Not straightforward

A while back we attended to a lady late at night who was complaining of abdominal pain. She had had an accident earlier in the day, but had adamantly refused treatment and transport by the attending crew.

We arrive at scene, and find an emotional woman sitting in a chair on the front patio. She stands up, tells us about the accident, and describes where the pain is - upper hip bone area, right where the lap section of the  seatbelt goes across.

And then she pulls down her pants to show us the bruising.

Hmm...not what I had expected, but we both look away and ask her if she could please pull her trousers back up, the sooner the better. She doesn't know if she should go to hospital or not, but we encourage her to get checked out.

At hospital, they breathalyze her for a blood alcohol concentration (BAC) reading - which, you guessed it, comes back as well above the legal limit. Upon being asked about drinking, she replies she had a couple to drink after she got home from the accident. Fair enough; but is that the truth? Was she in fact under the influence of alcohol during the accident? The police did not attend (why I do not know, apparently it happened at a busy intersection), and she refused transport. Possibly she wanted to avoid the authorities.

Conspiracy or not, it opened my eyes to the possibilities, and to get the cops involved if there is any doubt at all. Drink Driving is not something that should be taken lightly. Go harm yourself if you absolutely must (although I would recommend seeking psychiatric help instead), but leave others out of it.

A matter of laugh or death

I swapped a shift the other so I could get a day off in a couple of weeks, in order to go to a wedding. This allowed me to work with a friend and excellent paramedic on the ambulance once again - the fellow who taught me the ropes, who I was teamed up with for the first two months of my on road experience.

And it was excellent.

No whinging about calls, no silence in the cab, always chatting to each other, to patients, to members of the public. A very smooth operator. And great in tricky and time critical situations too. What more would you want?

We had a good shift: Started off slow, which allowed us time for some food, a chat to the staff and a drive around our local area (which I was unfamiliar to). A chest pain then came up on our screen, and on came the lights, down went the accelerator. Chest pains are a fairly standard call for us, this one was a bit difficult due to poor details of patient history (our patient had learning disabilities). But nonetheless a job we mastered - especially since I was shown how to do modified chest leads (9 lead ECG) with our 3 leads monitor. Another skill that is excellent.

A transfer next which stretched my partners communication skills to the max...40 minutes and hundreds of bad jokes, singing competitions, stories of the homeland, anecdotes about past jobs and generally made up fairy tales later we arrived at our destination, with a patient with a bleeding ear and a partner with a bleeding mouth :-)

Next up, we got a call where I don't want to go in to any detail at all, due to the fact that the police are heavily involved, and matters may go to court. No space for stuff like this in a public forum, sorry guys (I know you are reading this now with an intense dislike of yours truly growing bigger by the second..."why does this bastard have to tell us that he won't tell us?" Hahaha, curiosity getting to y'all?)
What I will tell you is that it tied up nicely with one of my current uni subjects. Maybe more to come about that job further down the track.

That job only took about 3 1/2 hours all in all, including police statements, standing in the pouring rain, a bit of medical treatment and trying to kill some time in the early hours of the morning. So we grabbed a sausage roll and some choc milk, had a debrief about what happened, and headed back to station for a kip.

Rounding up the day was another transfer with a sedated patient but a chatty nurse, easy enough. I had to head to uni after shift, so on the way back to the depot from hospital I popped myself in the stretcher, buckled up and caught up on some sleep.

Sweet dreams!

limb-o

Saturday night, and I am geared up for a big night. I want a big night. I need a big night. No tough jobs to sink my teeth in to means no experience for me. Throw it at me, give me the big stuff while I'm keen and enthusiastic.  Please.

Pretty Please?

Nothing too exciting again, but I can tick the burns bit off the 'to do' list. Our jobs were as following:

• Hip pain. Pretty bad hip pain actually, this was genuine 9 out of 10 pain on movement, zero on lying still. In went the drugs, and out went the patient...still in a considerate amount of pain, but coping. As soon as we had him on our stretcher, the only remnant of the pain was a dull ache, and that stopped soon after, namely when he fell asleep en route. Drugs worked a treat.
• Abdominal Pain, together with Nausea and Diarrhoea. Got the patient talking and comfortable, and had a smooth trip to hospital.
• Legs. We should have an additional set in the van for patients. We have a lot of patients with buggered legs. Why don't we carry replacement legs? Our next patient, for example, could have done with another set, together with another heart I s'pose. Patients legs were just absolutely, most definitely, quite over the top full of fluid (right sided heart failure, or congestive heart/cardiac failure aka CHF/CCF). The legs had ulcers on them too. So, what does big pressure, big water and big sores mean? Leaky Legs, correct! There were water droplets, like sweat, all over the legs. Mild SOB to go with it, but the legs were impressive (close to this prize shot I found on the web). A short explanation scribbled by somebody on her notes gave us a good chuckle: "Patients legs have swallowed today". Ah, no wonder they were so big, they had swallowed a 1.5 litre coke bottle *smirk smirk*.
• More Legs, this time the elements were in role reversal...from water to fire. A Stove had made unpleasant contact with the back of our next patients leg, burning it deeply. In correct drunken manner, a friend had applied betadine - an antiseptic cream. And hadn't cooled the burn. Ouch. Problem is, cream will trap the heat, and worsen the burn. So off we flushed it with Saline, cooled it with wet bandages, and then applied tea tree oil compresses - Burn Aid dressings (messy, but smell lovely!). Our patient stated he was in 10 out of 10 pain...so I considered, and even drew up our strongest pain relief medication. Only to see our patient had fallen asleep. So much for intense pain :-) I continued with our other pain relief instead, and made sure the burn was kept covered and cool.
• Last but not least to finish our limb-o: RFDS transfer for a patient who had taken a tumble and broken his wrist. It was 3am, so patient caught up on some sleep, while I filled out the paperwork and enjoyed the views outside.

Smiles and Spikes

As the title suggests, it was an easy going day with a slightly interesting case thrown in. We had

• the 93 year old lady (who looked like 63 and who's mind was even younger) who was feeling unwell, probably due to a mild reaction to some prescription medicine - one of the three medications she was one. And that at 93. Go Girl!
• an elderly patient collapse, again probably due to some reaction to his medication. He would not stop talking en route, all talk and smiles. Makes monitoring conscious levels easy :-)
• a transfer - slightly nutty old chap, but genuinely friendly. Started a great 'grumpy ld men' performance once he was back in his nursing home room with his long time roommate. Good laugh.
• an interesting trauma job: Our patient had tripped and fell out on a field. In the process of falling, as you do, she stuck her hands out to break the fall...unfortunately her hands aimed right to the spot on the ground where a couple of rusty metal spikes happened to be. Said spike then penetrated the top of her hand at wrist level, and came out the other end of the top of the hand, where the fingers are. Ouch. My first penetrating wound, but really not much we could do apart from re-bandage. I was very proud though: I remembered I had my camera with my, and took some pictures for the hospital, one of the wound and one of the metal spike. The nurse seemed appreciative of the added insight.

All in all nothing challenging. I'm sure those jobs will come, they are just unfortunately taking their time.

Busy Friday and lazy Sunday

Nothing much out of the ordinary though. Friday produced ten jobs callouts for us. Here they are:

• Female, late 60's, left sided arm pain, relieved with GTN, recently discharged from hospital...and promptly recharged to hospital (well...admitted is probably the more correct term....but if you can be discharged, don't you get recharged at some point in time?).
• Stood down, call cancelled. I had an inkling this would happen...the ocation was 20km away, and was a report from someone driving by of a person lying on the ground. Thanks to the police, we got to go back to our beloved depot.
• Priority one inter facility transfer - from one hospital to another. Interesting case this one actually, our patient had had a minor accident a couple of hours previously. To cut a long story short, the patient was not acting strange after the accident because of the accident, she actually had the accident because of having a body wide infection, with a couple of other things going on. Eventless transport, but some good insight thanks to the nice doc and nurse escort. Also an eye opener: you never know what could have caused an accident or funny behaviour!
• Kid who had grabbed mums sleeping tablets. Two of them to be precise. Two and a half hours prior to our dispatch. I didn't really clue in why we got sent light and sirens, but I was happy that kiddiewinks was alright. We transported mum and kid to hospital for a checkup. En route, child showed me he had a little bit of tummyache, so I gave him one of our great little vomit bags. He then proceeded to open it up, stick his head in to the bag, and make loud farting noises. Yep, this kid is healthy, and this is a taxi job :-)
• Male, Post assault in pub. No ordinary party at the pub though. It was flintstones night! I was met by Fred, one of the security fellows, who walked me though the club and introduced me to Barny, our patient. Wilma was on scene too, applying some TLC. And Betty was quite upset about her boyfriend. And the whole situation was quiet comical - literally.
• Picked up a job on our way back to a fitting octogenarian. Poor fellow didn't know what had happened, but he was compliant and came to hospital with us. His wife was pretty upset about the whole situation, and calming her down was not easy, as she didn't speak english.
• RFDS transfer for a non STEMI patient.
• Stood down, picked up a Priority One.
• Female complaining of migraine. But with associated health issues - so warranted an ambulance if you ask me.

If you were to see my case sheets, you would see a direct correlation between progressing of nighttime, the readability of my handwriting and the amount of information on the sheet. Working at 4am brings out the minimalist in you, treatment wise.

I did an additional Sunday nightshift for a mate who did a dayshift for me the other week. Actually, it was bastard mate who tried to tell me he did two resuscitations in a row.
Well, his dream job is to have a really off-yer-knob psychiatric patient. So I told him just that: We had a really psycho crazy mofo who we had to inject with Midazolam and Haloperidol, or else the police would have had to Tazer him. We also tied him down to the stretcher, and placed the scoop stretcher on top of him (tied down again), as a sort of makeshift cage, in case he arched up again. Wow, what a job, crazy.
Well, of course non of this happened, but revenge is sweet. In reality, it was a very cruisy night:

• Stood down for a Priority 1
• 80+ female post collapse, heart and abdo problems, all around not too healthy. Off to hospital.
• Transfer hospital to mens hostel. Nice fellow, great carers!
• 80+ female, who tripped whilst going to the telephone. Probably won't be coming back home, she had broken some bones and was aware of the implications it had. I felt sorry, held her hand, but couldn't speak her language. Sad.
• Stood down, the police took care of our person lying on the pavement.

The shift was good. I worked with another paramedic who I really get on with well. Throughout our jobs, we had monty python blaring on the radio, and we were singing along to such hits as "always look on the bright side of life", "eric the half-a-bee" and "never be rude to an arab". Brilliant.

feature

Ooh, look mummy, I've been featured in the new list of blogs up at EMS1.com!

Check it out here, and go pop by the other blogs too - they're well worth it.

Impersonator

Female, post assault, now short of breath, sweaty, complaining of chest pains.


It's late-night shopping in the 'burbs, Usually at this time of night we can get away with our lights only, but the traffic is flowing yet pretty thick. The siren bounces off the walls of the neighbouring houses, mushing a clean wail in to a warbled song from a dying duck who has just hit puberty.

A couple of minutes later we walk in through the doors of our patients house. Our first impression is to take  the pressure down, everything is going good so far. Turns out there was a fight between mum and daughter, and we have a more emotional rather than physical situation to deal with. Attendant attends to patient, I gather some background info for our paperwork. Apparently the daughter is still in the house.

"Hello?"


I turn around. This was a child's voice, a little girl. Was that the offender? Nobody to be seen.

"Hello?"

A child's voice, young female, a little scratchy, possibly even a little....

"Hello?"

...squawky. Damn bird! 

I had not consciously taken in the massive bird cage next to the front door. Cocky the cockatoo (well, a galah to be precise) was toying with my brain, and only trying to be polite. I walk up to the cage to reciprocate the greeting.

"Hello little bird!" I say.

"MEOW" it replies.

This bird has lost its conkers. Absolutely out of its mind, stark raving mad. Then again, if you are a caged bird surrounded by 6 cats, you would pick up a bit of foreign language here and there. As we leave, the bird looks at us and tells us to "nick off". No manners whatsoever.

- ~ -

The other jobs of the night weren't anything special, but here is a quick summary:

• Fellow released from hospital just hours before, still complaining of neck pain. Back to hospital again for reevaluation and pain management.
• Kid with Asthma, Kid was fine.
• Old feller with a blocked catheter/haematuria (blood in urine). Nice chap.
• RFDS transfer with a sedated, intubated and ventilated patient.