Few and Far Between

Hi all.

We all get called to attend those curly jobs which we have absolutely no experience in, nor any idea of how to treat, at least according to best practice. You know the one - where you madly flick through your Clinical Practice Guidelines on the way to the job and pray for a textbook presentation of symptoms.

It's not because you haven't learnt it, it's because you learnt it so long ago the information was lost in the labyrinth of your clinical mind in a haze of assessment techniques and rescus algorithms.

I had one of these jobs the other day. I was trying to knock off of night shift when the mandatory quarter-to-eight chest pain came in. So we did that job. Then about 100m from the depot a Priority 3 comes in for a fellow suffering the "bends", otherwise known as Decompression Illness. No further details.

With one hand scratching my head, the other immediately reached for my "bible" - otherwise known as the CPGs. I broadly know what the bends is, but that is mostly from year 10 science whilst learning about Boyle's law. The CPGs helped out a lot with some basic dos and don'ts, and symptoms and history to make note of. But it still left many questions unanswered in my mind.

Could I use Methoxyflurane for pain relief? What is current best practice in regards to transport position, knowing that a gas embolism is possible? What if the patient is time critical? Would a Priority 1 transport to the closest hyperbaric chamber be appropriate?

Lucky for me there is a Clinical Team Leader based in our communications centre for this purpose. I was able to phone this experienced paramedic and he advised me on the different possibilities and referred to the latest best practice in regards to Decompression Illness. He informed me that these patients were usually quite manageable, but in a small percentage of cases the patient can be quite ill.

Fortunately, our patient was the former. He had indeed experienced symptoms consistent with Decompression Illness (excruciating burning pain in the lower limbs, with paraesthesia) however it had subsided by the time we made contact with him. Never-the-less, I'm still waiting for my Crayfish I'm owed!

What curly, unusual callouts have you attended where you needed to consult your "bible" or call for additional expertise? What resources do you have available to you?

Until next time, don't kill anyone!

Clinical Case 002: Neurological

Initial Emergency Call:
67yo M, Unresponsive, Hx Diabetes.

You are dispatched on a Priority 1 (lights & sirens), and arrive at the scene in 13min. A woman who identifies herself as the patient's sister-in-law meets you out the front and states she found him unresponsive after he failed to show up for an appointment and had given the patient "honey in his cheek-pouch" as per the Communication Officer's directions. She confirms the patient is a diabetic, and takes pills for the condition.

You find the patient in the lateral position on his bed, with the sticky honey leaking from his mouth.

On Examination:
A: Partially obstructed by the honey, with snores and gargling noises present.
B: Bradypnoeic, with periods of apnoea.
C: Pulse tachycardic and strong.
D: Unresponsive to voice.
E: Nil apparent injuries seen nor felt on patient.

Vital Signs:
GCS: 4/15 (extends to painful stimuli).
HR: 128BPM, regular and strong.
RR: 8/min irregular and varied depths, with apnoeic periods.
BP: 195/75mmHg
SpO2: 78% on room air.
BSL: 13.8mmol/L (or 249mg/dL).
ECG: Sinus bradycardia.
Pupils: R > L, sluggish.

PmHx: Diabetes Mellitus Type II, Angina, Hypertension.

Medications:
GTN Sublingual spray PRN
Metformin 1000mg BD
Aspirin 150mg Daily
Metoprolol 100mg BD

Q1: What could be wrong with this patient? Provide a brief list of differential diagnoses.
Q2: Detail your pre-hospital interventions according to your service's guidelines and your scope of practice.
Q3: What other investigations would you - or could you - carry out?
Q4: Was the Communication Officer correct in instructing the sister-in-law to administer honey in this situation? If not, how could have he/she made a better judgement?

Please post your answers in the comments section. Please include where you work (Country, State) and your qualification (Eg. Paramedic, VAO, Student, EMT-B, etc.).

Return of the Vollie!

Hi there!

Long time, no post - I know, I know..! I guess that with these sorts of things (i.e. blogs) you start off fully intending to keep them up to date, but loose the "gusto" after a little while.

But never fear! I'm back - and this year shall be the best year! I'll tell you why...

1. It's my final year of my nursing degree! Yay for moi! I am in my third and final year of my Bachelor of Science (Nursing) at university and hope to bring to you the trials and trivialisations of a student nurse - there shall be plenty, I'm sure.
2. I will be applying for a place as a student Paramedic. That's right, I want to get PAID for doing ambulance work! After much thought as to whether I want to continue as a Nurse or apply for my original dream job as an Ambulance Paramedic, I have come to the conclusion that I much prefer the ambo side of things. However, nothing is set in stone so we will see how things pan out.

What do you think? Are you a Nurse cum Paramedic? Or the other way around? I'm looking for sound advice and reasons as to what path I should choose. Drop us a comment.

Anyway. So where have I been all this time? Well, since my last post many (many) months ago, I have completed two prac rotations for my nursing degree: One in a surgical ward and another at a mental health institution. Chalk and cheese you might say. I also enjoyed a holiday overseas on a tropical island and spent Christmas and new year with my family (Merry Christmas and a Happy New Year to you!). I also worked for a month as a swimming instructor to earn some money, which doesn't happen very often as a uni student!

I haven't done a single ambulance callout since November last year, so I look forward to returning to my role as a Volunteer Ambulance Officer this year and the spectrum of experiences that comes with it.

I'll keep you posted. Otherwise, give me a boot up the arse.

Cheers.