Somedays you look at a patient and just think to yourself, what is going on?
Most of the time it’s the humble chest pain. Is it their ticker or last night’s tikka?
You start of thinking that the pain’s a bit low, the patient ums and aahs about whether it’s their breathing causing the pain, and you just end up thinking – stuff it – treat for the worst case scenario.
I must say that I did visit a patient who had the classic chest pain after lawn mowing too much – and he just kept mowing – needless to say he got the stent that he was after. But things are always a lot murkier.
We recently received a call to a very dark path in a very dark park. The caller said that they couldn’t hang around but she’d seen a female in her 60′s unconscious on the gravelled path. Face down.
We pulled up and started wandering down the path. The 4 bystanders just stood arms crossed, chewing on fingertips. No one knew her and no one had turned her over to stop her pressing her nose into the dirt. That’s when we noticed the decerebrate posturing. Ooh, that’s not good.
We gathered some of the masses and, taking care of her spine, loaded her to our stretcher. We got her in out of the night and took a closer look. First glance said that she’d had a bleed in the cranium. Big haemorrhage in the brain. Stroke.
That’s when we got back to basics. The causes for altered conscious state? Number one – hypoglycaemia – low blood sugars. We felt it was a longshot, what with the decerebrate activity and all, but a drop of blood from a finger’s a quick test. And that would cross one thing off the list.
The reading was “LO” of the scale in a bad way. This looked like this ladies’ lucky day. As long as her brain wasn’t fried.
We got backup on the way, because they don’t trust us with IV sugars “yet”, and we gave her the Glucagon, popped a line in and waited for the cavalry.
Just as backup arrived she started to wake-up. A bit more magic juice from MICA and we trundled off to hospital.
She was itching to get home by the time we got to hospital.
I was going to verbal on a bit more about another job but you can only read so much before glazing over. Suffice to say the moral of the story is:
In ambulance things are never what they seem. Think outside the container.
