Ambulance Nut - Learning the Ropes

Curtain Call

2010-03-28T14:10:00.000-07:00

Even though a review of the blog is still in the hands of the services media and communications department I have decided it needs to come to an end. I don't do this lightly, in fact I do it with a very heavy heart.

A heavy heart, not because I need to close it, it always had the potential to be impermanent but because I have upset and hurt people I never intended to.

I have been naive in thinking that my tongue in cheek attitude to certain areas of my writing and comments would be taken in the way they were meant. Some of the alias I assigned people have caused offence and that was NEVER my intention. Why would it be? I've landed at a brilliant station with a good group of people, yes there will always be personality clashes but I have liked to think I generally get on with most.

I have now changed this dynamic. I have lost the trust of some. I will need to work hard to get that trust back and I hope this will act as the first step towards that.

Those on station who I know will inevitably read this, I would like you to approach me if I have upset you so I can apologise in person. I owe people that much at least. As I continue to state, upset and offence were never my intentions in any of this.

So I will make the blog public one last time for one last week. On Easter Monday the blog and all its content will be removed.

**************

To those readers who have been with me from the start and been so encouraging and supportive throughout, thank you. I appreciate all you had to say and all you have taught me.

And before I leave I will fill you in on some of my progress.

In August I completed the initial paramedic training course at Barony castle. The 6 week course was intense but it was great group of people and I had a lot of fun. I then completed my first 2 weeks of clinical placement before Christmas and then the final part in February. So as I type I am compiling the necessary paperwork to send to the HPC and become a registered paramedic.

So it also brings a nice conclusion to Ambulance Nut - Learning the Ropes. I still have an awful lot to learn as I appear to be learning the hard way. I hope to continue to improve and learn and to enjoy the job I have found I love.

And so Louise is disappearing and, as I've said, I hope by putting this to rest I can go some way to building bridges I have so spectacularly burnt.

I started a second blog, not anonymous or under an alias, as me. It simply chronicles my time in the Scottish wilderness, with friends and family. As I have eluded before the mountains are my refuge and I shall be finding some peace and adventure in them again very soon. If this is your thing, feel free to join me there.

http://viewsof-scottishadventures.blogspot.com/

So in one week time this chapter will close.

Over and Out

Ambulance Nut xx

Update

2010-03-25T12:43:00.000-07:00

I have spent today going through the entire back catalogue of posts.

I am satisfied that I have removed anything that could be deemed as inflammatory or offence to the service or any colleagues.

I have added and removed a few things from the side bar and all of the alias have been changed to random names.

I am now going to email the press officier for the service who is tagged on the service website as the person to deal with any media and communication events.

I will update as soon as I know anything. I have been made aware that my return to station after some recent time off my be made difficult so I want to be full prepared.

Fingers crossed!

Louise

A New Era

2010-03-19T09:22:00.000-07:00

Hi everyone,

I am completely overwhelmed by everybodies support for me to continue. Thank you!

The invites have been sent. I have decided on a plan.

In the next couple of weeks I will systematically go through all my saved posts. I will be looking for anything that could be deemed a broach of patient confidentiality and I will be changing the alias names to general names (obviously not the real ones! Going to borrow a baby name book and mix it up!).

Once this is done, and it may take some time, I will approach our media and communications department (on the advice of Tom Reynolds at Random Reality, thanks!) I will ask them to review the site and let me know if I am in breech of anything to do with my job.

If I am the blog will be closed.

If I am not the blog will go public again.

This may take some time to resolve and I appreciate you all sticking with me. I will update on other issues very soon as well and keep you in the loop as to the blog status.

Thank you again for your support its bought a smile to my face this week!

Louise xx

Invites

2010-03-16T10:12:00.000-07:00

Going invite only for a while. Need to work this out.

If you are a regular follower/reader please email ambulancenut@googlemail.com, I will be scanning through these.

This is all while I take advice on things

Update:

Thank you those who have requested already. I can't promise I'm going to continue, I'm still thinking my options through. But I have added you and I continue to appreciate your support.

This will be visible to anyone until Thursday. After that I will decide what to do.

2 Year Old and Big Questions to be Answered

2010-03-14T05:13:00.000-07:00

I have a decision to make.

Whether to continue this blog in the face of certain attitudes towards what I write.

I have always known some people on station know who I am and what I do. No one has ever made me believe this would cause a problem. Until now.

I have been receiving comments from an 'Anonymous' reader which I have not published as they serve to achieve nothing other than to personally bait me into saying something bad or asking me to explain some of the terms I have used in the writing. This person has even shed their anonymity by approaching me personally on a social network site, where I am friends with other work colleagues. By doing so exposing me further.

I have never shied away from critical comments and have always tried to answer them to the best of my ability. Take the comment thread from this job for instance. So I am not ignoring the comments because am scared of their critical nature but because they bring nothing to the blog.

Equally I have never meant to cause offence with the names I have chosen as alias for people. I have generally used either a personality trait or a hobby they embark on outside work. If I have ever offended anyone I genuinely apologise.

I have always believed I have protected patient confidentiality and been careful about when I write about certain identifiable jobs. The only way these jobs have been identified is if the other persons involved recognise it and know it was me there. This would have been inevitable whoever I am and however I write.

There are blogger's in the sphere who are identified and 'out' as it were. Tom Reynolds at Random Reality and Kal at Trauma Queen. They have learnt quickly how to write without causing too much controversy and protect patient confidentiality well. Both have emailed me in the past to offer advice and warning on some of the writing I have done and I have tried to take this on board. The blog has been going for 2 years now and hope I have learnt how to do this as well. Although maybe I am still very naive about the whole process.

So the decision comes.

Do I continue to blog in the face of possible hostile criticism from the people I work with on a daily basis?

If people know its me and I 'out' myself would this make life easier? People could then approach me if they do not wish to be written about, I am more than happy to maintain their anonymity.

Or do I cut my losses after 2 good years and close the blog altogether. It would be sad to do this as I enjoy the process of getting my thoughts into writing and getting commenter's opinions. As with everything I learn from this. I have also built up quite a following and I'm very proud of this.

I had hoped my 2 year birthday post would be a bit happier but this is the card I've been dealt and as always would appreciate your views on this.

Hope your all well and enjoying the beginning of spring!

Louise

In disguise

2010-03-07T11:28:00.000-08:00

He is sat on the edge of his bed puffing through the pain. He has a bright red face and is holding his lower chest.

"Hello, my name is Louise, whats been happening?"

Between the patient and his wife I get a story of central chest pain and upper epigastric pain for half an hour. He has had a similar pain before but not as bad as this. He has had some recent blood tests and is waiting for other investigations into pain, the doctor has told him he maybe has ulcers.

While we've been talking his vitals have been popping up on the screen one by one. Oxygen saturation 99%, pulse 112, blood pressure 154/87. Nothing popping up as completely out of the ordinary, its not unusual for people to be tachy with raised BP when they are in pain.

We hook him up to the ECG. His appearance and history points towards the epigastric pain he has been getting but something doesn't fit. He doubles up with spasms of pain every so often. He is adopting the classic see-it-on-casualty* 'I'm having a heart attack' pose.

But he has a flushed face, his vitals including his 12 lead ECG are within normal limits, no radiating of the pain and no nausea or vomiting.

We decide to go with caution and treat him as having a cardiac episode. Aspirin and GTN are administered and an oxygen mask is attached to his face on high flow. I offer him entonox for the pain but he declines, he had it before for a fractured ankle and it made him feel sick. We're a double technician crew so didn't have the option of morphine for pain relief.

As we pull him into a majors bay in Holy Hospital he begins to vomit violently. On the way in all his vitals had been stable, not changes to the ECG even with the spasms of pain. I give my handover to Nigel*, one of the A&E doctors who is very pro ambulance service and a pleasure to work with. He agrees the ECG and presentation suggest an epigastric episode but that something isn't right about it.

A couple of hours later we're back at A&E and able to check on how our patient is doing.

"The first ECG we did was normal. Did a second as his pain was worsening and it showed a massive anterior MI**. He got sent to Central Hospital"

Central is the main centre for PPCI (primary percutaneous coronary intervention). This where a patient having a heart attack can go straight to the catheterisation lab to get the coronary artery unblocked. Its a brilliant service, instant definitive treatment.

As an ambulance crew we can go straight to the PPCI centre by sending them an ECG straight from the defibrillator. However in this case his ECG was normal and he wouldn't have been accepted, his MI didn't become diagnostically apparent until sometime after the initial onset.

But he still got the appropriate treatment in the end and from what I heard back he was doing well following a stent being put into the artery.

* Did anyone see Trauma on Monday night? Hands up who else spent most the time laughing or shouting at the TV?!

** MI, Myocardial infarction, heart attack. His ECG showed ST elevation of approx 3.5mm in leads V2-V4. Big heart attack!

Progression

2010-02-23T14:58:00.000-08:00

Hi everybody

Hope your all well and still enjoying what I blog, when I get around to blogging it!

Things are progressing in the Paramedic department. Things had been stagnating for some time but I have suddenly made it onto the final steep down hill slope towards the finish line (or start line depending on which way you look at it!).

I will hopefully be updating you fully in next couple of months, in the mean time I will blog when I can around busy life and exciting things.

Take care

Louise x

Too Young

2010-02-17T10:24:00.000-08:00

Two people dead.

Too young.

Both knew the risks.

One ignored them. The long term effects on their health were there for all to see.

The other knew them. Knew them well. Took account of them. Fell victim to them.

One knew what they were doing to their body. Daily neglect and ignorance to the serious nature of their chronic condition.

One pushed their body to the limit and had done every weekend before with no problems. This time nature decided to have the last say.

One I knew through regular visits in a professional capacity. Pursuading them to leave the squalid flat and go to hospital to delay the inevitable a little longer.

The other I knew as a friend. A lively character and determined head strong in their pursuit of the ultimate goal. Generous and opinionated.

Two lives lost in one week.

Both preventable.

Both unnecessary.

Both too young.

Another Question - Answers

2010-02-08T07:13:00.000-08:00

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

2010-02-01T16:31:00.000-08:00

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!