He’s going to put a needle in your arm

After five weeks away from working on a truck I managed to land my first job back attending a genuinely sick woman.  She was  [tippy title=”hyperglycaemic” URL=””] Hyperglycaemia:  This is where your blood sugar count reads over 15 – for an extended length of time.  Diabetics who aren’t managing to control there levels will inevitably end up with high counts (the normal being between 4 and 8).  A fraction of the symptoms can be lethargy and fatigue, excessive hunger (polyphagia), excessive thirst (polydipsia), excessive urination (polyuria).  If left unchecked a coma can be expected and eventually death. [/tippy] and feeling in a bad way.

To make matters worse – for me anyway – it was a night shift and I had a throbbing headache.  And I hate nights!

The [tippy title=”MRU” URL=””] Motorcycle Response Unit:  These are similar to FRUs but obviously go round on bikes.  Big bikes.  1300cc I believe.  And they carry a lot of kit on them making the bikes very very heavy.  So it comes to no surprise that there is lots of mirth and laughter when news befalls everyone that an MRU has dropped their bike. [/tippy] gave me a good hand over and as he did so I frantically tried to keep up and write the information down on my note pad (the back of my gloved hand).  The poor lady was an insulin dependent diabetic and her [tippy title=”BM” URL=””] 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 Hypo and Hyperglycaemia . . . or for ruling out diabetic problems with someone who is drunk or is suffering a CVA. [/tippy] was in the thirties.  She also had a chest infection and had been vomiting lots.  Put this all together and the poor lady was exhausted and certainly needed to go to hospital.

“Is she dehydrated do you think?”  I asked automatically, trying to remember everything about diabetes and the things we can do for it.  I also tried to rub my temples in the vein hope that the pain would go away.

“Oh yeh, I reckon so.  There you go,” the MRU turned to me smiling, “you can get some fluids in.  That’ll be a good job for ya eh.”  He turned back to the patient beaming, “This nice young man will help you my dear.  He’s going to put a needle in your arm and give you some fluids and hopefully that should start making you feel a little better.  Not a lot, but its a start”

No pressure then.

But first we had to get her out.  And, like all genuinely ill patients, ours lived on the top floor of a large house.  With no lifts.  And steep tight stairs.  With clutter everywhere.  And she wasn’t small.

But, thanks to the dehydration – I presume – our patient was a lot less heavy than we first thought and soon she was in our truck lying on the ambulance bed.  Immediately, my crew mate set about doing the obs whilst I prepared for I/V access.

The tourniquet was on above her elbow and I was tapping around trying to find a vein.  Black African veins are notoriously hard to find and this poor lady was no exception.  In the end I could only home in on the tiniest, threadiest vein on the back of her hand.

The patient had spotted where I was looking and spoke up with a tired voice.

“They always get one here,”  she motioned to her upper arm where nothing was showing . . . at all.  “You’ll never get one in there, they never do”

“I think I’m going to have to try my dear”
“You’ll never do it there”
“It’s the only one I can find”
“Try up here”
“I can’t see anything up there sorry”
“That’s where they always go”
“Yeh, well I’m not going to be able to”
“That one won’t work”
“I’ll give it a quick go first though eh”
“You’ll never do it there”
“Trust me . . . ”

I slapped the vein gently to bring it up, gave it a wipe with an alcoholic swab and set aim with the cannula.

As I inserted the needle the patient winced harshly.  I checked for [tippy title=”flash back” URL=””] When the needle ‘pops’ through into a vein the back end of the cannula fills with a tiny amount of blood.  This is called ‘flash back’ and proves you’ve got into the vein . . . but its doesn’t mean you’ve finished! [/tippy].  Yes!  Got it!  I was in!  Piece of cake.  I drew back the needle a little and started to push the cannula up the vein.

Resistance.  Damn!

“Oooooowwww!  Oooooooouch!”  The patient was evidently not liking this.

And now a small bulge was starting to show where I was trying to push the cannula.  Bugger!   I’d [tippy title=”blown the vein” URL=””] This is the result of things like, piercing through the other side of the vein or it just being too thin to hold anything and just bursting.  The end result is the vein bleeding into the surrounding tissue causing swelling and bruising.  This is called ’tissueing’. [/tippy].  Still feeling I could claw this one back I tried one more little attempt at poking and pushing . . .


Feeling like my ear drums had just imploded I came to the quick and sensible decision to cease any further attempts and concluded that it would probably be best to let the hospital do it instead.

The MRU, sitting in the front of the truck, chuckled loudly and shouted through to the patient,  “Feel free to smack him one luv.  I would.”

Eventually we dropped the patient off at hospital and I managed to catch up with the MRU outside.  Expressing my disappointment at not getting the cannula the MRU laughed out loud.

“Knew you wouldn’t get that.  Black African AND insulin dependent.  Not a chance mate.”

I wasn’t too deflated and the rest of the night passed with the usual [tippy title=”NFH” URL=””] Normal For Hackney. [/tippy] jobs . . . of which, I will write about in the next entry I’m sure.