Another Question - Answers

GP: "Ok, this gentleman has had ongoing chest pain since 4am and it hasn't been relieved with his own GTN. All his vitals are normal and he is NSR (normal sinus rhythm). Sending him in to rule out cardiac cause for this pain."

Louise: (Looking in the envelope with the GP's letter in) "Ok. NSR? Is his ECG in here?"

GP: "There isn't one. We only have ECG on the defib."

Louise: (Looking confused) "But you said he's NSR?"

GP: "Yes. From his pulse and having a listen"

Louise: (still looking a bit confused) "Ok"


I wasn't trying to be clever and catch out the GP but I was genuinely confused by her statement that you can diagnose NSR through a patients pulse and heart sounds.

You have seemed to agree with this in your comments. Feeling someones pulse gives you an idea of rhythm, regularity and strength of the heart beat and by experienced listening the hearts sounds can give an idea of how the valves are functioning.

All these could be normal and patient may still show abnormalities on an ECG tracing which stops it from being termed NSR.

I am still happy to be corrected in this line of thinking! As always........ still learning the ropes!

Another Question

Ok, time for another easy post for me, I have another question inspired by a conversation had at work with another health professional.

Here it is.......

With the aid of only a stethoscope and feeling someones pulse, can you tell if they are in Normal Sinus Rhythm?

As usual I will wait and see what answers I get before filling you in the story!

Changing Feelings

"Crap"

The message that appears on the screen is not one we want to see.

'Caller believes its accidental'

The snow is starting to flurry down slowly, not heavy but the sky looks threatening. We want to put the foot down but its safer not to. We're no help to anyone if we're in a crash.

This isn't our usual area. Unfamiliar street names pass by as we follow the Sat Nav closing in on our intended location.

Apart from the odd navigation instruction to DramaQueen* I'm silent. Thinking through all the different scenarios that may play out if the call is as given. None of them are good.

I'm thinking myself calm. Talking myself through the steps I need to take.

We pull up in the cul-de-sac. Its grey and the snow does nothing to lift the colour. Our strobes bounce back off the grey and white to illuminate the small street, coming to life with the arrival of people. People that shouldn't be here on a normal day.

The police aren't on scene yet, but there is no danger in the message and no chance of us waiting for them.

A young teenager stands at the end of the path in school uniform, he doesn't appear to be feeling the cold even though he is just in a thin white shirt. He is hugging a older women.

He points down the path, "last house on the right". He looks shell shocked, his young eyes have seen something he didn't need to.

We grab all the gear and head towards the house. There is no need to knock the door is a jar when we approach.

I step in the front door and head towards the stairs.

I hear DramaQueen* enter the house behind me and skid on the hall rug with an expletive. She looks up and swears again.

There is a mirror on the stairwell. I've been progressing up the stairs with my head down and don't see what DramaQueen has seen in the mirror.

I see it soon after though.

At the top of the stairs I take in the scene instantly.

The loft hatch is open. There are 2 lines running from deep in the loft to the hatch. One is a blue rope the other appears to be a telephone cord.

The cords run down to the neck of our patient.

He is silent, still. Not what I expected. He doesn't look real.

There is a tall step ladder behind him. We nod an agreement. I climb up the first couple of steps and take my tough cuts out.

We have no timeline and not information. We decide to cut him down. No one wants to see him in this position and we need to assess properly if there is anything we can do.

We both know there isn't.

I know to cut above the knot as DramaQueen takes his weight and lowers him to the ground.

We apply the monitoring pads and get the expected steady tone of asystole. There is post mortem staining to his hands and lower legs.

We turn off the machine, remove our equipment and leave it by the front door. As we are about to leave the police arrive and ask us for an update.

We explain our movements and actions. We have no idea if we're the only ones who have been in the house since he was found.

They had received the same message as us en route. No we didn't believe it was accidental. Not with two cords attached.

We head to see the family. The young man and his mother. He is still waiting outside, still not feeling the cold.

I introduce myself and say the words that I've had to say before and are of no surprise to him. I ask him when he last saw his Dad and who found him.

"I did, when I came in from school"
"Was he supposed to be working today?"
"No, he had the doctors this morning. I think it was because of his moods recently"
"Ok, was your Mum home?"
"No she works all day"

I thank him for his help and tell him the police will want to speak to him and his mother. He said she was in a neighbours house. I try to persuade him to join her and get out of the cold and snow that is now coming down heavier as threatened.

We walk to the ambulance to put the kit away and begin the paper work.

I'm feeling different to the usual DOA's. Its not because its the first time I've seen a hanging. Its not the job itself. I can reconcile myself with the things I see quite well, although images still stick, they don't haunt. People alive and suffering are much more harrowing then those long dead and beyond help.

I'm angry. That's why I feel different.

I'm angry that, although this man had obviously come to a point where he felt he could no long function in the is world, he committed suicide knowing the first person back to the house, the first person who would see him hanging from his loft hatch would be his 13 year old son.

And I'm angry with him for that.

News?? Really?

We saw this on BBC Reporting Scotland this morning

Buckfast involved in 5,000 crime reports

I'm sure frontline officers and a couple of nights out in the ambulance would have saved someone a lot of money in collating this reasearch!

For us the usual calls we get involving the vile drink are, as mentioned in the report, someone having recieved a hole in the head from a bottle.

Or the other and infinately more annoying one is is the 'Male/female throwing up blood' call. Where we arrive and politely inform the 'patient' and their family (usually another hysterical drunk) that they are not infact dying and vomiting blood.

Blood is not generally seen as purple thin liquid.

Happy New Year

Hi Everyone!

Happy New Year, I hope you all had a good and safe one. Hope those of you working weren't put through it too much!!


I would like to thank you for sticking with me a busy and at times very hard year. There has been a lot happening and I promise to update you on several situations (including my progression through to Paramedic) soon.


Thanks again and I hope normal service (whatever that is!) will resume soon. I have a bit of time of to recharge coming up and hope to be back on form after that!


2010 is shaping up to be an exciting year for me so watch this space!

Louise xx



And remember people................ Objects in your rearview mirror may be closer than they appear...............................

Questions

What just happened?

Did I read the situation right?

Did I put too much emphasis in my head on what the lady told me when I got out the vehicle rather than reading the situation myself?

I know I did the right checks, but did I get the right answers?

I know what I saw, don't I?

Should I be so angry at the extra crew's response to my handover? Or in hind sight were they right to be so sceptical?

Was the patient really ill? or was it the drink?

Did I think that he was really that ill and dismiss the significance of the drink?

Has the patient pulled a fast one on me without me realising?

The patient didn't die, he seemed well recovered when he left with the other crew, I did the right systematic things, I handed over to the crew with all the information.

So why do I feel I need to justify and question what I saw and as a result what I did?

Why do I feel that the other crew were looking down their nose at me thinking "Silly Girl"?

Why do I feel so crap about a job I know I did right?

Merry Christmas

Merry Christmas Everyone!!!



Hope you all have a good time and don't forget to give your friendly neighbourhood ambulance crews any spare chocolate to see us through the weekend!

(I wanted to post a picture but my computer is playing silly buggers!)

Here's a link to last years picture.

Louise xxx

Winter Weather

Take care people! Be safe!

Louise xx

Changes

Making a few little changes to the site to hopefully make it better and easier to get in touch with me.

I'm not particularly computer tech gifted so stick with me and I hope it doesn't go pear shaped!

Stuck

She's in some state. She's not going to be easy to move. She has fallen and can't get up.



We stand assessing the problem, some furniture removal and an extra pair of hands is required.



She is sat on the floor at the end of the bed, her legs are folding underneath her in an unnatural manner that can't be comfortable, nothing appears broken its just not a position people would normally choose to sit in. She has a thin nightie covering her ample mass and has managed to drag the duvet off the bed to try and stay warm. No one knows how long she's been here, it could have been all night.



All her weight has been on her lower legs for hours. They have turned a nasty shade of black and have gone beyond being painful into the realm of numbness.



Throughout the assessment of the room and devising a way to get her out she as been talking to us. Her only complaint is of not being able to move, she can't recall when she fell or how long she has been here. Her home alarm necklace is sat on the bed side table, well out of reach. She is hypothermic but her vitals are stable for now.



We move the mattress off the bed giving us a lower platform. The plan is to raise her body off her legs and lay the top half of her on the bed base. That way we can get a blanket under her torso. Then we need to move the bank of wardrobes from behind her to get the chair in. If we tip the chair and use the blanket to pull her up we might just have half a chance of getting her out of here.



It takes 3 of us to pull her torso onto the bed. Something in the bed base breaks as we do it. A quick apology for wrecking the house is made before we move on.



We can now see the full extent of the damage to her lower legs. From just above the knee joint down to the feet her legs are black with patches of purple and red showing through. They are both frozen to touch and have the consistency of those pink 'stress balls' people use as desk decoration. When we press to test the capillary refill to see if there is any circulation the colour changes to white.



"1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16......" I stop counting. The colour in normal circulation should return in less than 2 seconds. I begin to attempt to find a pulse but that to is elusive as is any sensation to the skin.



As my colleague and the RRU help the son and neighbour move the wardrobe to make room. I try talking to our patient again.



She is very tired and as she complains of this her speech starts the slur. I try to keep her talking and try to assess her GCS and level of confusion.



I start wonder if she is stroking out. Has lifting her off her legs caused a clot to be released into her blood stream? Its a possibility but doesn't change our predicament.



We can't move any faster then we already all. I put the oxygen up a notch and help with the final move of furniture. We're ready and in position to try and get her up. We tip the chair so the edge is near her backside, if we can use this the tilt her as well we have half a chance.



It works, sort of. After some repositioning we get her set on the chair and start down the stairs. She is now slipping into the realms of unconsciousness, her head lolling back as she loses control of the muscles to keep her head up. We can wake her easily enough but the 3 of us can't stop to assess it, we just need to get her out. Quickly.



A look passes between us. We're all thinking the same thing. She is giving up in front of us. Its all too much and she is tired of fighting.



We get her on to the trolley bed. It's not dignified and it's not protocol lifting but sometimes that goes out the window when moving very ill, big patients. We know it shouldn't and that one day this may come back and bite us in the arse.



As my paramedic colleague takes the 'jump' seat to assess her airway and breathing. I grab the bag and mask to have it to hand. I also take out the big cardiac monitoring pads. I don't need to be told she will need close monitoring.



I layer her body with a foil blanket sandwiched in between 2 other blankets. She needs warming gently.



We call ahead to inform the resus team and I weave through the early evening traffic, lighting up the dark night with the blue strobes. The drivers tonight are paying attention and the drive goes well, just one of those where everything flows.



We roll her into resus. Her legs have been changing colour slightly since being released. Some of the black is becoming a definite purple, its now a patch work of angry red and blotchy purple and black.



Her conscious level and breathing have improved slightly en route but she's no where near out of the woods yet.