Thursday, 5 March 2009

Finally I have 3 days off. I feel knackered after 5 days on the trot.

Chest pain from a DRs surgery. There was one of our Paramedics already in the surgery, he was on a placement for his Paramedic Practitioner training and he handed me a 12 lead ECG. It showed flipped T-waves which is an indicator of ischaemia. On board we connected him up to our monitor and started treating him. He had chest pain for 24 hours which wouldn't go away and had difficulty breathing when lying flat through the night. I suspected that he had a heart attack the previous day. He had probably had a sub-endocardial infarct which basically means that it hasn't affected the full thickness of the heart muscle. Never the less it is still serious and needs prompt treatment. When transferring him from the carry chair to the trolley he became very breathless but as soon as the oxygen was on it eased off. He still had pain which wasn't relieved by nitrates so I put a line in to give him some morphine but he declined this.
At hospital he was told off by one of the CCU nurses for not having pain relief even more so because his heart rhythm was now in fast AF and the ST segments were now starting to elevate. The team then started to fuss about him with some urgency. By giving pain relief to cardiac chest pain patients not only does it take the pain away it also takes the strain off the heart and reduces the risk of nasty heart rhythms which can be fatal.
Our next call was to a COPD patient who was staying at his holiday home with his wife. He also had a double colostomy and abdominal fistula. The call was a possible bladder infection. He had an infection alright, probably septic. He was more breathless than usual, had a temperature of 39.9 and was also tachycardic & hypotensive. He had a total of 1000mls of IV fluids en-route and a 500ml bag connected as we arrived at hospital to keep the vein open. His blood pressure was still only 83/40 when we got there. I saw his wife the next and found out that he had a serious chest infection amongst other things and would be in for a few days.

The rest of Monday and the following day were pretty unremarkable with the usual routine jobs.


I was on overtime again. I know what your are thinking, MONEY GRABBER! Too bloody right, take it while you can. It won't last forever.

I was on the new response car and was soon on my first job. It came through as a penetrating injury. A 12 year old managed to get a knitting needle stuck in her thigh. When I arrived I was shown up to the bedroom where the young girl was being comforted by her dad. There was a wooden knitting needle sticking out of her thigh. Compared to the other one I could tell that it had gone in approximately 4 inches and it taken some of her pyjamas in with it . I cut up the leg to get a better look. Being in a lot of pain I started her off on some Entonox which really hit the spot. She was out of it at times. I did say that I may need to put a drip in her hand and give her something stronger if when we come to move her it starts to really hurt. She didn't need it, the Entonox was more than effective. I was backed up by a critical care ambulance who then took over care and transported her to A/E.

A collapsed female who kept passing out while sitting/standing. She was taken in by a crew.

My third and final job was to a lady in her 40's who had a stroke a year ago and had only just started to recover. She phoned her friend in a distressed state who then called 999. Her friend recognised that she may be having another stroke and went straight round there. I used the FAST and Miami emergency neurological deficit exam and quickly concluded that she was indeed suffering a stroke. I checked her other observations and got on the radio to see where my back up was. The crew arrived about 60 seconds later and our patient was quickly on board and en-route to A/E. The stroke team were ready and waiting and according to the crew the DRs think that she may have suffered a sub-arachnoid haemorrhage. I was thinking of a clot at the time and thought that she may have been a candidate for stroke thrombolysis, sadly it wasn't to be.
I'm not sure what happened to her maybe she got transfered out to the neuro centre for an operation.


Mart said...

Whats a critical care ambulance?

mac said...

In our service we have critical care paramedics. They work on their own dedicated ambulance or on one of the HEMS choppers. They have extra drugs such as ketamine & midazolam = a few others I believe. They have CPAP and I'm not sure but they may have ultrasound equipment to detect bleeding in the abdomen, or it may only be on HEMS. Apparently they have some other tricks up their sleeve but I'm not sure yet. I'm trying to find out myself at the mo. Unlike us stretcher monkies they are'nt part of the deployment plan. They can self task to serious jobs or may be given them via control as usual. Still early days yet. The uni course is 9 months plus more hospital placements. Hope that helps.