GCS 3/15 Outside The Door

There were two interesting jobs today, I'll tell you about one now and let you wait until tomorrow for the other one.
We got called to the very common “Male Drunk – Police on scene”, I'll not moan about how often we get called to this type of job, you've heard it all before…

We arrived on scene and were met by a policeman who firstly apologised before leading us to a man who was approximately 30 years old. The man was obviously drunk, and smelt heavily of alcohol, along his arms were the scars of a “cutter” – something else we are seeing more and more of these days. The policeman told us that the patient was refusing to give his name or medical details, only that he was called “John“. We approached “John” and he agreed to come to hospital with us. I got him into the back of the ambulance and he refused to let me touch him – so I couldn't do my usual battery of tests (Blood pressure, pulse, blood sugar, oxygen saturation, respiratory rate). In fact he didn't want to talk to me at all, and sat in the back of the ambulance not talking, at one point he threatened to leave the ambulance – but I managed to persuade him otherwise. Don't ask me why, I normally let drunks go as soon as they say they don't want to go to hospital.

All went as normal until we rounded the corner to the hospital, where he got off of the chair and laid on the trolley-bed. One hundred yards later and we pulled up to the hospital and I told him to get up, then I told him louder, then I did a sternal rub to wake him up – and there was no response! I then slipped an oropharyngeal airway into his mouth, this would wake anyone up – but not a flicker…he was deeply unconscious. This meant he was due for the resus room.

We rolled him (rather quickly) into the resus room and was met by a rather angry Sister – she wanted to know why we hadn't pre-alerted the hospital, I explained that he had just lost consciousness outside the department. She then asked me why he didn't have oxygen on him, again I repeated that he collapsed as we were outside the hospital. We got him onto one of their resus trolleys while the doctors in the department ran into the room.

For the third time I explained what had happened, and that I had no vital sign observations – and this time they paid attention, and accepted what had happened.

To be honest I don't blame them, the A&E department rarely has any surprises – the hospital is forewarned about any “nasty job” we are bringing them – to suddenly have a seriously sick patient turn up without any warning is always a bit of a jolt

Now the patient was unconscious the nurses were able to do those vital observations that I was unable to do – and they were all normal. His pulse, blood pressure and blood oxygen levels were all better than mine, his blood sugar was also well within normal limits and there was no obvious reason why he was in such a deep state of unconsciousness.

He was quickly intubated, and we left the department. I've spent some time thinking if I missed anything, if there was anything I would have done differently, but to be honest I don't think there was. Even if I had managed to get a full set of vital sign observations, they would have all been normal and there was nothing that indicated his condition changing so quickly. I can't 'assault' a patient who has refused a procedure (like observation taking), and all I could do was exactly what I did do – watch him while we took him to hospital.

The current idea is that he had taken an overdose of some sort along with the alcohol, and that it had started to work. Because the patient hadn't spoken to me, I had no way of knowing if he had taken an overdose.

It's one of those jobs that you want to find out what happened to the patient, and tomorrow I shall be asking exactly that – and I'll let you know.

4 thoughts on “GCS 3/15 Outside The Door”

  1. Don',t hold us suspense? From wot doth the poor blighter[chappie,bleeder or sot ] suffer ? was he faking it or was he a faker?

  2. I have a question. If one goes to the doctor for an apt., and it's say for a 'hangnail' (no infection) and refuses to be weighed, do you see this as a reason to refuse to treat the patient? Weight is critical when dispensing the proper amount of meds, but I wonder..is it needed each time? This post reminded me of an incident, so that is why I ask.Thanks …

  3. Only some drugs need an accurate weight, most (especially the ones doled out by GPs) don't. However – some doctors like to keep check of peoples weight, smoking habits, drinking habits, etc in order to (a) Provide decent advice, and (b) sometimes they get money for reporting the same to the government,As for a reason to not provide treatment…well, no, not unless the person was so obese the treatment either wouldn't work, or would have a reduced chance of working. For example heart transplants. But for a hangnail – no.

    Did that answer your question?

  4. Probably the rather ubiquitous GHB (liquid E – whatever it is called in your neck of the woods). One moment they are a healthyish obnoxious drunk, the next they are apnoeic, unconscious and focal fitting (nice eh).Oh…and tell Sister to get a life. Nothing is perfect. What did she want you to do…radio through and do your interventions in the ED bay???

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