Monday, 25 May 2009

Late meal breaks, crews down, no spare trucks and vehicles breaking down but yet we soldier on. Beautiful sunshine over the bank holiday weekend and I'm stuck at work. It didn't help when my wife text me with 'Hope you're having a nice day at work, I'm off to the beach with the kids.'
Talk about rubbing salt into the wounds! By all accounts they had a nice time. I on the other hand had to slog it out at work.

RTA neck pain, falls, bowel obstruction (requiring morphine-did the trick though and she wasn't very well at all), collapse ? cause, dying swan hyperventilation (after being accused of stealing, this patient just wound me up inside. I'll post about it in the future. Arrgh!), CVA that wasn't a CVA, back injury etc etc. You name it we pretty much had it.
We also had a young lad who fell off his BMX and the brake lever went into his inside thigh and ripped it open. I could have put my whole fist in the wound! He was brave and I'm sure by the time we arrived at the hospital he was now an Entonox (nitrous) addict. Ha Ha. He didn't want anything else for the pain which surprised me. It was a big wound for a kid to have. He asked the A/E consultant if he could go to sleep when they stitched it up. 'I think that might be a good idea' she said softly. I thought 'Too bloody right!'
Cardiac arrest, middle aged man collapsed and smashed through a glass door backwards. He'd been down too long and was beyond help.
The other crews had been to a premature baby who had stopped breathing and was grey and floppy. Airway & breathing management was all that was needed, sugar level fine as well. No other interventions or drugs needed, just a heavy right foot and 20 litres of diesel. The baby took a little while to recover at hospital but by the time the crews had cleared up the little bundle of joy was trying to eat the 02 tubing! A job well done!
My last call yesterday was to guy who had fallen heavily onto his foot the evening before. It had now ballooned up and was bruised. You could feel & hear the crepitus and the swelling was creeping up the outside of his leg. He drained both an F size and CD size Entonox bottle and in the end I gave him some morphine. I'll check up on him tonight. I know it's rare but I think he has broken his Fibula. Usually both Tib & Fib break but there something about where the pain was and how he landed that made me think. I was also worried about compartment syndrome developing. I suppose I'm just being over cautious.
Back in tonight for one of two nights.

Saturday, 23 May 2009

Never ending.

It seems like I'm always at work just lately. Over the last few weeks I've had a run of 4 shifts but thankfully they will end soon.

Monday night wasn't that busy, 4 jobs in total if I remember rightly.

Cat A S.O.B. A Lady in her 50's who had been diagnosed with Chickenpox and Pneumonia was having a job to breathe. She was very ill and in a lot of pain. Her sp02 was 85% even on high flow 02 which was very worrying. Her skin was mottled and her chest pain was impeding her breathing. We weren't on scene long and on the way in I drew some bloods and gave her 5mg of morphine which worked well. She ended up in ITU. I've never known someone of her age having Chickenpox before. Basically her lungs had become so infected it was interfering with her gaseous exchange therefore she wasn't oxygenating properly. Very poorly indeed.

Acute abdo. Male, 60's complaining of severe abdo pain. He had a massive scar which ran down his belly due to diverticulitis and had a small hard mass which was causing him agony. My crew mate said that there was nothing we could do and that we would just go. I was less than impressed with that. There was something that we could do and that was to relieve his pain. One thing I will not do is take someone to hospital writhing in agony especially when I know as soon as we walk through the doors a DR will want the patient to receive pain relief. Treatment of pain is humane, the patient can think clearer and physiologically can help to improve outcomes. This patient was more than grateful for the 10mg of morphine he received.
We did 2 other jobs but I can't remember those.

Tuesday, another quiet night.

Cat A S.O.B. Man in a car on the side of the road. As we pulled up we could see he was on O2. He had COPD and had been driving his car with his own O2 on when he became SOB. He was grey and sweaty and struggling. We gave him some nebs and ran him into hospital. After handing him over to the staff my crew mate was strolling back to us when I noticed our patients eyes rolling back. He was retaining carbon dioxide and had gone into respiratory arrest. I slammed back the head of the trolley and raced him into resus as my crew mate ran for help. In resus I started suctioning his airway, dropped in an OPA and started bagging him. Soon there was a hive of activity and IVs were put in, bloods drawn and blood gases taken. I had the easiest job maintaining his airway while everyone else got a sweat on. 10 minutes later and an Anaesthetist turned up and took over airway management, eventually performing an RSI.
The staff grade DR said well done on managing the airway and he thought that it went very smoothly. It's always nice to get a complement from a member of the hospital staff. I also thought how much easier it is managing a patient in a well lit environment with every thing to hand, not like an ambulance.

We also had an impressive RTA where a front axle had been ripped from a drink drivers car. Luckily there was no one hurt so we left the police to arrest the youngster.

Asthma, pretty much in the middle of nowhere, a lady who reluctantly came to hospital. She had some nebs and IV Hydrocortisone. We had to take her to another hospital in a different area so after clearing up we where desperate to get out of there and back to base. We managed it.

I did some overtime on Wednesday night and to be honest I can't remember what calls I went to, all the shifts lately seem to blur into one long one.

Monday, 18 May 2009

All in a days work.

The weekend was run of the mill stuff, nothing exciting. On Saturday I fluffed the only IV that I could of justified on the last job of the day. A lady with renal colic who was in agony. She needed some decent analgesia but I couldn't get a vein. She said the hospital always had trouble in the past. We had to manage her on Entonox which was OK but not really hitting the spot.
Sunday was pretty much the same. However we did have a birth. A lady who's waters had broke earlier that morning and was just being driven to the maternity unit. But before they could pull off she had one almighty contraction and the baby started to crown. We arrived just as the baby did. Pouring down with rain (bloody typical English weather!) we had to work to get her and the baby out of the front seat of her car. I had to cut the cord on the roadside and after wrapping her in some hooded towels I rushed with babe in arms into the truck to quickly give the baby the once over. She was perfect with an APGAR score of 10 both at 1 & 5 minutes.
All the other drivers were rubbernecking as usual. With the mum now on the trolley, her husband helped my crew mate get her on board. Her placenta was still in situ and there had been minimal bleeding (no need for the syntometrine then!) so we decided to stick the lights and sirens on and cruise over to the hospital.
We also had a chest pain which on the ECG looked like the early stages of an Anterior MI but there wasn't enough ST elevation for me to thrombolyse (damn it!). We gave Aspirin and doses of nitrate spray but when the patient took his O2 mask off the pain started coming back so we gave him some buccal nitrates which helped. We had to wait for an escort (I wont go into detail but he had to have one) which was taking longer than we liked so I put in a cannula and drew some bloods for the hospital. I think he was having either an MI or Prinzmetal angina as the nitrates were helping keep the pain at bay. Anyway at hospital he was soon whisked off some where.
I'm on tonight as well but so far it's been quiet. SHHHHHHHHHHHHHHHHHHHHHHH

Saturday, 16 May 2009

Good news!

Just a quick update about our Intubated guy from my last couple of postings.
I enquired at A/E reception about his where abouts and found out that he had been transferred from ITU down to an acute ward. This meant one of two things to me, either he was fine or that he was not going to make it. I took a stroll over to the ward and as I walked along the corridor I looked in one of the side rooms and saw this guy. Was it him? I checked the names on the board and sure enough it was him. The staff were all busy so I went back to the room. I couldn't believe it. He looked healthier than you or I. I introduced myself and we chatted for about 10 minutes. He told me that the DRs still didn't have a clue what was wrong with him and that he had all manner of tests. He asked if we had to shock him, I told him we didn't but he wasn't in good shape at all. He thanked me and I left him in his side room.
These sort of jobs don't happen that often but when they do it makes you realise just why we are here.

Monday, 11 May 2009

Update: Unconscious male

I managed to get back to the hospital in the early hours and spoke to one of the A/E DRs regarding our unconscious chappie that I intubated. He had a head CT and that was fine. In fact they still hadn't reached a diagnosis and didn't have a clue what was wrong with him. He is now in Intensive care and the plan is to wake him up and see how he does. Unfortunately I'm not back to work until the weekend so I'll have to check up on him again, if I remember that is.

It's not often that as a Paramedic I get to intubate. If I do then it is usually Cardiac Arrest or severely head injured patient and even then those patients usually die. I said most, not all. Now this job has puzzled me. Yeah OK I had to give 10mg of Diazemuls for his ? seizure but surely that is not enough to knock him flat enough in order for him to tolerate an ET tube. The other puzzling thing is that they haven't been able to find anything wrong. At the end of the day, his airway was compromised big time and he was having some sort of seizure. I did the best I could with skills that I had available.

Time to earn my money.

Cat A unconscious, backing up the car. We arrive on scene 6 minutes after the car. A few people are frantically waving us down. A man in his 40's had collapsed, was barely breathing and blue. The RRV tech already had him on O2 and had done some baseline obs by the time we had arrived. His airway was clamped shut and a nasal airway was proving unusually difficult to insert. There was dark red blood and vomit coming from his mouth. His pupils were dilated, his Oxygen levels were 71% initially rising to 94% on O2 and his BP was a little low at 110/72. He was a big chap! Was he having a bleed or some kind of seizure? I didn't know, all I knew was that we had to get him out quickly. While my crew mate moved the truck to another doorway I stuck a line in and drew some bloods. It took a while to get him out because he was heavy and we had trouble getting him round the corner through the door. But with some help we managed it. Now on the truck we connected him to the monitors while I suctioned his airway. He looked like he was having some form of seizure so I gave him 10mg of Diazemuls which seemed to settle him down. I still wasn't happy with his airway so we positioned him on to his back and carried on suctioning. I popped in the laryngascope and swept his tongue to the left, a bit more suction and then in with an 8.5 ET tube. He was tolerating it so I inflated the cuff and connected him up to the BVM and assisted his breathing. Although he was breathing, it wasn't adequate so I just gave a helping hand. His BP had also dropped to 91/61 so I had some fluids running as well. I pre alerted the hospital and carried on ventilating him en route. Another check of his BP and it was down to 85/40 so I opened up the fluids a bit more. His O2 levels were 100% and he was still tolerating the tube. But when I re checked his BP it was unrecordable and he had no radial pulse. I connected him up to the transport ventilator and shouted through to my crew mate that I was going to put in another line. I waited until we went through a few roundabouts and found a big vein in the crook of his elbow. I managed to get in a 14g brown (this is the biggest size IV we carry) and set up some more fluids. As we pulled into the hospital his BP was now back up to 99/64. At this point I had got a little bit of a sweat on! We handed over to the staff and by now his resps had increased with good tidal volume so they connected him to a patient circuit. Surprisingly he still tolerated the tube and was trying to wake up. They also tested the bloods that I had obtained but found nothing out of the ordinary. Puzzling! There was a bit of a discussion about whether to paralyze him or just to continue sedation. The decision was to keep him sedated with propofol.
As of yet I haven't been back to the hospital to see how he is getting on but hopefully I might find out later on as I still have nearly 6 hours of this shift to go.

Friday, 8 May 2009


Today I was crewed up with another Paramedic (recently registered) and the expectations were high. By that I mean everyone else thought that we would go to all the 'proper' jobs.
'Oh, those two are together today. We'll be doing all the falls and probably wont get a look in' said one colleague. To top it all after our first job we had an army medic jump on the truck to observe for the shift. That was the kiss of death! Even my crew mate thought because he was working with me that he get some good jobs. The trouble with all this expectation is that nothing usually happens. I always say 'If you come in and don't expect proper jobs then you might be lucky and get a couple that require our skills. But if you come in with high expectations then you'll go home disappointed.' And that is how it usually happens.

1. Seizure. 11 yr old who had stopped fitting on our arrival. History of a single seizure 2 yrs ago. Thoroughly investigated and found that strobe lights affected him. This AM he had been sitting close to the TV and had a seizure. Monitored and transported to A/E for further assessment.
Picked up our army medic at A/E
2. Chest pain. Lovely elderly lady who was cheeky and could talk for England despite being severely breathless. O2 and into the truck and around the corner to A/E. Her heart rate was 150+ and climbing, it was also irregular. Turned out her problem was fast AF.
A stint of stand by at the Dr's surgery.
3. Chest pain. Whilst at the surgery one of the DRs came out and said 'Just to give you the heads up lads, I've got a patient inside with SVT who'll need to go to A/E' And sure enough the job came through. Must have been the quickest Cat A response time ever! We were slightly miffed as we were tucking in to sausage rolls and a steak slice as he came out! Middle aged lady with a pulse rate of 190+and feeling light headed. O2, IV access and a 12 lead then blue lighted in. On the way I tried the valsalva manoeuvre with a 20 ml syringe which worked briefly and brought her heart rate down to 115. It was short lived and despite repeated attempts her heart rate was still banging away at 190+.
4. Urgent journey. Urinary retention from a nursing home. By the time we got there the patient had managed to empty his bladder but had now developed diarrhoea. The nurse in charge didn't really want him to go in because of this so we agreed to let her contact the GP and arrange further assessment. At last a nursing home that actually uses common sense!
5.Fall. Assistance only. GP was attending anyway and did so while we were on scene. We left her to deal with the patient.
6. Fall. Elderly lady who fell down a few carpeted steps and bumped her head on the plaster board wall. Very anxious and not completely recovered. A trip to A/E.
7. Entrapment...................................................In HANDCUFFS! Young lad larking about with mates in the street put on one of the cuffs and couldn't get it off. A friend was worried about circulation. On scene within a minute and quickly followed by Fire & Rescue. I was going to get our bolt croppers out but seeing as Fire were right behind us decided to let them get on with it. In the end they used a leatherman tool to pick the locking mechanism and set the lad free. The funniest part was when said that it was too tight and would have to take his arm off below the elbow. His face was a picture! He walked off with his mates soon after.

With shift now over, my crew mate looking thoroughly peed off, said 'Thanks for a thoroughly average day!'
Well I did say don't come in with high expectations didn't I!
I spent a little time chatting on base with some of the night crews and an officer who had been at a Police shooting during the day before driving home.

Back Saturday and Sunday night. I wont be expecting much!