Keeping The Worry Off My Face.

His wife lets us in, it's one of those houses that are so clean I feel bad about traipsing my boots all over the carpet. Our patient is a man in his eighties sitting in a chair. He's spotlessly clean, wearing a shirt and a tie, hair brushed back.

He looks like a ghost, the blood has drained out of his face. As I enter he looks up at me and smiles.

We had been called from pretty much around the corner, the wife has already thanked us for getting there so quickly. She's called us because, as she describes it her husband had a fit.

He's normally fairly healthy, a bit of a cardiac history but no epilepsy or diabetes, nothing that would suggest a seizure.

I bend down to his eye level and start talking to him, my hand snakes out and automatically takes his wrist. I feel for a pulse.

Bom………Bom………Bom………

His heart is beating around 25 times a minute. It should be sixty or more. It's no wonder he looks so ill.

I give my crewmate the look. The look that says, “Uh-oh, something's wrong here, we need to speed it up a gear”.

I tell her, “Let's get the gentleman in the back of the ambulance eh?”

She understands and jogs out for the carry chair, we don't normally move faster than a stroll. Given the type of call it was given as we've brought loads of equipment into the house with us, we can't always carry the chair in as well.

“I feel sick”, says the man and his face drains of even more colour, something I didn't think was possible.

He vomits, his eyes roll back in his head. Warm brown liquid flows over his tie, down his shirt and onto his lap.

I look at this and scrabble to find that pulse again. I'm just about to grab his ankles, pull him off the chair and start CPR when he opens his eyes.

“I feel a little better now”, he says.

His wife tries to help me remove his tie, but I'm the one with the gloves on so I tidy him and wipe him down a little while I wait for my crewmate to return. It's only been seconds but it felt much longer than that.

After being sick his pulse had come up a bit but it soon starts to drop again. We bundle him into the chair and rush him out to the ambulance.

We are only three minutes from the hospital and normally we wouldn't 'stay and play', but there are medicines that we can give to speed up his heart, fluids we can give to bring up his blood pressure and an ECG to do to see if the cause for this sudden slow pulse is due to a heart attack.

If it's a heart attack we'll be bypassing the hospital three minutes away for the angioplasty centre, which depending on the traffic, is at least twelve minutes away.

The ECG show a complete heart block not a heart attack, something I'm extremely grateful for.

I often joke with patients that they should only worry if I look worried. In this case I'm trying to keep the worry off my face.

“Let's get a line in him and give him some atropine”, I say to my crewmate – then make a mental note to apologise to her later, she's the paramedic she knows her job. It's just that when things start to get serious I can get a little… directive. I think it's because I tend to think aloud and because I used to be a nurse – a rather bossy nurse sometimes.

Despite the medicines his pulse remains the same but at least his blood pressure is coming up with the fluids and with him being laid down.

We blue-light him into the hospital. Three minutes later he is on the hospital bed being looked after by two nurses and a doctor.

His wife is in the relatives room, the resus room is full and another call is coming in (another patient with much the same problem as ours), so the staff can't take the time to talk to her.

I fall back into my nursing mode. I sit with her and hold her hand, she thanks me again and I apologise that the hospital staff haven't spoken with her yet. I explain that they are very busy and she tells me not to worry. I explain to her what the doctors are doing and that the likely outcome is good now her husband is in hospital.

Meanwhile in the ambulance the timer is ticking up, someone in Control is watching this and will be wondering why we are spending so much time at the hospital. I don't even give it a thought.

I pop my head back into the resus room, the doctors are happy that our patient is stable – he's looking a lot better although his pulse is still a little low. I let the wife know. She thanks us again.

We clean the ambulance and get ready for our next call.

A little later one of my colleagues takes our patient to another hospital to have a pacemaker fitted, I hope it's all going to go to plan and that there is a happy outcome.

25 thoughts on “Keeping The Worry Off My Face.”

  1. Good job with a great result. Well done to you both. So often they go the other way with Atropine. I'm glad it wasn't the case for him or his wife.

  2. Now you see, this is exactly why I joined up….. to help people who are in need of help. I am sure hundreds of other ambo staff across the country and world can give an example of a similar job, I know I can, and it makes all the other calls that don't necessarily require our attendance and medical experience worth while. I hope the pacemaker gets this chappie back on in his feet and feeling better soon.

  3. It's great that you took the time to talk to her, even if you didn't have it.There's something very sad about this post, I don't really know what.

  4. well done, its nice to hear the good side of your job too, and me as an ex nurse, that a little nursing for a patients relative from you went a a long way, no insult inferred to the hosp staff

  5. ……and the sad thing about this job is that the only thing the ambulance service will record about this job is that you failed to meet your hospital turnaround time. Somewhere you now appear on a list as a failure as a result of this job. How demoralising is that for God's sake.The impact you had on those two frightened people means nothing to those faceless, bureaucratic twits. Sigh.

  6. Oh believe me from someone who see's too much of the “green men” you guys/gals do make a difference to alot of peoples lifes !!Sometimes a smile, is enough, when protocol stops you doing anything !!

    Keep up the good work as it is appreciated !!

    Donna

  7. Totally with you on that, sam!anyhow… nice job, Tom. A look and a smile and even just a gentle touch on the arm of either patient or spouse or both can go a long way. I am a fervent believer in not bludgeoning people with technology. It can be introduced quickly and effectively without rudery

  8. Yep – and that is why I feel more than happy to say, “**** 'em”.I do what I do for the benefit of my patient and their relatives, not for the benefit of the government.

    And if they moan, I'll tell my local management team why I did what I did and they'll support me, because they are decent people.

  9. Yep – they are busy and understaffed. It's why I help out sometimes with stuff like this.I *like* my local hospital – so I'm more than happy to put myself out somewhat to give them a hand. Even when it's not such an obvious 'right thing' to do.

    But the nurse in me is still alive – can't help it.

  10. Another excellent post!I was at a talk by the St John's people this week and they said that if you suspect someone is having a heart attack and they ask to go to the loo, you should try to talk them out of it, as if they do pass water, the release of pressure would trigger a cardiac arrest. Is this true, and if it is, why aren't we told abotu it if we go on first aid courses etc?

  11. The older I get the more emotional I am, I got properly misty-eyed reading this. I can imagine that this couple will be singing your praises for years to come, your actions will have made such a difference to them. I'm so glad there are still people like you in the service and I hope to goodness if I ever need an ambulance someone like you will be on it.

  12. The Loo be a popular place for one to die from a heart attack., My grand father and father both died there. Both in their late eighties.

  13. I think they've kinda got the wrong idea there – it's actually opening the bowels which can precipitate a cardiac arrest, as the nerve which slows the heart down is the same as that which makes you want to open your bowels (although there is some debate as to whether it's actually the slowing down of the heart that makes you want to go to the loo…). I've come across it happening only 2-3 times even though I've worked in cardiology/A&E/critical care for quite a while, so I'm not convinced it's that common.Generally I don't think you can stop someone going to the loo, but it's usually a good idea (as with any reasonably ill patient) to either go with them or make sure they keep the door unlocked.

  14. Sigh! indeed Sam; So on behalf of the faceless bureaucratic twits…I don't have a list of failures (and if I did I doubt Tom would be on it) I guess my main point about nursing in the manner described by Tom is that nurses have a full compliment of information available to them when they do it. A nurse can give individual care to a patient and their family because they know what's going on with all the rest of the patients in their ward/unit. They are fully aware that the patient two beds over is not having a cardiac arrest and of course were that to happen they would stop what they were doing and deal with the medical emergency.

    Ambulance staff do not have that information. They don't know if there's a cardiac arrest down the road, they don't know if a kid's just been knocked over and more importantly they don't know where the nearest available ambulance to any of those calls would be coming from.

    Does any of that mean that this sort of personal care is wrong? Well no, but it's worth remembering that all those faceless morons like myself, who don't care about patients, only targets, actually work for you and our job is simply to recognise that we need to get the best possible care to EVERY patient, not just the one in front of you at that moment in time.

    DSO

  15. I think it's more a case of feeling very ill sometimes goes with a feeling of a need to have your bowels opened. As a nurse I always worry when a very poorly patient wants the loo for that.

  16. This is one of those posts when people like me (non medical) just would like to rip our eyes and elbows out, to have made such a difference.There's no other way of saying it!

  17. Just been referred here by this week's BritMeds courtesy of Dr Crippen..Do you not have the facility for external pacing in the ambulance? I'd have thought it'd be a better option than atropine, which doesn't usually work with CHB.

    Also, fluids?

  18. Atropine will certainly ablate your vagal tone.. but CHB isn't (ever?) due to parasympathetic predominance. External pacing on an otherwise conscious patient is pretty nasty even @40bpm. I presume you guys don't stock Isoprenaline but I'm guessing that's what A&E gave him before sending him for his pacer. Sounds like speed was the key. Good save.

  19. Hold on, folks, we are talking about an ambulance crew on the road, 3 minutes from a hospital, and someone is suggesting sedating the patient, who has only recently vomited, prior to pacing. Atropine – yes. It's first line drug of choice for all bradycardias. Fluid – yes. If you have a bradycardic, hypotensive patient, a little filling goes a long way to improving cardiac output.

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