More Oxygen Please

There I am, on the 8th floor of a block of flats, a mile or two away from one of the better hospitals in the country. I'm with a 69 year old female who has suddenly developed difficulty in breathing.
This is not the normal “I've had a cough for a bit” difficulty in breathing that I find myself at all the time – no, this women is seriously struggling.

Her pulse is 130 (Not Good), her breathing rate is 40 (Not Good), her oxygen levels when I walk in the room are at 86% (Really Not Good) and she is cold and sweaty (Also Not Good).

I give her oxygen which brings her oxygen levels up to a more respectable 95%, a quick listen to her chest reveals a wheeze and crepitus, so I give her some Salbutamol medication with the oxygen to open up her airways, and she tells me that this has brought some relief.

I'm not happy with the way she looks, nor with the way she is breathing, so I phone up the RRU desk, only to be told that there are no ambulances to send, as they are all busy, and actually they are holding calls all across the sector.

Holding calls means that people want an ambulance, but there is no ambulance to send

The patient is getting some relief from the medicine I've given her, but the proper place for her is a hospital. The way she is sweating suggests that her condition is not getting any better.

Then she tells me she wants to go to the toilet, to open her bowels.

It's now my turn to break out into a cold sweat – as an A&E nurse one of the things you very quickly realise is that when people are ill, and they open their bowels, they have a nasty habit of dropping dead.

I really didn't fancy trying to resuscitate her in the toilet, so I kept persuading her that she really didn't need to go to the toilet, and I kept willing the ambulance to turn up.

Finally, I glanced out of the window of the flat, down onto the street, where I saw the sweet, sweet sight of an ambulance pulling up.

Glancing at my watch I see that I have been waiting with the patient for 35 minutes. I'm unhappy because my patient had to wait so long to get the ambulance that she needed so she could go to hospital for some essential treatment. Then I realise that without me turning up she could have died.

So sometimes it feels nice to be needed, and it is nice to see the RRU doing something more useful than just making sure our response times are up to government standards.

Just one job, during a normal nightshift.

22 thoughts on “More Oxygen Please”

  1. I was chatting with an ambulance driver over the weekend, he mentioned that he'd jokingly suggested he'd was going to write up the stories he'd come across in his work, the funny, the sad and everything in between.Just thought I'd mention it, lest he beat you to the punch!!

  2. Sorry to be so gross, but does no one else ever get the sensation that their insides have rearranged themselves a bit after a poo, especially if it's been hard work doing? Perhaps it's this shifting or effort that is just too much for an already failing system.Snoop

  3. Funny that, I've known two patients to collapse and arrest in the loo recently, maybe its somthing to do with blood pressure dropping as all the organs get more room to expand.. Hmmm interesting, I see some reasurch coming along…

  4. I know round here they have a habit of having heart attacks in the loo – and not getting found for an hour or so. Had a bit of a do recently when an ECG machine was brought in for repair because it wasn't picking up a trace – on a dead patient…..

  5. I have renal failure and chest problems and so if I get overloaded with fluid or I get a chest infection I go Tachicardic and have to be rescued by ambulence men.I think that the London Ambulance staff are a bunch of life savers. The most I have had to wait for help was 25 minutes when I was ill at home during the rush hour.

    That 25 seemed like a lifetime .. at the time. So I know just how you must have felt with your old lady.

  6. Straining to go open your bowels does funny things to your heart rate and blood pressure…its called the Valsalva maneouver.. essentially the heart speeds right up…sloows right down and then right back up again too in response to changes in blood pressure…”Valsalva maneuver: A maneuver in which a person tries to exhale forcibly with a closed glottis (the windpipe) so that no air exits through the mouth or nose as, for example, in strenuous coughing, straining during a bowel movement, or lifting a heavy weight. The Valsalva maneuver impedes the return of venous blood to the heart….”

    My guess is the extra strain this puts on on an over stretched system might be what does it…

    Interestingly (or not) the valsalvas maenuever can be therapuetic ( I think for some arrythmias… but may be someone who already has their medical degree can comment on that??)…


  7. Reynolds, you're correcti used to work in a CCU, if a patient wanted to have their bowels open and they were unstable, the crash trolley allways seemed to gravitate to their bed, as if by magic…and low, a few minutes later… 200 joules

  8. Thanks a bunch Reynolds, your blog is a neurotic's dream and a source of hypochondriacal inspiration. So, not only do I worry (thanks to you) about the ends of my fingers and toes getting bigger, I now have to worry about my daily dump when I'm not feeling too clever. Geez! xxx

  9. As a copper working nights not too far away from you I can sympathise with how long the truck took to get to you. We ended up taking people ourselves to A&E, sometimes driving there v. quickly with crossed fingers…(PS I'm not having a go at the LAS here, merely sympathising!)

  10. You are right, the Val salva maneuver is used when someone is in SVT. It's the 'first line of attack' when treating someone with the condition. Of course you should have them on a cardiac monitor while they do it.The joke amongst medical people is 'If you don't poo yourself doing it, then you aren't doing it properly'

    If that doesn't work then you try medication (Adenosine), and when that doesn't work, you sedate them and give them a shock across the heart (a lower power than when you are shocking the heart in a cardiac arrest)

  11. Cheers for that. If we had the vehicles we'll get there as quick as we can.And yes – when you are ill 25 minutes seems like a lifetime…

  12. On holiday in Jersey I ended up being whisked to A & E with a supraventricular tachycardia. To try and get the heart rate down from a pretty constant 230 bpm (it had been much higher initially) I was asked to lean forwards, hold my breath and push down as if trying to go to the loo. It was hoped that this would get the heart rate back to normal but wasn't successful and ended up with a couple of injections of a drug to reset the heart. Overnight in intensive coronary care and a couple more days in hospital for observation, not a great holiday!Anyway, to get to the point, sounds rather like the Valsalva maneuver.

  13. The impression that we get is that you guys are reluctant (understandably) to take people to hospital. Of course this might just be because we don't get to see the patients that you take in.But you know as well as we do, that if we are busy, then it can take a while for a truck to turn up.

    I couldn't do your job, if only because most of the time people are actually happy to see us turn up.

  14. Talking to my station-mates after the job, they all had the same “oh dear” response when I told them that she wanted to go for a poo…

  15. Bathroom be the most dangerous place in the house for Heart failures and/or broken bones for golden year folks. There be a lot of stress on the Organs and it be hard, if one is at the limits of energy available. ScaraeusF

  16. oh yes, the fabulous vasovagal syncope. any loss of conscousness due to activating the vagus nerve (anything from fainting to cardiac arrest) straining on the toilet is just one way to bring this about. this site has some information about it: always hated those calls very messy and often slippery…. I never wore my work boots into my house for a good reason….

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