Breathless

The first of my two nights, wasn’t too bad, as I mentioned, I didn’t have to wait too long for an ambulance to turn up. 

Shame about the second night…

My first call was to a 71 year old female with ‘Difficulty in breathing’.  

I turned up, and was met by loads of small children.  Making my way to the patient, she was using her own home medication to try and ease her asthma.

It wasn’t working.

A quick check of her oxygen levels showed 71%.  It should be above 95%, below 85% makes me rather worried.  You might guess that 71% really put the wind up me.

I spoke to the son while preparing my treatment.  He’d obviously seen this before, as he gave as good a description of the patient and her problems as I would have expected from a medical professional.  The patient had been in intensive care twice for her asthma.  If an asthmatic ever ends up in ITU, then it shows how rapidly the patient’s condition can deteriorate.  At the very least, it makes me rather nervous that the patient will ‘go off on me’, and it suddenly turns into a respiratory arrest.

The medication was given to the patient, Salbutamol – a nebulized drug administered straight into the lungs in the form of a gas.  I was also giving her a large amount of pure oxygen in an effort to raise her blood oxygen levels.

Then I turned around and nearly fell over three rows of eight children, quietly sitting cross legged and staring up at me with big brown eyes.

“Don’t mind them”, said the patient’s son, “It’s Eid, so the whole family are celebrating”. 

“She”, he said indicating the patient, “has twenty one grandchildren”.

I nearly suggested that this might be why she was breathless…

So now it was time to wait for the ambulance to take this very sick patient out of my responsibility and off to the hospital.  I could see her getting more and more tired, although her oxygen levels were more normal (if only because I was blasting plenty of oxygen down her face-mask).

“Would you please leave the room”, asked her son after talking to the patient, “she needs to use the commode”.

Now, ask any medical professional when is the most dangerous time for your patient, and I would think that 99% of them would say that it’s when they go to the toilet.

“Hmmm… alright”, I said, “but someone stays with her”.

I was standing right outside the room, waiting for a shout for help and then for me to bound into the room to resuscitate her in front of twenty-one small children.

Luckily for all involved, she survived her encounter with the commode, and we settled down to wait again.

While I was waiting, I was constantly reassessing the patient.  I really wasn’t happy to have her waiting so long because while my treatment was improving her condition somewhat, she needed better care than I could give.

The son offered me a cup of tea.

He knew how serious it was, he knew that the ambulances in the area were probably picking up drunks, and yet he understood my apologies, and offered me a cup of tea.

Thankfully the ambulance arrived, and because of my earlier treatment, the patient had become a little more stable.  She still needed urgent hospital care, but I wasn’t worried that she would die on the back of the ambulance.

It had taken forty-five minutes to get an ambulance to the patient.  Sometimes I like that I’m on the RRU when I can get to a patient in time to actually make a difference.

I also love the drugs I carry, I don’t use them much, but when I need them, they really do come in handy.

I hope everything turned out alright, because as I followed the crew and the patient out to the ambulance, the son shook my hand and said, “Thank you”.

Waiting 45 minutes for his critically ill mum to get a proper ambulance, and still he thanked me.

11 thoughts on “Breathless”

  1. Hi Tom,Do you administer adrenaline for asthma patients there?

    We had an elderly patient who had been suffering an asthma attack for three days before she called us, she was saturating at 56 according to the monitor when we arrived! Salbutamol was administered on scene and adrenaline en-route.

    Although, in our case, we had a one minute response time (we were parked down the road!!) and we were about 4 minutes from hospital.

    Craig

  2. he called for help and it came in the form of you. they wanted medical help quickly, and they did. that may be what the thank you was for, making the differance for her.

  3. Tom, you provided care and reassurance for not only the patient but all her assembled family too. That probably helped almost as much as the nebuliser and oxygen in its own way. As an asthmatic myself, having calmness and authority around me in times of bad attacks makes a massive difference. Someone assuring you that you will be ok, and providing the medication to back that statement up makes all the difference in the world. Well done, and London is a safer place for having YOU in the RRV.

  4. This makes for easier reading. Terrible spelling has always been my most serious weaknes!Some of these comments are beginning to develop echoes of “the cult of personality”! Yes Tom 45 minutes is a long time to await a real ambulance, one capable of transporting the seriously ill patient to a place where she can get as you say better help than you were authorised to give. I take it this was not only Eid, but also the fifth of November, always a busy night. Due to this overburdening the poor patient got half an ambulance crew, and isn't she lucky her respiration didnt suspend! I can easily visualise what a catastrophe that might have been. All those little bones might have got crushed in the controlled panic of the situation. If she had gone into full cardiac arrest, the older children would have had to take their turn performing weak compressions on her naked chest! Thats if the could have stood their ground in the first place. Half an ambulance is not enough! I can just imagine Mr Flahertys' reaction to this type of scenario, way back when he was a simple trainer of emergency personnel. “You've got to get them in”, is what he would have said! Suboptimal is a life saving drug in the hands of Paramedics, but the treatment is best commenced in the calmness of the patients own home and soon as steady improvement is observed, the locus of treatment should be moved post haste to the mobile treatment centre, which is located in the back of an emergency ambulance. These patients and their relatives are in too many cases conned into accepting second best and a mockery of the orcon and professional standards. It would not be so bad if there were at least two professionals on scene, but for my tax and national insurance money, send me an ambulance every time!

    This all adds to your steadily increasing stress levels!

    Eat well and prosper

  5. Craig, Yes, we do have adrenaline for asthma/allergy treatment, I've used it once or twice, but in this case, as she was getting better saturation and her pulse was somewhere in the 140's I thought I'd hold off.

    Bloody good stuff when it is needed though…

    -Tom

  6. As a RRV EMT how much difference is there to the treatment that can be provided as opposed to the extra drugs and skills that a Qualified SR Paramedic would have at their disposal? Do you find that you are limited/held back from providing the best care?

  7. It'd be nice to think that most people would say thankyou to someone who responds to their call for help, and provides drugs, oxygen and a level of expertise to a severely ill family member, probably saving their life into the bargain.Bloody pitiful that an old lady can be in that state and her family can give you a cuppa while waiting for the ambulance though.

Leave a Reply

Your email address will not be published. Required fields are marked *