Arrr-Efff-Deee-Esss

It's good how night shifts will usually work themselves out according to what you have planned the next day - especially for Volunteer Ambos as many will have work commitments. For myself, last night was one of those nights as I had a Mid-semester test for Applied Pathophysiology and Pharmacology 2.

1 job, which is fairly standard for a night shift at my depot. An Arrr-Efff-Deee-Esss. Or RFDS for normal people; Royal Flying Doctor Service job. What the Perth city slickin' Paramedics and Ambulance Officers will call a "Jandakot" we call "RFDS" as we take the patient from Regional Hospital to Regional Airport, whilst the Perth Ambos take the patient from Jandakot Airport to the admitting metropolitan Hospital.

Two patients were on this particular flight, and after losing the traditional fight with the nearby Paramedic crew over the intubated/respirated/cannulated/spasticated patient, we got the STEMI fellow. The really sick intubated ones have the RFDS crew ride along in the ambulance to the airport (and do all the work) then we get to relax. Can't win 'em all.

I receive the handover from the ED Doctor: "60yo ♂ presented to GP's office complaining of 4/10 chest pain radiating down L) arm. Too hard basket, sent to A+E. ST-elevation in inferior leads, positive Troponin, responded well to MONA (Morphine, O2, Nitrates, Aspirin), nil pain for 2hrs. Up to metro for cardio review at CCU."

Great. I flick through the notes, and steal the pink copy of the transfer form. Mine! I see the patient has Insulin Dependent Diabetes Mellitus (IDDM), and note the last urinalysis (u/a) with Glucose++ noted. Might wanna do a BSL en route to make sure he isn't getting hyperglycaemic with the stress of his predicament, which is understandable for a older bloke about to fly, after an MI.

Stress → Sympathetic Nervous Response (flight or fight) → Adrenal Glands release Adrenaline → Glycogenolysis from Liver = ↑ BSL.

This isn't what happened.

We got the patient onto our guerney, monitor on, then into back of ambulance.

So how are you feeling Mr Angina Pectoris? Yeah, good thanks. Goodo, let me know if you get any more pain or such wont you? Yeah, no worries. Goodo, so you take insulin for your diabetes? Yeah mate. Okay.

I do a set of obs, and off we trundle to the airport when I notice the Gent getting a bit restless and sweaty. Uh oh. Are you okay? Yeah Buddy. Hmmm, BSL time methinks.

After squeezing what felt like the last drop of blood from the man, the glucometer revealed an impressive 2.0mmol/L.

Do you feel Hypo at all Mate? Oh, yeah, a bit...

I internally chuckle as I crack open a Glutose 15 and hand it to him. "Here, you better eat this."

It made for an interesting handover to the RFDS staff.

See where the Royal Flying Doctor Service has it's planes LIVE, so you know when to expect those good 'ol Priority 3 "Jandakots" here...