Two different days – Part 1

It has been a while since writing . . . well, in fact a long while.  “Why is this?”  I hear everyone cry.

**listens for crys . . . nothing but gentle winds, a tumble weed drifts past and a distant church bell**

Well anyway, I reckon its writers block – or whatever the hell people call it.  Its not for the lack of interesting things to write about that’s for sure.  I have a long list of anecdotes from colleagues that I desperately want to put up – and I will, honest.  But for now, lets break back into it gently . . .

Shortly after the previous post I had two completely different days from each other.  And its for these reasons I like working for the Ambulance Service so much.  You really don’t know what you’re going to get each job and anything can spring up.  Admittedly, a high percentage of what we go to doesn’t end up being life threatening (and that’s a good thing for the patients) but trying to predict what sort of job you’re going to get next is really a pointless task.

Therefore, I have split the two days into two separate entries.  This one has the fun filled day of proper jobs and the next one has the fun filled day of not so proper jobs.

Day 1 – fun filled day of “proper jobs”

Job 1) Started day with an RTC close to station.  Motorcyclist vs van.  Van pulled across motorbike’s path who “T-boned” it at about 30mph.  Side of van caved in, including the B pillar (supporting strut).  Front of bike destroyed and visor and chin guard ripped off patient’s helmet.
Collared, boarded and conveyed to Royal London.  Got off lightly with a broken arm, dislocated shoulder and a broken zygoma (cheek bone).

Job 2)  A 50 year old woman with very low  of 70.  She was gasping slowly and deeply for air and looked pale and ‘big sick’.
This was a load and go – and think and do en route.

Job 3)  A 70 year old with exacerbation of .  In classic form to this condition the patient was sat in a tripod position fighting to force air in and out of their lungs.
This was another load and go and think and do en route.  But, at least by the time we’d arrived at hospital and after administering all the indicated drugs the patient was able to talk – albeit in short breaths.

Job 4)  Another Mental Capacity case.  This time a 78 year old man in a nursing home who was refusing all food and fluids.  An ambulance had been called out to him the day before for the same thing but he’d refused everything and they’d had to leave him be.  So, here we were presented with the same problem.  The man was thin, pale and looked malnourished but by all accounts had all his faculties about him.  He was polite enough to co-operate with everything we asked of him and we were able to do all our ‘obs’ and paperwork.  But, none the less, he did not want any help and didn’t want hospital.  He’d simply “given up”.  And after all his sentences he’d politely finish with a gentle whispering smile, “I’m ok, it’ll be alright”.
Again, there was nothing we could do for him other than tie things up.  We contacted family and did all the necessary paperwork and bid our goodbyes.  He held our hands and thanked us, smiling, and then just lay there staring at the ceiling.

Job 5 and our Off-Job)  A 56 year old in cardiac arrest -i.e. their heart had stopped beating.  Within a minute of the call there were five of us paramenaces working on the patient.  Whilst CPR was in progress we hooked the patient up to our Lifepak machine to monitor her heart rhythm.  She was in  which meant we couldn’t ‘shock’ her but it did mean we could give her adrenaline.  And within a minute of giving adrenaline the patient had a return of spontaneous circulation (ROSC) – i.e. her heart was beating again . . . we’d got her back!!  I’d never been part of a ressuss that had had this outcome before so understandably I was a little surprised, and sat there staring.  But after a few seconds I snapped back into gear and continued helping to get the patient ready to go to hospital.
As this was our off job, the other crew stepped up and offered to convey the patient for us and do the bulk of the paper work.  We followed them to the hospital and then were able to go home only forty minutes over due.

Days like this don’t happen that often but when they do you can’t help leaving work buzzing.  And needless to say, as soon as I got home I had a nice cup of tea and promptly fell asleep . . . on the toilet – much to the amusement of my wife.

The next day was to be in stark contrast to this one – all apart from one small piece of news we were to receive about our mental capacity patient from this day . . .

Binder

 

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Saturation – ie the amount of oxygen saturating in their blood each breath.  A normal level in a normal patient would be between 94-100%.  COPD patients can be expected to be between 88-93%.  If your sats are low, you generally look ill! 
COPD – “Chronic Obstructive Pulmonary Disease”.  A generic term used for a long term illness associated with the lungs – eg, Asthma, Emphysema, Bronchitis etc.  Patients with COPD usually present with difficulty in breathing (DIB) and are a high percentage of our call-outs.  Smoking is a massive influence to this condition – I reckon if we could take the general public round with us sometimes to visit the folk who are COPD due to smoking, it would probably turn things around. 
 PEA – “Pulseless Electrical Activity”.  This is a rhythm seen on the FR2 or Lifepak machine which resembles the heart beating.  And to an on-looker would look like the person is alive.  Sadly they aren’t at that stage as there is no pulse.  The electrical circuits are firing fine, but the heart isn’t beating. 

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