Thursday, 14 August 2008

Trainee cont'd

About an hour to go until the end of the shift and we're sitting on standby not far from our station. The radio pipes up, 'we've got a category C fall for you', this should see us out nicely til the end of the shift. The location wasn't far away and we were soon on scene. It took ages for someone to open the door. It was eventually answered by a man in his early fifties who seemed anxious and said his mother had fallen in the bathroom. He'd been out most of the day and came back to find his mother on the floor. How long she'd been there no-one knew. Making our way through the house we arrived at the bathroom. There on the floor was the lady. She hadn't fallen, she had collapsed. There was vomit all around her neck and she was barely responding. With virtually no room to work we managed to get into the bathroom, I was in the empty bath! Her airway needed suctioning so I got on and did that, my crew mate then started to apply some oxygen. She was a horrible grey colour and very clammy. Drifting in and out of consciousness we managed to get out of her that she had experienced lower back and abdominal pain. I was struggling to find a radial pulse at this time, it was really thready and rapid at 120 beats per minute. Her BP was about 70 systolic, that's low! The average adult needs their systolic pressure to be above or around 90 systolic in order to maintain adequate oxygenation of all the organs & tissues.
While my crew mate was securing IV access I started to feel her abdomen, it was distended and it was also pulsating. This is a result of blood being pumped in the abdominal cavity. You've got to remember that the heart is a powerful muscle and pumps blood with some considerable force to enable it to get right round the body and that the aorta (which branches directly from the heart) is the largest vessel in the body, the abdominal aorta is not far down from the heart. The next thing I know is I've got a blue glove in my face, my crew mate had written 'AAA' on his glove. I had only ever read about abdominal aortic anyeursm or AAA in books and never seen a patient with one. AAA is basically a swelling that has occured on the abdominal aorta. Some times they are picked up on scans or are undetected until it ruptures (usually fatal) or starts to leak. If they are detected early enough they can be repaired by surgery and we are talking M A J O R surgery. This lady had no history of this and apart from high blood pressure was relatively healthy. Prehaps her BP had been high for a while despite her medication and it caused her AAA to start leaking, who knows!
We tried to reassure her son who was quite shaken and suprised as he thought she had just fallen and didn't realise the severity of the situation. The next thing was to get her out, she wasn't the smallest of people and it was going to be a struggle to get her out. The carry chair was not an option because if we sat her up almost certainly there would be a significant drop in her BP and put her into cardiac arrest. Some thing we were trying to avoid, we're there to help save her or at least prevent deterioration until she was in the land of bright lights and shiny steel AKA the operating theatre.
Another crew was needed so while waiting for them I gathered some IV fluids and the scoop stretcher and brought them into the house. Eight minutes later they turned up and come into the bathroom, ask us what we need and set about helping get the lady out. One of the crew got in the bath and bent over to get hold of the scoop stretcher when rrrrrrrrrRIP, his trousers split. From arsehole to breakfast time and his spotty boxers were exposed to one and all. Given the seriousness of this job it was a real struggle to keep a straight face, but being the professionals that we are, we managed it. Now finally secured on the vehicle and properly monitored we were on our way. I passed a pre alert call to the hospital while my crew mate was putting up some more IV fluids to help maintain her BP. She was now responding a lot more and aware of her surroundings.
At the resus room we were met by the team who quickly set about their tasks. Bloods, x-ray and a ultrasound scan soon confirmed it was a AAA. Meantime her son arrived and we took him to the relatives room and explained that a Dr or nurse would be out to give him a better idea of what was happening. He thanked us and we made our way back to the vehicle and then base to clean and restock it, finishing on time.
Next day we enquired about our patient and soon learn that she suffered a cardiac arrest on the way to the operating theatre. They tried to stabilise her BP in resus, managing to for a short while and decided to race her to theatres. She was pronounced dead at 22.00.

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