Why does it seem to only rain when I'm out?

The weather forecast is for a week of rain.
I don't rely on the forecast but it does give an idea.
I ride a push bike and constant wet does get me down.

65F - Anxiety was her main issue. Anxiety about the couple of odd heart beats she had a couple of hours ago (PVC's) she had several while we sat there and talked and discussed what we were going to do. Patting the dog and chatting with us seemed to help a lot. She opted to stay at home and pat the dog some more.

41F - Post ictal.

41M - Threatening self harm at the top of some cliffs on the coastline. The cops had him and he felt pretty foolish now but you can't withdraw word spoken so of we went to the hospital for the psych's to have a talk to.

3/12F - Mum had a fall with baby in her arms and after mum had landed Bub fell out of her arms at ground level. So there really wasn't anything in it but new born skin does show marks very easily. A happy attentive laughing baby was what we found and was left with family and some instructions for observation.

61M - Multiple syncope episodes.

40M - Deceased.

23F - MVA the driver of the worst car from a 3 car accident caused by a drunk driver. Car was a small 5 door hatch and while I'm not allowed to put pictures up because some pencil dick in an ivory tower says its an invasion of privacy but tell that to all the bystanders on the footpath shooting photo's or the press photographers present, maybe someone will send me a photo of the wreak, she was without any major injury. A small abrasion from the steering wheel airbag and some abrasions on her shins.

See you at the big One.

Taz

Day one of new roster.

25M - Struck in the mouth with a bottle or such. Split lip and a bit of a few teeth missing. Transport for stitches.

92F - Chest infection.

19M - I've met him before, he was transported earlier today and I've picked him up again.
We need a management plan for this behavioural problem child.

44F - Headache/Anxiety a chat for 20 minutes or so and some panadol and she didn't want or need to come to a hospital.

35M - Dislocated elbow and wrist from a fall playing basketball.

And that was the day, a bit wet and cold.


See you at the big One.

Taz

I keep mentioning BAL's

Thanks for the question Reece.

Hey Taz,

You mention BrAlc in a number of your posts.

Do you do the analysis on road or does the ED do it or perhaps on scene coppers.

I'd love to have a brethaliser at some jobs but in my service its a no no - yet its more common for my patients to get a BrAlc tube when they get into ED than it is for them to get an ETT tube - my thought are if they can why can't we..

Interested to hear what you do

No we don't have a breath analyser in the kit.

Our small non major trauma hospital in the middle of the city does however.

They receive a lot of drunks on the party nights of the week as well as alcoholics off the street at any time and while a BGL will dismiss a hypo as the cause of the apparent intoxication, what they blow will assist in what level of treatment they get. That is, a bed or can they sit in a normal chair to sober up.

One of our major trauma centres did until very recently insist that all intoxicated pts get a bed and then wondered why they had ambulance crews lining up out the wazoo due to no beds for really medically sick pts and this still happens when some of the less progressive staff are on.

My local or nearest hospital have the ability to triage the level of intoxication from experience and what indicators I've supplied about the pts ability and use their waiting room and cheap vinal recliner chairs in a corner of the department with great success.

To help out my nursing staff (at any hospital) I'll take a set of obs on their machine for their triage notes, I'll take bloods without being asked and at that one hospital I'll also get the pt to 'blow in the bag', it can be as funny as hell and it gives me a figure for you.





See you at the big One.


Taz

The last day we work together.

As a level 2 Officer my partner still has many things (jobs) to tick off and we've managed to cover a lot of those while we worked together.
Wherever possible I have let them perform a treatment even if it's my shift to treat just so the procedure isn't so mystical and so they can begin to construct their own method.
We have had to talk to each other for the entire length of the shift, no I mean really talk as for four weeks the stereo in the vehicle didn't work so we have become very close.
While they don't leave our station the roster has them working on my days off so we won't get to see each other but they know that if there is ever a need, I'm there for them.

7F - woke up with a sore neck. We managed some paediatric analgesia and left in Mum's care.

17M - At school, sprained ankle.

82F - Assist another crew with extrication.

83F - Mechanical fall while rushing in a public place. A big gash on her knee (not a good spot) that was going to need professional sutures and management.

70M - IP, at the train station and way too plastered to be allowed anywhere near the platform having had several witnessed stumbles before the fall that got us called. We suggested a trip to a hospital to be in a safe place to sober up. Did a breath analysis and he blew 0.227, four and a half times the legal limit to drive and he wasn't driving his legs to well at all.

50M - Serious mental health issues.

32F - Behavioural mental health issues.

26F - Drug effected rape.

See you at the big One.

Taz

Last two shifts of the roster.

So for nine weeks I've had the same partner.
On Saturday a new roster starts with a new partner!

But today,

C/t a MVA but the crew on scene could handle.

Hot back up for a level two crew for IV fluids for a hypovolaemia.

53M - A third party had called about him but he wouldn't even let me in. He had capacity and competency so I have to respect his wishes.

62M - Known epileptic, post ictal on arrival and not in his usual pattern he through a second one in the back of the vehicle. I midazed him and transported.

20M - Three car MVA his rolled and came to rest on the drivers side. Glass cut from crawling out, that's it. Very lucky boy. The other drivers were uninjured.

72F - Lateral neck pain post a fall.

50F - Lower back pain, non traumatic.

82M - Near fall, suffers from NPH or Normal Pressure Hydrocephalus. Bystanders thought it was something more acute. We left him with his son/carer.

20M- Minor lac on his chin that I dressed and he decided that he didn't want a trip to hospital.


See you at the big One.

Taz

Forgot to post about my last night shift!

Baby sat a pt for a day shift crew, 3 hours to unload.

37M - Post ictal, known epilepsy, responsible person (sister) turned up and took him home.

20?M - Concerned passerby called about this IP. He was outside the backpackers where he was staying. Go inside my son and sleep it off.

29F - IP, fell down stairs in a pub. A good mechanism to suspect spinal and the 0.20 blood alcohol she tested would dull any pain. She turned out to have not a thing wrong, drunks do usually don't hurt themselves but,,,,,

73M - This is embarrassing, man cold and wants to see a Dr at 3am.

60F - Renal colic.

40F - Mental health issues.

See you at the big One.

Taz

Who put the brakes on the work?

44M - Has an hypoxic brain injury with paraplegia from a heroin OD and while transferring from the wheelchair to his bed in the aged care home he slipped to the floor. With only a single staff member on at night we attended and put him to bed as he had not injured himself.

74F - Hospital to hospital transfer, cerebral haemorrhage for further treatment.

28M - Been out celebrating his birthday and gets blind. A taxi drops him on the footpath and his lovely girlfriend (who was at home) struggles for the next hour to get him up the stairs into the apartment block and only makes it to the second floor of the three storey building and you know which their apartment was on, before he just stops even half arsed helping.
Ambowife would have got a blanket and pillow and left me there but she rings triple zero (911 or 999 for you readers overseas). He's not much of a size and she was amazed by how easily we move him, amazing what a finger hidden in the arm pit and a wedgey will do. Left in the care of someone sober and responsible with instruction for care.

19M - Might have real mental health issues or may also just be attention seeking, not my call.

What a shockingly slow night.

See you at the big One.

Taz

One busy shift puts me behind posting.

Our second day we're run from pillar to post and finish late and I just can't get the energy to sit here and post. So that's why there hasn't been any!

82M - The soft edge of the mattress does 'em in every time when the oldies sit on it. Public assistance, lift off the floor, nil injuries, stay at home ol' mate.

??F - Assist another car with an obese pt, in fact two extra crews attended, had a fall two days ago and has only been able to roll around on the floor. Doesn't have a phone and lives in housing commission tower block.

21M - Anaphylaxis to peanuts, no known allergy previous. From a local LMO surgery, no airway involvement but with the strength of this reaction it will come if he's not careful.
We had a good ol' chat about driving as he's attended (by direction of the Court)one of the lectures I give and I tell them at the end if you get sick or attend a hospital in the city you will find me there and I won't remember your name. But they do mine.

99F - The bed edge again. A brilliant lady and loving family and again with no injury she can stay at home.

27M - Non traumatic back pain at work in an office.

37M - Transport from a hospital Detox unit to the ED for seizures.

75M - Fall, our motor cycle paramedic called for a unit to attend just so he could assess the pt out of the eyes of the public. In the end the pt refused too much fuss and left.

21F - In the cells awaiting bail for late reporting to a police station whilst on bail already by a day. Decides that the PID she thinks she has had for three years might get her out quicker.
It didn't and the hospital we went to was in the opposite direction she wanted to go and she left ten minutes after arrival.

87M - Hip pain, non traumatic.


See you at the big One.



Taz

I had an observer today.

In fact We have him for three shifts.
A third year medical student, full of knowledge not bad with the bedside manner and agreed with all of my diagnosis and treatments (clever lad).

54F - Ever Ambo in Sydney knows this address and the pt there. A very frequent caller. I couldn't convince her to stay at home. She doesn't need an ED.

??M - Assist load and transport pt with a STEMI.

48F - Rear ended in her car, lateral muscular neck pain.

72F - Reported and confirmed syncope by the pt herself. Gastro symptoms since last night and really should have stayed at home today. Didn't want a hospital, told me how she would self care and it was perfect so the hubby drove her home.

??M - Fitting, must have been fitting on the run because he was gone when we arrive a minute after the call was made.

90M - Mechanical fall at home, #NOF.

69F Chest pain. I think by her description of her gardening the day before I think that's the cause.

34M - #Tib/Fib.

See you at the big One.

Taz

I declared last night a COLD night.

That is, I got my jacket out of the locker and put it in my bag. There has been a cold snap with the night temp for the past two nights being 7C (44F) a drop from the 14C (57F) it had been.

The jacket didn't get worn but it was there if I needed it.

52M - From Air Ambulance to a hospital for an angio post STEMI.

19F - Uni student educating herself about drinking to excess! With good friends who while also drunk, could walk, had not vomited, recognised that they were not able to cope with her but stayed with her at the train station, elected one to come to hospital with her.
Being a Uni student I think she will be doing this study again yet before she's got the gist.

28M - The job came down as a dislocated knee but it was pretty straight and weight bearing (as he walked to the bar for more beers) when we arrived so we left.

34M - Lac inside mouth from alleged assault. Wanted the hospital.

19F - Who claimed she suffers from spontaneous Vaso Vagal Syncope episodes. While we witnessed episodes of GCS 3 there was no bradycardia, sinus pause, sinus arrest or decrease in BP and we were looking for them so I'm not accepting that.
The registrar explained it away as an extreme vasodilation response to alcohol and temperature changes, I'm struggling with that one too as they occurred even with the pt supine after 20 minutes in the back of our warmed car and a blanket.
We witnessed GCS 3 episodes of varying length with random spasmodic muscular twitching, some of it quite extreme not like tonic but very strong, tachyponea with reduced tidal flow and no drop in SpO2 readings.
This is cerebral, this is some sort of seizure and while the specialists back in London (she's a backpacker) can't decide they also haven't seen an attack or had her on monitors and BP cuffs when they've happened.
But I'm a shaggy arsed ambo so what do I know, just what I saw.

24M - Asthma, puffer not working, already on steroids with a PEFR of 100 before our nebs.

So that was the first officially notarized by Taz cold night.


See you at the big One.

Taz

I got too excited with yesterdays work.

A sudden cold snap dropped the work and the temperature.

89F - At home with a mild fever. Carer wanted her checked, everything good for her age just a slight fever. 'Do we have to take her to hospital for that?' So we talk about paracetamol and it's safe use and suggest a take two and see your LMO in the morning if your still a little warm plan.

48F - Got rear ended at low speed. The tow truck boys rang for us but most of her pain was from carpo/pedal spasms from the heightened emotional state from her first every accident. Took her to hospital also.

22M - Walked out in front of a taxi doing about 50kph (31mph), left a crater with his head in the windscreen and walked off the road. Apart from a graze on his ankle neither I nor the Drs could find any other injury!

42M - Hearing voices telling him to by some methylated spirits for self conflagration.

25F - Coccyx pain quite severe post benting over????


See you at the big One.

Taz

And wasn't it a MAD Monday!

51M - Well known alcoholic who we're transporting from hospital to a detox centre again. As always we hope he does well.

39F - A really good bike stack over the handle bars, looks like the nose and wrist took most of the impact.

32F - Reason for calling an ambulance ' I want to see a Dr' would not supply any further details about why. So list this job as a Psych case and go to the appropriate hospital. Triage gets about as much as us from the pt along with her demand for drugs. Pt left an hour or two later. Was not known to the mental health team, no medical Hx with the hospital?????

82F - SOB, for about three days, seems to be cardiac related, has a very large Hx.

18M - Fainted is what it said on the data screen, fainted at one location but was walking to another and we were to meet him there. We waited and waited,,,,, UTL.

30M - Indigenous pt with foot rot or to be professional fungal infection. Left the first hospital because they didn't treat him quick enough. The hospital we saw him at 6 hrs later won't be any quicker. Foot rot doesn't triage very high.

73M - Two weeks of deterioration at the n/h and is now very septic. It's amazing the old fella is still alive.

51M - Walked into a car. We're parked in a street grabbing a coffee and something to eat when there's a thud and impact with the rear of the ambulance. In my wing mirror I can see a male lying on the road, out I hop to investigate.
Ol'd mates walked out from behind us and only looked at the oncoming traffic on the other side of the road and no that on our side that will of course be the first to hit him if he was to walk out,,, which he does. Luckily the car is being driven carefully and slowly by another aged person and the pt bounced off the side of it and into the side of us before falling to the ground.
Pt has two dogs, one knee high on a leash barking and the other an Irish terrier looking thing just watching.
Commence primary survey, conscious, alert, orientated, denies injury, three cars full of police turn up and surround the scene, someone takes the leashed animal away, chest clear, abdo soft, arms intact, look at the lower body and there's the terrrier with it's front paws wrapped around his upper calf HUMPING THE HELL out of his leg like there's no tomorrow.
Pt completes survey by kicking the dog off his leg while I'm laughing along with 12 cops and the bystanders.
Pt declines transport.

59F - Slipped on wet pavement and may have fractured her nose and wanted hospital.

40M - Assaulted, tells us that his mate punched him to the ground and then stuck the boots into his body and head, he blacks out and when he come too gets kicked in the head a few more times. They are both pissed, offender is back in room, pt at the foyer with building security.
The injuries look bad, swollen eyes, nose, chest wall seems deformed, pupils are not the same and are more sluggish than I would have expected for just booze. Spinal precautions, pts GCS=15. Enroute it drops to three, tolerates and oral airway for 15 secs and then pops up to a 12 for a minutes or two while I call ahead before dropping again to a three.
Will follow up this one.



See you at the big One.

Taz

A lot of Mums must have been happy.

It was Mother's Day today here in Australia and by the amount of work around most mum's got a well behaved visit from their family's.

Our son got a text message at 0630 to remind him to call his mum and I rang mine in between jobs around 0930.

63M/F - Fall related minor injuries but unsure of the reason for the fall I went a seizure route.

89F - Doesn't use her walking stick because she's worried that she will trip over it, might have saved her from tripping on some uneven pavement. No injuries luckily so we escorted her home and made her a cup of tea.

25M - Booze and some Benzo's 9 hours ago???? so what, of course he's drowsy. The authority that our voice and commands carry amazed his friends who ???? couldn't wake him. He declined the transport offer. I was happy with that.

29F - Been on a bender (vanilla essence) not a common intoxicant and both my partner and the triage nurse didn't believe me that it was about 35% proof. Transport for mental health as well as detox.

62M - From a country town via Air Ambulance for some CABGs.

36M - Punched to the face twice and feels funny. Funny alright, by the time I'd finished assessing that he was uninjured the Police had reviewed the CCTV and he was looking like he started something he couldn't finish and was crying foul! Left in the tender mercies of the long arm of the law.

And that was my Mother's Day.
Beat my Father's Day won't be busier.

See you at the big One.

Taz

Did not use a single bit of kit.

Oh yes we took BP's and all the obs to be through but not a single bit of other equipment was used.

55M - Came home from work (painting in an enclosed space with oil based paint) and felt nauseous! Instructions given and left at home.

80M - Decreased mobility, for like the last four years. Somehow convinced the nursing home LOM that he needed to go to hospital and I couldn't refuse.

80F - Hospital to hospital transfer for a pacemaker.

88F - Shaking, we couldn't see it but she wanted to go to hospital. There were clearly issues to do with her living alone in the hostel and family.

78M - Simple fall without injury just needed assistance up.



See you at the big One.

Taz

And the drunks have it.

Some days it's just hard to come up with a title for the post, as you have noticed from the last one. I try to make it relevant to some content of the post no matter how tenuous.

54M - Abdo pain and vomiting. Suffers from MEN1, he understood his condition and the treatment required but had tried to ride it out at home. Didn't work and needed a lift to hospital now.

36F - There had been a fight at home, there had been alcohol drunk by both, I don't take sides but she had the blood on her. Minor lac in the central part on her hair. Should be fine just don't wash your hair or touch it and it will heal, do you want to see a Dr ,,,, no sign here and leave her with the Police for statement and to pack up and get out of there. 5-6 hrs later there she is in the waiting room, showered and changed and in because it won't stop bleeding, refer to instructions on scene! Last I see of her is her chucking a tantrum with the Dr and the time he's taking to write her discharge letter.

76M - Chest pain.

26M - Walking pissed in those silly looking long toe'd shoes they wear now days. Slips over and whacks the side of his head. Did all the neuro stuff and spinal stuff and in the end all it was was a very impressive 10cm crescent shaped scalp lac above his ear, needs stitches.

24F - Pissed enough to be hallucinating. Very impressive too, I've seen many a IP who couldn't see but this was a first and I had witnessed her in full flight interaction with the hallucination. We did transport because she was a danger to herself.

36M - Very deep lac over eyebrow from cause unknown. The was skull to be seen under it and he wasn't aware of it at all. I was just impressed that we managed to get him to the hospital I didn't worry about spinal precautions even though they were clearly indicated because even though he had not been combative with us he was ready to fight and the drop of a hat. They sewed him up, got an x-ray and that was it he left.

So drunks made up more than half my work, little as it was.

See you at the big One.

Taz

97F - Had a fall last night and was put back to bed by staff. Unable to get out of bed this morning and we get called. No shortening, rotation. Has had both hips replaced anyway. Turns out a fractured pelvic ramus.

68M - Fell on a chair at a cafe just around the corner but was in too much pain to walk in. Fractured ribs by all accounts.

46M - Long term Meth amphetamine user which has lead to, Diabetes type 1, difficult to control currently ketoacidotic, GI bleeding, nausea/vomiting, lethargy, severe weight loss.

28F - Smoked some weed and feels really weird and wants to talk to a mental health team about whether she should adjust her bipolar meds as a result. We transported as requested by the pt but I couldn't bring myself to enter triage with my partner and the pt.

85F - Chest Pain.

30M - OC spray after not doing what was directed by the police. We came, we washed, we left.

78F - Abdo Pain, Hx of liver troubles, lovely couple, will have been married 60 yrs next year.

82F - Rushing around by her own admission in the shopping centre and wasn't paying attention when she stepped onto the escalator. A couple of minor skin tears and her daughter came to collect her.

See you at the big One.


Taz