Emergency Medicine - Part 2

'RELATIVES: Ignore any first aid advice you’ve ever been given and just throw a glass of water in your loved ones face. Works a treat.'

continued.......

“61 year old male, burns to chest.”

Burns to chest isn’t that common except in cases of major burns. Normally it’s legs and arms, either from spillage or stupidity. Burns kit in hand I headed inside. The air was ripe with the smell of burnt hair. The patient was lying on the kitchen island topless. He’d lent over the hob whilst it was on. He had been trying to change the bulb in the extractor hood and set his shirt on fire. Apart from being a candidate for a Darwin award he was also beginning to look like an entry in The Great British Bake Off! 

There he was, lying flat as if he was planking, being buttered. Yep! His wife was scooping handfuls of butter out of the pot and basically basting him. He was only a few steps away from being floured, rolled out flat and being put in a pastry tin ready for roasting. 

“No more butter!”

“But he has a burn!”

“I know, but no more butter! We need to get him into the shower room and run cold water over it and keep it clean, OK?!”

She un-trustingly nodded at me. I am only trying to help! 

Once he was out of his cold shower, I dressed the wound with aqua-gel and layered some cling film on top. He also got treated to some morphine and entonox. 

I was fully expecting his wife to say ‘I can’t believe it’s not butter’. 

Sorry! That was awful!

“27 year old female, breathing problems, ?panic attack”

On arrival I was greeted with what had become a very familiar sight. Patient hyperventilating. Relatives fanning patient and running around like headless chickens. Often it’s the relatives that need the most help! The patient was crying and wasn’t being quite about it. She was also full flow in her panic attack. 

“Why is she soaking wet?”

“We poured water on her head?”

“Why?”

“To calm her down.”

Almost as she said it a hand flashed past my face. Then in slow motion I watched a glass full of water empty and start making its way through the air towards the patients face. With unerring accuracy the entire contents hit her square in the face.

Sure enough, the crying elevated to new levels. I don’t think she needed the second glass…..

“Stop it! What are you doing?!”

“Trying to calm her down.”

“I don’t think throwing cold water on her face is going to do that. All it’s going to do is make her wet and cold. I am now also wet. No more water. She’s not on fire!”

“OK, sorry, she needs to calm down though.”

The classic home treatment and I’d had the pleasure of witnessing it in all its glory! I can’t think of any situation where this would be my first choice or treatment. No one like having cold water poured on their face. No one! Least of all those who are already stressed or panicked! It is just such a bizarre thing to do! I would love someone who frequently uses this technique to let me know their rationale! 

“25 year old male, burns whilst cooking”

I blogged about this job before at length in Getting Egged, but I’ll share with you the highlights once again!

This guy had been cooking for his friends. He had used an industrial sized saucepan to cook a spaghetti bolognese for his friends. He’d decided to cook wearing only his pants, as you do. During the motion of transferring the vat of bolognese from the hob to the table he slipped on the wet floor and poured the entire contents of the saucepan over his torso, arms, groin, neck and legs. Probably close to 50% burns. It was actually really bad! 

Anyway, his friends knew exactly what to do in such perilous circumstances. Crack eggs onto the burns. Not just a 6 pack or even a Waitrose 9 pack. Nope, a Costco 24 pack of eggs. Every single one, cracked over his burning body. When you combine eggs with heat they begin to cook. By the time I walked in to the chaos, it was basically a giant omelet with a head. 

What followed with one of the most difficult and painful scrambled egg removals I’ve been involved in. The poor guy was an absolute trooper and to get morphine inside of him I ended up having to cannulate his feet! 

As is always the case, before we left to take him to the trauma centre I gave some excellent health promotion and financial advise to his friends. Namely, by telling them to use tap water, not eggs in the future….

*          *          *          *          *

This little lot would make an excellent sketch! TV producers, take note!

People really do the strangest things and never ever cease to amaze. I genuinely wouldn't be surprised if I walked into a house to find a patient in a bath tub full of tined mackerels for treatment of a sore throat! It seems to be the done thing! No doubt I’ll have more to share in the near future but this should keep you all going for now! Anyone else experiences any particularly bizarre treatments for medical emergencies?! Please share! 

Anyway, this has made me all hot and bothered. I must go and throw water in my face, crack an egg on my head, douse myself in vinegar, bathe in olive oil and rub myself with butter and apply my potato skin body scrum. It what all the cool kids do, right?!

Emergency Medicine - Part 1

'RELATIVES: Ignore any first aid advice you’ve ever been given and just throw a glass of water in your loved ones face. Works a treat.'

I laughed when I tweeted this the other day. I know it’s a poor reflection on myself to be laughing at my own jokes, but I was just reliving the countless times I’ve gone to patients and found myself asking ‘Why are they soaking wet?!’. Invariably, the answer isn’t that they’ve just been out in the rain but that they just had a glass of water thrown in their face. It’s like some mythical sick joke! ‘I know, this person feels sick, let’s chuck water in their face! That’ll make them all better!’ It’s absolutely bonkers! Anyway, to that end, I thought I’d share some of my favourite home remedies that I have encountered! They range from the bizarre to the outright ridiculous. I wonder if JRCALC would consider putting any in our treatment guidelines! 

“52 year old male, cardiac arrest”

I had finished work for day but on hearing a cardiac arrest on the general broadcast with no units assigned I offered up for it. It’s what we are here for right?! I rushed to the address and was bet at the end of the road by a franticly waving man. Once he had my attention he literally sprinted like Usain Bolt down the road and into the house. This level of urgency must mean it was as given. I grabbed every bit of kit I could possibly need and headed up the stairs. I could hear the wailing and the crying, everyone was stressed and despite carrying the payload of a jumbo jet I bundled my way past all the screaming relatives to the patient. 

He wasn’t in cardiac arrest. He wasn’t even unconscious. He was however laying on the floor having possibly had a faint or panic attack or a combination of the two. He was soaking wet and absolutely stunk of vinegar.

“Why is he wet, and why does he smell of vinegar?!”

“We poured a bottle of vinegar on his head.”

She said it like I was being the idiot for asking such a stupid question! 

“Why? Why have you poured a bottle of vinegar on his head?”

“Because he wasn’t breathing properly.”

Aaaaahhh, I didn’t realise that the treatment for dealing with breathing problems was vinegar on the head! This will be helpful for so many patients! My next VDI will go something like:

-Morphine  √

-Paramedic Drugs  √

-Tech Drugs  √

-EZ-IO drill and needles  √

-Diagnostic equipment  √

-Vinegar  √

-IV fluids  √

Good to go! Vinegar!! Amazing! Needless to say, I left this particular cardiac arrest at home with advise and some adjustments to their next Ocado delivery.

“15 year old female, burns to leg”

From what I could gather, she had spilt a hot drink on her legs. The history wasn’t exactly forthcoming due to the circus of panic that was surrounding the patient. If I didn’t know any better I would have thought her legs had just been amputated. A woman barged past me as I was trying to get closer to the patient they had called me to see. The woman had two handfuls of potatoes. I would go on to found out that these were extra potatoes on top of the ones that had been used prior to my arrival. 

Eventually I managed to fight my way through the crowd to get to the patient. Standing over her was a relative. Frantically peeling potato skin onto her scalded leg. Yep! Potato skin. Sod all that running under cold water lark! Who needs that, when it’s much easier to turn your daughter into what was essentially a giant human potato rosti! 

“What are you doing?!”

“She has a burn, we peel potatoes.”

“I can see that, but can we stop, and get rid of the potato peels please?! We need to run it under cold water! Not dress her like a hash brown!”

“No more potatoes?”

“No, no more potatoes!”

It was a minor scald. Once she was clear of starchy veg and cleaned I was able to put a burns dressing on. She was then taken to hospital. Again, shopping list and future treatment advise was given. Will we see potatoes joining aqua-gel and cling film any time soon?! Hmmmmm!

“47 year old female, collapsed”

I find that when jobs have very little information to go on, it’s a sign that the patient isn’t going to be that unwell. On arrival, the familiar signs of overreaction and panic were evident! I’m always amazed how many people can fit into such small rooms! When someone becomes unwell the entire world, their wives and extended friends of friends seem to congregate in the room when the invalid lies! As I entered the room I had to ask all non-essential well wishers to wait outside so I could have room to do my thang!

As it turns out, I wasn’t needed. They had it all under control. My under control I meant the patient was lying on her back, legs being held up in the air whilst having olive oil massaged into her feet.  And by massaged, I don't mean a relaxing spa massage with relaxing oils. I mean a frantic, verging on violent massage or some kind of weird, lubricated tickle torture. Admittedly, it wouldn’t have been my first choice of treatment for a panic attack but what do I know?! 

“What’s with the oil?”

“She faint, we oil her feet.”

“Ah, OK, how about we stop that and sit her up so she can breath, I imagine holding her legs over her head will be making breathing a tad difficult.”

Sure enough, once the room was less like the mosh-pit of a Slipknot concert and she was upright and not being contorted in an oily mess, her breathing improved. I left her at home, again, with advise on what to do should a similar situation arise again. Somehow, I don’t think Olive Oil will be joining Sodium Chloride and Glucose any time soon. You never know though…..

To be continued......

Getting Egged.........

"25 year old male, burns whilst cooking"

We were due to finish work in ten minutes, so getting sent a job wasn't greeting with joy if i'm brutally honest. In fact, it was greeted with expletives the words 'stich-up'! Nevertheless we set off on the 11.3 mile journey to the far reaches of the city fully expecting to be cancelled for a nearer vehicle. Wishful thinking! We pulled up outside already x-ray (our shift was finished), grabbed our stuff with the addition of the burns kit and headed in to the flats. The flat was crowded to say the least, 10 or so 20 something Romanian guys filled the corridor leading to the kitchen. I could hear our patient groaning in pain and swearing in Romanian as I got to the door. Drama queen was what I was thinking, how wrong I was!

This guy had been cooking dinner for his friends. Spaghetti Bolognese to be precise. He had cooked the sauce in a huge industrial pan, and I mean huge. For some strange reason he had been cooking in just his boxer shorts. Whilst transferring the pan from the hob to the table he had slipped and the entire contents of the boiling pan had gone over him. He was scalded on his face, neck, chest, arms and hands covering 40% of his body. The hot oil in the sauce made it worse too, his skin was bubbling and peeling everywhere and he was in agony. With burns we always advise running under cold water for 10 minutes but invariably different cultures have different ideas. There are old wives tales for what is best thing to do with burns, most commonly potato skins or butter are what we find! Trust me, neither are a good idea! Today however I saw something new and completely bizarre. Our patients friends were under the impression that the best thing to do was crack eggs on the burns. So they did. 24 of them to be precise. Quick question: What happens when you add raw egg to heat?! Just sayin'!

That is how we found our patient. Lying on the kitchen floor, just wearing boxers, surrounded by bolognese sauce, badly burnt and covered in fried / scrambled egg. It looked like he was mummified in an omelette! We helped him up and marched him (slowly) to the bathroom and sat him in the bath where we showered him in cold water for 10 minutes trying to get the bolognese soufflé off his body. Once dry we started the arduous task of dressing his burns as best as we could. After the first futile attempts we decided to wait until on the truck to dress them properly. We carried him downstairs and got him on the bed. The adrenaline was wearing thin and he was in a lot of pain. He was chuffing away on the Entonox but it was having little effect. He needed Morphine and lots of it. Our main problem was he had circumferential burns to both arms where we would normally cannulate and burns to his hands and wrists. Our only other option was his foot, something that is very rarely done but on this occasion had to be. We got fluids running to combat the likely hypovolemic shock that would occur from this percentage of burns and loaded him up with morphine. We now started to dress the wounds with water-gel burn dressings and cling-film. 

Ambulance services in this country work to guidelines. That basically means we work to a set rules but at our discretion can deviate from them. If it works it was a justified deviation, if it doesn't, well, do the maths! Hung out to dry springs to mind.  In this case there is a guideline about only using water-gel dressings to cover a maximum of 12.5% of burns as there is a possibility of causing hypothermia. We had been reminded of this by CSD but they were not with us or with our patient. They couldn't see the pain he was in and the relief he was getting from the water-gel. We covered all of his burns on the basis we can keep him warm with blankets and monitor his temperature but there is nothing else we could do for the pain. Friday night rush hour traffic for 14 miles to the nearest trauma centre could take 35-40 minutes. I for one wasn't going to deny him an opportunity to be in less discomgort. Fluids flowing, Morphine in, burns wrapped and dressed, blue call placed, we headed off. 42 minutes, 2 bags of fluids, 2 cylinders of Entonox and 20mg of Morphine later we arrived at the hospital. I handed him over to the waiting trauma team, explaining the soufflé mishap that had occurred and our ignoring of guidelines. The staff were more than happy that we had dressed all the wounds and said the guideline we had ignored was pre-hospital health and safety nonsense! We felt vindicated. Regarding the eggs......

"Eggs?! Are you bloody serious?! 

People do the strangest things to treat medical problems and I will never cease to be amazed. Needless to say, we were almost 4 hours late off but I didn't care one bit. Very few ambulance staff would care for that matter. It was a great job. If someone genuinely needs us, being late off is the least of our worries.