Wednesday, 20 August 2008

Nearly there

Well no more jobs on the 17th, fortunately there were 2 crews in before us and we were safe until the 3 night crews took over. However they both got jobs and we left for 45 mins waiting to see if we got a job that would make us late, it never came. Finished on time. Yippee.

Started my night on Monday only to find out my crew mate went sick so I ended up working on a RRV. It didn't bother me as I enjoy the odd shift on the car. Did 6 jobs in all with a couple of stints of standby. Did a SOB call to a guy with Emphysema (Chronic obstructive airways disease/COPD), he recieved some nebulised salbutamol and ipratropium bromide which did the trick, 2 non--injury falls, a chest pain, 10 year old abdo pain and a 28 year old female with abdo pain, turned out she had just been diagnosed with an ovarian cyst and had recently been discharged from hospital. She still had a niggling pain since her discharge and had developed severe pain. She was sweaty, pale and in excrutiating pain. After 10mg IV of maxalon and 5mg of morphine she was a lot more comfortable. When I looked at her hand for vein to cannulate she said that she didn't have very good viens and that the hospital took a while to get one. That was a challenge in my eyes if ever there was one. The first vein I saw was a small straight one on the back of her hand. I opted for the smallest cannula, a blue 22g, and got it in straight away. Job done!

I'm now well into my final shift of 4, pretty quiet, a bit of standby early on and during that a bit of education with crew mate who is a trainee Technician. Going through all the drugs and kit in the back of the truck. Only one job so far and that was to a lady who fell off the last fews steps of a ladder whilst going into her cellar. She had fractured her forearm and had done a proper job of it. A complete break midway between her elbow and wrist. When we examined her it was floppy and looked like she had another elbow. Both bones, the radius and ulnar, were broken completely in two. You could feel the crepitus (bone ends grated). She had a couple of glasses of scotch prior to our arrival to help numb the pain. The important thing to assess in an injury like that is to evaluate whether there is any nervous or vascular compramise such as loss of feeling, pulse and capillary refill and temperature of the limb. She hadn't lost any feeling but there was a very faint radial pulse and she had an extended cap refill time, her fingers were going cold as well. With that we applied some gentle traction and immobilised her arm in a vacuum splint, that restored some circulation. Watch and rings removed from her left hand as well in case of swelling. Now she said it was getting more painful but had to contact neighbours about looking after her dog, she also wanted to contact her daughters, both were DRs. This was wasting time and she needed to be in hospital. I don't think she realised the severity of the break even though I pointed out to her that she might need an operation in the morning. I was imagining her arm having to be amputated if we didn't hurry up. After a neighbour arrived we managed to get her on to the ambulance, get an IV and did some observations. Her BP was low which apparently was normal for her, her other observations were fine. The pain was now getting worse so I asked her if she'd like some pain relief, she said no and that she would only have some when the pain got unbearable. All I could think of was the crepitus, that makes me shudder just thinking about it.

Just got back from taking a gent in with a possible stroke (CVA). Also checked up on our lady from earlier with the fractured arm, yes it was a bad break and yes she will be having an operation on it tomorrow.

Oh well better have some kip, day off tomorrow and only 2 and a half hours of this shift to go.

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