After the heroin OD I was sent to a Cat A 16 miles away. It was passed as unconscious and then downgraded to a Cat B Not Alert. I arrived at the care home and was shown through to my patient. He was flat on his back and drifting in and out of consciousness. Airway was good and his breathing was adequate so I went on to the other usual checks such as pulse (which was irregular), blood sugar, blood pressure, pulse oximetry (this was a little lower than we liked) and pupils etc. The staff heard an almighty thud and found this chap completely out of it lying flat on his back. Although he was struggling to stay awake I was able to assertain that he had central neck pain. He was in reasonable health and surprisingly not on a great deal of medication. A crew arrived sometime later and I was pleased to see the Paramedic. He was on my Uni course and also on my in-house Paramedic course, a really decent bloke.
I relayed my findings to the crew and we quickly set about immobilising our patient and giving him oxygen. As usual it was a struggle getting him out as there were so many right angles and door ways we had to stand and tip the long board. I helped load the trolley and stayed with crew as they connected him up to all the monitoring equipment. Within 15 minutes of their arrival the crew were off to hospital.
Last night I had a text from the Paramedic on that job, he said that the patient deteriorated en-route so he popped a line in him, he also confirmed that the patient had bad fractures to both C2 and C3 (two of the bones in the neck). Hopefully it's just fractures and no spinal cord damage. There were no signs of SCI (spinal cord injury) on scene so I am hopeful.
Apart from the OD and Neck fracture on Tuesday I also attended:
A collapse: Young male at work recently diagnosed with tonsilitis who collapsed. He had a high temperature and hadn't been eating or drinking properly for the last few days. He went to hospital and was later transferred to a specialist ENT unit. Probably a condition called Quinsey.
Fall: Elderly male who had a live in carer. He bumped his head and was initially going to hospital as he was on the blood thinning drug Warfarin. It turned out his carer got confused between Furosemide and Warfarin and he wasn't taking the latter. He changed his mind and refused to go to hospital so when my back up arrived they just turned around and left. He should of gone really but if they refuse there isn't a lot you can other than refer them to the GP.
RTC: Minor rear end shunt, Police on scene. A male just wanted his neck checked out. He was walking about and complained that the right side of his neck and shoulder was uncomfortable. He declined immobilisation and was happy for me to take him to the hospital in the car. I'm no DR and not at all cynical but I was thinking along the lines of Acute Compensitis.
Fall: A regular faller who had slipped whilst transfering from his wheel chair to another chair. It was passed as an assistance call but on examination I found that he had a temperature of 38.5 (the norm being 36.9-37 depending on which book you read! Like everything else in medicine.) and his heart rate was up. As he had a catheter in situ I figured it was a UTI (Urinary tract infection), he declined hospital as he would prefer to be treated at home. He wasn't that bad so I called the OOH GP service to arrange a visit. A catheter change and some Trimethoprim would probably sort that out.
Finished on time again.