Monday, July 03, 2006

Busy Saturday

I was offered overtime for Saturday on either the day shift or the night shift on the car. I chose the day shift, thinking that I at least wouldn’t get slaughtered running round after people who’d drunk too much and started fighting after the England match.

So I started at 6.30am, trundling around my area for a while, re-fuelling the car and generally enjoying the gentle start to the shift. Due to the heat, I was expecting a busy day of running around to people who’d collapsed with fainting and other heat-related problems. In the end, I did eleven jobs – my busiest shift on the car yet, and conveyed two patients myself as they were minor problems and because the service was so busy, there weren’t ambulances available to attend.

The most serious was a call to a 40 year old male with breathing difficulties. On the way, I considered it could be an asthma attack brought on by the heat. I walked into the house to find most of the family in the lounge calmly watching TV. The patient’s wife lead me through to the bedroom, where I was confronted with a deathly pale man. I immediately started him on 100% oxygen, as I asked him what had happened.
“I’ve been getting pains in my chest on and off for the last couple of days. I’ve also had pain in my stomach, and I can’t keep anything down.”
“Do you have pain at the moment?”
“No.”
I took his pulse – it was racing along far faster than it should be. His blood pressure scared me – 54/35. It was way too low. I laid him flat, and put his feet up on a box.
Then I got on the phone to control.
“Has an ambulance been assigned yet?” I asked the dispatcher.
“Not yet, nothing to send.”
“Can you ask Sector to GB it please – I need an ambulance here urgently, preferably a paramedic crew.” I gave him the obs I’d taken.
“Ooh blimey, yeah I’ll get sector to GB it.” GB stands for General Broadcast, and is a call to all ambulances asking if anyone is available to attend the call. Any crews that are just about to finish completing paperwork, and are reasonably close to the call will come up available and offer to attend it.

A couple of minutes later, control rang back and told me there was an ambulance on the way, but it was running a fair distance. He told me the call-sign and I breathed a sigh of relief. I knew the crew – one was a brand new paramedic who had just started her mentoring period, and the other I knew to be a bloody good paramedic.

I suspected he was bleeding internally somewhere, so while I waited, I felt his abdomen for any signs of bleeding and tenderness. If there’s bleeding in the belly, the abdominal muscles tense up to protect the internal organs. This is known as “boarding”. If there is tenderness, the patient tends to push your hands off his abdomen to stop it hurting. This is known as “guarding”. There was neither. I also felt for a pulsatile mass that could indicate an Abdominal Aortic Aneurysm but didn’t find one. (Click here for more information and a couple of diagrams)

When the crew arrived, I handed over, and stayed to help. This was going to be a difficult removal. The first choice for getting him out was going to be on the carry-chair, but we were worried about his blood pressure bottoming out when we sat him up. We decided we’d give it a go. We lifted him onto the chair, and immediately his eyes rolled and he started fitting.
“Quick, back on the bed,” I said and we dumped him unceremoniously back onto the bed. Almost immediately, he came back round.
Plan B. We got the scoop stretcher – a metal stretcher that we can put under a patient with minimal movement – and strapped him to it. We knew he wasn’t heavy from lifting him onto the chair, so we were satisfied we could get him out without asking for another crew to help – besides, we weren’t sure there would be one available.

We got him out without any further problems, and we got some IV fluid running to help restore his blood pressure. The crew took him to hospital on blue lights.

I don’t know the outcome – I’m hoping to be able to find out from the crew sometime this week. I’ll let you know.

**UPDATE**

Apparently, my suspicions of an internal bleed were confirmed. They found a Gastro-intestinal (G.I.) bleed. He will make a full recovery.

4 Comments:

Blogger Lola Cherry Cola said...

Yikes, sounds like a hell of a job. Working on saturday in all that heat, I don't envy you.

7:01 am  
Anonymous Irma said...

I hate not knowing the outcome. It's like watching a good thriller from the beginning and then missing the last fifteen minutes. Do, please let us know. Thank you.

Irma.

4:42 pm  
Blogger Spike said...

What Irma said. Hope you find out.

4:52 am  
Blogger sandiggity said...

I love your blog. I took an EMT-B class over a year ago and learned a lot. I chose to teach tennis when I'm on breaks from school instead of working as an EMT but this blog is bringing back memories of class and rides. Cool stuff.

4:59 am  

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