24 November 2016
Working a busy night shift with his paramedic mentor and her emergency ambulance crewmate, Alex gets to cannulate two patients.Our first night shift presented two critically ill patients where we ‘blued’ them in to the nearest A&E, including a young child with severe croup and an exacerbation of COPD (Chronic Obstructive Pulmonary Disease). Due to the massive pressure on the ambulance service, general broadcasts (GBs) became a common trend. At one point we responded to a call that was five hours+ old. The last of four night shifts proved to be very productive in terms of PAD sign offs, however we did care for rather ill patients.
We arrived on scene, in the early hours of a wet morning in Central London, to treat an elderly gentleman who experienced two episodes of LOC (Loss of Consciousness). He stated he did not remember collapsing, was complaining of right shoulder tip pain and had significant medical history of two previous heart attacks. Within five minutes of walking through the door we had attached a 12-lead ECG to help us diagnose his condition. I was handed the printout to see he had 2-3mm of ST elevation in leads V1, V2 and V3 which was suggesting an Anterior STEMI (ST Segment Elevation Myocardial Infarction).
The patient stated his ECGs can appear abnormal, and the LifePack 15 machine also didn’t detect the elevation to say “MEETS STEMI CRITERIA” like it should have done which was strange. After a very quick consultation with my mentor and crewmate we decided to play it safe and assume the worst-case scenario, as a precautionary measure. Our patient was a really nice man who took the diagnosis in his stride. He was more focused on making sure his wife would look after the dog and cat, which were having a friendly sniff around our response bags, whilst he was in hospital!
After settling down in the ambulance I was tasked with putting in a cannula. I set about doing a mini kit-dump, selected the site as his right Antecubital fossa and proceeded to successfully place an 18g cannula! I was so happy I was able to perform professionally and calmly despite being in a time-critical situation.
On arrival at the Cath Lab (dedicated heart attack centre) the team of cardiologists discussed a major symptom that the patient did not complain of: chest pain. Despite the patient not complaining of chest pain they proceeded to run with our initial diagnosis and to put him on the operating table. When they were preparing to anaesthetise him, one of the team discovered an ECG from just under two years ago on the records system. It was identical to our ECG, so the decision was made to not go ahead with the operation, but instead to keep him under close observation on the cardiology ward. It was very interesting to see such a similar tracing, and given the history provided the doctors said we made the right judgement call by transporting him to a specialist centre.
Two jobs later in the shift I managed to cannulate again, this time to let my paramedic mentor administer an anti-sickness drug called Ondansetron. Our final patient of the last night shift certainly challenged our clinical judgement on a diagnosis. He was presenting with multiple abnormalities including reduced mobility, being hypothermic in a hot room, oxygen saturations of 90% on air and being extremely hypertensive. We recognised this elderly man was ‘big sick’ and worked as efficiently as we could on scene before placing a pre-alert to the nearest hospital – we decided to pass it as septicaemia with a source of infection being the respiratory system.
My new mentor, crew mate and I get along really well, I believe our bond was initiated by my offer of chocolate on the first shift and our shared desire for it… My paramedic mentor is international and has been working in London for a few years now. Her emergency ambulance crew mate has an extensive military background and an excellent choice of sweets at 3am. I am really looking forward to our next set of day shifts; hopefully the weather won’t be so harsh on us!
Alex studies Paramedic Science at ARU. You can find out more about this and other degree courses at one of our Open Days.