Friday, 3 October 2008

You know it's bad when..................

You know it's bad when there are kids waiting for you at the front door, crying and pleading for you to do something.

We are called to a hemorrhage/lacerations call near to our station and on our arrival there are two young children waiting on the steps out side the house. As I grabbed the response bag they both came over, sobbing, 'please do something my mummy is bleeding out of her mouth, please, please.' On entering the house we were met by a male in his late forties, whilst ushering us upstairs he explained that his wife was having a shower when he heard a loud thud and when he went up to see what all the noise was he found her on the bed bleeding from her mouth and unresponsive. Now in the bedroom we were confronted with a semi naked female who was face down on the bed, patches of blood on the bed were also visible. I quickly rolled her on to her side and could see she was having some form of seizure. I wanted to put in a nasal airway but she started to flail her arms about so I opted for some O2 instead. Her husband was asking if she was going to be OK but I just had to tell him that I honestly didn't know and that he should go and make sure the two girls were OK. My crew mate went down to get the drugs bag and the carry chair with the husband in tow. This patient had no previous history and was normally fit and well so what was the problem? Was she having a first fit or was she having a cerebral bleed? Whatever it was we needed to stop this fit. As I put in a 20g IV and secured it down my crew mate was entering the room so I got him to draw me up a saline flush and 10mg of diazemuls. After 5mg she stopped fitting and we were now able to get her on the carry chair, down stairs and on to the truck. As her breathing pattern was unpredictable I got out a BVM and assisted her breathing as and when she needed it, my crew mate was attaching all the monitoring equipment. One last thing, the patent's personal details, the husband had gone to write them down. As soon as he returned we were off to the hospital 7 miles away. He and his girls followed on in their car. I did tell him not to try and keep up as we would be going in on blue lights, something that some relatives fail to do! On the way in the patient started to respond and was following simple commands which was encouraging. She even managed to tell me that prior to her collapse she had a bad headache and heard ringing in her ears. Perhaps I was making a fuss over nothing, perhaps this was a first fit and she would go on to be diagnosed with epilepsy where she would receive medication to control her fits, I hope so. On arrival we were greeted by the A/E Doc and a couple of nurses, when I explained to the Doc what had happened he just gave me a wink and said cheers. The husband turned up some time later minus the girls, he had dropped them off with friends and rightly so, no children should ever have to see their loved ones like that if they can help it. I showed him to the relatives room and went back to clean up the truck.
About an hour later we arrived back at the hospital with another patient, some one who most definitely didn't deserve an ambulance trip to hospital I might add! The Doc spotted me and came over, 'Massive sub arachnoid bleed' he said. 'Bloody hell, what's the prognosis?' I replied. 'It's hard to say, she's going to be transferred to the neuro unit soon.' 'Right, thanks for that.' I said, thinking about those poor girls. You can read about SAH here
Later we were to return and transfer her over to the neuro unit 30 miles away. She had received 4mg of morphine but was still in a lot of pain, I wanted to give her a bit more but the consultant anesthetist preferred that I didn't as it wouldn't completely remove all of the pain. Fair enough. She needed to be where the bright lights and shiny steel was, the operating theatre. A heavy right foot would probably be more useful than another couple of mg of morphine. She was a bit more responsive this time round but not fully with it just saying it hurts, it hurts. We arrived there in one piece and got her up to the neuro ITU ready for surgery.
I've seen the husband out and about but still don't know how the op went or if she even made it. I hope so

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