Monday, 15 September 2008

Quality shift again

Working with a trainee Technician last night. I think she was expecting lots of trauma and excitement! You see I've got this reputation for getting a lot of the 'proper jobs' and I think she thought her luck might be in. Well, it didn't really happen. First call was for an unconscious in the street, no other details. We arrived to find that a passing motorist had noticed a male in his thirties unresponsive on the ground. He had checked to see if he was breathing and then called us. He stayed until we arrived which is quite rare. Most people call us 'on the run', i.e see something, call us and keep on driving.
Sure enough the guy wasn't responding, I shined a torch into his eyes, his pupils were constricted. Great a possible heroin OD! His breathing was slow and he had a pulse. On with some O2 and out with the drugs bag. Only minutes earlier my crewmate had been talking about heroin ODs and that she hadn't given Narcan yet, now this could be her chance! No such luck, the guy woke up, pupils now the size of dinner plates. He jumped up and started shadow boxing, it was quite possibly the worst Mohammed Ali impression I had ever seen. Very commical. 'What's your name mate?, 'Not tellin Ya, It's a secret', great another uncooperative punter. He was actually alright, not aggressive at all. He was infact grateful that we were checking him over. He was clearly drunk and had been assaulted, displaying a swollen cheek and multiple abrasions. Really he needed to go to hospital to be properly checked, especially as he was intoxicated. Alcohol is great at masking other potential problems such as head injuries.
After yet more dancing about in the back of the truck he eventually got out and said he was going home, information he wasn't going to disclose to use for some reason. We weren't going to pressurise him as that could make an OK situation into a potentially volatile one. We tried to give him advice but he was off on his heels and into the night.

Next job was a possible stroke. A very large lady who had previously suffered from 3 strokes and a had a permanent left sided weakness. She unconscious and snoring, a sign of a partially obstructed airway. She had saliva and blood coming from her mouth and was very clammy. Getting her out to the vehicle was a challenge but we managed it.................just. We could of got a second crew but we didn't have the time, we needed her out there and then. Her observations were unremarkable with only her pulse rate a little higher than normal at 106 bpm. I wanted to put a line in and get some bloods but she had poor veins, I got it in but the vein collapsed.
That wouldn't be the first cannula I fluffed that night!
She actually responded to oxygen therapy alone and by the time we were at hospital she was coherant again. I was now pretty convinced she hadn't suffered a stroke, the recovery was too quick.

The police called us out to a possible 'narcotic' OD. It was a patient familiar to me and he wanted to kill himself. Steaming drunk on cheap cider and claiming to have taken 20 tramadol tablets at 50mg a pop he was not in a fit state to be left alone. Convining him to go was tricky. He struck a deal with the police officer and shook on it. The deal was, 'You can have a smoke and then you go with these nice ambulance people to get the right help!' No, he wanted another smoke. He was also asthmatic and tried to fake an attack by holding his breath and stating he couldn't breath. This was our chance, we shouted 'Quick, we need to get you to the ambulance for some oxygen' and with this we rushed out to the truck. On the way in I constantly checked the onboard camera to make sure my crewmate was ok in the back. I noticed she was trying to wake him ans saw her approach the window in the bulkhead. 'I know he's probably faking but can you just check him quickly?' I pulled over and got in the back. The guy was lying on his back with his eyes wide open, motionless. Good colour, breathing fine, pulse oximetry 100%, not much wrong with him. I touched his eye lash and he fluttered them. 'Alright stop messing about!' I said. Up he shot and grabbed his own windpipe and repeatedly tried to strangle himself, he was squeezing so hard his head was going purple. I jumped in and wrestled with him removing his hands in the process. I read him the riot act and told him to stop being so bloody stupid and to grow up. 'Think about your child' I said. 'What sort of role model are you going to be if this the way you act!' he soon settled down again. He got a bit upset and said he wanted to die. 'No you don't, let's get you to the hospital and get you some proper help'. I'm normally very laid back but sometimes you've just got to be firm. He'll recover and get discharged and do it again just like all the other times.

We did a couple of other jobs and actually had a bit of time on base. At around 2 am we were called to a Cat A breathing problem. This chap was quite poorly and you could hear his breathing long before entering his bedroom. He had recently been discharged after spending nearly a year in various hospitals due to knee operation going wrong and suffering multiple complications including 3 heart attacks and a stroke. He awoke from his sleep with severe breathing difficulties and it wouldn't go. He sounded like he was drowning which he basically was. Fluid was accumilating in his lungs and starving him of the oxygen he so desperately needed. The fact he had 3 previous heart attacks and the way he was presenting to us my thoughts were Left Ventricular Failure (LVF). This condition can occur after heart attacks, the heart muscle becomes weakened as a result. After a period of time the heart struggles to pump effectively and the blood backs up in the circulation, with no where else to go the fluid component of the blood leaks back into the lungs and causes the severe symptoms. This guy was really struggling. He had already been through the mill and this was the last thing he needed, his wife was near to breaking point. We treated him with oxygen and nitrates and a nebuliser, this eased his symptoms eventually. I could have given him furosemide but we don't carry it in my part of the service. We could have provided him with continuous positive airway pressure (CPAP) ventilation but we are still awaiting ethics committee approval on this form of treatment. I could have given him morphine but he didn't have any pain. It would have had two effects, reduction in pain and because of it's depressive effects would have eased his breathing. I also wanted to put a line in but his veins were so poor I couldn't get one in. The most important thing was that he arrived at hospital alive and doing much better. It would have been nice to give him that little bit of extra treatment.

1 comment:

epocalypse said...

Yup, we definitely need some decent treatment for LVF, we too are awaiting furosemide on our motors and have heard noises about getting CPAP (though if we did get some on our station I think they would be getting used on some to make them quit snoring).

Until then I afraid we're sticking with GTN & GTF; Glyceryl Trinitrate followed by Getting The Fuckout.