Out of Place

"93 year old female, fall"

It's that time of the shift again, 'Nan down'! I've said previously that these are generally my favourite types of job. The patients are normally polite and extremely grateful for us being there. Sometimes we get tea and biscuits and more often than not, they don't go to hospital. It is also nice to go to someone who genuinely needs us.

We pulled up outside and were beckoned towards the house by the concerned neighbour who had found her on the floor.

"She's been there for 12 hours, bless her. She's in the downstairs toilet."

Poor thing. I headed round the hallway to where she was and what I saw shocked even me. I just starred for a few seconds and made the following observations.

1. That shouldn't be facing that way!
2. That shouldn't be up there!
3. That shouldn't be that colour!
4. How in God's name are we going to get her out?!?

So, with or without medical knowledge we all have a grasp of human anatomy. We all know, therefore, that the foot has no place anywhere near the shoulder. We also know that it shouldn't be blue. THAT is what was facing us! Not only was her leg so badly twisted / fractured / dislocated, but her other leg was wrapped round the toilet and her arm was stuck behind some pipes. It was like a contortionist meets a Rubiks cube + injuries. 

We immediately asked for more hands. No way would 2 of us be able to get her out of there. She apologised for wasting our time! If only she could have met our last patient who was drunk in the street and full of venom. (In fact the way he was spitting resembled a venomous snake!) I started her on Entonox while we tried to assemble some kind of plan. Unfortunately, like most other bizarre jobs, this ISN'T in the books! A couple of FRUs arrived and joined in the "ooohh's" and "eeeek's" and "ouch's". We decided it was going to be best to free the limbs that would be 'easily' freed, get some IV access, load her up with morphine, get her out with the bad leg still in that ghastly position, and then finally straighten her leg. Simple!

Bear in mind it was a tiny downstairs toilet, and there was a step down into it, we managed to get two of us inside and one in the doorway. We set about freeing her arm first which just involved forcing the pipes away from the wall long enough for the arm to be retrieved. I had visions of the pipe bursting and us all being in a whole world of difficulty! Luckily the arm came out without drama. With some light force and assistance her good leg shortly followed. Luckily for a 90+ year old she had relatively good veins so cannulating her turned out to be rather simple! Within a few minutes, the morphine was in and she was complaining of less pain. Now the 'fun' bit!

The doorway wasn't wide enough for us to be able to lift her in the position she was in and carry her out. The room wasn't wide enough to realistically straighten her leg inside and then get her out so some more head scratching occurred! It was decided that a rescue board would be slid down to us. We'd lift her off the floor a few inches whilst the board was slid underneath. Then, we'd carefully slide her along the length of the board, through the doorway and into the hallway. It worked a charm! Now for the leg. After another dose of morphine and plenty of Entonox we went for it, slowly. I felt a vile click as her knee cap moved about but now her leg was straight (ish). By 'straight' I'm not taking into account that her foot was still facing the wrong way. The fracture dislocation of the ankle was going to be left for the hospital to deal with. We secured it into a vacuum splint, continued with pain relief and got her out and off to hospital as quickly as possible. 

The position she had been in was so bizarre, it was hard to explain to the waiting trauma team just exactly how we found her and what state her leg was in when we got there. Even the Orthopod, who enjoys breaking bones on a daily basis, pulled a grimacing face. He said it was the worst case of 'shoulder foot' he'd heard of!

Very rarely do I see injuries that make my stomach turn and it isn't often that I look at someone and literally don't know where to start! People manage to fall and get stuck in some of the most incredible positions! I really don't know how. I just hope I'm never unfortunate enough to do anything similar. I can't even comprehend the pain. It doesn't bear thinking about!

Not Again

"84 year old female, fall"

It was the start of the shift and this particular patient had been lying on the floor for about two hours. Not a priority right?! Patient care is the ambulance services number one focus right? Hmmm. Anyway, grumbles about the right and wrongs of making an 84 year old wait on the floor for two hours, off we went! We were let into the house by our patients husband who clearly suffered with dementia. He shuffled up and down the hallway for most of the time we were there. Very sad to see. Our patient was lying on the floor in piano / bedroom. Her bed was now downstairs and placed a few feet away from a wonderful grand piano. She used to be a professional pianist and this way she could still lose herself in her music without the need to struggle with the stairs. 

We assessed her whilst she was on the floor and quickly determined that there were no injuries. The only problem was that she had been incontinent. We got her up and onto the chair. The evening carer hadn't shown up which is what had caused her to venture to the toilet in the first place so we were left doing the carers work. We undressed her, gave her a flannel wash and re-dressed her in her night clothes. She hadn't been wearing an incontinence pad when we found her so I assumed it was because she'd been on the floor so long. She was so thankful and grateful and apologetic, it must be so horrible to lose your dignity in such a way. Hospital wasn't on the agenda because she cared for her husband who was still shuffling up and down the corridor.

Once it was established that she would normally help her husband to bed, we said we'd put him to bed, then come and put her to bed, to save her walking around with her frame too much. So, for the second time we did the work that the carer  that they pay for should have done. We took her husband to his bedroom, undressed him, washed him, re-dressed him, gave him his pills and put him to bed. Job done! Now, back to our patient.

My crew mate had prepared her medication and a glass of water. We gave her all the pills which she took so now it was just a case of bed and goodbyes. We stood her up and immediately noticed the wet patch on the chair. A cursory glanced down made it clear she'd wet herself. Not again! Remember that assumption I made?! They really are the mother of all f**k ups! It was then that I noticed I pile of incontinence pads stacked behind the door! So, we undressed her, washed her, re-dressed her and got her into bed. Again, she couldn't stop thanking us and apologising despite my threat of charging her £5 for of every time she said 'sorry'! We packed up our stuff and said our goodbyes when she said:

"I'm really sorry, but I think I need the toilet."

Bags down, duvet off, swing legs around, help up with frame and usher quickly towards the toilet. Unfortunately, at 84 'quickly' wasn't something that was going to happen. She slowly shuffled, one step at a time towards the toilet. 4 meters, 3 meters, 2 meters, fart, 1.5 meters, fart, 1 meter.....

"Sorry, I didn't make it."

The smell confirmed our fears. Not again! We got her onto the toilet, we undressed her, we extensively cleaned her, we got yet more clothes and redressed her, we got her back into bed and we put a load of washing on. I finished off my paperwork including a vulnerable adult form (she clearly needs more help and commode) and then said our goodbyes. On cue, the front door opened and in walked the carer......

Getting Schooled

"71 year old female, fall"

Elderly fallers are our bread and butter jobs. We do them day in and day out and unlike drunks, I don't get bored of them. They are always appreciative and more often than not it's a case of getting them up, making a tea, having a chin wag and leaving! Who wouldn't like that?! Sometimes of course they do injure themselves, head injuries, neck of femurs (NOF), hips and wrists. One slight saving grace, is as we get older, we feel pain less and less!

We pulled up outside the house, navigated the overgrown path and got the torch out to open the key safe on the wall. Key safes are wonderful things but I don't like them! I like that you get into the house when someone is in need, but I don't like letting myself into a dark house! It creeps me out! I always open the door with a very tentative 'Hello, ambulance' desperate to hear a response. Luckily, today, I got a response so followed the noise!

Lying on the floor was the loveliest of ladies. We were greeted with a huge smile and despite her clearly broken ankle she was full of the joys of spring. That was a good thing for me because at 1am on a Friday night my joys of spring were somewhat waining! We chatted away whilst we did what we do! Check for neck pain, pulse, respiratory rate, blood pressure, temperature, blood sugar, look at pupils, head to toe survey, check for pain down the back, assess the injury, check for a pulse in the foot, find it and mark it with a cross and place foot in a box-splint. While this was all going on, chat about life through the haze of the Entonox, laugh when she laughs, stick a cannula in her vein, give some morphine and when she starts feeling sick give an anti-imetic. Once ready to move, lift her up onto our chair, grab an overnight bag of stuff, carry her down the stairs, lock up the house, load her onto the ambulance, quick ECG due to medical history and off we go to hospital! Simple! 

Despite her blood pressure being very good on arrival, the morphine and dropped it a fair bit so we raised her legs on the bed. We wheeled her into the A & E department and 'offloaded' her (it's a phrase that makes her sound like a Tesco delivery but it's the term that is used!) onto the hospital bed whilst being watched by the handover nurse. I then went to give my handover, complete with a smile on my face. 

Before I continue, bear in mind the patient is in her nightie, her legs are raised and her left leg is in a huge, bright yellow box splint. It was pretty  obvious what was wrong, roughly speaking! 

Anyway, the handover, I put on my best smile and my cheeriest voice! 

"Good evening"

"Hardly"

"That good eh?! 

"Right, what's the problem?"

"Ketamine overdose......." I said with a rye smile.

*cue the awkward silence and a death stare from the Matron*

Wow! If looks could kill! She glared at me like I had just drowned a kitten. Clearly I'd picked the wrong crowd to waste my best gags on! I'm sorry, THAT IS FUNNY! Maybe it isn't! Maybe I just think I'm funny! Surely though, a bit of light humour at an appropriate time isn't a bad thing. Obviously I wouldn't do it on a blue call or when I've got a patient who wouldn't find it funny but this one had a wicked sense on humour and shrieked with laughter! It's part of the job! If you can't have a laugh to cheer up your patients or a grumpy looking nurse, what can you do?! 

I completed a very mundane, highly factual handover, the nurse vaguely listened and then left. We bid farewell to are patient who was still smiling and very thankful and off we went. As we walked away my crew mate turned to me and said:

"You got schooled!"

That I did. And there was me thinking that laughter was the best medicine!