Wednesday, 28 January 2009
Another night cont'd
Our first call was to a Dr's surgery for a young woman with a PV bleed, it was a surprise because this was 19.00 and all the surgeries are shut by this time. Before we got there we were given another call but soon stood down and re assigned the Dr's call. By the time we had turned around and had been up and down the road several times our heads were spinning. We eventually made it to the surgery and were greeted by a young DR who handed the patient over. All her obs were stable so we just took her in to hospital plus her 5 month old baby.
The next call was passed as a diabetic, Cat A unconscious. Like most of these calls we were expecting a hypoglycemic patient which we usually treat on scene, job done. But not this time, her sugar level was 13.4. The care home staff had also done it prior to our arrival and it was 11.2. That's not the problem then. The patient was a reasonably large lady whose airway was compromised by her tongue flopping back and partially blocking off her windpipe, there was also copious amounts of phlegm in her airway as well. I inserted a nasopharyngeal airway (NPA) and then an oropharyngeal airway (OPA) and with the help of an off duty staff responder we got her onto the trolley and into the truck. The only real abnormal observation was her diastolic pressure which was 114. The lady appeared to be having a massive stroke. I said to my crew mate that I would have to stay in the back with her as I wanted to secure her airway which he was fine with and the fact that her oxygen saturations (SP02) were now dropping to 77% despite assisted ventilations. I was unable to intubate her due to her anatomy (large short neck which can make intubation very difficult) but was able to insert a Laryngeal airway (LMA). She tolerated this for a while but as her SP02 were now rising, her gag reflex was also returning. In the end I removed the LMA and just had to manage the airway as before which also involved lots of suctioning. On arrival we were ushered into the resus room. Whilst the DR examined the patient I maintained the airway. Unfortunately the ladies pupils were fixed and dilated, massive stroke as we thought. See pictures above to see the airways that I used.
Third call, DRs 999 and the DR was still on scene! It was the same DR from the previous evening who we took the abdo pain from. When I told him that the lady had a leaking aneurysm his jaw nearly hit the floor. After a couple of minutes chatting about her we got on with the job in hand. Male in his fifties with COPD & schizophrenia. He queried an MI because the patient had an hour and a half of sweating and severe breathing problems but no chest pain. On board the truck we came up with a different diagnosis, chest infection! His SP02 were 78% on air so we put him on 4 litres of O2 which brought them up to an acceptable 93%. Again he denied having any chest pain but did have a rattly cough producing thick green sputum. He looked white as a sheet and he eventually went to the assessment unit down the corridor from A/E.
The last job was at 03.50 this morning. Overdose. 19 year old who had taken 8 co-codamol with vodka and wine. The problem was that she is possibly allergic to co-codamol, she also had a Chinese take away earlier and according to her relative she also had an allergic reaction to one of the ingredients in the past. Her pupils were pin point (a classic sign of opiate overdose), her was breathing laboured and she was lethargic. And on top of that she also had swollen eyes, lips, a flushed complexion and hives all up her back and neck. Airway wasn't compromised and her lungs were clear. For a young girl she certainly was on a lot of meds including beta blockers (these can often masks the signs of severe allergic reaction). She responded well to some IV Narcan which I followed up with some IV Chlorphenamine. I would have set up some fluids as her blood pressure was 60/38 but it soon rose to 95/52 after the Narcan, I didn't bother with them in the end. After I handed the patient over the hospital staff rolled their eyes. I mean if you know you are allergic to something then why take it? She obviously had issues and didn't really want to talk about them.
Although not as busy as usual we did have some pretty genuine work over the last couple of nights.