Pseudo-Collapsers – part 2

The last of the case studies . . .

Pseudo-collapser 1

A young 20 something year old, smartly dressed man had randomly fallen to the floor whilst sitting on a wall as a group of young Asians walked past.  Bemused as they were they did the right thing and called for an ambulance.

Being new I was very concerned for his welfare and couldn’t work out what clinical reason he would have for collapsing.  My crew mate however, was less than impressed . . . so, after the initial checks we threw him onto the trolley bed and loaded him onto the ambulance.  His only ID was a release letter from the local prison dated that day.

He was taking everything that was thrown at him – not a flinch at a squeezed ear, the sternum rub was brushed aside with gentle breathing and at least four pens were snapped over his finger nails before we gave up on that.  I wanted to blue him in thinking something was wrong . . . my crew mate looked at me incredulously – especially when I suggested ‘securing the airway’ with an .

She eventually smiled at me, much the same way someone smiles at a little puppy who’s pee’d on the floor for their first time.  Gently moving me to one side she grabbed her tough cuts (scissors) and approached the patient speaking loudly.

Crew mate:        We’ll need I/V access

And with that she started cutting up the sleeve of his shirt.  Instantly, the man came round and desperately tried to retract his arm – but not so quick as to make it look too obvious.

He was a lot more co-operative after that . . . and we didn’t blue him in.

Pseudo-collapser 2

This one came down as a 30 year old male collapsed in the street.  We arrived to find a Turkish man slumped in a chair on the pavement of a busy high street.  His wife was frantically trying to waft air at him using a magazine.  We could see he had good colour and if he was truly unconscious in the position he was in he would have fallen off the chair.

My crew mate set about trying to wake him whilst I had a quick chat with the FRU who’d just arrived.  The FRU recognised him and before leaving us to it, he informed me he’d been out to him a couple of times before, all for the exact same thing.

The FRU left and I turned back to see how my crew mate was getting on.  She was obtaining a brief history from the wife.  At that moment I caught the patient opening one eye and quickly glancing around before shutting it again.

My nostrils flared and my lips tightened.

After our checks in the street we ‘assisted’ him onto our truck and placed him on our bed where coincidentally, he started coming round.  His first complaint was not being able to move anything, especially his legs – so, I attempted the .  I did it quick so as to catch him off guard and low and behold he snatched his legs away with a yelp.

Binder:       Seems your legs are working fine sir

His wife was eventually cottoning onto his behaviour by now and by the end of our tests she was not amused.

Wife:           Get up now Paol*.  We not going to waste these people’s time any further.  They should be dealing with worse sick people than you . . . GET UP!  COME, WE GO!

He eventually did what he was told and left.  But not before shaking our hands and thanking us for all our help . . . !

Pseudo-collapser 3

This was a 73 year old gentleman with Parkinson’s.  He’d had it for nigh on 20 years but it had become more aggressive over the last year.  He had not been dealing with it well and had been channelling a lot of his anger and distress on his doting wife.

We arrived to find our patient sprawled out on floor at the top of the stairs.  An FRU had been on scene for a short while and my initial thoughts were that we needed to load-and-go.  But the FRU gave me the background story – it was much the same as the 20 year old Bengali lad from the previous entry.  She also showed me that his obs were fine and finished by demonstrating his failing reactions to the hand and eye tests.

This one both annoyed and upset me at the same time.  Here was a retired man, clearly struggling with his condition.  That was sad in itself . . . but downstairs his wife of over 40 years was distraught with grief and worry over her husband, not knowing that what he was doing was solely for attention.

We tried everything to rouse him but he wouldn’t have it.  When trying to move his head I accidentally let it drop . . . there was that instant moment when you cringe because you know its going to make a horrible “thud” when it hits the floor – but it didn’t.  Instead, our patient gently lowered his own head down and even had the audacity to adjust his position to be more comfortable afterwards!

I’m not sure what annoyed me the most though – the fact he was pulling this off in front of his wife or the fact that he weighed nigh on twenty stone and we had to carry him down an awkward set of stairs.

His condition never changed however, even when he was handed over to the hospital staff where they took over the laborious task of trying to rouse him.

Pseudo-collapsers 4

This one happened when I’d literally been out only a couple of weeks.  I was working with another colleague who’d been out only a little longer than I, so we were both very green.

The call had come down as 45 year old collapse in the street.  We arrived to find a private ambulance crew on scene crouched over the patient lying in the middle of the street.  A crowd of onlookers had gathered round and were watching expectantly.

Our patient was lying on his back, mouth open and eyes staring straight up.  We were given the briefest of hand overs by the private crew.

Private crew:     We were just passing and we saw him step out of the pub here and just collapse.

No one seemed to know anything more about him.  I think I was thrown by the fact that he had a bounding pulse and was breathing – but didn’t respond to anything else.  I think I would have been better prepared if he’d been in cardiac arrest.  Thankfully, my crew mate was far more switched on than me and said he’d get the bed.

We quickly loaded him onto the ambulance and shut the doors so no one could see our panic stricken faces.  Taking a deep breath we then set about trying to get a response.

Nothing.  No answer.  No movement.  No reaction.  Nothing.  To anything.

Enter an FRU who’d just arrived on scene.  He shut the door behind him, said hello and smiled down at our patient.

FRU:                 Ah.  I see you’ve met Mr Tellison*

Our perplexed looks must of given away our ignorance.

FRU:                 Right.  I see.  **and then in a whisper**  He’s a regular caller round here.

Our looks mustn’t of changed as he appeared to sigh and try a different approach.

FRU:                 Ok.  We need to secure that airway don’t we, so what do we do?
Crew mate:      OP airway?
FRU:                 Yep, that’s right.  Away you go then.

I helped my crew mate size one up and he carefully inserted the airway into his mouth and down the back of his throat.  The patient didn’t flinch or move a muscle.

FRU:                 No.  No.  No.  Come here.  Step aside.  That one was far too small . . .

He picked out the biggest OP there was in the bag.  Smiling out the corner of his mouth, he gently inserted it into the patient’s mouth and down their throat.  And then he started wiggling it, continuing until the patient couldn’t resist any further.  In a flash the patient coughed, knocked the FRU’s hand to one side, sat up, spat out the OP and then launched into a chorus of cursing.

Patient:            Ah ye fecking eejuts.  Ye fecking wankers!  Conts the lot o’ yerz.  Feck off ye fecking feckers . . . ah ah’ll feck yers so I will . . .

He didn’t seem to want to stop.  And he didn’t seem to be spitting it at anyone in particular either.  My crew mate and I just stood there watching, wide eyed and open mouthed.

The FRU, sensing his job here was done, stood and went to leave.  Before opening the door he turned to us and smiled.

FRU:                 Mr Tellison will calm down in a few minutes.  He’ll then be as nice as pie.  He’s from southern Ireland as I’m sure you’ve already worked out.  He doesn’t have any medical conditions, he’s allergic to penicillin and doesn’t take any regular medication.  He’ll want to go to the local hospital because he lives quite close by but he’ll probably leave before they look at him because he gets quite impatient.  I’m V750**.  Its been emotional.  Goodbye.

And he wasn’t wrong.

Binder

*not his real name of course
**not their real call sign of course

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Small tube that gets put into the mouth and a tiny bit into the throat to stop the tongue from rolling back and occluding the airway
 A quick reflex test to show up any neurological problems . . . you run an object (like a pen) up the sole of their feet.  If the big toe curls backwards (extends) then it can be a sign of neurological damage, like a CVA. 

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