tag:blogger.com,1999:blog-40512834046500447462024-03-06T06:49:20.944+00:00UK Street medicmachttp://www.blogger.com/profile/12224939870747906286noreply@blogger.comBlogger169125tag:blogger.com,1999:blog-4051283404650044746.post-64096862117291825032012-10-17T13:20:00.001+01:002012-10-17T13:21:15.481+01:00Paramedico trailer<iframe allowfullscreen="" frameborder="0" height="270" src="http://www.youtube.com/embed/yYEeBO61z_Y?fs=1" width="480"></iframe>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com1tag:blogger.com,1999:blog-4051283404650044746.post-28876466803138194772012-02-24T10:21:00.002+00:002012-02-24T10:31:31.551+00:0090 Enquete, SAMU l'urgence au quotidienFrench Prehospital care which is provided for by SAMU and Pompiers. Physician led system.<br /> Unfortunately I'm limited to "Je suis mal al a tete" or jai mal au dos!" Nevertheless there are several of these shows available to watch. Even though it's in French (obviously)it's pretty easy getting the jist of things (if you have EMS/prehospital background). Well I enjoyed it anyway.<br /><br /><br /><iframe width="560" height="315" src="http://www.youtube.com/embed/jT38MEJPoBg" frameborder="0" allowfullscreen></iframe>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com4tag:blogger.com,1999:blog-4051283404650044746.post-65743303999756638662012-02-23T18:21:00.000+00:002012-02-23T18:21:11.783+00:00Tell Me And I Will Forget | Watch the Documentary Film Free Online | SnagFilms<a href="http://www.snagfilms.com/films/title/tell_me_and_i_will_forget#.T0aDjsGP8sg.blogger">Tell Me And I Will Forget | Watch the Documentary Film Free Online | SnagFilms</a>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com0tag:blogger.com,1999:blog-4051283404650044746.post-36960274043462480322012-02-21T14:48:00.001+00:002012-02-21T14:50:26.036+00:00Me and the misses (no kids, yayeeee!) are off to New York City in a few weeks time so if any guys on an EMS bus want to let me get a pic that would be great.machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com0tag:blogger.com,1999:blog-4051283404650044746.post-47329013782338438382012-02-21T14:34:00.001+00:002012-02-22T15:11:01.971+00:00South African EMS<script class="45ddfef0-a74a-11e0-a92a-0026bb61d036" src="http://embed.snagfilms.com/embed/embed.js?filmId=45ddfef0-a74a-11e0-a92a-0026bb61d036&width=500"></script>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com1tag:blogger.com,1999:blog-4051283404650044746.post-38311292317632586252010-08-04T23:28:00.003+01:002010-08-04T23:50:39.386+01:00Bright lights and shiny steelI get a call, Cat C, the lowest priority call. Female unwell. I'm working on a response car and arrive within a few minutes. The door is open and I'm faced with an elderly lady sat in her arm chair complaining of abdominal pain. As I get closer I notice the beads of sweat running down her face and chest. This lady isn't well at all. There is no back up available, I'm on my own. A quick examination reveals no radial pulses, indicating that her blood pressure is very low. She has abdominal pain radiating through to her lower back. I don't need a medical degree to work out what's going on. This lady has a leaking AAA (abdominal aortic aneurysm) and the clock is ticking. I call for a crew and start my other observations, ECG, blood pressure and oxygen saturations. She has an enormous vein on the back of her hand which is a dream come true in a seriously unwell person. I place a 14g IV with ease. The crew arrive and another BP is obtained, it's 70 systolic. 500ml of Hartmans is run through by the time we get to the Resus room, pressure now 99 systolic and before we know it the consultant is performing an ultrasound scan. Diagnosis confirmed, leaking AAA.<br /> The last place this patient needs to be is A/E or in the back of an ambulance, she needs to be in the operating theatre or as one of my old training officers likes to put it "She needs to be where the bright lights and shiny steel are".<br />When I last checked she had gone to the operating theatre (OR for my US colleagues). I don't know the outcome. I hope she made it.<br />The job came in as a Cat C call, it turned out to be a genuine Cat A. If a Cat A breathing difficulty came in I would have been redirected to that and chances are it would be a 15 year old hyperventilating having a panic attack. My Cat C lady may not have made it.machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com4tag:blogger.com,1999:blog-4051283404650044746.post-72692881663074040942010-08-04T22:51:00.002+01:002010-08-04T22:59:04.821+01:00Chronicles of EMSI'm back! Don't know how often I'll post or what about. Many seem to have fallen by the way side. Shame really. Just been watching chronicles of EMS with Mark G (aka medic999) and it reminded me of when I was in Richmond VA. Wish I'd had a camera and filmed it know. Doh!<br />Anyway I've added the link (look left), Enjoy.machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com0tag:blogger.com,1999:blog-4051283404650044746.post-67639492868959304822009-09-19T16:01:00.002+01:002009-09-19T16:03:35.078+01:00What a beauty<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiC6IWZaFIqIF3z9MC1nMOjJoaq86et-QT6L2Gmc4l4KSm7RHkIcmsmDlkGyKxP6r_O6MQBiH9prF_w9QlVmvUewgtUo8jAtPmLZuPzjOKFAJAfWIzLLdHYlJ1Ig0tDUG8DC7R1uibfzYv4/s1600-h/vulcan1.jpg"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 400px; DISPLAY: block; HEIGHT: 387px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5383194332945372418" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiC6IWZaFIqIF3z9MC1nMOjJoaq86et-QT6L2Gmc4l4KSm7RHkIcmsmDlkGyKxP6r_O6MQBiH9prF_w9QlVmvUewgtUo8jAtPmLZuPzjOKFAJAfWIzLLdHYlJ1Ig0tDUG8DC7R1uibfzYv4/s400/vulcan1.jpg" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEij8pkvSGy1g1C_mPgsRwFuuci6cZCtz06GzNvBzqGFSJrEzOZrUJSqXo_quh7JH5QDgKJCoX4lBwZxF53KLfa9IABxg1TiBV85uQ-xs7tCN8SVxJbKrZsAhfOC_gnlj1-90GVkPVeZnglu/s1600-h/500-avro_vulcan_XH558_takeoff.jpg"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 400px; DISPLAY: block; HEIGHT: 262px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5383194329133781442" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEij8pkvSGy1g1C_mPgsRwFuuci6cZCtz06GzNvBzqGFSJrEzOZrUJSqXo_quh7JH5QDgKJCoX4lBwZxF53KLfa9IABxg1TiBV85uQ-xs7tCN8SVxJbKrZsAhfOC_gnlj1-90GVkPVeZnglu/s400/500-avro_vulcan_XH558_takeoff.jpg" /></a><br /><br /><div>Nothing ambulance/EMS related but I've just been watching this fly. Such a beautiful aircraft.</div><br /><br /><div></div><br /><br /><div></div></div>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com10tag:blogger.com,1999:blog-4051283404650044746.post-84506571446392050812009-09-11T10:27:00.002+01:002009-09-11T10:29:02.089+01:009/11 Never forget.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqaBUY_EG6KoL1hfLJ8vIP6zZ8qZc1PdQrJUft8DnsCqc3U73Y6r6jrC6AttB-MDCG_1Dm_p_SaTBOnTZkTRlsV3TLizw0MvS0hius48_s5Pp-9sOYEimIFL-_DDJWRk4E7TRfqdK_JRZ-/s1600-h/sunriseid9.jpg"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 264px; DISPLAY: block; HEIGHT: 400px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5380139309149576578" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqaBUY_EG6KoL1hfLJ8vIP6zZ8qZc1PdQrJUft8DnsCqc3U73Y6r6jrC6AttB-MDCG_1Dm_p_SaTBOnTZkTRlsV3TLizw0MvS0hius48_s5Pp-9sOYEimIFL-_DDJWRk4E7TRfqdK_JRZ-/s400/sunriseid9.jpg" /></a><br />God blessmachttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com0tag:blogger.com,1999:blog-4051283404650044746.post-64477432415949302562009-09-05T08:38:00.004+01:002009-09-05T22:21:44.742+01:00Running on emptySat at the hospital waiting to push clear. We pause as we hear the crew, that had previously cleared, get a job. It was to a person in a car on the side of the road and they were having real difficulty locating the person. Oh well, so we pressed clear. Next thing we get a job and it's also to a person in a car on the side of the road. Psychiatric problems. I was wondering why we copped the same job seeing as the other crew were closer. As we are so often reminded by control "You don't know the bigger picture", I wasn't going to argue. Even if we really wanted to get back to base for a cuppa. Details were sketchy and the location was somewhere along a road that stretches pretty much from one end of the county to the other. It was passed as a Cat C, non-life threatening. We heard some radio traffic and it appeared that the other crew were still attending, not because it was serious but because there was two separate incidents. Two cars, both psychiatric patients, both wanting our help and both crews non the wiser of the exact location of either. We eventually got a description of the car and went to search in the west. The other crew were searching the east. As soon as we were on the dual carriageway we spotted a car in a lay-by on the opposite side of the road and people were waving. Because of the central reservation we had to drive 9 miles to the next slip road and back again to get to our patient. Police were also thundering up and down the road. "They must know something we don't" I thought. We arrived and pulled up in front of the car. As I got out I could see someone lying in the front passenger seat and as we drew closer he appeared to be dead! His colour was appalling, white and grey with blood and faeces mixed in for good measure. Not quite what we were expecting at all. I took a closer look and spotted a deep laceration to one of his wrists. It had stopped bleeding. He was incoherent and moving around without any real purpose. I tried to put an oxygen mask on him but he kept tearing it off. A severe lack of oxygen in the system will do that. While he was waving his arms about I spotted another deep laceration this time it was at the crook of his elbow on the same arm as his wrist laceration. He had done this to himself and had done a good job too. I glanced behind him and in the rear on the floor was a mass of congealed blood. He must have lost half his blood volume. I was surprised he was still alive! As my crew mate was bringing the trolley over I decided to get some IV access in the chaps arm as everything else was proving fruitless. A couple of police officers helped stabilise his arm while I inserted a 16g (grey) cannula. I stuck it down and then secured it with a bandage so he couldn't rip it out. I didn't attach any IV fluids at that point because I knew that the IV would be pulled out for sure. We managed to get him out of the car and onto the trolley and then into the vehicle. I got the fluids running (as there was no radial pulse) while my crew mate desperately tried to obtain a blood pressure. Unrecordable. I needed another line. The only other real option was one in the leg. I could have gone IO but spotted a vein on the inside of his ankle. And in went another 16g and another bag of fluid. No time for blood samples, the hospital could get them via the femoral route later. All while we were working on this guy I spotted a German couple in a motor home filming us, cheeky buggers! We weren't there long and were soon off to hospital. His blood pressure was now 82/36 after a 800ml of fluid and there was a weak radial pulse present. He had also settled and was now tolerating the O2 mask but was still incoherent. This guy needed blood and not basically water in a bag.<br />I think he had cut himself sometime earlier as his blood vessels had clamped shut and were no longer bleeding (the critical hemorrhage kit was not needed). A few minutes later we arrived at hospital and went straight into resus. The young DR seemed impressed that I managed to get a 16g IV in his arm especially after all the blood loss but when I lifted up the blanket and showed her the 16g in his ankle, TA DAAA!!!, she grinned "Blimey, we had a bet when we got the pre alert and it said Paramedics have an IV, we all said it will only be a green (18g). And you've got 2 greys in! Well done!" (I'm so glad I work where I work. The hospital staff are great and we are like one big family)<br />Anyway we clear up the truck and off we go on to the next job. Later we see the guy who is now a nice pink colour and reasonably coherent, enough to have a simple conversation with. He received 6 units of blood and was due to go to theatre to have his tendons, nerves and blood vessels repaired.<br />Why he harmed himself, lord only knows. A good job though!machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com2tag:blogger.com,1999:blog-4051283404650044746.post-40885453459814836092009-08-22T00:55:00.001+01:002009-08-22T00:58:22.833+01:00This just cracks me up<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTR8Qh6lHThdDmGCBnszoUx1z__tjHUv3Er2fdLcMvZhJBaRGjDPiEgrWR1WpU-POL3Op3_Ru1CGFht-T9AY7sjNrJeeq9Fe6g2ddlhHxTL-gSMs24Ojmilc5fkqG62e1lRZ1wFfE1gHKl/s1600-h/YouGetWhatYouPayFor.gif"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 400px; DISPLAY: block; HEIGHT: 248px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5372570306276971618" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTR8Qh6lHThdDmGCBnszoUx1z__tjHUv3Er2fdLcMvZhJBaRGjDPiEgrWR1WpU-POL3Op3_Ru1CGFht-T9AY7sjNrJeeq9Fe6g2ddlhHxTL-gSMs24Ojmilc5fkqG62e1lRZ1wFfE1gHKl/s400/YouGetWhatYouPayFor.gif" /></a>I have no experience of the private ambulance sector but this picture just cracks me up!<br /><div></div>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com1tag:blogger.com,1999:blog-4051283404650044746.post-6921020097041520692009-08-21T23:57:00.002+01:002009-08-22T00:34:18.727+01:00Bang and the dirt is gone!Working as a Solo responder<br />Cat A chest pain 8 miles away<br />Get there in 7 minutes despite traffic<br />Well looking lady with mild chest discomfort (4/10 at worst) with no previous history<br />O2, Aspirin & Nitrates = pain free<br />Complete paperwork whilst waiting for a crew<br />Told that crew are coming from over 20 miles away<br />Asked "Do you want them on red?"<br />Reply "Er Yes"<br />Nearer crew comes clear and arrives a little while later<br />Patient still pain free<br />More obs on truck<br />12 lead ECG showing inferior MI (heart attack)<br />Still no pain, what to do?<br />Get a line in and take some bloods<br />Get husband into truck<br />Go through <span id="SPELLING_ERROR_0" class="blsp-spelling-error">thrombolytic</span> check list<br />Now patient is experiencing mild chest discomfort<br />Before checklist completed patient goes into cardiac arrest<br />Immediate CPR whilst <span id="SPELLING_ERROR_1" class="blsp-spelling-error">defib</span> pads applied<br />Charging, stand clear & shock<br />1 minute CPR<br />Charging, stand clear & shock<br />1 minute CPR<br />Oh crap this is turning into a training scenario, all colour now drained. She ain't gonna make it<br />Charging, stand clear & shock<br />CPR then blip blip blip<br />Pulse check = palpable carotid and radial pulses<br />20 seconds of <span id="SPELLING_ERROR_2" class="blsp-spelling-error">BVM</span> ventilation<br />Patient responding<br />Patient <span id="SPELLING_ERROR_3" class="blsp-spelling-error">bradycardic</span> at 30 <span id="SPELLING_ERROR_4" class="blsp-spelling-error">bpm</span> and not improving<br />500 <span id="SPELLING_ERROR_5" class="blsp-spelling-error">mcg</span> IV Atropine done<br />Pulse 68, <span id="SPELLING_ERROR_6" class="blsp-spelling-error">BP</span> 115/74<br /><span id="SPELLING_ERROR_7" class="blsp-spelling-error">GCS</span> 15/15<br />Consent given<br />Heparin and <span id="SPELLING_ERROR_8" class="blsp-spelling-error">Tenectaplase</span> given (or as I like to call it drain cleaner aka <span id="SPELLING_ERROR_9" class="blsp-spelling-error">cillit</span> bang)<br />Pain free<br />Husbands jaw picked up off the floor<br />Soon into <span id="SPELLING_ERROR_10" class="blsp-spelling-error">resus</span> and off down to CCU<br />JOB DONE!<br /><br />Check up on patient on my way home<br />ECG back to normal<br />Patient pain free and doing well<br />Transferred to cardiac centre a few days later for <span id="SPELLING_ERROR_11" class="blsp-spelling-error">angiogram</span><br />No further treatment required<br />Discharged home<br />Thank you letters to the service, myself and the double tech crew that backed me up<br /><br />Message to crew: Thanks for getting there when you did and thanks for a great team effort<br />Message to patient: Glad you are now OK, thought we were going to lose you briefly<br />Message to self: Be proud of what you do no matter how many routine or <span id="SPELLING_ERROR_12" class="blsp-spelling-corrected">inappropriate</span> jobs you go to<br /> There will always be that one person who will require your skills where you will make a differencemachttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com3tag:blogger.com,1999:blog-4051283404650044746.post-25807892153598025312009-08-20T22:09:00.002+01:002009-08-20T23:04:56.975+01:00Sorry to bother you......................er what!A couple of weeks ago............<br /><br />After a non eventful day of transfers, GP admissions and Cat A calls 'that weren't' we were on our way back to base when we were asked to standby at another station in the next town. I was fuming, after all we only had an hour til the shift ended. Had we done something to piss control off? I doubt it. As we are so often reminded "You don't know the bigger picture!"<br />Anyway we arrive at the station to see 2 ambulances there. I was fuming again and so was my crew mate. But before we could even enter the station we got a job. Cat A allergy call midway between this station and ours so off we went. A tech on an RRV was also dispatched. It was to a child stung by a bee.<br /><br />Mum is at the door and is already apologising for calling us out but stated that she was worried as her son was struggling to breath. Good enough reason to call I thought to myself. Sure enough he had been stung and was showing early signs of anaphylaxis. Reluctantly he got on board the truck after we reassured him that we would take good care of him and that we wouldn't hurt him. My crew mate stood the RRV down<br />Respiratory rate increased with a mild wheeze and chest tightness. Puffy eyes and his lower lip had started to swell. Tingling on his top lip and tongue and difficulty swallowing coupled with a sensation of a lump in his throat. Pulse rate 115. Alarm bells were ringing. He was also starting to feel itchy although I couldn't see any obvious hives.<br />We needed to start treatment but a child is not always the best patient to convince. Sometimes they are great and if they are that poorly they'll let you do anything as long as it helps. Other times you can't do anything but drive. I said I wanted to give him some medicine to make him better and that I didn't want him to have to wait until we got to hospital 20 minutes later. I must have said all the right things because he allowed us to treat him. I pinched his hand to let him know that the IV I was about to insert wouldn't hurt too much which he was a bit hesitant to start with but gingerly offered me his hand again. I prayed to god that I wouldn't cock this IV up. You only get one shot at a child. Funny thing was that he covered his ears with his hands but because I needed one of them to cannulate he substituted a hand for a shoulder.<br />And in went the 20g IV, no problem. A sigh of relief came over his face. "All done, that's the worst bit" I said proudly. Mum then lifted her jaw off the floor "Bloody hell, I'm surprised he even let you go near him!" she said. As I administered the Chlorphenamine and the Hydrocortisone I explained to the child, his mum and now the dad who had just turned up, what I was giving and why I was giving it. At the same time my crew mate had drawn up some adrenaline and injected that into his upper arm, again with no incident. Both parents proud of their child for being so brave. As a dad myself I couldn't have agreed more.<br /><br />A pre alert to the hospital and we were soon there. We arrived with a child that was showing a good recovery. One of the regular Docs was on duty and said "This the anaphylaxis, airway OK?" "Yep" I said. "OK pop him over there and I'll see him in 2 ticks. I see the guys have taken good care of you, they've done our job for us." she said. "Not quite Doc, I didn't take bloods", "Doesn't matter we don't need them, good job though". The mum had a look of relief on her face that she had done the right thing.<br /><br />Moral of the story especially when kids are concerned, never apologise for thinking that you bothered us. This is one of many examples of why we are here. If the mum hadn't bothered to call and decided to wait and see or chose to put her son in the car things could turned out a lot worse.<br />Anaphylaxis is life threatening and does and will continue to kill if it isn't recognised and treated early.<br /><br />A good job to finish off the shift even if we did finish late.machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com1tag:blogger.com,1999:blog-4051283404650044746.post-34489932057795043682009-08-20T10:51:00.004+01:002009-08-20T16:53:19.846+01:00It's all in the history<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1lAOIEZTSYyWfnCKhOf2fIh9q3uFac2s8HA4TuFARcehBWIYMJ1qYnqrAoXN7PyNeSaKo1KbteuIfvA-pubPHT7Xh4VHWQvpKUN2-6eEyXoKh373PzVcezjFxF1T53i06uzjyh8_Wiqze/s1600-h/n5551227.jpg"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 400px; DISPLAY: block; HEIGHT: 261px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5372002047587224946" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1lAOIEZTSYyWfnCKhOf2fIh9q3uFac2s8HA4TuFARcehBWIYMJ1qYnqrAoXN7PyNeSaKo1KbteuIfvA-pubPHT7Xh4VHWQvpKUN2-6eEyXoKh373PzVcezjFxF1T53i06uzjyh8_Wiqze/s400/n5551227.jpg" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2vlnmFKXp-qYAMXLrXk1d8M9UDcdNGPtOaDN29QSq7rb5HbvMxq-IABd5iqVTCHTFDyNsvzrHARZcZ0rmttI8nHDzIkNDgDz7lgoNw4WFdyqPGg4plvcDhXwdI4NXqjxPjFJGky5-ng8x/s1600-h/pericarditis-ekg5.jpg"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 400px; DISPLAY: block; HEIGHT: 209px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5372001257861150290" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2vlnmFKXp-qYAMXLrXk1d8M9UDcdNGPtOaDN29QSq7rb5HbvMxq-IABd5iqVTCHTFDyNsvzrHARZcZ0rmttI8nHDzIkNDgDz7lgoNw4WFdyqPGg4plvcDhXwdI4NXqjxPjFJGky5-ng8x/s400/pericarditis-ekg5.jpg" /></a><br /><br /><div>999 call chest pain, young guy, mid thirties. Unless the patient is a cocaine user or has some congenital heart defect then usually these calls tend to be nothing too serious. But you can't be complacent in this job and have to keep an open mind. Too dismiss such a call prior to arrival on scene is a dangerous thing. </div><br /><br /><div>On arrival the patient was providing the dying swan act but was in obvious discomfort. A history of a cough with mild left sided chest pain which started the previous evening. It had now become more severe. I could see my crew mate raise his eyebrow with some disbelief that this was nothing too urgent. Admittedly I was probably thinking along the same lines. He was showing signs of primary hypervetilation with pins and needles in his hands and mouth, cramping of the fingers and a rapid respiratory rate. His pulse was over 100. I took his temperature which was normal. BUT until we have examined the chap and carried out some other observations, including a 12 lead ECG, we needed to keep an open mind. Taking a deep breath aggravated the pain even more and he was wriggling around on the bed. </div><br /><br /><div>Whist taking his BP and acquiring the 12 lead ECG it transpired that he had a previous infection....................................around his heart and and some form of heart scan. I took this to be an echocardiogram. When I asked earlier about any previous medical history this had obviously slipped his mind. This is so often the case when in hospital a patient will admit to having a whole array of ailments that they failed to disclose whilst in our care. Can make us look daft at times. </div><br /><br /><div>A quick listen to the chest revealed clear & equal air entry and o2 saturations were in the high 90's. Leaning forward eased the chest pain but when asked to take a deep breath or lay back caused the pain to get worse. Now for the 12 lead. Abnormal to say the least. There was ST elevation (sign of a heart attack) and alot of it. But there were clues that lead me to believe that this was not a heart attack. The type of pain was wrong for a start. The ST elevation was wide spread (showing in leads II, II, AVF, v2,v3,v4,v5,v6) and saddle backed. There was also very slight reciprocal changes in I & AVL. My provisional working diagnosis was Pericarditis (an inflammation of the sac surrounding the heart). There are many causes but is usually caused by some form of infection. I popped in a line and took some bloods. Why? Well for one the hospital gets busy and it's one less thing for them to do. They don't have to recannulate, they use our lines and it lets them get on with other things. Also because I like to be prepared for the worst. There is a rare complication of Pericaditis which is caused by blood/fluid filling up the pericardial sac. It's called cardiac tamponade which is life threatening and is usually only seen in severe chest trauma and only a small amount of blood is needed to impede cardiac function. Like I said I like to be prepared.</div><br /><br /><div>I also gave some o2 and bags of reassurance. He soon settled and we chatted on the way to hospital. I let the hospital know we were coming in and had an uneventful journey to A/E.</div><br /><br /><div>We were met by one of the staff grade DRs and a CCU nurse and made our way into resus. They did do a double take when looking at our ECG and quickly wanted to rule out a heart attack but after I handed over and gave them the history they were thinking the same as me. But they still wanted to check their own ECG. It was agreed that it was pericarditis.</div><br /><br /><div>He was discharged some hours later with anti inflammatory drugs and some strong oral analgesia.</div><br /><br /><div></div><br /><br /><div>I read recently in a DRs blog about how Paramedics can't take a history and are not diagnosticians and how we are all bound by protocols. All I can say to that is that agreed I am not a DR and would never compare myself to one. But as a Paramedic I can obtain important information, examine the patient (obviously not as thoroughly as a DR, we don't have the time or facilities to allow for this) and carry out certain observations which can point towards what the problem may be. Sometimes we may not have a clue. But in this case it was the history and ECG that provided me with a pretty clear cut answer. </div><br /><br /><div>As for protocols, yes it was cardiac chest pain but not typical to a heart attack. Yes I know all too well that a lot of heart attacks present with atypical (different to the norm such as no pain, abdominal pain etc) signs & symptoms but this all pointed to Pericarditis. And yes I know that Pericarditis can mimic an MI and that there have been occasions where a patient has received unnecessary thrombolysis (mainly in hospital and occasionally out of hospital. Did I give aspirin or GTN? No. I didn't give morphine and pre hospital thrombolysis certainly wasn't indicated. I could have given Ibuprofen but in the short time he was our care it probably wouldn't have provided any benefit. We work from guidelines now and I try and provide the most appropriate level of care to each of my patients. I don't believe in filling people up with drugs when there is no indication for it. </div><br /><div></div></div><br /><div></div><br /><div>The ECG is one I found on google and NOT the patients.<br /><br /><div></div><br /><br /><div></div><br /><br /><div></div></div>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com3tag:blogger.com,1999:blog-4051283404650044746.post-90390962714143129992009-08-20T00:49:00.001+01:002009-08-20T00:50:49.877+01:00Back againI've given all this blogging lark a bit of a break but now decided to carry on.<br />Back soon with what I've been up to.machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com1tag:blogger.com,1999:blog-4051283404650044746.post-30162193827448081912009-06-15T17:01:00.005+01:002009-06-16T10:02:07.440+01:00Addison's Disease/Adrenal InsufficiencyOk here we go.<br /><br />What is it?<br />Addison's disease was discovered by Dr Addison in 1855. It is a rare condition affecting mainly, but not exclusively, people between the ages of 20-50.<br />Right, we should all know that we have 2 kidneys. On each kidney sits an Adrenal gland. The adrenal gland is a bit like a Cadbury's creme egg. For example the chocolate is the cortex and the soft fondant centre (yum yum) is the medulla. Cells in the cortex produce hormones called Aldosterone and Cortisol. Together they help to control/regulate the blood pressure, regulate salts in the blood stream and help regulate the immune system. They also help balance the effect of insulin in regulating blood sugar and helps the body respond to stress. The cells in the medulla produce adrenaline and noradrenaline which have various actions throughout the body.<br />Now in Addison's and adrenal insufficiency the adrenal glands produce little or none of the above hormones. I think I'm right in saying that Addison's is known as primary insufficiency. Now just to complicate things there is a secondary insufficiency. Lying under our brain we have the Pituitary gland. This produces a hormone called ACTH which controls the amount of cortisol produced in the adrenal glands. With me so far? Good.<br /><br />There are many reasons why we may fail to produce these hormones:<br />Primary Insufficiency:<br />Addison's ( >80% of cases), surgical removal, trauma, Infections (TB/HIV etc) and cancer. There are more.<br /><br />Secondary Insufficiency:<br />Congenital, trauma, surgery, radiography, cancer, long term steroid use for other conditions and tumours of the pituitary gland. Again there are more.<br /><br />What ever the cause these patients require life long steroid treatment. They do this by taking oral steroid tablets every day.<br /><br />What's a Crisis?<br /><br />Basically anyone who has the above conditions and for whatever reason are unable to keep their oral steroids down or is affected by other factors that increase the body's natural demand for cortisol such as trauma, stress etc. If someone is having surgery then the surgeon usually has to ensure the patient will have enough steroid cover for the procedure. This helps the body cope with the extra stress.<br /><br />There are many causes of a crisis such as infection/ tummy bugs, stress, trauma and any form of serious illness. If patients vomit or become unwell then they usually double up on their own steroid tablets and if necessary give themselves a <span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">hydrocortisone</span></span> injection. Not everyone is given a home injection kit though. A lot of sufferers manage their condition extremely well even if they start to feel a crisis coming on. Once they feel better then they will slowly wean themselves off the higher steroid doses and back on to their normal dose.<br />Sometimes people become very ill very quickly and are unable to keep their tablets down. That's when they need an injection. That's when we come in.<br /><br />People may feel weak, dizzy, have a low blood pressure, rapid pulse and sometimes a low blood sugar. People can have seizures and become unconscious. If left untreated death will occur. It is a potentially life threatening condition. On the outside it could be just someone vomiting but when you find out they have Addison's (and understand the problems that causes) it changes the game somewhat. Be aware, not every one will present with the classic signs of shock. If they can't keep oral steroids down they need <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Hydrocortisone</span>. The aim is to prevent a crisis not just to treat it when it comes along.<br /><br />There are some good websites that explain the condition far better than I have. All you have to do is GOOGLE ADDISON'S DISEASE and go from there.<br /><br />It's amazing reading some of the <span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">patients's</span></span> stories from a few years ago and you will see that back then hardly any ambulance staff knew anything of Addison's. We didn't have <span class="blsp-spelling-error" id="SPELLING_ERROR_2"><span class="blsp-spelling-error" id="SPELLING_ERROR_3">Hydrocortisone</span></span> (<span class="blsp-spelling-error" id="SPELLING_ERROR_3"><span class="blsp-spelling-error" id="SPELLING_ERROR_4">HYC</span></span>) back then. Well we do now which is a step in the right direction.<br /><br />Some advice though. Make sure you have a medic alert bracelet or some other obvious means of letting us know that you have this condition. If you are an Ambulance Technician (and you can't give <span class="blsp-spelling-error" id="SPELLING_ERROR_4"><span class="blsp-spelling-error" id="SPELLING_ERROR_5">HYC</span></span>) use common sense and ring A/E to get permission to administer it <span class="blsp-spelling-error" id="SPELLING_ERROR_5"><span class="blsp-spelling-error" id="SPELLING_ERROR_6">IM</span></span>. You may just save someones life. Actually I don't know why Techs can't give it nationally, it comes under the same drugs act that covers <span class="blsp-spelling-error" id="SPELLING_ERROR_6"><span class="blsp-spelling-error" id="SPELLING_ERROR_7">Glucagen</span></span>, Adrenaline and <span class="blsp-spelling-error" id="SPELLING_ERROR_7"><span class="blsp-spelling-error" id="SPELLING_ERROR_8">Narcan</span></span> (which enables techs to give these drugs in the first place) All UK Paramedics can now give it IV/<span class="blsp-spelling-error" id="SPELLING_ERROR_8"><span class="blsp-spelling-error" id="SPELLING_ERROR_9">IM</span></span> and where I work via the IO route.<br /><br />Hope this has helped. I'm waffling now so I'll sign off. <span class="blsp-spelling-error" id="SPELLING_ERROR_9"><span class="blsp-spelling-error" id="SPELLING_ERROR_10">Byeeee</span></span>.machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com1tag:blogger.com,1999:blog-4051283404650044746.post-69479095306958853072009-06-15T11:18:00.002+01:002009-06-15T12:09:48.404+01:00Adrenal Crisis<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikJIUC4jDYaFM9KR0tbt80L8aPg036quDUCw9YS6pDDHC1wXtXLE5H236bvl7vkpfKzRlq0YdGD5HRuSGDy9cAn3RbI08ciq7PdGeyX7SE1bn0zI6xcuwpfRVA1VRSkpCo7Q3eYfzeISPG/s1600-h/openemergcard.jpg"><img id="BLOGGER_PHOTO_ID_5347509899781513394" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 250px; CURSOR: hand; HEIGHT: 174px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikJIUC4jDYaFM9KR0tbt80L8aPg036quDUCw9YS6pDDHC1wXtXLE5H236bvl7vkpfKzRlq0YdGD5HRuSGDy9cAn3RbI08ciq7PdGeyX7SE1bn0zI6xcuwpfRVA1VRSkpCo7Q3eYfzeISPG/s400/openemergcard.jpg" border="0" /></a><br /><div>I've had a busy week. Cardiac arrest, sudden death, diabetic hypo, countless falls and an imminent birth (That we managed to get to hospital just in time. It was close though, she wasn't budging initially but as soon as I opened up the mat pack she shouted "No, not here! I didn't want this!" "Well you've two choices, take some really good breaths on this gas and air and let's get you down to the vehicle or we'll have to deliver here. Your choice." I said. With that she gulped the gas and air and made it to the truck. We were only 2 minutes from the hospital and were there in no time. They had called the midwife but she refused to come out. I phoned maternity and requested one to come out as birth was imminent but then cancelled her as we were en route.)</div><br /><div></div><br /><div></div><br /><div></div><br /><br /><div></div><br /><br /><div>I was on the car over the weekend and Saturday was spent mostly going to calls but being stood down again. Then 25 minutes towards the end of my shift in comes a call, Sick person, Cat B. "Bugger!" It's not far and en route I get an update. Female with a histroy of Addison's Disease. I'm greeted by the woman's kids who show me into the front room. My patient has been vomiting for 24 hrs plus, unable to keep her oral steroids down and had already given her self her own Hydrocortisone injection 5 hours earlier. She was not good. I needed to get some more steroids into her but her veins were non existent. I tried twice but there was nothing. The ones in her hand were like trying to cannulate an electric cable, tough. I gave up and gave her an IM injection instead. She did say that she had terrible veins and that they always had trouble at hospital. She did ask me to put an IV in her ankle as that is what they usually end up doing in A/E. I said I'd rather not if I can help it. She also had severe abdo pain radiating into the back so I gave her some gas and air. No sign of a crew so I called up control. "Nothing assigned to you yet, why, did you need one then?" "Er yes please, bearing in mind this lady is suffering from an Adrenal crisis and it is potentially life threatening." "OK, we'll get one running." They took ages and my patient was pleading for me to have another go at getting a line in. She wanted some anti-sickness meds and as her BP was low I needed to get some IV fluids going. Her sugar was OK (this can be low in a crisis) and she had good oxygen saturations. The crew arrived and after a little bit of banter (she was in remarkably good spirits despite her condition) we got her onto the truck. Now she was lying down I had a look at the vein in her ankle, it was a beaut. "Right I'll have one attempt and that's it." I said. "Please do, I'd rather you got one in now." She said.</div><br /><div>And in it went, 4 vials of bloods, some IV Metoclopramide (she was already taking the oral version) and some IV sodium chloride and they were ready to go. I gave a pre alert to A/E and off she went. The vast majority of my on scene time was taken up waiting for the crew to arrive. I finished 45 minutes late, at time and a half mind you, and it was for a genuine patient so I didn't mind. It didn't help that I left my house keys at home and had to wake my wife up at 1.15 am to let me in. Whoops.</div><br /><div></div><br /><div>For those non-medical types and trainee techs etc that might read this blog my next post will be a brief overview of what Adrenal crisis and Addison's disease is about. Stay tuned.</div>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com1tag:blogger.com,1999:blog-4051283404650044746.post-57617965451729389262009-06-11T00:15:00.000+01:002009-06-11T00:17:04.518+01:00Oops, where's my bloody car door gone?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGcmwnT6v_85Iue_6ynOVLBjRSfxyHqM2QQgEtsQ9m_SIgka_MpRf35Mr16cbf6BUPq4zPq1WcGUFRp9Mk4n_yOvPk9JYgPNRKgeCvS9GknrjUQEs47vK9isKwOCZAaBWaTqbvlv1ZcKY4/s1600-h/Photo116.jpg"><img id="BLOGGER_PHOTO_ID_5345841792251249666" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 300px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGcmwnT6v_85Iue_6ynOVLBjRSfxyHqM2QQgEtsQ9m_SIgka_MpRf35Mr16cbf6BUPq4zPq1WcGUFRp9Mk4n_yOvPk9JYgPNRKgeCvS9GknrjUQEs47vK9isKwOCZAaBWaTqbvlv1ZcKY4/s400/Photo116.jpg" border="0" /></a><br /><div></div>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com1tag:blogger.com,1999:blog-4051283404650044746.post-20405220004211135162009-06-09T23:28:00.002+01:002009-06-10T00:04:07.308+01:00Is it me....................what do you think?This call occurred a couple of weeks ago and I still find myself questioning one of the decisions made by the DR at A/E.<br /><br />Our first job of the night was to a child who had fallen from a rope swing that his dad had just put up in the garden. We arrive on scene to be greeted by a panic stricken father who leads the way round to the back of the house. On the floor is a small boy lying on his side, conscious and breathing (always a welcome sight in any ill or injured kid, I'm sure you will all agree) and covered in the customary emergency layers of blankets. A quick assessment reveals that his <span class="blsp-spelling-error" id="SPELLING_ERROR_0">ABCs</span> are good. However he has bony tenderness in the centre of his neck (C-spine), he also has some thoracic bony spinal tenderness. It is causing him great discomfort despite his mum having already giving him some oral paracetamol solution. He has no <span class="blsp-spelling-error" id="SPELLING_ERROR_1">neuro</span> deficit and all his limbs are moving. Because of the 'mechanism of injury' we need to be very careful and immobilise him. We pop a collar on him and keep him chatting. Despite the pain he is very compliant and I offer him some oral morphine to ease the pain of which he is <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">grateful</span>. Next we roll him onto a vacuum <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">mattress</span> for comfort and suck the air out. On to the trolley, into the truck and of to hospital with mum. Dad follows in the car. On the way I do the usual observations which are normal for his age and I find out that mum is a paediatric nurse at the local hospital.<br /><br />Now, back to the mechanism of injury; the swing is my height-over 6' and according to dad the swing managed to unhook it self when the kid was at full height. He landed on grass but his back took the full brunt.<br /><br />I phone the hospital and speak to one of the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">Jr</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_5">DRs</span>, as I know they were busy, just to let them know what we have and how long we will be. We arrive 10 minutes later with a child who is now relatively pain free. This is the bit I'm stuck on. After releasing him from the vacuum <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">mattress</span> I take control of <span class="blsp-spelling-corrected" id="SPELLING_ERROR_7">the</span> head and direct the log roll while the DR examines his back.<br />"when I press you tell me yes if it hurts, <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">OK</span>?" says the DR<br />"OK" says the child<br />Pressing on the neck soon generates a yes and another yes and another. Now onto the thoracic spine and another yes etc. The DR then says "I think he'll be <span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">OK</span>" and asked the boy to move his head left and then right, no problem. However when the DR asks him to lift his head up off the trolley he can't because it is too painful..................in the middle of his neck and back! The DR still says "I think he will be <span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">OK</span>".<br />Dad shakes my hand and both parents thank us, we book in the patient and are off on the next job.<br />What I don't understand is why didn't the DR refer him for an X-ray? Yes I know kids have soft bones, yes he landed on grass (which wasn't that soft) and yes he probably will be <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">OK</span>. But if there is CENTRAL bony tenderness over any part of the spine, child or adult, then surely that warrants an x-ray. Again I know x-rays shouldn't be dished out 'willy <span class="blsp-spelling-error" id="SPELLING_ERROR_12">nilly</span>' but if the mechanism is there.................................<br /><br /><br />I'm sure/hope he was fine. I should really follow it up (too busy that night) and have a chat with the DR.<br /><br />This is no way a dig at any A/E DR just my curiosity. I'm pretty sure if it was one of the more senior <span class="blsp-spelling-error" id="SPELLING_ERROR_13">DRs</span> then investigations might have been slightly different. I don't know.machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com7tag:blogger.com,1999:blog-4051283404650044746.post-28403861298599911782009-06-07T23:51:00.004+01:002009-06-11T00:05:13.940+01:00At the end of a night shift...........................<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4bwpNESsRYzYJE_L-v6AZ8TrDptkRh22BJCuO5A95rWdWgEja2go6YXOWjybI1o3V3BapzyzyecCH1w36IkpGDdf_P9tTIeKhsqIUbTlIaLUhFcOD1R7qAYnoeoG6vLse7jDAi7PFiriR/s1600-h/Photo032.jpg"><img id="BLOGGER_PHOTO_ID_5345838792465900594" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 300px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4bwpNESsRYzYJE_L-v6AZ8TrDptkRh22BJCuO5A95rWdWgEja2go6YXOWjybI1o3V3BapzyzyecCH1w36IkpGDdf_P9tTIeKhsqIUbTlIaLUhFcOD1R7qAYnoeoG6vLse7jDAi7PFiriR/s400/Photo032.jpg" border="0" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBqDS3iXbzAsINlWU2Vtwi1mqBpq5t2LHmZee52veACWAy-w9ahZu8y2pCDdnQELguFC7AqjGEmiU6glI46WyiNkrfcE_TEYmcjHxWwyK1K3mDsGr4ykuEH0EVPI5ebJHBggiuNEYP6-i1/s1600-h/DSC01823.JPG"><img id="BLOGGER_PHOTO_ID_5344722587597785874" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 240px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBqDS3iXbzAsINlWU2Vtwi1mqBpq5t2LHmZee52veACWAy-w9ahZu8y2pCDdnQELguFC7AqjGEmiU6glI46WyiNkrfcE_TEYmcjHxWwyK1K3mDsGr4ykuEH0EVPI5ebJHBggiuNEYP6-i1/s400/DSC01823.JPG" border="0" /></a><br /><br /><div>For me it was a rotten end to a night shift. I was fortunate enough to go home to my wife and family. The driver of this car was less fortunate.</div><br /><div>RIP</div></div>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com2tag:blogger.com,1999:blog-4051283404650044746.post-35882376205781842032009-06-03T23:56:00.004+01:002009-06-11T00:02:53.017+01:00The Fall<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixGZu05y8bqV3UNXL0P9TOnMANRYQWDPMFOgzRw94f0QtxiLeqJHfzX-zturBm2u9wWePNIgCAVn82XtJPpOFhW16Gcy-_HMj04ixv8GVD_Ljd4FWdqhzexiYsq5jr7zrrA_eRY70e8HGw/s1600-h/Photo417.jpg"><img id="BLOGGER_PHOTO_ID_5345838039401303906" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 300px; CURSOR: hand; HEIGHT: 400px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixGZu05y8bqV3UNXL0P9TOnMANRYQWDPMFOgzRw94f0QtxiLeqJHfzX-zturBm2u9wWePNIgCAVn82XtJPpOFhW16Gcy-_HMj04ixv8GVD_Ljd4FWdqhzexiYsq5jr7zrrA_eRY70e8HGw/s400/Photo417.jpg" border="0" /></a><br /><div>Another 999 call. A fall in a retail park<br />"It's probably some old dear who has tripped over in one the shops" I joked.<br />About 3 minutes later we pulled into the retail park.<br />Jokingly I said "Nah it's probably someone who's fallen through the roof"<br />Before we knew it we had an update on the radio "Cardiac arrest, young male fallen approx 40ft through the roof"<br />"SHIT!"<br />Now on scene, ambulance doors swung open. I grab my Para bag, response bag and drugs kit. My crew mate grabs the suction and critical hemorrhage kit. Through the doors we are confronted by a crumpled heap. Above him is smashed ceiling panels and about 40-50ft above that is a smashed skylight.<br />The patient isn't in cardiac arrest but he's not far from it. Massive head, facial and chest injuries are obvious. We needed to act fast if we were going to give him any chance of survival.<br />By now a <span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">RRV</span></span> Paramedic from base had arrived and we quickly set about suctioning the airway and then moved the patient onto his back. He wasn't breathing adequately and his radial pulses were virtually non existent.<br />First thing to sort was airway. I had a quick look with my <span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">laryngoscope</span></span> but saw nothing but blood so I suctioned some more then started to assist his breathing with a <span class="blsp-spelling-error" id="SPELLING_ERROR_2"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">BVM</span></span>. Another look, more suction and then in with an ET tube. Airway was now secured. Next was breathing. It was quite evident that there was significant blunt chest trauma. One side of the chest was higher than the other, breath sounds were diminished and it was hyper resonant. I opted to insert a wide bore IV into the chest to allow the air to escape. Radial pulses started to get stronger. All the while my colleagues were getting other kit sorted. My <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">crew mate</span> then took over <span class="blsp-spelling-error" id="SPELLING_ERROR_4"><span class="blsp-spelling-error" id="SPELLING_ERROR_3">ventilations</span></span> while my self and the <span class="blsp-spelling-error" id="SPELLING_ERROR_5"><span class="blsp-spelling-error" id="SPELLING_ERROR_4">RRV</span></span> Paramedic both got big IV lines into the arms. At this point various other colleagues turned up including a local Basics DR. He just wanted to know how far we had got and then we reassessed <span class="blsp-spelling-error" id="SPELLING_ERROR_6"><span class="blsp-spelling-error" id="SPELLING_ERROR_5">ABCs</span></span>. Next thing we know HEMS are en-route and within minutes they are walking through the door. The HEMS DR gave some RSI drugs to make sure the patient was properly asleep while the HEMS Paramedic performed a <span class="blsp-spelling-error" id="SPELLING_ERROR_7"><span class="blsp-spelling-error" id="SPELLING_ERROR_6">thoracostomy</span></span> on the damaged chest. This made a huge improvement with <span class="blsp-spelling-error" id="SPELLING_ERROR_8"><span class="blsp-spelling-error" id="SPELLING_ERROR_7">ventilations</span></span>, my needle decompression improved things as well but the <span class="blsp-spelling-error" id="SPELLING_ERROR_9"><span class="blsp-spelling-error" id="SPELLING_ERROR_8">thoracostomy</span></span> really did the trick. Next we started some <span class="blsp-spelling-error" id="SPELLING_ERROR_10"><span class="blsp-spelling-error" id="SPELLING_ERROR_9">Hypertonic</span></span> saline. <span class="blsp-spelling-error" id="SPELLING_ERROR_11"><span class="blsp-spelling-error" id="SPELLING_ERROR_10">Epistats</span></span> were also inserted as there was significant bleeding from the severe <span class="blsp-spelling-error" id="SPELLING_ERROR_12"><span class="blsp-spelling-error" id="SPELLING_ERROR_11">maxillofacial</span></span> injuries. A pelvic splint was also applied just as a precaution and a rapid ultrasound of the chest and belly was carried out to detect internal bleeding. Now with everything in place and all the best possible treatment it was time to load the patient into the aircraft. Many shoppers were filming us as we walked through the car park, probably out of morbid curiosity. When the helicopter lifted off there were even more people filming on their phones and as soon as the helicopter vanished they had all practically <span class="blsp-spelling-corrected" id="SPELLING_ERROR_13">disappeared</span>. The young lad was flown to the Royal London by passing all the local A/E units as it is the <span class="blsp-spelling-error" id="SPELLING_ERROR_14"><span class="blsp-spelling-error" id="SPELLING_ERROR_12">UK's</span></span> main trauma centre.<br />We had to give our details over to the police, which is the norm in these situations. Next was the task of clearing up which was now like a war zone. Police asked if we could check over the patients work mate who was in a state of shock so I went over and had a chat with him. He was just dumbstruck.<br />After a quick debrief in the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_15">car park</span> we were back on base restocking.<br /><br /><br /><br />I've since found out the poor lad died this morning.<br />Everything that could be done was done right there and then. We gave him a chance.</div>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com7tag:blogger.com,1999:blog-4051283404650044746.post-91406176189589416922009-05-25T11:18:00.002+01:002009-05-25T11:49:40.545+01:00Late 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.'<br />Talk about <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">rubbing</span> salt into the wounds! By all accounts they had a nice time. I on the other hand had to slog it out at work.<br /><br /><span class="blsp-spelling-error" id="SPELLING_ERROR_1">RTA</span> 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. <span class="blsp-spelling-error" id="SPELLING_ERROR_2">Arrgh</span>!), <span class="blsp-spelling-error" id="SPELLING_ERROR_3">CVA</span> that wasn't a <span class="blsp-spelling-error" id="SPELLING_ERROR_4">CVA</span>, back injury etc etc. You name it we pretty much had it.<br />We also had a young lad who fell off his <span class="blsp-spelling-error" id="SPELLING_ERROR_5">BMX</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_6">Entonox</span> (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!'<br />Cardiac arrest, middle aged man collapsed and smashed through a glass door backwards. He'd been down too long and was beyond help.<br />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!<br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_7">crepitus</span> and the swelling was creeping up the outside of his leg. He drained both an F size and CD size <span class="blsp-spelling-error" id="SPELLING_ERROR_8">Entonox</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_9">Tib</span> & 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.<br />Back in tonight for one of two nights.machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com0tag:blogger.com,1999:blog-4051283404650044746.post-25153912678715763772009-05-23T23:49:00.002+01:002009-05-24T00:29:57.984+01:00Never 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.<br /><br />Monday night wasn't that busy, 4 jobs in total if I remember rightly.<br /><br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_0">sp</span>02 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_1">ITU</span>. 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.<br /><br />Acute <span class="blsp-spelling-error" id="SPELLING_ERROR_2">abdo</span>. Male, 60's complaining of severe <span class="blsp-spelling-error" id="SPELLING_ERROR_3">abdo</span> 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.<br />We did 2 other jobs but I can't remember those.<br /><br />Tuesday, another quiet night.<br /><br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_4">COPD</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_5">nebs</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_6">resus</span> as my crew mate ran for help. In <span class="blsp-spelling-error" id="SPELLING_ERROR_7">resus</span> I started suctioning his airway, dropped in an <span class="blsp-spelling-error" id="SPELLING_ERROR_8">OPA</span> 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.<br />The staff grade DR <span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">said</span> 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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">environment</span> with every thing to hand, not like an ambulance.<br /><br />We also had an impressive <span class="blsp-spelling-error" id="SPELLING_ERROR_11">RTA</span> where a front axle had been ripped from a drink drivers car. Luckily there was <span class="blsp-spelling-corrected" id="SPELLING_ERROR_12">no one</span> hurt so we left the police to arrest the youngster.<br /><br />Asthma, pretty much in the middle of nowhere, a lady who reluctantly came to hospital. She had some <span class="blsp-spelling-error" id="SPELLING_ERROR_13">nebs</span> and IV <span class="blsp-spelling-error" id="SPELLING_ERROR_14">Hydrocortisone</span>. 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.<br /><br />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.machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com0tag:blogger.com,1999:blog-4051283404650044746.post-29152871310301648902009-05-18T20:52:00.003+01:002009-05-18T21:12:43.483+01:00All 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Entonox</span> which was OK but not <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">really</span> hitting the spot.<br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_2">APGAR</span> score of 10 both at 1 & 5 minutes.<br />All the other drivers were rubbernecking as usual. With the mum now on the trolley, her husband helped my <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">crew mate</span> get her on board. Her placenta was still in <span class="blsp-spelling-error" id="SPELLING_ERROR_4">situ</span> and there had been minimal bleeding (no need for the <span class="blsp-spelling-error" id="SPELLING_ERROR_5">syntometrine</span> then!) so we decided to stick the lights and sirens on and cruise over to the hospital.<br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_6">thrombolyse</span> (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 <span class="blsp-spelling-error" id="SPELLING_ERROR_7">buccal</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_8">Prinzmetal</span> angina as the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">nitrates</span> were helping keep the pain at bay. Anyway at hospital he was soon whisked off some where.<br />I'm on tonight as well but so far it's been quiet. <span class="blsp-spelling-error" id="SPELLING_ERROR_10">SHHHHHHHHHHHHHHHHHHHHHHH</span>machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com3tag:blogger.com,1999:blog-4051283404650044746.post-29397347952958287412009-05-16T11:53:00.002+01:002009-05-16T12:04:21.220+01:00Good news!Just a quick update about our <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Intubated</span> guy from my last couple of postings.<br />I enquired at A/E reception about his where abouts and found out that he had been <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">transferred</span> from <span class="blsp-spelling-error" id="SPELLING_ERROR_2">ITU</span> down to an acute ward. This <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">meant</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_4">DRs</span> 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.<br />These sort of jobs don't happen that often but when they do it makes you realise just why we are here.machttp://www.blogger.com/profile/12224939870747906286noreply@blogger.com3