Thursday, 2 April 2009

Nights again

I'm now, thankfully, on my last of 2 night shifts. Last night was steady with us racking up 7 calls.

1. Chest pain. Female in her 30's. It initially came through as a Cat A chest pain but was downgraded to a Cat B. She recently had her gall bladder removed and was now experiencing excruciating epigastric (upper abdominal) pain. This pain was exactly the same type of pain she had before her gall bladder removal. Her surgeon had told her that she may get this if there were some gall stones left in the system. There obviously was. She had taken the usual pain killers but they hadn't touched it and was on all fours on the bed as this was the most comfortable position. The Entonox wasn't doing anything for her so I had no choice but to cannulate her. Her veins were tiny and I failed the first time. To be fair I managed to get it in but it wouldn't advance as there was a valve and a kink in the vein. Another go on the left hand was more successful (should have tried that one first!). It took a while for the Morphine to kick in but when it did, it worked a treat. She was looking forward to going back to work at the Fire & Rescue control room but was now faced with more time off.
2. Chest pain. Another Cat A and this time it was over 30 miles away! It wasn't a Cat A at all. A lady basically getting anxious because she woke up disorientated at the health spa she was staying at.
3. Fall. ? fractured arm. We got this job on the way back from our previous call. A lady had been putting her shopping in her car when she felt her arm 'go'. Someone called NHS Direct aka NHS RE-Direct (standing joke in the ambulance service) and they said call an ambulance! She has a tender bicep and that's it, she can move her arm and there is no bony tenderness or deformity. 'Do I have to go to hospital?' she says.
'You don't have to go anywhere you don't want.' I reply.
She didn't want to go to hospital anyway and said that it was her family fussing about her. I suspect she pulled a muscle so referred her to her GP for the morning. Before leaving we gave her some advice on RICE (Rest, Ice, Compress & Elevation) and to take some simple painkillers.
Why call an ambulance for that? I would be too embarrassed to.
4. Breathing difficulties. On the way to this job we passed one of our other crews who were supposedly on a cardiac arrest so we offered our services. The Paramedic came out to stand us down and said 'It's not a cardiac arrest at all, I don't what the **** is going on!' There were police every where so I suspect that it probably alcohol related or a punch up. We were reassigned our original breathing difficulties and got going. This chap was struggling and had refused to go to hospital a few days before with similar problems. The previous crew had then passed him on to his own GP who diagnosed a chest infection and prescribed antibiotics. This time it had got a lot worse. His Oxygen levels were low, SpO2 of 80% even on O2, his pulse rate was 140 and his blood pressure was very low. A Salbutamol and atrovent nebuliser was having some effect en-route and we also took bloods and set up some IV sodium chloride to keep his vein open. I didn't really need a stethoscope to hear how terrible his chest sounded but did anyway. I had to just to make sure he had air going in and out on both sides. We alerted the hospital and were greeted by a Dr & Nurse on arrival. I was thinking along the lines of Pneumonia.
5. Urgent journey which wasn't, 999 call which wasn't? We had a phone call from control to say that an ex-paramedic who now works for the urgent care team needed us to go out and do an ECG on a chap with chest pain. It was for a cancer patient who this ex-paramedic was looking after over night. The patient had a 20 minute episode of chest pain which was right sided and moved slowly up to his neck and then eased off. We checked all his obs including his 12 lead ECG which looked better than yours or mine. In fact it looked like a text book sinus rhythm. The patient didn't want to go to hospital and the urgent care team were happy with this. After so much chemo he was just fed up and who could blame him.
6. Breathing difficulty. Cat A. A lady with a history of chest infections, heart attacks and fluid on the lungs. She was very breathless, especially on exertion and needed to be in hospital. She had wet sounding lungs and was basically drowning in her own fluid. Her ECG showed a left bundle branch block (LBBB) which was probably from her previous heart attacks so we couldn't do much about that. After some nitrates and a salbutamol nebuliser her breathing eased and she had settled. At hospital she thought she could transfer her self on to one of their trolleys but soon gave up when she became breathless again.

Another pretty standard night shift.

I'm on my last night shift now as I type this and it's nearly over. I'll post about it tomorrow. Then I'll have 4 days off, I wonder how many garden centres and kids clothes shops my wife can drag me round in that time!


Dark Side said...

I have so been there with the gallbladder thing and exactly as you descibed, it appears it is far too common.

Thankfully after a second operation I have now spasm free.

mac said...

It's surprising how many people suffer from this. All we can do is ease the pain, make them comfortable and get them to hospital