Proper jobs come round once in a blue moon. But when they do, its a bit like the buses – they all come at once.
We only had four jobs the other day. This was because we had to spend two seperate occasions at the dreaded Vehicle Fitters and eventually had to swap onto another truck.
First job, a hypoglycaemic patient with a [tippy title=”BM” ]“Blood Sugar”. A terminology used for measuring someone’s blood sugar count in their blood. Usually done for Diabetics but in the emergency services, done to . . . . um, anyone really. Very useful for diagnosing certain problems – like Hypoglycaemia (low blood sugar – indicative of an Insulin Dependant Diabetic) . . . or ruling out diabetic problems with someone who is suffering a CVA. A normal reading will be between 4mmol/L to 8mmol/L.[/tippy] of 1.7. He was hiding under his bed sheets and peering out at us with a look of terror and anguish. Sweat was pouring from him and his sheets were drenched.
After the initial pleasantries it was clear to us that we’d have to hold him down to give treatment. There’s nothing satisfying about doing this but sometimes it just has to be done. And, after one Glucagon injection(IM), several sandwiches and a sweet cup of tea later we were able to leave the patient at home fully back to normal and with our closing words of “just doing my job man”.
After changing vehicles at the fitters it was onto our next job – a [tippy title=”hyperglycaemic” ]“Hyperglycaemia”. This is where your blood sugar levels are high. Technically, anything above a reading of 8mmol/L is considered not normal. However, hyperglycaemia is generally recognised at 13mmol/L onwards and signs and symptoms can start at as little as 15mmol/L onwards. Some signs and symptoms can be; weight loss, excessive thirst, dehydration, excessive urination, excessive hunger, extreme tiredness and deep laboured breathing (Kussmauls Breathing). If left unchecked the person will most likely slip into a coma and die.[/tippy] patient with a BM measuring “High” on the monitor (this means its through the roof and at a minimum of 30mmol/L). The patient looked unwell, very obviously dehydrated, poor mobility and kept drifting off to sleep. We gathered them onto the ambulance where I was told to get I/V access to give fluids!
Right. Access. I/V access. Ok. Um . . . right, I needed a cannula. What else? Erm . . . er . . .
Whilst I struggled remembering what basic bits and pieces I needed to gather together, I smiled at the patient and reassured them that we were going to look after them. I made sure not a single one of my frayed nerves showed externally and took my time as best I could, under the circumstances. I was about to insert the cannula when my Mentor touched my arm and whispered to me, “take a deep breath and let it out slowly”. She must have noticed the tiniest beads of sweat starting to form on my brow – or probably that I was gibbering like a pathetic child and frothing at the mouth. Either way, it helped and the cannula went into the tiny vein first time.
I secretly “high-fived” myself – but not before letting the patient bleed onto the ambulance floor as I failed to place pressure on the vein to put the cap on the end of the cannula . . . but these “little” faults can be excused.
After about 200ml of fluids the patient had perked up lots and even managed a smile. And we felt that we’d managed to do something good and worthwhile when we handed them over to the hospital staff.
The next two jobs were “blued” into the hospitals. The first was a poor woman with suspected haematemesis (vomiting blood) and melaena (gastrointestinal hemorrhage coming out as black tarry poo – not good). Again, she looked very sick. This was pretty much a “scoop and run”. Because of excessive hyperventilation we found it hard to obtain an accurate blood pressure but later the hospital told us it was 63/33!
The last job was a suspected [tippy title=”CVA” ]“Cerebral Vascular Accident” Or, “stroke”. This is when a clot of some sort enters the circulatory system of the brain and gets stuck – thus causing a blockage and subsequent possible necrosis of the brain that is being blocked. This is where the FAST test is useful. Having an extremely high blood pressure can be a cause of this. Once the diagnosis is made it is best for the patient to be transferred to a Stroke Unit – and this can sometimes mean bypassing several hospitals en route to do so.[/tippy]. Upon arrival it was clear the patient was reduced [tippy title=”GCS” ]“Glasgow Coma Scale”. The GCS of a patient determines how “with it” they are. Obviously a Doctor wouldn’t be saying “this patient has a reduced GCS as they’re not with it” but would justify their statement with a score. It is scored out of 15 taking into account reaction of eyes, verbal and motor skills. If the patient scores 1 in each they are GCS 3 – this is very bad and would suggest a coma of some sort . . . or at least very drunk! If they are GCS 15 then this is good.[/tippy] as they were confused and struggling with articulation. The more the patient tried to speak the more incoherent they were and it appeared that this was distressing the patient as they knew something wasn’t right. It was also clear from the history that only an hour before, this person had been up and moving and talking normally.
We attempted a FAST test but the patient was frightened and combative. Therefore, it was a “load and go” situation again. The carers on scene contacted the patient’s family as we started moving her to the ambulance and we got ready head off sharpish – as this was now time critical for the patient. Cannulation and an ECG were also ruled out as the patient withdrew from all efforts to do so.
It took us twenty five minutes of aggressive (but safe! Honest!) driving for us to travel the 7 miles to the Royal London Hospital. And after rushing the patient into resuss we handed over to the Stroke Doctors.
As I sat in the ambulance afterwards, sipping a cup of tea, my Mentor approached and informed me that the doctors had decided they would not be [tippy title=”thrombolysing” ]“Thrombolysis” is the breakdown of blood clots. Specific “clot busting” drugs will be introduced into the patient’s system as part of the therapy to treat disorders like CVA’s.[/tippy] the patient as she was over the cut off age of 80. Apparently it is not considered to be in the government’s best interests to treat patients over this age. Not viable I guess.
The patient was 81.
This means there will be no treatment for her other than palliative like care. It did nothing less than boil our blood and break our hearts. And as this was our off job it left a bitter taste in our mouths.
Weekend off now and back on Tuesday. I will now attempt to keep these posts regular.