Monday, 24 November 2008
'She's my sister-in-law and she has taken 60 of these.' as she hands me an empty packet of solpadol.
n.b we were initially informed that the drug was Tramadol although it wasn't
'She is having problems with her husband and I'm really worried about her!'
'OK let's go in and see her shall we.' I say
Inside I'm gobsmacked at the size of it all, beautiful wooden floors and the sweeping stair case and the kitchen, well my wife would have a field day. Inside the open planned kitchen there is a woman lying semi-conscious on the sofa. To cut a long story short she appears to have taken all the solpadol (solpadol is an opiate containing Paracetamol and codeine) and is showing signs of an opiate OD such as pin point pupils, decreased respiration's and reduced conscious level. We treat her with O2 and IV Narcan which does the job and take her to hospital. What we later learned was that at the end of the road and at the exact time of
our job there was a car accident. A local teenager had pulled out of a junction on the busy dual carriage way and had been struck by a van travelling at high speed. She was in cardiac arrest. A couple of crews and the air ambulance attended and despite bi-lateral chest drains and every thing else that goes with a serious trauma job she died.
A sad tragedy had occurred with in a stones throw of where we were. Even if we were there as it happened there would have been nothing that we could have done to save her. It's still horrible to think that someone died right under our noses.
Sunday, 23 November 2008
'Yeah man he's only done 20 quids worth of gear and drank some beers, that's all' said one of his mates.
Out with the BVM and an OPA (oral airway), his pupils were pinpoint (a classic sign of opiate OD) and even in the moonlight he looked pale. As I started to ventilate I asked my crew mate (who is a trainee) to get out the drugs bag and give 800mcg naloxone/narcan via intra-muscular injections, one in each arm. It's funny because only earlier I was talking to him about what skills he has used so far and what did he need to get signed off. Although he had given Glucagen IM in the past he didn't get it signed as this was before the new policy had come into effect. The new policy being that all trainees now need to be signed off (twice) as competent at administering drugs via IM injection, this was his chance.
At this point the police turned up and quickly arrested his mates, why I don't know.
With a good patent airway the next step was to administer the narcan. My crew mate did well and pushed 400 mcg into each arm. I carried on ventilating him for a good few minutes but nothing was happening, he was still not breathing. I opted for a tube and attempted intubation there and then but as I got through the cords he gave a massive cough so I withdrew the tube. I reassessed his airway and breathing but still nothing so I swapped positions with my crew mate so he could practice his BVM technique. Next step was to give more narcan but first I needed to get IV access which can be pretty tricky in IV drug users. Not in this case, the patient had cracking veins so I popped in a 20 g pinky and gave another 800mcg of narcan. Within about 30 seconds he was back in the land of the living. A life saved.
He was no bother on the way to hospital which makes a change! Most of the time when you have ruined a heroin addicts hit/fix they usually moan like hell but not this guy, he was nice as pie and happily came to hospital to be checked over.
It's now 03.30 am and I'm tired. Must try and get some sleep. I'm not holding my breath though!
Friday, 21 November 2008
'Come on we've got a red call!'
Now, I'm not great at waking up at the best of times. The night shift had been pretty quiet and we were lucky enough to have had about 4 hours sleep on base.
I manage to haul myself up and make my way to the vehicle. On the mobile data terminal (MDT) the message reads 'Lights and sirens response, SOB, GP advises patient will need oxygen.' From that I knew that it was a Dr's red call but what I didn't know was whether a DR had actually visited or not. Probably not. We usually get updates of the job en-route but didn't get anything extra.
When we arrive on scene about 5.5 miles away we see that the front door is open so make our way over. Inside there is a lady, about 70, who was really struggling to breath. You didn't need a stethoscope to listen to her chest as the wheezing was so loud. I still had a quick listen so I could detect/rule out a pneumothorax (collapsed lung). Her air entry was equal with a pronounced bilateral expiratory wheeze so straight on with the high flow oxygen while my crew mate was moving the vehicle.
On board I gave her a Salbutamol nebuliser which only provided mild relief so after about 5 mins I gave her another, this time we added Atrovent (Ipratropium Bromide). Her peak flow was only 150 (her normal was around 350 which in itself is pretty poor), O2 saturation's was 90% with a pulse rate initially running at 110 bpm. I decided to cannulate her and administer 200mg of Hydrocortisone. She knew exactly what we were doing as she was an ex nurse and repeatedly kept thanking us for what we were doing even though she wasn't out of the woods yet.
It all started around 2 am when she was woken from her sleep with severe breathing difficulties so she decided to contact the out of hours GP. The GP obviously heard her breathing on the phone and called us.
By the time we reached hospital her O2 saturation's were 98% and her pulse rate had come down to an acceptable 90 bpm although she was still a bit wheezy. We were greeted by a DR and 2 nurses who took my hand over as we transferred the patient to the hospital trolley. As I turned round another nurse came into the cubicle with a tray with 2 vials of hydrocortisone drawn up into syringes and bloods tubes.
'What do you want them for? I've done all that.' I said.
'Have you?' said the nurse.
'Yep, I did say when I gave the pre alert.'
'Oh OK I didn't know. I'll get rid of them them, thanks for that.' she said.
Our patient is now doing much better and after doing an arterial blood gas the DR looks at a loss as to what to do next. He wanders off and starts to write some notes while the nurses get on with repeating some obs. Our patient thanks us and we wearily make our way back to the vehicle hoping to get back to base for a bit more shut eye.
After a week of doing nothing of any significance it was nice to have a proper job just to remind us of why we are here.....................even if it was at 4 am!
Wednesday, 19 November 2008
We were called to a care home for an unconscious female. She was in bed, unresponsive, malnourished, dehydrated and no heavier than 5 stone in a wet raincoat.
'How long has she been like this then?' I said knowing full well that this wasn't something that had suddenly happened.
'Don't know, I've only just started my shift and I don't know much about this lady.' came the reply.
'Really' I thought to my self.
It amazing how many times we get the same old story, no-one knows anything about the patient, they've just come on shift or 'it isn't me that usually looks after her.'
No-one seems to know!
This lady is poorly sick and needs to be in hospital. She is severely dehydrated with barely palpable radial pulses. She is also hypoglycemic (although not diabetic). She needs some fluids and IV glucose. One attempt and that's it. This was before we had the
EZ-IO (http://www.vidacare.com/ez-io/index.html) We're in! A 22g bluey in her hand. 50ml of glucose and a bit of fluid en route. She starts to stir.
Overworked, understaffed, don't know this, don't know that. We've heard it all before. There is no excuse to allow patients to get like this.
Monday, 17 November 2008
I was working on the RRV when I got a call, 'Rollover, 1 female trapped'. Everything was being sent including the air ambulance, basically every man and his dog.
The accident is on an S bend and road is slippery after some light rain. Within minutes I was there. The usual helpful member of the public was there directing traffic, he gets every where that bloke! Before I pulled up I spotted the windmills, these are those people that think that we are blind and have a need to stand at the scene waving frantically. Perhaps they think we have got multiple incidents along the same stretch of road and need to wave us down in case we drive by. Funny old thing the car on it's side gives it away! Never mind.
I grab my kit, analyse the scene for hazards and quickly check to make sure there aren't any other casualties that have been ejected from the vehicle. There are 4 people gathered at the side of the overturned car and one kneeling by the boot.
'There's some one in the car', says someone. 'We didn't want to move her just in case.'
As I lift up the boot hatch I am confronted with a wriggling mass of coats and bags.
'Can I get out now?' a voice says.
'Hold on.' As I crawl inside. 'Are you hurt?'
'Any neck or back pain, did you hit your head, seat belt worn?'
No, no and yes were the replies.
'Well let's get you out then.' I said.
'Yes please' said the woman.
Before I get her out I call up control and ask for just one vehicle to attend and to cancel the air ambulance and fire & rescue. Although standing down fire & rescue in this country is pretty much impossible.
I have to detach the back seat and slide it out and then remove the coats and bags that are now only partially covering the woman. As I guide her out I am deafened by the sirens of the approaching ambulance. As it pulls up the trainee tech driving turns them off, her crew mate gives her a filthy look and shakes his head. I thought she parked it on my head they were that load! Never mind she'll learn.
The woman is now out and is unharmed so we put her on board the ambulance to have a proper look at her. The crew move the vehicle down the road so it is out of the way. While I'm talking to the Police two fire appliances turn up.
'She's out mate.' I say to the watch commander.
He turns to his colleague from the other fire truck and waves him goodbye. He walks off looking disappointed.
'Right, we'll make the car safe then.' he says.
The woman is being checked over in the ambulance so I pop over to see if the crew need anything. The woman is fine and doesn't need to go to hospital. I then make myself available for calls.
I got another call to the same spot on Thursday this week for a car on it's side, again non-injury. We have been to a lot RTAs on this stretch of road with most incidents thankfully being only minor injuries. Although 4 lads in one car were killed not that long ago at the same spot.
Saturday, 15 November 2008
Some more pics from my trip to Richmond. The FD dropped in and told us about their role in prehospital care with RAA. One thing I found amazing is this; Like us in the UK, RAA have a response standard, theirs is 8 mins 59 seconds. But the only thing that stops the clock in Richmond is an ALS ambulance, that's a vehicle with at least one crew member who is a Paramedic. If a fire truck or a RAA field supervisor or BLS ambulance turns up first with in this time it doesn't count. Irrespective if they save a life it still doesn't count. Another thing I found astounding is that Richmond's population size is very similar to that of Southampton in the UK but in Richmond they have 20 fire stations and that RAA put out on average 16-18 ambulance crews daily and about 8 crews at night. This doesn't include the rescue volunteer squads dotted about the city. I know for a fact that there aren't that many fire stations in Southampton and that South Central Ambulance probably don't put out that many ambulance crews during the day.
Richmond FD have a few nationally registered paramedics as firefighters and the FD work closely with RAA.
Thursday, 13 November 2008
Wednesday, 12 November 2008
Once we managed to prize her hands from the steering wheel we checked her over, she was fine. She managed to take out a brand new wooden fence. So new in fact the council workers were just packing away their tools. Didn't they laugh.......................not! Oh well at least I know my £1500 annual council tax money is being put to good use.
Non-injury, sign here!
" There has been a number of incidents nationally involving housing association properties where tenants who are suspected users or suppliers of drugs are secreting DIRTY NEEDLES with in the bottom corner of light switches.
The needle is placed in between the rocker switch and the front plate, meaning that any person attempting to turn the lights on is likely to get a needle stick injury to the finger."
Unbelievable. So to my fellow emergency workers across the land, BEWARE!
After the 'Big Ben' style door bell stopped ringing the door opened and we were face to face with an overweight male in his fifties. 'Quick come this way' he said as he ushered us in. 'Are you all right?' I said to him, he was ever so wheezy and sounded like he was having an asthma attack, In fact I nearly gave him a nebuliser there and then on the spot. 'No I'm fine, it's my wife. Come up here, quickly please.' he replied.
It seemed to take ages to climb the enormous sweeping staircase. The patient was sat on the edge of her bed and was crying. As she looked up we could see the frustration in her eyes. It wasn't the fact that she couldn't speak it was more that what ever she said made no sense. We managed to find out that she suffered from high blood pressure and was taking tablets for it. After doing her temperature and sugar level we moved on to her BP which was 146/78, nothing remarkable there then. As she was symptomatic we popped her on some oxygen.
She still needed to go to A/E and within a few minutes we were on our way. Her husband, whose wheeze had now calmed down, came with us. The patient had been on O2 for around 5 minutes when her speech started to become clearer, it was no longer garbled. A few more minutes and it was getting better, by the time we were at A/E it was back to normal. As we unloaded her on the trolley her husband was leaping around shouting 'Hallelujah, she's cured! You boys are wonderful, you've cured her!' and he was repeating this up and down the corridor. I kept expecting James Brown to pop up and shout 'Can I get a Witness, amen'. With what we were presented with we queried a TIA (transient ischaemic attack, a sort of angina of the brain), did some obs and gave O2. That was it! But the husband thought we were miracle workers. A little while later the grateful husband came up to us and asked if we thought it was definitely a TIA but all we could say was that he should let the Drs run their tests to confirm it. He was more interested in our opinions than those of the Drs.
He was over the moon that his wife was doing well.
A TIA is sometimes called a 'mini stroke' and it is where there is a brief interruption in the blood supply or temporary blockage of a blood vessel in the brain. Patients usually recover within 24 hours but if patients have lots of these it is just a matter of time before they have a full on stroke. Patients with high blood pressure and/or an irregular heart rate (known as AF or atrial fibrillation) are particularly susceptible.