Fearful all night.

When was the sh*t going to hit the fan and we get our normal drunken abusive pt's?

72F - Found outside a local nursing home, they thought she had suffered a fall. After going through her possessions and knocking on an address she thought she lived at I discovered she was a happy dementia pt for a nursing home miles away and that she had been reported missing and Police were looking for her. We left her with the social worker at the hospital until police could collect her.
One pleasant pt.

56M - Pancreatitis, truthful alcoholic, just needing some pain management.
Second pleasant pt.

24F - Discharge to a private clinic from ED post a less than ten second syncope.
Third pleasant pt.

59M - Diarrhoea, has eaten two containers of prunes???? no bloody wonder! After my primary examination I wanted to take him to hospital for hypotension that had not resolved, tachycardia and tachyponea and variations on the 12 lead ECG. He totally refused, he understood my concerns and what the possible worst outcome may be of not getting checked by a Dr tonight (death) but still refused in a very nice way.
Fourth pleasant pt.

18M - ???Thought??? he might have been bitten by a spider. No swelling, no bite site, no nothing. 'Go home Dude'.
He was pleasant, not bright but pleasant, number Six.

30M - Happy Scottish gent who had tripped and cut his head. Needed stitches and he was our Seventh pleasant pt.

33F - Bi-Polar, Attention Deficit Syndrome, Schizoid, Personality Disorder, Rat Cunning! Absconded from a hospital during treatment for an intentional overdose, found one hundred km away at a rail station threatening to jump????? Police wanted us to search and transport as our male officers can with our Mental Health powers. She was testing the boundaries during the transport but was pleasant enough.
Number Eight.

20something M - passed out, unable to locate. Very pleasant number Nine.

50something M - assaulted, unable to locate. Very pleasant number Ten.

22M - Mandible fracture after being king hit. Sounds like it was an innocent attack and I spoke to him hours later it was an unusual fracture mostly involving the teeth and near bone on the right side of the mandible. A very pleasant dude too, number Eleven.

22M - Push bike onto car. Yes onto the car. cars travelling along road, he's being a 'risk taking' male doing tricks on the footpath and mucks one up falls off bike onto the windscreen of the passing car.
Pleasant not bright. Number Twelve.

30F - Domestic assault. Really just a transport for the Cops.

And all this was accomplished on overtime!!

How's that?

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

Taz

Grabbed an O/t at home.

81M - SOB, discharged from hospital and placed in some very nice respite care but it looks like the heart just can't keep with the oxygen demand.

28M - ?Gastro, had V & D for five days.

24F - Pick of the work, second degree burns to the whole anterior thigh and medial aspect also from a hot cup of tea directly onto bare skin. The skin over a third of the wound had pulled away and rolled up at the bottom of the site. Cannulated standing in the shower for IV access for the analgesia, cling wrap seemed to make the pain worse so I used the Burnaid Gelpak and a bag of fluids with an atomiser.

Backup the motorcycle Paramedic but he cancelled us on the way.

26F - Depression, thing have just built up and the pills seemed the way out. While what she took was not really harmful the intent was.

77M - from Air Ambulance to a hospital, STEMI.

83F - Unwell with a long list is the easiest description.

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

Taz

No serious drugs needed on this shift.

90F - Unwell, Vomiting and Diarrhoea???

26M - Altered LOC post ?syncope face plant in the pub. Pt was concealing information also.

36F - Three witnessed syncope episodes, obstetrics issues leading to hypovolaemia. 500mls of fluids bolus on scene before transporting.

?25M - IP.

22F - Panic attack, then refused to come out of the apartment block and on ring back cancelled.

18M - Bony prominence abrasions post assault.

?34M - Hearing voices, when we arrived a delivery driver told us that a man wearing no pants was on the payphone before we arrived but had walked off.
Guess that's our pt but we couldn't find him.

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

Taz

Quiet and cool nights.

We have now received a new Defib at station to replace our old but serviable Zoll M Series. We now use Lifpak 15's, training has been underway for nearly a year when Qualified Officers returned for re-certification but some revision was required as well as training for those who have had none.
This completed I've been bunging the full set of leads on and taking Diagnostic 12 Leads at every opportunity for three days.

Our first sick person however was fated not to benefit from it, progressive EMD or PEA that was totally unresponsive to pharmacology. I was a bit down after this, the pt was conscious with our arrival and remained so for five to ten minutes while backup arrived to assist extricate but mine was the last face and voice he saw and heard. With general arrests the pt is usually GCS 3, pulseless, cyanosed and rarely warm.

6M - Cerebral Palsy, Absence seizure, perfectly described by the parents but stable with me.

34M - Mis-behaving in the Police cells, sustained a self inflicted hand injury, got verbal with me, non life threatening injury, he can wait until the Police have finished with him. Lesson 1, don't use bad words with me, directed at me it will not help your cause.

51M - suffers Sleep Apnoea, forgot to go to sleep with the mouth guard devise, stopped breathing, woke wife with an Hypoxic Seizure, they've seen it all before knew to ring us for 100% O2 and were really cool and calm. Stayed at home once we got a good GCS and competence and capacity from him.

Several hours down and an early dialysis pt who when we arrived was in hospital already for other treatment.
On the way back to station diverted to

44F - Anxiety requesting transport to hospital.

Knocked off an hour and a half late.


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

Taz

Answer to a Question.

Squeezey said...

Taz, you mentioned you had a patient with a mental health history. Have you developed any strategies to best communicate with these patients during an acute episode. We have just begun to learn about patients with a mental health issue that present for other medical problems, and how to best relate to them, so I would be interested to hear your thoughts.

This Ambulance Student doesn't mind asking the simple questions does she?

When I was attempting the Degree by distance ed from a Uni in the town with a famous motor racing circuit I failed the Mental Health Module, let me get that out of the way first.

Some time later I had a full time student with me from that institution as a ride-a-long.
We attended a pt with an extreme violence history against Police, who was armed with at least one knife, who had already inflicted some wounds to herself, was intoxicated, agitated and depressed.
The police asked if I would mind having a talk to her first just from the door.
Twenty minutes it took to have her voluntarily surrender the three serrated edge knives, move to a neutral, open area of the lounge and to accept the police to enter the apartment behind me while I sat in the same space and chatted with her.

Later I asked if anything from the Module would have helped her if that had been her in the ambo role? 'No' it wasn't really ambo centered, more nursing.

I'm very honest with the pt.
I do ask direct questions and don't apologise for doing so.
I don't tell them I know how they feel because I don't.
I maintain eye contact with them and level.
I have never felt threatened by a mental health pt, very very few are dangerous to you, mostly to themselves.
I can listen for a very long time and not switch off.
I can talk with ease to everybody.
Do you enter the world of a full blown manic or delusional pt? Yes if it helps you establish communication.
Compassion and Humanity go a long way to get them to trust you.
They usually want help.

More confused Squeezey?



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

Taz

OMG!

CSI Miami have shot themselves in the foot with medical scenes so bad I wanted to change the channel and then some new program called Trauma (drama) about American EMS and Rescue Helicopters gives me thirty minutes of poor acting, wrong, inappropriate and inaccurate procedures.

That was it.

The TV got turned off.



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

Taz

Second rostered shift, third day straight.

I am feeling a bit tired but an easy day helped.

96F - Transfer from Rehab to a nursing home.

44F - Painful left wrist after being pushed to the ground in an assault.

46F - ? Anxiety attack, interestingly she had an AMI (heart attack for the non medicals) eight days ago, had a stent put in and is now back at reduced hours at work.
Is the diagnostic bump itching?
Ours were, unfortunately I have nothing to report on her tests.

49F - Fall on the road returning to work, heaps of left hip pain, unable to straighten, it looked different to the right but need an X-ray.

36F - Post Ictal - regular pattern is a single seizure, her partner of many years collected her from work and took her home because we were happy with her progress.

23M - Borderline personality disorder, schizophrenia, Alcohol abuse, savage self harm mutilations to arms and with police in a park pissed. Sorry hospital we had nothing else to do with him.


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

Taz