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.

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