Blood Goes Round And Round, Air Goes In And Out

It's only when I get close to the address that I recognise where I'm going. I've been to her a couple of times, a seven year old who has regular fits – the mum never panics and it's normally a pretty easy job to get the child out to the ambulance and down to the hospital. It's the end of our shift so for us it looks like it's going to be a nice little 'off job'.

The mum waves at us from the front door, she seems unconcerned which is always a good sign, she's seen her child fit before and obviously it can't be too bad an episode. She directs us upstairs.

Lucy, the little girl, is apparently asleep on the bed, a damp patch near her head means that she has either vomited or drooled during her fit.

I start with the basics, airway and breathing – it's a check that we do without thinking, almost all of our patients are breathing.

This one isn't.

'Pass me the ambu-bag', I ask my crewmate.

'That can't be right', I think. I bend down, sitting on my haunches so that my eyeline is level with Lucy's chest, it must just be a trick of the light.

Nope, she's not breathing.

Still thinking that my eyes are playing tricks on me I put my hands on either side of her chest, hoping to feel the rise and fall of the chest.

There isn't any.

So I start breathing for her. My crewmate has already put the oxygen monitor on Lucy's finger, it's showing 78%, much, much lower than it should be.

As I 'bag' her, my crewmate asks the mother what happened. Lucy was having a fit so her mother gave her some medication to stop her coming out of the fit. She used to have one type of medicine but it was discovered that she was over-sensitive to it and as well as stopping the fit it would also stop her breathing.

The doctors, being wise, realise that perhaps another drug would be advisable. Perhaps this drug other drug wouldn't stop her breathing.

No such luck.

However, I'm fairly relaxed. Lucy's oxygen levels have come up to 100% and she's moving around under her own steam. It's always weird to have a patient who isn't breathing for themselves start moving around under you, it's even weirder if you are doing CPR on someone and they are trying to fight you off.

She's still not making any effort to breathe for herself but that's no problem – she's got a nice open airway and it's an easy job to breathe for her.

Time to go, so I pick her up, sling her over my shoulder and have a quick trot down the stairs and out to the ambulance.

She must have had a growth spurt as I can't remember her being this heavy…

I put her down on the ambulance trolley, re-check her airway and continue bagging her. She's still got a bit of a gag reflex so we can't pass a breathing tube into her airway. We are only a few minutes away from the hospital, so we decide to have a nice relaxed 'Blue Call' into a pre-alerted hospital

Nice and easy, bag her all the way in, no problem.

And then, that beautiful, clear, open airway disappears under a mountain of vomit. All hope of getting air into her lungs vanishes with it.

I reach for the suction, with a bit of effort I clear away the debris of dinner – whole chunks of food that were in her airway and now spread around the floor of the ambulance.

A part of my brain asks why, at this late stage of the night, there is so much undigested food in the girl's stomach.

The airway is now clear and I can resume breathing for her, sadly our ambulance is now covered in chunks of partly-digested stew. It's going to take quite a while to get it clean.

We roll up to the hospital and are met by my favourite paediatric nurse (actually, that's a lie – all the paediatric nurses at this hospital are my favourite).

'I knew it would be Lucy', she says to me as we wheel the trolley through the Resus doors. By now she is making some effort to breathe, so it's all looking rather good.

My crewmate and I are happy, even though we have a big clean up job ahead of us because this is what we get paid for.

8 thoughts on “Blood Goes Round And Round, Air Goes In And Out”

  1. Nice job to end the shift on apart from the 'floor stew'. Experience of these type of jobs make it much easier to deal with the mechanics of respiration etc. A good history of the patients condition and prior dealings with her obviously helps.

  2. I just wondered, Tom, what the significance of the meal etc is? You say she seemed heavier, and that it was late to eat: is there some underlying digestion problem too?

  3. Probably picking up on a point thats far from key. But every ward i've worked on I've had patients who are 'frequent flyers'. There was on chap on my acute medical respiratory placement who came in every couple of months with an infective exacerbation of COPD. Every time he was greeted like a long lost son, given a gentamycin nebuliser and discharged a few days later in good shape. Its how we expected it to go every time. Until, eventually the gent nerfed his kidneys and he died on that admission. It took a lot of time to process that mentally because of the usual 'plan' of his admissions. it was inconceivable that he would be more than a little unwell.

  4. Well done, poor child. My Aunt was a bad epileptic it's a horrible condition. I think she died aspirating, she was in a home run by nuns who were lovely with her. I think my grandfather had funny ideas about medicine and had given her various “cures” instead of conventional medicines. My grandmother used to look after her until she couldn't cope any longer. I remember when I was a child she was always willing to play with me.

  5. Tom I just want to remind you what a superb job you do ! no way do i believe that you will want to stop ! these jobs are the ones that need you to keep on going ! hope the light is at the end of your winter tunnel !

  6. Nice job. In the US, we have too many who would see this as a reason to carry flumazenil (the benzodiazepine antagonist). As if it would be sane to give to a seizure patient. We too often forget, or never learned, the basics. The basics were all she needed and what you appropriately delivered.

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