Monday, 22 September 2008

Saturday, A better night

All the calls we had on Saturday were genuine.......................which is rare! Nothing too exciting but all needed our help in some shape or form.

1. Assault. Male 41 attacked with a baseball bat. Just a hard working family man who had a call from his or his mates stepson, I forget which to come and get him as a gang of people had threatened to 'do him in'. This guy went to look but couldn't find him so on exiting a car park by a convenience store a van pulled up. About 4 men got out with baseball bats and knives and proceeded to beat the hell out of this guy. 4 nasty head lacerations and a broken nose. Blood everywhere. Speaking to the police at the hospital, they said they had a good idea who was responsible and would stop at nothing to get them. They also said that they would have them all in custody that night. Yeah yeah yeah I thought. Half an hour later the whole gang was nicked, I couldn't believe it.
2. Male 55, headache. This chap had mental health issues and had similar events in the past. He was really agitated. I was on the verge of calling the hospital and asking a Dr to give me permission to give this guy some IV Diazemuls to sedate him. We only use the drug for fitting or for sedation in certain illegal drug ODs. Fortunately we were able to calm this chap enough to get him to hospital.
3. Male 31, diabetic with severe respiratory distress. It was only round the corner from the hospital so we were there in seconds. This guy was breathing at 30+ breathes a minute (the norm being around 12 - 20) he also had a temperature of 41.2 (again the norm being 36.9-37). His sugar level was slightly up and his O2 saturation's were slightly low. O2, base line obs, load and go. At hospital within a minute.
4. Male 40ish, history of Autism who had a fall. This was at a care facility, he had fallen in the bathroom and pulled the emergency cord straight away. A bit of blood but once cleaned up had nothing more than a cut lip and a bloody nose. Patched up on scene and left with the care staff who weren't too keen on him going to hospital anyway.
5. Female 28, Severe respiratory distress. This young single mum had been diagnosed with a recent chest infection and prescribed anti-biotics. She is also Asthmatic. For 2 hours she had been trying to self medicate an asthma attack, her own inhalers weren't working. She was clearly in trouble and trying to put a brave face on it. We gave her O2 and a salbutamol nebuliser in her flat while her daughter was skipping around merrily with a pink rucksack on her back. This neb failed to improve her condition so I handed my crew mate another salbutamol neb along with an Atrovent neb. Still no real response and she was getting worse. She had that exhausted look to her, not a well bunny. Her peak flow was only 200 at best (her normal was 450), O2 saturation's 92% and tachycardic. I had a look at her tiny veins on her right hand. There were two small straight blue lines and only one was good enough for an IV. I put a little bluey in (22g cannula, the smallest we have) and gave her 200mg of hydrocortisone (steroids). Steroids work by dampening down the immune response and in this case work in the lungs by reducing inflammation within them thus easing breathing. We gave the hospital a pre alert and ran her in on red (blue lights). We handed over to the 2 A/E Dr's waiting for us who didn't even realise that we carried hydrocortisone! The Dr seemed to be at a loss as to what to do after doing a blood gas. 'You've not given me much else to do.' he said smiling away. The girl was now beginning to recover and moved from resus down to the main A/E dept. I always thought the actions of Hydrocortisone was of a slow onset even when given IV but after researching it on the net it appears that it starts to take affect within the hour, usually within minutes. You learn something new everyday.
Our guidelines state that you can consider Hydrocortisone where the call to hospital time exceeds 30 minutes. Where I work this would be most cases because by the time the patient has called, we mobilise and get on scene, assess and initiate treatment and then travel to hospital it would easily exceed 30 minutes. Anyway in severe/life threatening Asthma steroids need to be given early.

It feels good knowing you've made a difference.

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