I know I said I was going to post the following day but to be honest I've been so busy I haven't had the time. So here goes (before the station alerts go off again!). Yep that's right I'm on another night shift.
Back to last week or was it the week before? I can't remember. Anyway I was working with the same trainee as in my previous post. Two shifts, midweek. The first call of the day was to a diabetic with prostate cancer who was due in at the treatment centre for a surgical procedure. We were called because his wife couldn't move him. He had collapsed on the toilet and was 'off legs', a term commonly used in the UK. We took one look at him and realised that he was unwell. He was grey in colour, lethargic, had low blood pressure and was also hyperglycemic. His wife thought that if she called us he would get his procedure carried out quicker. Sorry, it doesn't work like that, we need sort out immediate problem before anything else. On with some high flow O2 and some IV sodium chloride. By the time we got to hospital he had perked up but still had to assessed by a DR before he had his surgery.
Our other two crews had been called out to a male who had jumped from the top of a multi storey car park. He was critically injured. The crews did an excellent job as usual but unfortunately he died of his injuries later that day.
Our next call was to a lady having a possible stroke. When we got there we were confronted with an unconscious lady on the floor. She was gurgling and her breathing was laboured. She tolerated an oral and nasal airway. It wasn't looking good. Her airway was becoming a major problem and after lots of suction I intubated her. Although she was still breathing, it was ineffective so I took over. Getting her out of the house was a nightmare, there were right angles everywhere and trying to get her out flat was impossible. In the end we had to get her on a carry chair and weave our way through the property eventually reaching the ambulance. I hooked her up to the ventilator and all the other monitoring equipment, her BP was 214/115! On the way in I tried to get a line but there were no veins anywhere so I left that to the hospital. We arrived about 15 minutes later with lady still ventilated, en route she had stopped making any respiratory effort so I had to support it fully. I carried on ventilating as the A/E DR assessed her. He struggled to get a line in but after several attempts he got one. I didn't feel so bad that I missed. There's nothing wrong with knowing when to give up and let someone else take over or have a go. I see no point in digging around leaving the patient like a pin cushion, if you can't get a line you can't get a line. She had a CT scan and a massive stroke was confirmed. She died later that day.
We also had a couple of elderly patients with hip fractures who needed morphine and a chest
pain. Plus the usual non-injury calls, nosebleeds and chest infections.
A couple of days later I was with yet another trainee and got a call to an asthmatic. She only lived about a hundred yards from the surgery so she made over to there. The GP had started her on a salbutamol nebuliser and added some ipratropium bromide to the next. It wasn't doing much for the patient. I switched of the electric nebuliser and plugged into my oxygen. On board the vehicle I checked her peak flow which was only 120 (her normal being 450). She had a pulse of 128, resps were over 40 and O2 sats of 90% so I gave 200mg of IV solu-cortef (hydrocortisone) and a further neb. This seemed to make things a little easier by the time we got to hospital. They say steroids can take hours to start to have any effect but I've researched solu-cortef and have learnt that it is a rapid acting steroid with an onset of action between 30-60 minutes. I now always try and give it early in patients suffering acute/severe asthma unless of course we are round the corner from the hospital, then it's a neb and heavy right foot.