a patient who is no longer breathing. We had no problems as I gave it nice and slowly. At A/E resus the DR gave another 10mg of Morphine, I thought I was brave giving 10mg to begin with but she clearly needed it. The nurse said wait till she has some Midazolam then and we'll put it back in. Another proper job.
6. Unconscious, young male who work up suddenly, fell out of bed and bumped his head. He was all panicky that he had a brain abscess, something which he had a few years back. I wasn't convinced with this job but I guess you had to be there. He decided to see his own GP when they opened.
Wednesday, 15 October 2008
What a contrast from Monday, only 3 patients! Having said that we had 4 RRVs and an ECP running around taking some of the heat off of us. And only an hour of standby, great!
1. Fits, male with a history of epilepsy who had suffered a small seizure whilst out shopping in town. He was on floor and conscious but a bit dazed. All he wanted to do was go home and sleep it off so after checking him over we took him home, which was only about 500 yards away. We then contacted his GP surgery with a view to them reviewing why he was having more and more seizures.
2. GP 999, male with post operative hernia problems had visited the GP who decided he needed to go to A/E. There was a technician on a RRV on scene who after giving us a handover said that he would of taken the patient to A/E but the Dr thought it would be more comfortable for the patient to lie down. The hospital was half a mile away and it took my crew mate longer to fill out the clinical report form than it did to drive to the hospital and off load the patient!
3. SOB, female with Emphysema who had been seen by a GP an hour earlier at home. As we looked at the GP's note it said in the top left corner 'Advised to dial 999 if gets any worse'. I asked if her breathing was this bad when the Dr was there to which the husband replied 'Oh yes.'
I couldn't believe it so I told them that next time it gets this bad just to call us straight away. The lady was really struggling so we needed to move fast. My crew mate gave her a salbutamol and atrovent nebuliser while I was securing an IV line, the last patient I went to like this ended up having seizures and going into respiratory arrest. I didn't want to take any chances. On the way in to hospital her condition improved with the treatment so we took her down to the medical assessment ward but within a few minutes her breathing started to become worse again. 'Over to you then' I said to the staff. The lady still managed to thank us for what we did and then blow us a kiss and wave us goodbye.
Oh well another couple of night shifts to contend with next. I'm not the biggest fan of night shifts as I personally think that the quality of work isn't the same as during the day. Some may contest that fact but all I can do is go on personal experience.
Tuesday, 14 October 2008
1. Fall, female who had fallen down the stairs of a double decker bus as it was pulling away. She was conscious and alert with an obvious head injury that had been bleeding briskly. The usual c-spine precautions were taken. When at A/E her head started to bleed again quite heavily and she ended up in Resus.
2. Dr's 999, male in his 40's at a GP surgery. One of our RRVs was on scene first and when we arrived the patient was on O2, had a line in with some fluids running. The Dr queried an upper respiratory tract infection (URTi) and had administered 1200mg of Benzylpenicillin. I couldn't work out whether the GP had used the RRV guy's drugs or his own as the RRV's drug bag was in the treatment room. The patient was in a bad way with a pulse rate of 140 and a temperature of 39.0, he was septic and also in a lot of pain. The DR said asked if we could give him some morphine and another litre of fluid on the way in which is what we did. We have to be particularly mindful of the airway in these types of patients, even the Dr suggested we may have to nebulise him with Adrenaline if he deteriorates. The patient was so poorly he ended up in Resus and then eventually he was intubated and taken to intensive care.
3. Fall, female in a care home. Was is it a simple trip or was it a collapse? No one knew. She had a couple of lacerations to her wrists and a nasty one to her lower leg with her ankle also being considerably swollen. Monitored, wounds dressed and a bit of TLC en route to hospital. She was discharged a couple of hours later.
4. GP Urgent journey, male with a history of recent bladder operation had suffered post op complications. The Dr had seen him at home and deemed it nessecary for him to be admitted.
5. Abdo pain, female college student with what initially sounded like appendicitis. We were only 2 minutes from the hospital so one rounds of base line obs and some gas & air for pain relief.
6. Cat A convulsions, female well known to us standing in her doorway who said she couldn't cope! Inside she had an 8 month old baby which I spent nearly an hour playing with, having a young one myself I was in my element while my crew mate was busy on the phone arranging social services and getting things sorted. She stayed at home and when her mum turned up she gave her daughter a right roasting because she didn't call her first. I would like to know where the Cat A came from seeing as it was the patient who made the call!
7. RTC car into a hedge, a middle aged man was shunted from behind at high speed and ended up being pushed up an embankment into a field which was 8 feet higher than the road. The other driver tried to do a runner but was caught by police. He had been drink driving and had no insurance or MOT, his excuse was that he had an argumant with his girlfriend and was going round to see her as she said she was going to kill herself. Our patient declined transport, against our advice, despite having neck discomfort. 'I feel fine lads, if I'm not good in the morning I'll pop up to A/E myself.'
Bread and butter stuff really, overall not a bad days work.
Saturday, 11 October 2008
Wednesday: 7 patients attended.
1. Unconscious, female in a care home who had been deteriorating over the last few days. Although she was unco she was maintaining her own airway but had very low blood pressure. High flow oxygen, IV fluids and a pre alert call to the hospital.
2. Unwell, male with lots of medical history who had been vomiting blood and passing bloody stools. All obs fine and relatively well looking. Transported to hospital for further tests.
3. Hemorrhage/lacerations, 15 year old female with a cut to her hand. After spending all of 2 minutes on scene dressing her hand and convincing her that she wouldn't loose it we took her to the local Minor injuries unit.
4. Neck pain, 8 year old on holiday who was on a water ride and was shunted by a boat. His pain had just about disappeared by the time we got there. He was more upset than anything. Mum and dad happy to look after him.
5. Deceased, male not seen for two weeks with flies at the windows. Police already on scene and broke in when we arrived. RIP.
6. Fall in the street, elderly female who had slipped on the kerb sustaining a nasty gash to her eye. TLC and taken to hospital for proper wound care.
7. Diabetic , male having a hypo at home. His wife had tried to give him lucozade and milk with sugar but he was getting worse. After popping a 18g IV in the back of his hand and giving him 100ml of Glucose 10% he was right as rain. Although when he came round he looked at our name badges twice and rubbed his eyes 'Oh I haven't had one of them bloody hypos again, have I?'. 'Yes you have!' said his wife, 'He's gets all silly when he goes low and there's nothing I can do!' she added. Nice couple and a nice job to round the day off with.
Thursday: 5 patients attended.
1. Fall, non-injury. Assistance and advice only. Not transported.
2. Chest pain, 999 call from a local DR's surgery. Female who had suffered chest pain for the last couple of days. Already on O2 and had Aspirin and GTN before we arrived. There was nothing on the 12 lead ECG and as she still had some tightness we gave her some more GTN. We took her straight to the medical assessment ward.
3. Headache, male with frontal headache which came on gradually, assessed at home with advice given. His wife had given him 2 paracetamol about an hour earlier which had kicked in while we were there. His wife said she panicked and wasn't sure if he was also suffering from one of his 'panic attacks'. Nice couple and very grateful as well as apologetic.
4. Chest pain, another female who had been having chest pain for several days! Two community responders were on scene when we arrived. We gave her O2, Aspirin and GTN which seemed to help slightly. She said to me that they have terrible trouble with her veins at the hospital. 'Right then, that's a challenge.' I said. I couldn't see any veins or really feel any but I managed to get an 18g in her right ACF and draw off 4 tubes of blood. I was pretty impressed even if I do say so myself. Careful, I may not get through the door if my head gets any bigger. Ha Ha. Knowing me I'll mess up an otherwise easy one next time.
5. Passed as a fall but turned into some thing a bit more interesting. We managed to find the location which was an alley way, after stopping at the wrong one up the road, DOH! Male in his 50's, he was a council worker who had fallen into bushes and thought he had been stung by nettles until he reached down and felt a metal spike sticking out of his leg. When we arrived he was in great pain but in good spirits. His work mates thought it was highly amusing, he was their boss. After putting a built up dressing around the spike to stop it from moving we got him onto the trolley and then onto the vehicle. He drained a bottle of Entonox (gas & air) and received 5mg of IV morphine. When we wheeled him into the A/E dept he became the centre of attention for the afternoon/early evening.
Friday: 5 patients attended.
1. Breathing problems, regular male caller. COPD (chronic obstructive pulmonary disease, such as Bronchitis or Emphysema) who was using his own nebuliser when we arrived. We gave him some salbutamol and atrovent using our nebuliser mask and O2, his mask was pretty naff so we left him one of ours. His breathing had eased after our treatment and he refused to go to hospital so we called his DR's surgery to arrange for a home visit.
2. Fall, male with Parkinson's who had sustained a head injury some time during the night but couldn't remember it. He made a good job of demolishing his sink unit when he fell. Collapse query cause, he had to go in. There was a Community responder on scene before us who had gathered all the patients meds and history for us.
3. Fall, female on a bus who had twisted her hip when the bus started to pull away without warning. She had an obvious NOF (neck of femur fracture/hip fracture). Her leg was shorter and was externally rotated, no need for an X-Ray it was that obvious. She was really calm and kept repeating her self stating that she was so angry with herself. She declined any analgesia.
4. DR's urgent admission, we were sent to another station 30 miles away for a bit of stand-by when we got this urgent job. When we arrived at the address my crew mate opened his door and before he could step out of the truck a male in his late 70's came out of the house with a holdall, strolled over to the truck and asked 'Where do I sit?' TAXI! I thought to my self. We had to take this patient to a hospital that neither of us had ever been to before and after being passed from pillar to post by various staff we finally got him to where he was supposed to be. Just a 40 odd mile drive back to base. Fortunately we didn't get any calls on the way back.
5. DR's 999 from a local surgery. Two Emergency care Practitioners were there and handed the patient over to me. Male in his 70's who was sweating profusely and had a high temperature. All his obs were fine and after an uneventful journey he ended up in A/E.
Weekend off but back in Monday to Thursday for a mixture of day and night shifts.
Thursday, 9 October 2008
The next lad, who had only passed his test six weeks ago, was only a teenager and after being questioned by the police officer on scene it was discovered he had been drinking needless to say he failed his road side breath test. Why do they do it? This car was actually slightly worse than the first and it was only due to the car being modern and with lots of airbags etc that he survived. I don't think he'll be driving again for quite a while
The third accident was to a car that had gone side on into a wall, the patient was also a teenager. This was a lot more serious. Fire & Rescue were on scene along with police and another Paramedic crew. No time for the roof to come off, this was a rapid ex job. Rapid ex is a way of extricating someone from a vehicle who has life threatening injuries but using very basic c-spine care. He was on O2, had an oral airway in situ and a c-collar on. With the help of the firefighters we got him out onto a long board and then started assisting his breathing with a BVM while quickly wheeling him to the truck. On board he was hooked up to the monitors, while the other Paramedic was ventilating him, I got a 16g IV in his right arm and started fluids. We had a Basics Dr attending as well who is an anesthetist at the local hospital and as he arrived I put in a 14g IV into the patients chest to decompress it. After explaining what we had he said 'Right, let's RSI him and then I'll do bilateral thoracostomies.' 'OK Doc.' we said and that's what happened. We weren't on scene long and raced this young lad to hospital. Sadly he lost his battle to survive a few hours later in the operating theatre.
Some times people who are badly injured are so far down the dying line that no matter what you do it's just not enough.
Tuesday, 7 October 2008
Sunday, 5 October 2008
Another spooky story from a few years ago, probably a coincidence though. It was a couple of months after moving into our brand new house and the new turf had just settled. I was playing football with the kids in the garden when I tripped on a piece of metal wire sticking out of the ground which I hadn't noticed before. I had cut the lawn earlier and hadn't gone over it with the mower so I was a bit puzzled as to where it had come from anyway After several attempts I managed to pull it out and bin it. I thought nothing of it, like you do. After a good run around with the kids I had to get ready for my night shift. Now here's the spooky bit; the first call of the shift was to a fall with very few details apart from we were backing up another crew. When we arrived there was another crew from the neighbouring county and fire & rescue. It soon became apparent that the patient, a lady in her 30's, had fallen on the pavement and landed on the verge but in the verge was a steel reinforcing rod sticking out of the ground and she had landed on it. In fact it had impaled her underneath her chin and penetrated all the way through her mouth and up into the roof of her mouth. She was still conscious but obviously unable to talk. A couple of lines were inserted, one in her foot! and the other in her hand. This was for fluids and pain relief before the fire fighters cut her free. It was going to be a delicate operation because one false move would of proved disaterous. A few minutes later a Basics Dr turned up to assist and asked if we had given any pain relief yet. The answer was no, it was about to be drawn up but because it was back in the days before we had morphine (we were using Nalbuphine at the time, which is not as good as morphine) and the Dr turned up, we thought he would give something better. One of the Paramedics said 'Are you gonna give Diamorph Dr? of which he replied 'You've got Nalbuphine haven't you?', 'Yeah' replied the Paramedic. 'Well give that then!' 'Err Ok' said a surprised looking Paramedic. So that's what happened, she was given 20mg of Nalbuphine. A short while later the Dr decided to give the patient some Ketamine as well. Once she was cut free she was put on a long board and rapidly taken to hospital. I checked on the tv and heard how the fire fighters had to cut her free, nothing about what we did. Oh well hey ho, the fact that she made a full recovery is all that matters. After all my waffling on, the 'spooky' part was a) me tripping over a piece of metal wire at home and b) the lady falling onto a metal rod. Both on the same day! Maybe it was an omen, I don't know. I don't usually believe in all that premonition stuff, it must have been a coincedence.
Saturday, 4 October 2008
Friday, 3 October 2008
We are called to a hemorrhage/lacerations call near to our station and on our arrival there are two young children waiting on the steps out side the house. As I grabbed the response bag they both came over, sobbing, 'please do something my mummy is bleeding out of her mouth, please, please.' On entering the house we were met by a male in his late forties, whilst ushering us upstairs he explained that his wife was having a shower when he heard a loud thud and when he went up to see what all the noise was he found her on the bed bleeding from her mouth and unresponsive. Now in the bedroom we were confronted with a semi naked female who was face down on the bed, patches of blood on the bed were also visible. I quickly rolled her on to her side and could see she was having some form of seizure. I wanted to put in a nasal airway but she started to flail her arms about so I opted for some O2 instead. Her husband was asking if she was going to be OK but I just had to tell him that I honestly didn't know and that he should go and make sure the two girls were OK. My crew mate went down to get the drugs bag and the carry chair with the husband in tow. This patient had no previous history and was normally fit and well so what was the problem? Was she having a first fit or was she having a cerebral bleed? Whatever it was we needed to stop this fit. As I put in a 20g IV and secured it down my crew mate was entering the room so I got him to draw me up a saline flush and 10mg of diazemuls. After 5mg she stopped fitting and we were now able to get her on the carry chair, down stairs and on to the truck. As her breathing pattern was unpredictable I got out a BVM and assisted her breathing as and when she needed it, my crew mate was attaching all the monitoring equipment. One last thing, the patent's personal details, the husband had gone to write them down. As soon as he returned we were off to the hospital 7 miles away. He and his girls followed on in their car. I did tell him not to try and keep up as we would be going in on blue lights, something that some relatives fail to do! On the way in the patient started to respond and was following simple commands which was encouraging. She even managed to tell me that prior to her collapse she had a bad headache and heard ringing in her ears. Perhaps I was making a fuss over nothing, perhaps this was a first fit and she would go on to be diagnosed with epilepsy where she would receive medication to control her fits, I hope so. On arrival we were greeted by the A/E Doc and a couple of nurses, when I explained to the Doc what had happened he just gave me a wink and said cheers. The husband turned up some time later minus the girls, he had dropped them off with friends and rightly so, no children should ever have to see their loved ones like that if they can help it. I showed him to the relatives room and went back to clean up the truck.
About an hour later we arrived back at the hospital with another patient, some one who most definitely didn't deserve an ambulance trip to hospital I might add! The Doc spotted me and came over, 'Massive sub arachnoid bleed' he said. 'Bloody hell, what's the prognosis?' I replied. 'It's hard to say, she's going to be transferred to the neuro unit soon.' 'Right, thanks for that.' I said, thinking about those poor girls. You can read about SAH here http://www.nlm.nih.gov/medlineplus/ency/article/000701.htm.
Later we were to return and transfer her over to the neuro unit 30 miles away. She had received 4mg of morphine but was still in a lot of pain, I wanted to give her a bit more but the consultant anesthetist preferred that I didn't as it wouldn't completely remove all of the pain. Fair enough. She needed to be where the bright lights and shiny steel was, the operating theatre. A heavy right foot would probably be more useful than another couple of mg of morphine. She was a bit more responsive this time round but not fully with it just saying it hurts, it hurts. We arrived there in one piece and got her up to the neuro ITU ready for surgery.
I've seen the husband out and about but still don't know how the op went or if she even made it. I hope so
Thursday, 2 October 2008
Just a random picture I found. I'm doing a bit of CBRN training. There was point when I thought I was going to die. The battery in the internal fan ran out and I wasn't getting any air to my suit. I quickly started to feel faint and frantically tried to get the suit off but couldn't as my gloves were taped to the arms with duck tape. Everyone thought that I was larking about until I fell to the ground. When some one eventually spotted that I was in trouble I was able to get the hood off. Wow, what a rush of air. The tunnel vision soon went away and I was back to normal. That was scary!