Tuesday, 17 March 2009

Time off

I've now got 7 days off! I could do some more overtime but I'm not going to, there is enough of it going around afterall. I think I've done more than my fair share and it's not like I haven't got any more shifts lined up!
I've already plumbed in the new washing machine that arrived this morning and cleared the garden of the old furniture that we've been slowly replacing. I'm sure the wife has got more jobs lined up for me. Ha Ha.

So just to conclude my shifts.

Wednesday night:

our first call was passed as a cat A Asthma, 3 year old. When given a potentially serious job, especially a child, I usually look up the possible drug dosages and jot them on my glove. This saves time when initiating treatment. So there we are racing to this child with 'Severe Respiratory Distress', I've written down the hydrocortisone dose on my glove, 57mg. I knew the salbutamol and atrovent neb dosages and was thinking to myself 'If it's bad we'll just load and go and I'll treat on route'. If I have to give hydrocortisone I'll probably give it via intramuscular (IM) injection into the thigh. I could give it IV but in a child with severe breathing problems trying to cannulate will be far more distressing for the child and that's the last thing we need. If the child needs assistance with their breathing then hydrocortisone will be the last thing on my mind as supporting breathing will be the main priority. Even more so if working solo or part of a crew. To provide effective ALS in kids you need more than 2 crew in order to maintain good uninterrupted basic care.
With all this in mind we arrive on scene only to find a response car already on scene. Nobody told us, no change there then. Inside we see a senior officer chatting to the mum and I start to scan the room for this apparently really poorly kid. I do however find a cheeky 3 year old sat on the sofa cuddling a teddy bear, grinning at me. No breathing problems. The child has been ill for 3 weeks, has a temperature and not drinking much water. The GP has already prescribed antibiotics but the mum wants him checked out at hospital as he can't keep any meds or fluids down. So after deciding which toy he wanted to take we got him & his mum on board. On the way he said he was a bit breathless so we gave him some oxygen which made him feel a little better. At hospital we handed over to the nurse and sat them in the paediatric waiting area. Personally I would of just rung the out of hours GP or popped in to my own DR in the morning but there are some people who think hospital will be the best option for every thing. Oh well it makes no difference to me as I get paid the same whatever calls I go to.

The rest of the jobs are just routine falls and drunks.

Thursday night:

We did have what was initially a serious job. An unconscious female who had recently been discharged from hospital earlier that day. Carers couldn't wake her and she was foaming at the mouth. We sorted her out after plying her with oxygen and got her to hospital in a better shape than when we first arrived on scene.

Another child, this time a 7 month old with a fever of 40.2. When going to a child that is potentially seriously ill I want to rule out certain things, hypoxia (lack of oxygen), menningococcal septacaemia (by searching for a rash amongst other things & then rapidly treating with antibiotics), seizures (terminating them with anti convulsants if needed) and hypoglycemia (which can be common in ill kids, not just diabetics either, and treating appropriately with IV glucose etc).
As we pull up I recognise the house. A very nice house in a nice part of town and after seeing the mum I knew why I recognised the place. Just before Christmas I took her husband into hospital with pneumonia and he was really poorly. I remember that he had severe chest pain and was hypotensive (low blood pressure).
The young mum burst into tears when we arrived and told us that she was awaken by her baby's erratic breathing. She been off her food for 2 days and then later that evening started getting irritable and developed a fever. Thankfully there was no sign of a rash and her sugar level was fine too. We had to wait a while for the grandmother to arrive to look after the 2 other sleeping children. Prior to our arrival the mum gave the child 2.5ml of ibuprofen. With a temperature so high the child risked having a febrile seizure so all we could do was watch as we took them both to hospital.
After we handed over, my crew mate made a remark which annoyed me.
'What was her problem? Is she spoilt or what!' I couldn't bite my tongue so I told him what I thought. Not in a nasty way but I just said that this woman was scared shit less about her baby and was probably panicking. I wasn't going to lose my temper as we actually get on really well but as my crew mate doesn't have kids and I have 4 I think I have a right to share the benefit of my past experiences.

More routine calls.

Overtime Sunday:

On the response car yesterday for a couple of jobs and then on a vehicle for the remainder to cover sickness, AGAIN!

Another child, Allergic reaction. It was a mild reaction to penicillin but didn't warrant any treatment by us. Some liquid piriton would have done the trick but we only have IV/IO/IM piriton and she wasn't going to get any of that as her symptoms weren't causing her any discomfort or distress. There was a long history of penicillin reactions in the family so the crew took her in for a check up. It didn't help that she had chicken pox as well and had been put on antibiotics as 2 of her blisters had become infected. You could see a fine rash developing on her skin, completely different from her chicken pox.

More falls, one which took us over 9 minutes just to get into the building thanks to all the key safes and care line buttons etc. Good job it wasn't an emergency!
We also went to a diabetic lady who was discovered by her friends. Her sugar level was low and she refused to eat any thing. After giving her 100ml of IV glucose she was wide awake again. This wasn't the first episode this week and she refused hospital so we referred her to her diabetic nurse in the morning. I also contacted the out of hours GP so the incident would be recorded and left the lady in the care of her neighbour.

I was due to finish at midnight but got caught with a late job, a chest pain. 69 year old male and there I was rubbing my hands thinking I may get to thrombolyse. I wouldn't have minded being late if that was the case but no such luck!!!

Back next Monday when I'm on a response car....................................................on overtime!

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