Monday, 30 March 2009

Welcome to the ambulance service!

I turned up at work this morning expecting yet another manic Monday only to find out that we were having yet another observer out with us for the day. Well that was it, cursed again!
We had an A/E nurse with us, in fact she was due to start in A/E today but was told to come the ambulance station instead.
We did 6 jobs in total and it was pretty much bread and butter work.

1. Diabetic/Vomiting. Regular caller (alcoholic & ex IVDU) who had D&V all night. 'I can't breath, I can't breath, I can't breath!' she kept saying (SPo2 98% on air & would give any one a run for their money at the world fastest talking person championships). She had vomit on her night dress and wanted us to get her changed. Begrudgingly we obliged. She had a broken shoulder from a previous fall and was playing on this, her care package had now run out and wanted us to get her up. I knew the moment we got her changed that she would refuse hospital. We spent 40 minutes on scene waiting for her to make her mind up. 'Wait a minute, wait a minute, wait a minute, I can't breath, oh I'm panicking now!
'Naaaah, I fell a lot better now.' she replied
AAAAARRRRRGGGGGHHHHHH! I thought to myself. So after checking her observations (which were unremarkable-surprise, surprise) and completing the paperwork we left her to it. My first words to our nurse observer were 'Welcome to the ambulance service'.
Back on base and I called up the patients GP and referred her to them.

2. Fall. Elderly lady who fell in the bathroom and was wedged behind the toilet. A local DR was already on scene and gave us the low down before leaving. 'Your the experts at this, if you don't need me I'll leave you to it.' were his departing words. She was riddled with arthritis and had a recent knee replacement which was now hot and inflamed. She was in a lot of pain. It wasn't long before we were on the road to hospital and her concious level had decreased. I popped her on some oxygen and tried to get a line for pain relief but as soon as I touched her wrist with the cannula, she flinched.
'Stop hurting me you're hurting me! she said.
' You're not sorry at all!' was her reply.
I wasn't going to persist so we just got her to hospital, moaning in agony all the way. I thought it was me but as we wheeled her through the ambulance bay doors she took one look at the floor and started moaning about the type of floor it was. I put her comments down to an infection originating in her knee which was making her delirious.

3. Fall from a height. We were backing up an EMT on a response car who was on scene with a guy who had fallen backwards off a ladder.
'You'll need a collar and backboard lads!' shouted the EMT as we approached. Our man had a large laceration (approx cm) to the top of his head, complaining of pain in his arm and lower back. After immobilising him and getting him on the truck I set about giving him some Morphine. His head wound started to bleed profusely, he had an obvious fractured arm and considerable back pain. With the Morphine now kicking in and my crew mate controlling the bleeding we rushed him in. We called ahead and were greeted by a full trauma team who set about repeating the Primary survey and then on to the secondary survey and scans, X-rays etc.
It took us an hour to clean out the back of the truck; head wounds bleed alot!
We later found out he had fractured his spine but will hopefully, in time, make a good recovery.

4. Overdose. Young female who took 30+ paracetamol last night and now had abdominal pain. Less than 2 minutes on scene and we were on our way to hospital. She had been waiting outside her parent's house and had called the hospital for advice, apparently they said dial 999. I doubt it, it was probably more along the lines of 'Get yourself to hospital and we'll see you'

5. Mental health patient under section. On scene were 3 police officers, a Psychiatrist and 2 social workers. We were called to transport this lady to a mental health unit. She remained silent so the police had no other option but to force her to come. They kept apologising as one of the officers carried her down the stairs into the ambulance. She remained silent all the way there. As I opened the side door to let her out I said 'Come on then we're here, don't worry there's no police about. Let's get you inside.' and with that she got up and walked into the unit.

6. Fit. Known epileptic lady who had recently undergone shoulder surgery. She had a small fit, nothing out of the ordinary but was now complaining of severe pain in her bad shoulder. In the past she had dislocated it (13 times this year!) during her seizures and needed it repaired in surgery. She now feared it dislocated again and was in agony. I started her off on Entonox but en-route I had to give her some Morphine as the Entonox wasn't really doing it's thing. She threw the old IV challenge thing at me.
'You'll never get one on this arm, all the veins here have been scarred and used up by the Paramedics and DRs when I've been status (Status Epilepticus-continuous seizures which is potentially life threatening) and when I've dislocated my shoulder before. The only good ones are on this hand!' She said wiggling her fingers on her bad arm. I couldn't see a vein but could feel one so I went for it........................................and got it in..............................albeit a small blue 22g cannula. It didn't matter, a line is a line and it was only for analgesia. At hospital she said thanks and we bid her farewell.

And that was Monday, the usual bread and butter work and finished an hour late!
Tomorrow we have a med student coming out with us. I wonder whether it will be the curse of the observer on that shift?

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