Monday, 11 May 2009

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.

No comments: