Saturday, February 20, 2010

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!

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