Second Night.

First up a sick person,

77M - Hypotensive (80mmHg sys), sweaty, on the floor, very narrow access. Son-in-law and I man-handled him out and IV fluids and Trendelenburg's position got the BP up to 115/74.

30M - From the national capital, up for a Buck's night (not his), Police found him in the footpath at Bondi and called his wife (who's in trouble now). We took him to a nice safe small hospital.

41F - Abdo pain. Frequent flyer, triaged straight to a chair in the waiting room near the front door.

77F - End stage Dementia, Blind, Hubby looks after her. He's Acopic. Apartment, while clean is cluttered with poor lighting. If we take her to hospital she wont be coming back to this.
He knows about all the great free services to help aged Australians stay at home but doesn't use them being too proud. We sat and chatted with him and his son to get them to use them.

28F - IP on the side of a road. Call came from a motorist as they drove past. She was gone (as they usually are) when we arrived.

16F - Chin Lac post domestic with B/f. Police involved, refused transport.

Second Sick Person.
82M - SOB/Febrile, 14 hr Hx of fever that was being treated with meds (Paracetamol) so the 40.2 Celsius we recorded was probably higher. O2 sats 82%, BP 150/80, Pulse 150. 150kg estimated weight of pt, backup called for muscle. Cooling with towels, O2 therapy increasing sats to 100%. I found this spidery vein in the back of his hand for access and fluid therapy. Three of us males got him down the one flight of stairs that of course had to be there for a sick pt and one rode with us for an extra set of hands in the back. Bat call to hospital and off we went.
Hospital thought it was a UTI??? None of the usual smell though.

50M - Large facial lacs, Refused to come with us, wanted to take it to the Bouncer outside the club. Left the scene with equally intoxicated wife, they're both going to be in for a shock when they wake in the morning.

22M - GHB OD, with some straight(less effected) friends who are taking him home. Bystander on the other side of the road rang it in. They were doing a good job so I left them with it.

My poor partner was struggling after 4AM and suffered my wide awake, bouncing off the wall with energy with good grace.

Be careful out there and I'll see you at the Big One.

Taz

Yes!!!!! Friday/Saturday nights.

What a time for my new partner to commence at their new station. It's a perminent posting and she comes from a regional centre with a big steel works south of Sydney and knowing where the better retail outlets are in the big smoke doesn't really help with our job.

Welcome to the city, first job

20M - GHB ingestion, job was called in as either an assault or unconscious. Pt is having a hissy fit with his boyfriend, there's lots of floppy wrists, pouting and 'bitch' this and 'fat cow' that. Pt has had too much 'G' and needs to come to hospital.

Duplicate call to an assault that already has a car on scene.

Two for one,
19F - Hand injury.
29M - LOC.
Cause unclear, transported together, Police are interested in them however????

50M - Birthday today, celebrating,,, maybe too much. Appeared to be having multiple seizure events. Know epileptic, got one lot of pharmacology from us and then with re-assessing the seizure, there was deliberate purposeful movement. So I'm now leaning more to solely alcohol related. Transported anyway.

20M - IP, sat up when I asked, answered when I asked, could walk ok, no health issues left on scene didn't what us.

21M - IP, says he was in a fight and was concussed????? probably but the grog was more to blame for the lack or co-ordination and slow mental processes. Transported for neuro obs.

As so finished our first shift together.

Be careful out there and I'll see you at the Big One.

Taz

Still no partner.

Team up with one of the other's on station who is single also.
As a Qualified Officer I can respond single if there is no-one immediately available to work with me but I can't transport so it's not much of a resource they still have to find a double crew to come and collect my pt.

77M - Syncope, two CABG done two weeks ago two more to be done. Might need them sooner.

49F - Claimed to have been kicked in the calf ????????

99M - Syncope, where do you start.

52M - Constipation. He was in the toilet for two hours so his friend called?????? Left at home, not constipated.

60M - IP called in by bystanders as he was a danger to himself in traffic.

54M - Pre-syncope, likely to be a Gastro bug by the sounds.

81F - Fell in the supermarket unable to weight bear. Later confirmed our suspicions, NOF.

20F - Taxi ran a light, she ran into him. Precautionary really.


Be careful out there and I'll see you at the Big One.

Taz

My new partner didn't show!

I heard a rumour that she was sick.

With a peer on overtime from another station then,

86F - Fall when out for her morning walk. Fall broken by a parked car but still hurt the shoulder.

95F - Cellulitis of the legs.

30F - Epigastric Pain.

46M - HT, tingling of peripheries, flushed. Might be pre CVA.

31M - Heavy palpitations before our arrival all we caught was quite high BP.

84F - UTI. GP didn't want to treat, call an Ambulance.

29F - Scabies. Had seen GP, didn't know what it was, call an Ambulance.

Be careful out there and I'll see you at the Big One.

Taz

O/t at Home.

68M - Hypo, managed at home, left in care of family to eat dinner.

59F - ? onset of a chest infection, requesting transport.

?50M - Assist another crew with a violent hypo that needed to be physically restrained just to get a BSL reading.

21M - Police were going to give him a ride home but saw the cut lip and get it checked first. Covering their arse, make sense.

20F - IP with friends some oxygen bandit of a doo gooder walking past called on their mobile. The friends were walking her home!!!!

59M - Had a ?vaso vagal getting out of bed at 0400hrs to go to the toilet and thought it must have been a heart attack. Transported anyway.

96M - A true gentleman who's grace, dignity and intellect charmed us, the nurses and Dr's all. Had a fall at home and took many hours to get himself up of the floor. Lacerations to his head but unfortunately he had struck the eye ball with such impact that it had ruptured.

And that was it, nothing to tax my skills.
Lets see what the rostered week hold.

Be careful out there and I'll see you at the Big One.

Taz

Back in, feet first.

O/t shift.
Co-Ord want us to go out early.

83F - Numb and cold legs. Independent, active, was feeling ataxic but walked well. She got a ride and lots of TLC.

27M - No psych beds at this hospital but there were at my local big hospital, borderline personality disorder, manipulative, thought he knew the system better than me,,,, Read riot act, shut up and sit down.

84F - Fluctuating GCS, normally 14 to deep sleep. Pupils very constricted but no result with 800mcg of Naloxone. After six hrs diagnosis was hypocapnia but cause unknown.

21F - Psych transfer from A & E to psych ward next block over.

29M - Country boy down in the Big Smoke for a Bucks night, horse play lead to a head laceration. Nice guy.

55F - ? Anxiety episode. Took some Valium before we arrived I checked her blood pressure three times, dropping each time, she signed the book, we left.

47M - Hand v Refrigerator, Fridge always wins. Took in for an x-ray.

24M - Dislocated shoulder, UTL, hoax call most likely.

27M - Head lac. Did not want anything to do with us. Ethnic dispute we left him alone.

21M - IP, woken up and walked off.

22M - IP, very polite, requesting help, was able to follow the simple instructions to 'vomit into the bag', 'don't spit inside the vehicle' and 'hold still this will hurt just a little'.
If only they were all like that.

44M - First ever seizure, neurological history, witnessed by us second seizure, pharmacology and urgent transport.

Brilliant night, got to station twice. First for a restock and five minutes of a crib break before the phone rang and then about forty minutes before the end of shift for twenty minutes and it rang again.
At my home station the next shift would have been there and offering to go out early, but this doesn't happen everywhere else.
So we did the job and knocked off two hour ten after the normal time.
A nearly 141/2 hour busy shift.




Be careful out there and I'll see you at the Big One.

Taz

That's it! Holidays are over.

So I have a few days of 'rostered off' before I'm back on-road.

I've had two phone calls today about two shifts of overtime in that period.

One at the famous beach in Sydney and one at my home station.

How good is that?



Be careful out there and I'll see you at the Big One.

Taz

I've been silent!

Strange isn't it?

I've finished the first season of House from the box set Ambowife got me for a present.

We've been for a ride or two.
We even went for a ride with a work colleague who is just starting out.

Finished a novel.
Finishing the Lance Armstrong Performance Program I bought at the same time as the novel and have been reading it at the same time.

Been giving Mosby's Paramedic Textbook a tickle as well as remembering that I had not finished some online education through ASNSW Education.

Been watching the media about the Federal Governments offer to take over State hospitals as well as some other issues that are really only of interest to local ambo's.

I have a fast tracked new Padawan on return, for a nursing background I think and the boss has already given me some instructions on that. I love introducing someone to the wonderful life of on-road Ambulance work.

Officially one more week before I am back on rostered shifts and I've only just got myself into a normal (for some) sleep all through the night type pattern and then I'll have to break it all up!

Still can't wait to be back in the saddle, not saying that the break hasn't been good for me, it has but I need to get back out there.

Be careful out there and I'll see you at the Big One.

Taz

I better explain myself about MIMS.

Checkout this post by Squezzy at Girl in Green

I'm bad because they do mention it but under a name I've not heard before, Toxaemia of Pregnancy. Further to that there is some misdirection or poor direction on the MIMS Online reference that I wish to go into.

Now in the MIMS Abbreviated Prescribing Information, the style we're normally looking at from the MIMS book we got from the GP. Contraindications does include toxaemia of pregnancy.

However if you follow through to the much more twisty and detailed Full Prescribing Information it has disappeared from the contraindications.

It is now only a precaution!!!

Allow me to cut and paste,

Use in pregnancy.All general anaesthetics cross the placenta and carry the potential to produce central nervous system and respiratory depression in the newborn infant. In routine practice this dose does not appear to be a problem; however in a compromised foetus, careful consideration should be given to this potential depression, and to the selection of anaesthetic drugs, doses and techniques.

Toxaemia of pregnancy. It is advisable not to administer methoxyflurane due to the possibility of existing renal impairment.

Now this sounds like a contraindication but it's not.

Reading a bit further about Toxaemia of pregnancy. It is pregnancy induced hypertension but it does not seem to be pre-ecclampsia until more severe or untreated lets look at some signs and symptoms.

Tox of Preg - elevated BP, protein in the urine, hyper-reflexia, bloating and oedema.

Pre-ecclampsia - severe elevated BP, headaches, gastric pain, even seizures.

Continued and untreated Toxaemia can lead to Liver and Kidney damage and that's where the hiccup is.

Our use is very short term analgesia at very small concentrations, do our Clinical Managers need to re-evaluate this pharmacology or change it to a guideline with further information?

I'm very confused the more I read, here are some possible adverse reactions.

Other reported events: cardiac arrest, respiratory depression, laryngospasm, bronchospasm, hypotension, bradycardia, renal failure, increased serum urea, increased serum creatinine, increased urinary oxalate excretion, increased serum inorganic fluoride, pallor, muscle relaxation.

Shit this stuff sound dangerous maybe we shouldn't use it!!!!!

Can't knowledge be empowering.

I've ranted enough I'm off.



Be careful out there and I'll see you at the Big One.

Taz

So what have I been doing with myself?

Not very much really,

After eight straight twelve hour shifts my body did just want to sleep and lounge.
So I did.

There have been a few bike rides.
An afternoon in the backyard with mower & wipper snipper.

I have commenced watching the first four seasons of House from the box set Ambowife bought for Christmas the year before.

I have initiated communication with some people that have not heard from me for a while.

I have a appointment coming up to donate some plasma and platelets, this will be my thirty second donation I think and again if you have ever vaguely thought about doing it, go and do it.

I have an education evening presented by ACAP on falls to attend and then I run out of things to do.

I'm sure I'll come up with something.

Be careful out there and I'll see you at the Big One.

Taz