Sunday, 18 January 2009

I'm Back!

Well I had a nice Christmas, luckily I had the day off but unfortunately I was back at work on Boxing day night. I haven't really stopped, doing overtime and more overtime etc. I've got to pay for the wife's New York trip somehow.

Since Christmas I've attended three cardiac arrests, several sudden deaths and numerous other ill people along with all the usual minor stuff. Two cardiac arrests were on the same day.
The first was right at the start of a day shift. It was to a male who had collapsed in the toilet and had stopped breathing. His neighbour was an A/E nurse and some relatives had knocked on her door to see if she could help. When we arrived she was doing CPR. Together we worked on him for an hour but it was to no avail. He had long standing respiratory problems and countless other ailments even if we had removed him to hospital he would never of made it. We found out from one of the responders also on scene that he was an ex ambulanceman from our station and that the responder was in fact his old crew mate. All I can say is we tried our hardest.

We needed to restock but before we could get back to base we were given another job, this was to a male fitting. This was another genuine job. This male had a previous stroke and was very unwell when we got to him. He was very pale and sweaty with a high temperature and kept going in and out of consciousness. He would fit and then stop and would then fit again, stop and then into another with no break. We had to intervene and give him some I.V Diazemuls. That did the trick. He wasn't well.

A few more jobs that day and it was time for a break. As soon as our break was finished we were called to a RTA and whilst on route it was now a cardiac arrest. We arrive to find a car had gone through a fence and was wedged on top of another, there was a group of people crowded round and someone was performing CPR. To be honest I thought someone had been knocked down by the car but in fact it was the driver. From what I can gather the patient had swerved off the road, crashed through the fence, got out holding his chest and promptly collapsed on the grass.
We shocked him 9 times and gave him I.V Adrenaline and I.V Amiodarone. We got a pulse back. In the back of the ambulance I intubated him for the journey and put him on the ventilator so I had my hands free. His BP was 98/56 but his pulse rate kept slowing down, way below 40 bpm. I ended up keeping him going with 6 x 500mcg doses of I.V Atropine on the way to hospital. In resus his 12 lead ECG showed a massive heart attack so the team decided to give him thrombolytics (clot-busting drugs). The patient was now waking and trying to sit up. As I had already secured his airway the resus team thought it be safer to sedate him. We also got a 'well done' from the consultant, which was nice. The last time I checked he was still alive.

The last cardiac arrest was last weekend. It was to a 58 year old male who had been experiencing chest pain all day. He was getting ready for bed at around 10pm when it suddenly got worse, his wife called 999 but he went into cardiac arrest whilst still on the phone. A crew had been dispatched while I was sat on base (I was doing an overtime shift on a response car at my local station). I was sent shortly after to back up the the crew. We shocked him 11 times and gave this guy all the resus drugs/fluids but nothing seemed to work. Over an hour we worked on him but we ended up calling it as he was in a flat line. He appeared to be relatively fit and healthy and wasn't on any meds either. A real shame. If only he had called earlier we may have even been able to have thrombolysed him. This was probably a family that just didn't like to bother anyone.

Chest pain, it's not worth taking the chance.

I've also been to few other really ill people but to be honest I can't remember.

6 comments:

Lumo said...

'Chest pain, it's not worth taking the chance.'

That is so true. Just this week we had a cardiac arrest brought in, 50 year old male, had been to see his GP in the morning complaining of chest pains only to be told everything was fine and was sent home. A few hours later he had a massive heart attack and died.

Just makes me think about people who will waste ambulances with non-emergency calls, but then some people having a real emergency won't even pick up the phone. I've heard of people driving to hospital with life threatening problems.

Glad you had a nice christmas anyway :)

medicblog999 said...

Cracking Job on the RTC Mac. Its not every day you get a good result like that one!.
Do you know if he made it to discharge?

brendan said...

Nice blog. One question I had though:

In resus his 12 lead ECG showed a massive heart attack so the team decided to give him thrombolytics (clot-busting drugs).

On this side of the ol' pond, he would've gone straight to a cath lab after resuscitation and AMI confirmation. Is there a reason most MI patients in England seem to just get thrombolytics?

PLEASE don't tell me it's because it costs less...

mac said...

We do have cath labs but not at our local hospital. Cath labs are all the rage in the big cities where they have the experience and expertise at hand, obviously due to number of procedures carried outand patient volume.

brendan said...

Ok, is there no procedure to transfer the patients to a facility with a cath lab?

mac said...

We do interfacility transfers to a couple of major hospitals which have cath labs. Because our prehospital call to needle times are very good in our area we find that we have actually aborted the AMI prior to arrival at hospital (post PHT). It's down to the hospital who they transfer. With this guy I think it was really 'shit or bust', he was post arrest,still unstable and we knew very little about his medical history. Although going to a cath lab seems to be gold standard for AMI there is no evidence to suggest which is the best treatment in the VERY early stages of AMI (such as less than 3 hours). Having said that a lot more of the hospitals in our area are providing PPCi/angioplasty and we are now administering clopidogrel (plavix) prehospital for STEMI pts.