Friday, 21 November 2008

Asthma

It's 04.00 am and I feel someone shaking me and soon realise that it's my crew mate.

'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!

2 comments:

mrkester said...

pre alert? is that the handover?

mac said...

No, a pre-alert is when we radio ahead to inform the hospital that we are coming with a poorly patient.