I should be working today, but (and I want loads of sympathy here folks) I'm off sick with a work related injury. Thankfully it's nothing too serious, certainly nothing as serious as last time.
On Thursday we got called to a big conference centre in town for a (possibly) suspended/dead/fitting male – so we rushed over there and were met by their security who had rather cleverly staked out both entrances to this place so that they could lead us to the patient. Parking up we had to climb a couple of flights of stairs carrying nearly all the equipment from the ambulance. Our first response bag, oxygen and associated kit, defibrillator, suction and carry chair are quite heavy, and as were were in a rush to get up the stairs we were a bit out of breath when we reached the patient.
The first thing that we saw (and were very happy about) was that the patient hadn't suspended, and was instead thrashing around on the floor with some security guards and the centre's medic sitting on top of him. Approaching closer we saw that he wasn't fitting, but was instead very combative, trying to fight off the people who were holding him down in a very confused nature. Aha! we thought, 'he's post-ictal'.
During the post-ictal phase of a seizure, the fitting has stopped, but the patient is often disorientated, sleepy or aggressive. In this case it appeared that the patient was both confused and aggressive – he wasn't responding to anyone trying to talk to him to calm him down, and he could only make guttural sounds. Normally these episodes last less than half an hour, so we stay with the patient until we can get them into the ambulance.
Sometimes the aggression can come from physically being held down, the patient is confused and frightened, and all they can feel is people holding them down – so they struggle. I suggested that the security guards let him go, which only resulted in the patient trying to stand up, only to fall over again (don't worry, we caught him) and unfortunately the centre medic got a head butt for his trouble. I managed to get a blood glucose reading, which was normal, and a work colleague phoned the patients mother, so I could get a bit of history. The patient is normally fit and healthy, not diagnosed with epilepsy, but has had two fits in the past two years. All during this phone conversation the mother could hear her son shouting in the background. He had never been violent before.
We resigned ourselves to a bit of a wait, so we managed to get him over to a leather couch, and held him down there – after ten minutes there was no change in the patients condition, normally they get a bit tired or they start to have a change in their condition. So we started to think about other ways in which we could help the patient at the scene. We couldn't get him to the ambulance while he was so combative, and so we thought he might need some form of sedation. I ran back to the ambulance and asked control to get us a BASICS doctor, or at least someone who could give some form of sedation.
Instead after about 10-15 minutes we got the Physician Response Unit, which is a new service where a doctor from the Royal London Hospital covers medical emergency calls, it's a bit like HEMS only without the helicopter, and instead of going to Trauma, they instead deal with medical emergencies.
The doctor (who is a very nice man) and paramedic crew with him took one look at the patient, listened to the patient's history and decided that sedation was a very good idea.
Cut forward 40 minutes worth of trying to sedate the patient with increasing amounts of medication. For the medically trained out there, the patient needed 10mg Haloperidol and 17mg of Midazolam. At one point the doctor was thinking about knocking the patient completely out and intubating him (something that has it's own risks). But luckily the patient was sedated enough for us to get him out of the conference centre, and into out ambulance, where we 'blued' him into Newham hospital just in time for him to wake up (the sedation lasting only around 15 minutes) where the doctors there did paralyse and intubate him.
We have few ideas why the patient was so violent and so deeply confused – it's something that will be investigated in hospital. We were considering epilepsy, head trauma (from when his head hit the floor), meningitis (so antibiotics were given on scene) or some form of brain insult. I'm asking my crewmate to find out what happened to the patient.
The reason why I am off sick? Well after holding the patient down for an hour and ten minutes, I managed to sprain my thumb. As I can't be considered safe to carry a patient downstairs, I'm taking today off (plus two days of leave) so that my thumb can heal and I can get back to
saving lives picking up drunks again on Monday. Oh, and it's my birthday tomorrow – 33 is such a young age don't you think?