Saturday, 21 February 2009

Another typical week

Well it's been a busy old week again. To begin with I was working with another trainee. When ever I work with this particular trainee I always seem to get lots of genuine work. I remember the first time I worked with her last year in the summer it was hectic.

This is how that particular weekend panned out.

Before I had time to even introduce myself properly the station alerters were sounding and we were off. First call was to a 19 year old who was complaining of flu like symptoms and a rash. When we got there we found out he had already phoned the out of hours GP who, on hearing his symptoms, suggested he phone 999. He had been unwell for a day or so with a headache, stiff neck, nausea & vomiting and was now developing a strange rash. His temperature was high and when I examined his rash I could only think of one thing - mennigococcal septicaemia (MS). You see the rash looked hemorrhagic in nature, it was under the skin and was spreading. With his symptoms I had to treat him for the worse case and that meant administering 1200mg of IV Benzylpenicillin. I basically said to him and his mum that if I didn't give it to him and got it wrong he could be very ill. The earlier it is given the better. If It wasn't MS the worst thing that could happen is that he would have a bad case of the shits. Both he and his mum wanted me to give him the antibiotics. At hospital the staff grade DR looked unconvinced and gave me the sort of smile as if to say I was acting over the top. He left one of his junior Dr's to deal with the patient. When we returned later we found out that the patient had indeed been admitted with Meningitis. I truly believe you should go with your instincts and I'm glad I did that day.

We also went to a GI bleed, blood pressure barely readable and two buckets of dark coffee ground coloured blood (hemetemisis). We managed to get some IV fluids into her and whisk her off to hospital.

A horse rider had fallen on the Downs. Just from the location details I knew we need to get one of the helicopters to transport. At the end of the track a walker approached and said that we could drive up the track for half a mile and then walk to the patient. "It's not that far!" said the walker. Famous last words, it was about another half a bloody mile! Obviously I can't name the patient apart from he was a famous publisher. He was pale & sweaty, complaining of severe pain in his hips and left hip. Fractured neck of femur and a fractured pelvis, not the best of combinations. I gave him some morphine on the hill side and waited for the chopper. His blood pressure was only 90/40 so I didn't risk giving him any more. Soon the helicopter was there and within 10 minutes he was packaged and ready to go.
With the odd bread & butter job thrown in for good measure as well, Saturday was over!

Sunday was pretty much the same.
About 10 miles from the hospital reports came in of cyclist in collision with a car at high speed. Not good I thought. We get there and by the side of the road is sitting a man in his forties in full cycling gear. He didn't look right at all, grey, sweaty and lethargic. I took a look at his bike which was unrecognisable. He was cycling at full speed, head down and arse up, trouble is the man driving the brand new BMW didn't see him and pulled into the pub car park right in the path of the cyclist. Bang! " He didn't half make a bang" said the BMW driver. No shit! I thought. The patient was drifting in and out of consciousness and not looking well. We had him immobilised and loaded within minutes. He said he was feeling sick so I gave him some IV metoclopramide for the journey. It's not the best anti sickness drug but it was all I had. The last thing I wanted en-route was to have to deal with an added airway problem. It worked.
In resus the A/E consultant (who looked really pissed off for some reason) asked if I had given an anti-emetic. "Yep and here are some bloods as well!" "Oh, thanks, well done" she said. "That saves us a job" I think she even managed a half hearted smile. Mind you it was hectic in the dept that day. I managed to get a peek at the x-rays. The patient had hit the side of the car with such force that he managed to impact his upper front teeth into his lower jaw bone. By that I mean he no front teeth, they had literally been pulled from their sockets and were now embedded in his lower jaw. OUCH!

A poor old man in his 90's had fallen and broken his hip. He was crying in agony. I've seen elderly people in pain before and usually they aren't complainers. This frail old gent was sobbing. His leg was shortened and externally rotated (obvious sign of a neck of femur fracture) and we had to move him. We couldn't get near him due to the severe pain. I tried Entonox but he was too frail so I gave him some morphine. It was a balancing act because his blood pressure was low so I had to set some IV fluids up and alternate fluids and morphine doses (morphine can drop blood pressure). We had to use a scoop stretcher to get him on to the trolley. This saved him from further pain by keeping him in the same position as he fell.
I had been out to him before and also had the unfortunate task of telling him his wife had died when we were called to her one morning, he was devastated. In fact he was in yesterday with abdo pains. I spoke to his daughter about the fall and his hip and she told me that they operated on him but he later went on to have a massive heart attack. He was in hospital for over three months.

Another call was to a lady who fell onto her knee on a hard tiled floor. She had a fracture/dislocation of the patella (kneecap). It wasn't the usual lateral patella dislocation that can easily be relocated on scene and needs nothing more than Entonox to achieve this, oh no, it was a superior dislocation with her knee cap in 3 parts. She had Entonox and morphine which worked a treat. Her neighbour and friend (a local GP) seemed unaware that we had morphine and said if he had known that I was going to give her something strong he would have used some injectables form his car. I thought if you were such a good friend then why didn't you give her something before instead of sitting with her for 15 minutes while she writhed around in agony in front of her family. Once in hospital she was to go on to have surgery to wire up her knee cap.

Not a bad weekend's work.

I was originally going to post about the jobs over the last week but got carried away with the above . I'll have to continue this tomorrow.

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