And the good work keeps coming until!

78M - Near syncope, a Hx of irregular HR but has lived a full and active life un-medicated for it. I'm seeing AF with some very long intervals and VEB's (ventricular ectopic beats).

28M - Had some hand surgery today under general anaesthesia and after discharge had to walk a long way to the car with the wife or rather told the wife he could walk and to not go and get the car, sounds more likely. Got the expected near syncope stuff, all obs good so we discussed options and we escorted them to their motel room (to make sure he could make it and because we're now in the foyer of the motel) and they were going to self manage.

The big job for the night,




The pt is in the house we carried him to the road in the dark down fifty odd steps on a spine board.

83M - Called in a simple fall in kitchen. Pt is prone on the floor, conscious but suffers dementia and is not appearing to comply with primary survey questions. Spider sense is tingling, log roll with family assistance onto back. All this time their asking why we don't just pick him up of the floor.
HR - 40 - 46bpm
BP - 56/30 both arms three times
Nil arm or leg movement, no Babinski's reflex at all and no Intensive Care Paramedic backup in one of the few times I really want them for their Atropine.
R1 assist load for the absolute prick of an extrication where too many extra hands would have only got in the way.
In 30 min he's out in the back of the truck, bilateral 14G cannulars, 500mls of Hartmann's run which is similar to Ringer's Lactate, nil change in obs and some ICP have just come available and will meet us en route, family are still asking is this really necessary. Bat phone it in on the way.
In the Resus Bay,
GCS = 14
HR = 64 - 68
BP = 84/48
RR = 18
Some movement has occurred with the right arm only.
CT showed a smashed C5 and a spinal cord tumour. Stabilised, packaged off to the Spinal Care Unit at a nearby hospital by the time we're back two pt's later.

My first witnessed and treated Neurogenic Shock.

21M - IP.

30M - IP, fell over and now c/o central neck pain without motor/sensory deficits. All the hospitals are full, it's been a busy night of some trauma and good ol' sick people so even with a Cat 3 triage we're stuck there for 6 hours plus till day shift can come as take over.

So a bloody good night with a shit finish.


See you at the big One.

Taz