Saturday, December 23, 2006

Sad But Good Jobs

We've just finished the second week in the TSing period. My trainees are working hard and coming along nicely, and they've had some good jobs too.

A woman in her 60's fell down a flight of stairs - 18 steps in total, and was far from well. We couldn't secure the airway on the patient - I did a quick check for signs of base of skull fracture, and in the absence of Cerebrospinal fluid from ears or nose, (although she was bleeding from the nose) and after quick consultation with the EMT on the car, I attempted to gently put in a naso-pharyngeal airway. There was resistance - which there usually is, and as there was already trauma to the patient's face, and the normal manoeuvres for getting the airway down didn't work, I didn't want to risk trying to push it down any harder in case it was a facial fracture that was preventing it going in. We couldn't get an airway in her mouth because she had trismus - where the jaw is clamped together.

To cut a long story short, we had HEMS and a BASICS doctor out, who did an RSI (Rapid Sequence Intubation), where they give drugs to interrupt the signals from the brain to the muscles - including the diaphragm so stopping the breathing so they can put a tube down the throat to secure and take control of the airway, then they "bag" the patient to breathe for them.

We took the patient to hospital, but she sadly died a few hours later from her injuries.

The crew have also seen their first "purple". We heard the call being given to a crew "the old fashioned way" over the radio as a suspended - LAS slang for cardiac arrest, and I quickly called up and asked if we could run as second crew to give the training crew experience.
When we arrived, the other crew and the FRU were already there, and as we got out of the ambulance, they called down to say that the patient was "purple", which is the LAS term for dead and beyond resuscitation.

We were able to show the crew what's known as Post Mortem Staining - the purple colour of blood pooling at the bottom of the body that occurs after death, and where the LAS term comes from, and also the onset of Rigor Mortis. It was sad because it was to have been his birthday the next day, and when we looked in his diary to see if we could find any next of kin details, we discovered he should have been going to a birthday meal with some friends that night.

Both were "sad" jobs, but also good, because the crew got some good experience. We're working Christmas Day, so hopefully we'll have a day of "nice" jobs. I somehow doubt it, but we'll see.

Merry Christmas to you all.


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