Saturday, 16 August 2008

1st of 4

Well I've just done my first shift of 4 after several days off. Not a particularly busy shift. Only 5 jobs and 3 lots of standby ( sat at response posts awaiting the next job).

1. Chest pain, male 60's with history of lymphoma. 5 mins of sharp chest pain resolved on our arrival. He has a hickman line in situ (this for withdrawl of blood samples and administration of chemotherapy). We do the usual 12 lead ECG & other monitoring which is unremarkable. No other symptoms and as advised by the oncology dept he is taken in to hospital for re-assessment and observation. I feel sorry for this guy, not only is he in the throws of cancer, his house was flooded and he is in temporary acommodation. His wife also had a stroke earlier in the year but fortunately has made a full recovery.
2. 2 year old fitting. RRV (Rapid response vehicle-lone responder) Technician is already on scene. The child has had oxygen and has come round from the fit. The child is an Epileptic and mum has already given rectal diazepam to terminate the fit. No need for us to intervene. After a discussion with the mum she is happy to look after her daughter as she has come round quicker than normal. The RRV Tech is left at scene to do the paperwork.
3. Elderly lady walking on some pebbles has slipped and caught her shin. Her daughter is worried as it has bled? Would have helped if she took the stocking off to have a look. Tiny wound the size of a 1 pence piece if that. Advise given. She didn't want or even need to attend the hospital.
4. Diabetic problems. Elderly lady with dementia in a care home. Had been up & about earlier but had a high blood sugar reading (hyperglycaemia), it was 30 mmol/l (the norm being between around 5 - 8, depending on what book you read.) When we arrive we see the Out of Hours DRs car at the end of the road, I know where they're going! When we told the carer she said that she called the DR hours ago but because the lady had deteriorated, she called for us. Good job too, the lady was unconscious with no radial pulses. High flow O2 and I put my tourniquet on early. At this point the DR turned up and stood in the door way. I basically told him what we were going to do, I simply said ' She's hyperglycaemic, unconscious with no radial pulses, she's going in (to hospital). She's already on O2 as you can see, I'll pop a line in, take some bloods and set up some saline.' 'Looks like you've got it all under control, I'll leave it with you.' He stayed 5 minutes to complete his notes and left. When we got her onto the vehicle her BP was 72/46, pulse 115 and still barely responsive. Because I put the tourniquet on early she had a great vein in the crook of her elbow (ACF) that was visible. I managed to get a 16g (grey) cannula but was unnable to get any blood as her BP was so low. She had a total of 600ml of fluid on the way in, her BP came up to 114/75. The DR in resus seemed impressed that I got a grey in, he was strugling like hell to get a line in on the other side. We all had a chuckle about it. We're fortunate to have a really good relationship with the A/E staff. Nether the less he got his line. I'll check up on her tomorrow, oops that'll be today then.
5. Breathing difficulties. Male in his 70's, only medical history was high blood pressure. Been short of breath (SOB) for 2 weeks! Seen by his GP several times and prescribed 2 lots of different antibiotics, obviousley not working then. His oxygen saturations were 91% on room air. Oxygen on and his sats were up to 98%. He was mildly pyrexic aswell (high temperature). We took him in and that rounded us up nicely. Finished on time for a change and ready to do it all again.
Apart from the diabetic lady, a pretty slow & routine day, not what I'm used to, I usually attract every one elses share of decent jobs.

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