Wednesday, 24 December 2008

Sunday, 21 December 2008

Puffy eyes

All night long we had been dealing with people with high temperatures and nothing much else. A quick assessment including obs and all were referred to the out of hours GP (OOH GP). We had just finished our break when right on time the station alerters went off. We checked the MDT to see what the job was, it was an allergic reaction. So many times we get to these jobs and find that some one just feels sick and nothing more. But this turned out to be the real thing. A few minutes later we arrived on scene to met by the patients mother who was grinning. 'Here we go again' I thought. On entering a small bedroom we were faced with a wriggling mass on the bed. Some where underneath was an 18 year old girl who was supposedly having an allergic reaction. Some swollen & puffy eyes popped up from the duvet. Eventually a whole head appeared and it soon became apparent that the young girl was genuinely suffering from an allergic response to something. We went through the usual checks like checking her tongue for swelling and listening to her chest etc. They were fine but both eyes were completely swollen and her top lip was about three times its normal size. Her face was flushed and she had urticaria (hives) all over her neck and arms. I checked her pulse and BP which were 100 bpm & 100/60 BP. She was a tiny thing in fact my eleven year old son was bigger than her so I wasn't overly worried by the BP reading however she was tachycardic. I asked of any known allergies, the answer was none. I also asked if she had started any new meds or had been in contact with any shellfish or dodgy plants, again the answer was no. The only thing they could think of that could have possibly caused the reaction was maybe an orange jelly that she had eaten earlier but without the proper testing we wouldn't know. I decided to administer some antihistamines to counter act the reaction. Everyone including our young patient were in good spirits but you could see she was uncomfortable with her symptoms. I had a look at her arms & hands for a vein, nothing! Great! I could have given it via IM injection but really wanted a line so the meds would act quicker and also in case her BP dropped suddenly enabling me to get fluids into her. I spotted a tiny one on her right hand so I tried to get a blue 22g cannula in, I got the flashback but it wouldn't advance. Out it came and into the sharps bin. Last try. I put the tourniquet on her right arm and waited patiently and within a short while a nice vein came up in her ACF. I opted for a pink 20g and got it in straight away, my crew mate then handed me 10mg of Chlorphenamine (Piriton) which I administered slowly.

'OK then let's get some shoes on and we'll pop you over to the hospital.'

Her boyfriend came with us and sat holding her hand on the way. I was busy doing more obs and filling in the paper work. The rash had now started to subside although her eyes were still really puffy and her top lip still swollen. I constantly checked to make sure her breathing was OK and that her tongue wasn't swelling. All was well until we pulled into the road leading to the hospital. Her boyfriend grabbed my arm and said that he thought she was struggling to breath. I asked her and sure enough her chest was getting tight and she was complaining of a feeling like there was a lump in her throat. I put her on some O2 and quickly administered 500mcg of adrenaline 1:1000 intramuscularly. I didn't have time to give any Hydrocortisone so I left that to the hospital. By the time we got into the dept her breathing was now easier.
Job done!

Thanks you know who.

Thanks for sending me those, you know who. Although each clip is brief they were filmed in Ney York, Time Square and Madison Square Garden. Now what would be funny is if the Paramedics/EMTs that were in these 'Rigs' saw this blog and could tell me what the calls were. They were filmed between the 4th Dec - 9th Dec, I think. A needle in a haystack springs to mind.

Sunday, 14 December 2008

Last weekend cont'd

G.I Bleed
Sunday was busy as usual. The moment the shift started , at 06.30, we were straight out on our first job. We had been called to a nursing home about 7 miles away for a Cat A haemorrhage/lacerations call. The only extra info was that the patient had been vomiting blood, also known as hemetemisis. We were met by an oriental nurse who showed us where the patient was. I seem to remember repeatedly asking her 'what's wrong with the patient?' only to be ignored. That really gets my back up. In the room we find a male in his 70's lying on the bed. Another member of staff was in the room tidying up. The patient had vomited up what the staff described as looking like 'coffee grounds'. That is an indicator that the patient could have been suffering from a G.I bleed. I asked if there was a lot of vomit and they said yes but unfortunately the staff had stripped the bed and disposed of the sheets. We could have at least gauged how much blood he had lost. He had a good radial pulse although a little on the rapid side which gave me a quick indication of what his circulatory status was. If an adult has a good palpable radial pulse it tells us that their estimated systolic blood pressure is above 90, therefore an adequate blood supply able to keep the vital organs perfused. We got the patient on to the vehicle and did some more obs. His O2 saturations were a little low and his pulse was around 125 however his blood pressure was an acceptable 128/76. A few minutes into the journey I retook his BP and it had dropped to 77/44. He then started to vomit more of the coffee ground liquid. I quickly swapped his O2 mask for a vomit bowl and cleaned him up. As we were on a straight piece of road I decided to pop in a cannula and run some IV Hartmans to boost his BP and maintain it at around 90. He had 500ml in total. Because I had pre alerted the hospital we were greeted on our arrival and ushered into the resus room.

While I was filling out my paper work an Irish Dr came over to speak to me and asked what had happened.

'I know I shouldn't say this but it was a job to speak to some one who actually spoke English in this nursing home!' I said. 'It was a real struggle to get any history out of them.'

'Don't worry about it, I always believe you should say exactly what you think.' came his reply.

'RIGHT my friend'. boomed the DR to the patient. 'Let's get some blood out of your arm and find out what's going on!'

Proper job!

We also had a lady who slipped on an icy path right next door to the Fire Station we use as a response post. Unusually there wasn't a vehicle there so we responded from about 8 miles away.
She had an obvious fracture/dislocation to her wrist. The fact that it was bent like a dinner fork and unusually rotated 180 degrees in the opposite direction kind of gave it away. She was clearly in agony and was a little pale & dizzy. She pleaded for some pain relief but couldn't get on with the Entonox. I said that the only other pain relief we had was the sort we give through a drip to which she replied 'Please give me something!'
When I said that it was Morphine she said 'Ooh I can't have Morphine it makes me sick!'

'But you're not actually allergic it are you.'

'No but I was ever so sick after I had it last time after I had an operation.'

'Some people can be quite sick anyway after an operation.' I said

'Well I've had lot's of operations and never been sick before.'

'Well I can give you an anti sickness drug before I give the Morphine and if I give it nice and slow (which we do anyway!) that should prevent you from feeling sick.'

She declined but soon changed her mind as the pain was clearly became unbearable. She had 10mg of Metoclopramide and 2 x 2.5mg doses of Morphine which helped considerably.

Another Fall
A call came in for someone who had fallen from a horse and as we were sat at the hospital we were the closest. It was about 5 miles west of the city. We received updates en route which stated that the woman was in her twenties and had fallen from a horse, she had apparent back and chest injuries. We pulled up on the side of the road and were met by a young girl , she said that our patient was about 100 metres along this country path. More like half a bloody mile! It took us ages to get to her and to top it all the path consisted of mud only. My trousers and boots were filthy. On the floor was quite a large woman covered in, yep you guessed it, coats. She still had her safety helmet on and looked uncomfortable. Not surprising really considering it was bloody brass monkeys (freezing), wet and muddy that day. Her horse was tied up to the fence close by and was being calmed by another woman. We quickly assessed the woman on the floor and established that she was short of breath, had significant pain and bruising to her left chest & epigastric region (this is just below where the breast bone ends). She was also complaining of some thoracic back pain (in the middle of the back). She had good air entry but I was reluctant to give her Entonox for pain due to the fact that if she did have a collapsed lung then I would cause it become worse. We put her on some O2 and then out with some more Morphine . Without being rude she was a large girl but only needed 5mg to make her comfortable. We have to be careful when giving Morphine to chest injuries because it can cause respiratory depression which in turn will worsen hypoxia if we are not on top of our game. On the other hand this girl's pain was inhibiting her breathing and by me administering some Morphine eased her pain thus enabling her to take deeper breaths, avoiding hypoxia. However prior to giving her the pain relief I had to get a line into her hand but her previously calm horse started to get a bit skittish. There was a brief moment when the horse 'neighed at 150 decibels' and raised it's front legs. Although not in immediate striking distance it wouldn't of taken much for it to get loose. I very nearly crapped myself!!
My crew mate had done nearly the equivalent of a half marathon getting various bits of kit from the ambulance. For a split second I nearly even felt sorry for him. Naaaa. He gets paid enough, ha ha. From the start it was a chopper job but out of four possible options none were available. Our two HEMS choppers were both on trauma jobs and the Police/Ambulance combo chopper was grounded due to an equipment upgrade, even the neighbouring ambulance service's helicopter was busy on a trauma job. There were no other ambulances available so we ended up getting Fire & Rescue to assist us carrying the girl out to the vehicle. We only needed a few extra bods but two Fire appliances turned up, one from our county and another from the next county. Before they arrived my crew mate went to the road to wait for them and while I was waiting I had a little bet with myself. I bet they come walking up the path with their helmets on. Sure enough through the trees I saw all these yellow helmets. I shook my head. Joking aside they were a great help.

Another proper job.

Saturday, 13 December 2008

Last weekend

Last weekend I worked with a Technician who is on his 3 year Paramedic Uni course. Nice guy, competent, reliable and best of all has a good sense of humour. An absolute must in this job! Anyway Saturday dragged on with nothing really going on, a few routine 999 calls, Lot's of pointless stand-by and a Dr's admission which was about a 70 mile round trip. We cleared up at this hospital and they even tried to send us on some more stand-by. I don't think so.

'Er we haven't had our second break yet and if we do have to go on stand-by somewhere can it be somewhere with facilities!'

'Roger, sorry about that, I pushed the wrong button, you can RTB (Return to base)'

'Roger, will do'.

So off we went. Stayed on base for a while but copped a job at 18.10. We where on a 18.30 finish with no one else on base. As Dick Dastardly would say 'Drat and Double Drat!!!'
It came through as a sick person and that he had been to the hospital earlier.

'Right let's get him on board and go' said my crew mate.

We were on scene within minutes and went inside. A lady directed us into the living room where a young man in his early thirties was lying on the sofa not looking too clever. On the other side of the room was a baby asleep in a small chair and another child was quietly playing. It transpired that this chap had been to the hospital earlier with chest pain, had x-rays, bloods and an ECG. He was discharged with anti-biotics and pain killers-diagnosed with a chest infection. Well he may have had 'just' a chest infection then but now it was bit more serious. He was pale, breathless, pulse of 140 (which was barely palpable), blood pressure of 100 systolic and had a tympanic temperature of 40.8. I quickly exposed his chest and abdomen to check for any signs of a bacterial rash, although more common in children and adolescents, I didn't want to miss anything. No rash.
Now on the vehicle we repeated his obs. His pulse oximetry read 89% on air and his blood pressure was still low. We did a 12 lead ECG which looked fine but he was still complaining of severe chest pain. We gave him high flow oxygen, cannulated & took bloods, IV Metoclopramide, IV Morphine and in total a litre of IV fluids. Despite the IV fluids his blood pressure and pulse remained the same although he did say that he felt considerably better by the time we delivered him to the hospital.
I handed over to one of the A/E nurses and before we could off load him onto one of their trolleys the DR who had seen him earlier came over. He looked worried, may be he was thinking of what he may have missed. I briefly explained our findings to the DR, bid fairwell to our patient and booked him in at reception.
A late job but I didn't mind as it was a worth while job. I found out later that he was admitted to a medical ward.

Credit Crunch

The world is in economic meltdown, businesses going bust, people losing their jobs and homes being repossessd. It's like going back to the recession of the eighties. It's at times like these I'm glad I'm a Paramedic, glad I work in an area where at some point someone will need me. Everyone needs healthcare and always will.
Even at a time like this there is shed loads of overtime and I am taking full advantage of it, after all I need the money. Don't we all! Not only is christmas as expensive as ever but I've also got to pay for my wife's New York trip. I don't mind though, she deserves a break. Which reminds me I may be getting some video clips of FDNY because a couple from my local station have just been to the 'Big Apple'. Watch this space.

My timesheet looked odd, it showed mainly annual leave and overtime with only a hand full of rota'd hours. You see I get 277.5 hours annual leave but up until recently had only taken 44! I was politely informed by our scheduling dept to 'Hurry up and book my leave or have it allocated for me'. I've now done this but because we get a fair amount of time off any way I decided to book some overtime shifts.........................on days that I was on annual leave. Loads a money!!

Tuesday, 9 December 2008

On another night shift, on my own, been run ragged going all over the county. All crews have been non-stop. I've now been on base for a while and have had time to think........
Our friend's sister and husband lost their 2 and a half year old little girl under tragic circumstances two weeks ago. Her funeral was yesterday. I couldn't bare loosing any of my children and wouldn't know how to carry on. To think we were all at a birthday party only two days before, celebrating. If only it had happened there, I know I could have made a difference.

God Bless Little One