Friday, 17 October 2008

Thank god that's over!

Don't get me wrong I like my job but just lately I feel like I do nothing but work! 4 days off and then back in for an overtime shift on a RRV.

Update on my last 2 night shifts.

Wednesday: 5 patients.

1. Passed as a stroke but was a diabetic having a hypo. We weren't needed as their was a RRV Technician on scene who had given a Glucagen injection. We hung around for a little while just in case the patient needed some IV glucose. She didn't so off we went.
2. Fall, assistance call only.
3. Unconscious, female in a care home. Very pale and blue around the mouth. Her blood pressure was also low and she had a history of chest infections and heart failure
4. Psych/suicide, female who was intoxicated and decided that it might be fun to slash her arm and belly with razor blades. We cleaned her up but she declined hospital. She went off with friends who were going to look after her and take her to the DRs in the morning. They weren't best pleased that she wasn't going to hospital. What can you do? If someone is alert and orientated they have the right to refuse.
5. Chest pain, male in his 30's who had an episode of chest pain. After wasting over 20 minutes deciding whether or niot he wanted to come with us he declined, opting for a lift with a mate. All he was worried about was how he was going to get back from the hospital! I doubt he was having a heart attack, his ECG looked fine and he was too well looking. Anyway he had similar episodes in the past with nothing found and was due a scan.

Thursday: 6 patients.

1. GP admission, suicidal male and at risk of self harm. This was a paranoid schizophrenic that I later learned had a history of violence and assaulting staff! This information wasn't relayed to us with me finding it out by reading the GP letter & notes. I was pissed off to say the least. To top it all the GP failed to refer the patient to the right dept which kept us hanging around at the hospital for ages. The patient was as good as gold and asked me not speak to him on the way in. Fine by me!
2. Fall, elderly female who fell in the morning and now had severe right sided back pain. TLC and a little diesel to get to the hospital.
3. Abdo pain, female with severe abdo pains, occasional chest pain, sob and looking pretty poorly. It all started of with vomiting earlier that evening. Her ECG was horrendous and she was in lots of pain. I managed to get a little bluey into the back of her hand and sort out her pain with some GTN & Morphine. She refused to take any Aspirin. After being seen in resus we moved her down to the coronary care unit where I gave her the rest of the Morphine as her pain started to return. This saved the staff a job as I already had it with me and they didn't need to go to the drugs cupboard and draw it all up. My suspicions of a heart attack were right. Her ECG showed Left bundle branch block (LBBB) and as she had no apparent cardiac history I assumed that this was a new cardiac event. The problem with LBBB is that it basically blocks the view of the left side of the heart making it a bit more tricky to diagnose a heart attack. A proper job!
4. Fall, regular dementia patient with very minor abrasions, the staff admittedly panicked on this one. We left him there.
5. Fall, intoxicated female who fell with someone landing on her arm. This was an obvious dislocated elbow. I screwed my face up like a bull dog chewing a wasp and said to my self 'Shit, that's gotta hurt.' I gave her 10mg of Morphine with gas & air which completely knocked her out for the journey. We have to be extremely careful when administering Morphine to patients that are under the influence of alcohol as they can both depress the central nervous system and lead to a patient who is no longer breathing. We had no problems as I gave it nice and slowly. At A/E resus the DR gave another 10mg of Morphine, I thought I was brave giving 10mg to begin with but she clearly needed it. The nurse said wait till she has some Midazolam then and we'll put it back in. Another proper job.

6. Unconscious, young male who work up suddenly, fell out of bed and bumped his head. He was all panicky that he had a brain abscess, something which he had a few years back. I wasn't convinced with this job but I guess you had to be there. He decided to see his own GP when they opened.

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