This may turn out to be war and peace so I won't hold it against you if you don't get to the end!
Let me tell you about a shift I had recently. By the end of my shift B (D was still on leave) and I had worked out that had the four people we attended that day, or their friends or relatives, thought about what they were doing we wouldn't have been needed by any of them.
Patient #1: Let me start with not the patients fault..... It was a call to an elderly lady with breathing difficulties, found in a bit of a pickle by the sheltered housing scheme manager. When we arrived she had taken her inhaler and was looking ok if a little short of breath. She was deaf as a post so it was hard going. Inside the pts NOMAD (drugs box) was a note from the pts daughter saying 'please help mum with her inhalers she is having trouble breathing'. My thoughts there, ring the Dr, your Mum shouldn't be having trouble breathing and may have avoided us dragging her into hospital with saturations of 88%........
Patient #2: Definitely the pts fault..... Woman in early stages of labour, has had gradual increases in blood pressure which has meant she has had to be seen by a consultant at another hospital rather than the one she is booked into. The consultant decides she is not suitable for a midwife led delivery and she is moved over to the care of the other hospital for a consultant led delivery. Today she goes into labour and rings the midwife led centre to see if she can go in. Over the phone she lies and says she has had no problems during pregnancy and has only ever seen midwives. She turns up at the midwife led hospital and is told she can't deliver there and as she is too far into her labour to go by car we have to go pick her up and take her to the other hospital. Now I wouldn't want to go to the other hospital but she had enough notice to up hospitals and book into a closer, nicer hospital, not just lie and turn up at a hospital you have been told you can't deliver at because you and your baby could be at risk.
Patient #3: Blame can be spread between three parties, my control, the supermarket and the pt. We got the job as pt feeling lethargic, stiff neck, pins and needles in hands feet and around the lips, aches all over. For starters the job should never have got to us. Next, we arrive and the pt is a young male, looking a little wiped out but GCS 15, well perfused and talking happily. He states that he just doesn't feel himself, feels weak and achy and very tired. We check him over, BP a little on the low side but then he was young and slim and temperature a little up (about 0.4 of a degree higher than mine), we then checked his O2 saturations and ECG, everything fine. The pins and needles was from all the deep breathing he was doing because he felt a little nauseas. We send him home in a taxi to be looked after by his girlfriend with instructions to see his GP. He most probably has a virus or something similar. He apologised for us being called but I get the impression he didn't do much to stop it. The real problem arose when the staff cancelled the taxi they had called the pt for him to go home and called an ambulance instead.......
Patient #4: Male, diagnosed with gastroenteritis three days previously, with SEVERE abdominal pain. When we arrived he was laying on the sofa, not in obvious pain but I'm not saying he wasn't in any. We checked him over from top to bottom and found nothing wrong. He had had diarrhoea for a while but was showing no signs of dehydration or ill effect. There was some tenderness on palpation of his abdomen but other than that nothing....... So I did the spiel, I can't see what is going on in there but I expect it to be as diagnosed, nothing more serious. He had had all the tests the hospital could do so what more could we do. Nothing had changed since the hospital visit it just hadn't got any better. I suggested they speak to the Dr about better pain relief and they said that they had spoken to the GP while we were on the way and he had said to let us deal with it. Thanks..... In the end the chap went to bed with instruction that they should visit the GP if nothing had changed after the weekend or earlier if necessary. Were we needed, nope not really.
I have to say with regard to any ambulance call that to dial 999 you must be worried therefore you will always get my full attention and all the tests I can do for you to ensure there is nothing worrying going on. I just wonder sometimes that's all........
The next day, apart from our first call and one in the middle which were 'B' cats, all our other emergency calls were given as 'A' cats. I know that two of them were 'A' cats and another was likely to have been but we didn't get there as we were stood down as there was a closer crew cleared down. All of these 'A' cat, eight minute response, calls came in when we were on base or close to base and were a good 10 minutes away down the motorway...... I think someone must have put something in the water........and there was an hours bed wait at the hospital throughout most of the day. This made me late off.........
Friday, 23 November 2007
Tuesday, 20 November 2007
AAA
Yesterday I worked on a response car as D was on leave and had a good day, well apart from the lack of meal break and the migraine at the end..... I did several chest pain patients, one of which was back pain not chest pain, the other two were unlikely to be having anything significant going on as nothing was showing up on our 12 lead ECG.
The one with back pain was my most interesting job. I got there, walked and thought, oh this may be cardiac, he doesn't look very well. When I asked what the problem was it was back pain not chest pain. I asked a couple of questions about how the pain came on and if he had done any heavy lifting, he said no. He was quite pale and starting to sweat. He had a weak radial pulse on the right but nothing I could feel on the left. At this point I started to get twitchy so I popped him on 100% oxygen and took his blood pressure, which was 80 systolic. I thought, this may be a triple A, abdominal aortic aneurysm, which is a bad thing. When the crew arrived it was an experienced crew and they thought it may be kidney stones or something similar. I mentioned my thoughts to one of the crew and it was left as that. They gave the patient some morphine and popped him up the hospital.
I found out today from the crew that he had been transferred to the JR in Oxford that night for surgery on his AAA and did not look well. Obviously it is good for me to know I made the right diagnosis having never seen it before but I don't think they were expecting my patient to survive and I feel bad that I was right.......
Other than that I got soaked through at an RTC, even my knickers were wet........ I wish people wouldn't crash their cars when its raining (please, please, please....!!).
The one with back pain was my most interesting job. I got there, walked and thought, oh this may be cardiac, he doesn't look very well. When I asked what the problem was it was back pain not chest pain. I asked a couple of questions about how the pain came on and if he had done any heavy lifting, he said no. He was quite pale and starting to sweat. He had a weak radial pulse on the right but nothing I could feel on the left. At this point I started to get twitchy so I popped him on 100% oxygen and took his blood pressure, which was 80 systolic. I thought, this may be a triple A, abdominal aortic aneurysm, which is a bad thing. When the crew arrived it was an experienced crew and they thought it may be kidney stones or something similar. I mentioned my thoughts to one of the crew and it was left as that. They gave the patient some morphine and popped him up the hospital.
I found out today from the crew that he had been transferred to the JR in Oxford that night for surgery on his AAA and did not look well. Obviously it is good for me to know I made the right diagnosis having never seen it before but I don't think they were expecting my patient to survive and I feel bad that I was right.......
Other than that I got soaked through at an RTC, even my knickers were wet........ I wish people wouldn't crash their cars when its raining (please, please, please....!!).
Friday, 16 November 2007
dishy dishy dishy....!!
Just a quickie! My apologies to B but, oh my, we did a transfer from HWHL to WPH last night and the ITU Dr was, well, gorgeous!! He was good looking, flirty, funny and had a lovely accent! D (who is engaged and was trying to take off her ring) and I were grinning like Cheshire cats most of the way back from WPH! D inadvertently mentioned her fiance when we arrived at WPH but I remained single throughout!!
We only did the one job all night! Spent around 3 hours on cover at my parents house on soft sofas with freeview TV and cups of tea!! Still the world was going by without the need for our services so thats all good!
We only did the one job all night! Spent around 3 hours on cover at my parents house on soft sofas with freeview TV and cups of tea!! Still the world was going by without the need for our services so thats all good!
Thursday, 15 November 2007
Hips and Poo!
So, I am still somewhat bored, although I have had to use my brains, in conjunction with D's brains to extract some pts from their awkward positions.........
The title of this post really reflects what D and I have been to over the last few days. It all started with a faller. When we walked in I thought there was a strange smell which got worse as we got towards the bedroom. To cut a long story short we picked the pt up off the floor, started doing a few bits and pieces, watched her walk badly, realised she was dirty (unable to clean herself after the toilet) and started asking questions about the diarrheoa and suddenly, oh yes, she had C-Diff in February and the Dr says it hasn't fully cleared. The the pt piped up and said that she had had a sample tested and had that hospital bug........ I then flashed back to a colleague saying that C-Diff smells very distinctive and I thought that'll be it then.
The son who had turned up just after us was very little help, he cleared out her fridge while we were there and none of the food was in date, he said she hadn't asked for any food in a couple of weeks - well what was she eating?? When was the last time he had seen her?? The place was a mess, cold drinks, dirty clothes, feces on cushions, blankets, the carpet. What were the carers doing? She hadn't been to bed for a few days, again why was she left to live in that state??
Due to the surrounding issues I made the decision that the pt needed to be in hospital. She couldn't look after herself and it didn't look like she had the support to stay at home. The son even said, its easier when she's in hospital....... She lived in Wexham's PCT but was normally taken to Frimley so I rang control so they could contact Frimley and let them know I was coming in with a pt with C-Diff. More of a courtesy than a necessity so they could prepare. They were strangely nice when we got there. The staff at Frimley have a habit of looking at us strangely as we are from Berkshire not Surrey, add C-Diff on top and I expected a frosty reception but no, very friendly and accepting!!!
This is a major difficulty with pre-hospital care, especially for the elderly (and mental health problems...) as A&E, or even hospital, is often the wrong place for the pt, yet there is nowhere else for us to take them. Drs tend to be worse than useless (my apologies to the good ones - you are out there I know) and palm people straight back to us when a referral to a respite care centre or such could be the real solution. Admittedly C-Diff or the like will throw a spanner in the works for anyone.
Another two of our pts kept the poo title alive, another acopic pt with diarrheoa, although not C-Diff and a Drs urgent who was generally unwell and had an accident on the way to hospital......
As for the hips, one definite fractured neck of femur (the smack you in the face obvious type) and a couple of falls onto hips which were waiting for replacement. The first of which involved a Paramedic for pain relief (the one who turned up could also be classified as the comedy act!!) and some logical thinking and organisation (hmmmmmmmmmm(!)) to get the pt out comfortably. Good job and the pt was smiling by the end of it!
Next a couple of police stories. The first: I was driving (D not feeling well) and heading out of FPH grounds. A dark car came into the hospital drive followed by a police car on blues. I assumed the car was being pulled for speeding or the police car was on their way to A&E for something. The dark car ended up on my side of the road, I stopped, they stopped as I was in the way and then the driver got out and legged it, followed swiftly by the two cops...... We drove by, close the police cars door and then drove round the roundabout (waiting for another cop car on blues) and went back to have a nose. The driver was on the floor under a cop and a security guy and as we drove out again there were 4 or 5 police cars now parked on the wrong side of the road........wonder what was going on there and wonder whether they noticed the ambulance that drove round twice...!!!
Secondly, as I pulled into a parking space last night at home a car approached me and the window wound down, I assumed they were after directions so I wound down my window (probably silly at 2am...) and suddenly realised they were police in an unmarked car. The woman driving said, was I home, I said yes just got home from work. She said that she thought I had seen them, paused and pulled in so I didn't have to drive past them. I said no just deciding where to park due to the boyfriends parents car being where I normally park. They said goodnight and drove off. Only then did I think, why would I have noticed them they were in a black or dark blue Vauxhall (I think)........ Oh well, my first run in with the police on the road!!
Right, that is the end of war and peace. Me, well, after having migraine after migraine, I am feeling better this week. I have what feel like sun burnt legs (a new rather annoying but not problematic MS symptom, I assume) and am still tired but much better than last week. Was loosing my patience last week..... The OH's parents are here this week. They arrived on Saturday and leave on Saturday, they have been fine, I haven't seen much of them so far due to work so I am happy with that! They have decorated upstairs so that is looking nice and fresh, getting ready to sell next year.
Right I'll stop waffling now, back to bed for a nap before work!
The title of this post really reflects what D and I have been to over the last few days. It all started with a faller. When we walked in I thought there was a strange smell which got worse as we got towards the bedroom. To cut a long story short we picked the pt up off the floor, started doing a few bits and pieces, watched her walk badly, realised she was dirty (unable to clean herself after the toilet) and started asking questions about the diarrheoa and suddenly, oh yes, she had C-Diff in February and the Dr says it hasn't fully cleared. The the pt piped up and said that she had had a sample tested and had that hospital bug........ I then flashed back to a colleague saying that C-Diff smells very distinctive and I thought that'll be it then.
The son who had turned up just after us was very little help, he cleared out her fridge while we were there and none of the food was in date, he said she hadn't asked for any food in a couple of weeks - well what was she eating?? When was the last time he had seen her?? The place was a mess, cold drinks, dirty clothes, feces on cushions, blankets, the carpet. What were the carers doing? She hadn't been to bed for a few days, again why was she left to live in that state??
Due to the surrounding issues I made the decision that the pt needed to be in hospital. She couldn't look after herself and it didn't look like she had the support to stay at home. The son even said, its easier when she's in hospital....... She lived in Wexham's PCT but was normally taken to Frimley so I rang control so they could contact Frimley and let them know I was coming in with a pt with C-Diff. More of a courtesy than a necessity so they could prepare. They were strangely nice when we got there. The staff at Frimley have a habit of looking at us strangely as we are from Berkshire not Surrey, add C-Diff on top and I expected a frosty reception but no, very friendly and accepting!!!
This is a major difficulty with pre-hospital care, especially for the elderly (and mental health problems...) as A&E, or even hospital, is often the wrong place for the pt, yet there is nowhere else for us to take them. Drs tend to be worse than useless (my apologies to the good ones - you are out there I know) and palm people straight back to us when a referral to a respite care centre or such could be the real solution. Admittedly C-Diff or the like will throw a spanner in the works for anyone.
Another two of our pts kept the poo title alive, another acopic pt with diarrheoa, although not C-Diff and a Drs urgent who was generally unwell and had an accident on the way to hospital......
As for the hips, one definite fractured neck of femur (the smack you in the face obvious type) and a couple of falls onto hips which were waiting for replacement. The first of which involved a Paramedic for pain relief (the one who turned up could also be classified as the comedy act!!) and some logical thinking and organisation (hmmmmmmmmmm(!)) to get the pt out comfortably. Good job and the pt was smiling by the end of it!
Next a couple of police stories. The first: I was driving (D not feeling well) and heading out of FPH grounds. A dark car came into the hospital drive followed by a police car on blues. I assumed the car was being pulled for speeding or the police car was on their way to A&E for something. The dark car ended up on my side of the road, I stopped, they stopped as I was in the way and then the driver got out and legged it, followed swiftly by the two cops...... We drove by, close the police cars door and then drove round the roundabout (waiting for another cop car on blues) and went back to have a nose. The driver was on the floor under a cop and a security guy and as we drove out again there were 4 or 5 police cars now parked on the wrong side of the road........wonder what was going on there and wonder whether they noticed the ambulance that drove round twice...!!!
Secondly, as I pulled into a parking space last night at home a car approached me and the window wound down, I assumed they were after directions so I wound down my window (probably silly at 2am...) and suddenly realised they were police in an unmarked car. The woman driving said, was I home, I said yes just got home from work. She said that she thought I had seen them, paused and pulled in so I didn't have to drive past them. I said no just deciding where to park due to the boyfriends parents car being where I normally park. They said goodnight and drove off. Only then did I think, why would I have noticed them they were in a black or dark blue Vauxhall (I think)........ Oh well, my first run in with the police on the road!!
Right, that is the end of war and peace. Me, well, after having migraine after migraine, I am feeling better this week. I have what feel like sun burnt legs (a new rather annoying but not problematic MS symptom, I assume) and am still tired but much better than last week. Was loosing my patience last week..... The OH's parents are here this week. They arrived on Saturday and leave on Saturday, they have been fine, I haven't seen much of them so far due to work so I am happy with that! They have decorated upstairs so that is looking nice and fresh, getting ready to sell next year.
Right I'll stop waffling now, back to bed for a nap before work!
Friday, 2 November 2007
Bored......
I am getting bored at the moment. I know I shouldn't moan but I don't think I have seen an ill person at work in a while........ I have given out some oxygen and entonox but other than that....... Don't get me wrong, I don't wish that people are ill or get in accidents but it is what I am trained to do, highly trained professional me!!! Tee hee!!! ;0)
So I have seen my MS Nurse and Occi Health, nothing much to report from either really. S was interested in this latest relapse and how I was doing emotionally, I let her know what had been happening at work. She wants to see me again in January and I have to have my second lot of bloods done next week sometime. Occi Health did pretty much the same and wrote a report saying that the short shifts are a good idea and that I should have more than one day off between shift blocks, not that the latter will happen, hopefully, cause if it does I'll either have to come off the rota or loose money. They didn't want me to make any decisions about the future yet which was good. I was starting to worry about them saying I shouldn't be doing the job, or that I should be on light duties, you get the point!
Apart from feeling somewhat tired yesterday I seem to be doing quite well! My vision is much much better most of the time but it comes and goes depending on how tired I am, fortunately it doesn't make any difference to my vision unless I close my right eye so I can forget about it for most of the day.
Oh, I have started my appraisal at work. My team leader/supervisor D (the one I was crying on) seems to think I am doing ok and I am a useful member of the team!! He says that my biggest 'problem' is my lack of confidence in myself. I am forever worrying about the decisions I have made and if I make a mistake I beat myself up for ages. I must add that I have, to my knowledge, never made a mistake that led to a poor outcome for a pt. Apparently I am a lot like d when he was still relatively new, I should get better at the self confidence thing then!! Still got quite a bit of the appraisal to go so we will see what he thinks about me over the rest of it!
Thats it........bored bored bored..........
So I have seen my MS Nurse and Occi Health, nothing much to report from either really. S was interested in this latest relapse and how I was doing emotionally, I let her know what had been happening at work. She wants to see me again in January and I have to have my second lot of bloods done next week sometime. Occi Health did pretty much the same and wrote a report saying that the short shifts are a good idea and that I should have more than one day off between shift blocks, not that the latter will happen, hopefully, cause if it does I'll either have to come off the rota or loose money. They didn't want me to make any decisions about the future yet which was good. I was starting to worry about them saying I shouldn't be doing the job, or that I should be on light duties, you get the point!
Apart from feeling somewhat tired yesterday I seem to be doing quite well! My vision is much much better most of the time but it comes and goes depending on how tired I am, fortunately it doesn't make any difference to my vision unless I close my right eye so I can forget about it for most of the day.
Oh, I have started my appraisal at work. My team leader/supervisor D (the one I was crying on) seems to think I am doing ok and I am a useful member of the team!! He says that my biggest 'problem' is my lack of confidence in myself. I am forever worrying about the decisions I have made and if I make a mistake I beat myself up for ages. I must add that I have, to my knowledge, never made a mistake that led to a poor outcome for a pt. Apparently I am a lot like d when he was still relatively new, I should get better at the self confidence thing then!! Still got quite a bit of the appraisal to go so we will see what he thinks about me over the rest of it!
Thats it........bored bored bored..........
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