MORE Opinions Required

Ok people, I require your help AGAIN! Thanks for all the comments in Opinions Required. Same question, except this time I have changed 1 number and added one word.

I did a job a few weeks back that I want to write about. First though, I want some different opinions from you lot! 

"94 year old male, chest pain, suicidal, verbally aggressive, police requested"

That was the information that I had. I chose not to wait for police because he was 94! I was feeling particularly bolshy on this particular day!

The patients brother met us outside the flat and gave us a run down on his past medical history. The highlights included, paranoid schizophrenia, delusions, hallucinations, psychotic outbursts and OCD. Today he is extremely agitated. We entered the property and cancelled the police. 

I swung open the bedroom door. The patient was standing in the middle of the room holding a zimmer-frame. He stared at me. He slowly starts walking  towards me.

"Get out of my fucking flat or I'll throw you out of the fucking window, I mean it. Fuck off."

He says this whilst raising his fists.

*          *          *          *          *

So! What I want to know is, what would you do? What should I have done? What are your thoughts on the situation I find myself in? I welcome the views of everyone! Ambulance staff, police, mental health working, nurses or anyone who wants to share what they'd do! Please comment!! 

Thanks, Ella x

Opinions Required

Ok people, I require your help! I did a job a few weeks back that I want to write about. First though, I want some options from you lot! 

"44 year old male, chest pain, suicidal, verbally aggressive, police requested"

That was the information that I had. I chose not to wait for police because I was feeling particularly bolshy on this particular day!

The patients brother met us outside the flat and gave us a run down on his past medical history. The highlights included paranoid schizophrenia, delusions, hallucinations, psychotic outbursts and OCD. Today he is extremely agitated. Despite all of the above, we enter the property without the police. 

I swung open the bedroom door. The patient was standing in the middle of the room. He stares at me. He slowly starts walking towards me.

"Get out of my fucking flat or I'll throw you out of the fucking window, I mean it. Fuck off."

He says this whilst raising his fists.

*          *          *          *          *

So! What I want to know is, what would you do? What should I have done? What are your thoughts on the situation I find myself in? I welcome the views of everyone! Ambulance staff, police, mental health working, nurses or anyone who wants to share what they'd do! Please comment!! 

Thanks, Ella x

Tea And Toast

"89 year old male, collapse, irregular breathing, not responding"

I remember my first ever shift on an ambulance. I remember everything about it, every job, every patient, the two people I was with, where I was working, how I was feeling etc etc. There was a job that day which was given as 'COPD patient, difficulty breathing, not responding'. My mentor turned to me and said 'this guy could be very unwell, he may die on us'. I didn't understand how he could possibly know that! He told me it was just a feeling he sometimes got. Sure enough the patient was unwell. Very unwell indeed! On route to hospital he went into cardiac arrest and despite our best efforts he died. I remember feeling quite amazed that my mentor had predicted it from the minimal information we had. Well, years later, and I get those feelings, and today I had one! 

I told the student with me to grab everything we would to take to a cardiac arrest. She looked at me like I was drunk, but I was insistent! We headed into the care home and were told the patient was on the second floor. My student pressed the button for the lift, I didn't wait and with surprising vigour, I bounded up the stairs. My student didn't follow, and waited for the lift with one of the carers. I was quickly located to the room and sure enough, lying on the floor was our patient, well and truly in cardiac arrest. I started CPR, got the oxygen on him and attached the defibrillator. The student was no where to be seen. It turns out they had to wait ages for the lift, then went to the wrong floor and then couldn't find the room. I later explained that no matter what floor the patient is on, as a first responder, if you suspect the patient could be very unwell, never take the lift! 

As resus attempts go, this was quite long and drawn out. Once everyone had arrived, there were 5 of us in total sharing the workload. By sharing, I mean the two students were doing the lions share of the CPR, I was doing nothing but running the resus (perk of arriving first) and the other two were administering the drugs etc. We got his heart started at least 10 times but it was never sustained for longer than a minute or so. Each time it started beating it was slow and weak. We tried external pacing to no effect and it quickly became clear he was just reacting to the adrenaline we were pushing into him via the vein in his neck. After 90 minutes we stopped. We'd exhausted all of our options for the guy and after seeking advise from some grown ups we ended CPR, removed the oxygen and called a time of death. 

It was quite sad. He hadn't been unwell, and only just moved into the home so wasn't known well by the staff. It was just his time. As is protocol, we requested police for the unexpected death and started our reams and reams of paperwork whilst the students started clearing up! A carer appeared in the doorway.

"Would anyone like some tea?" she said.

We all unanimously nodded away! How very British! There is nothing a good brew can't fix!

"How about toast? Would anyone like toast?"

Again, we all kind of looked at each other and started nodding away! 

"Yes please, thank you!"

She disappeared off and we continued with the writing. Five minutes later she and another carer appeared with two large trays and set them down on the dressing table. There was pots of tea and coffee, sugars, milk, a selection of biscuits and about slices of toast with a pot of butter! Amazing! One of the students took up the role of 'chief butterer' and the other begun taking orders and pouring drinks. It was much needed and very appreciated. We sat around talking about the job, looking at the patients photos of himself and his family and talking about the life he had had whilst drinking tea and eating warm buttered toast. 

The door then opened and two police officers entered the room. Take a freeze frame of what they saw:

5 members of the ambulance service, one sitting in an arm chair, one sitting on a bed, two sitting cross legged on the floor and one leaning against a chest of drawers, all with a cup and saucer of tea in one hand, toast in the other and a dead 89 year old man lying in the middle of them.

This sums up our job and a picture paints 1000 words. Some may think it's not appropriate, some may think it's extremely weird. To me, the last 5 people this man had contact with, who tried for 90 minutes to save his life, were sitting around toasting (excuse the pun) his life with tea. I like to think that he would have looked down and enjoyed his very British send off. 

R.I.P

Don't forget, nominations are now open for the MAD Blog Awards 2014. Please go and nominate me by clicking HERE. Thank you! 

Reservoir Dogs

Having hosted a great guest blog by Binder Smiff from Not-On-My-Shift.org a few weeks ago, he kindly gave me the opportunity to share my ramblings over on his blog! He wanted humour and buffoonery as a vague theme, and seeing as being a buffoon is a speciality of mine, it wasn't to hard to find something relevant! Anyway, this was my guest post! Enjoy!

"84 year old male, chest pain"

It was student season. For 4-5 weeks the university students were chucked out from the comfort of their lecture rooms to the unforgiving shift patterns of their respective mentors. It is during this time they home their skills and learn how to take a patient history, diagnose conditions and talk to people. Of course, always under the watchful eyes of one of us! I remember being chucked into the deep end all those years ago. staring blankly at an expectant patient and not having a clue what to say, there were so many awkward silences! It's just part of the learning process. 

We headed off to this particular non-descript chest pain and one route discussed what relevant questions should be asked. Chest pains are a very common call to go to and as such, it is one of the first things that students get well accomplished at doing. However, as today proved, it is often far too easy to get overly focused on one thing, and not looking at the big picture! 

The door to the care home was eventually opened and we headed in! It always amazes just how long it takes them, despite having called 999 and presumably expecting an ambulance to arrive! We followed the carer upstairs and were presented with our patient, who was lying on the floor! To me, it was painfully obvious why we were called. To me, the injury was obvious, as was the fact they had said chest pain just to ensure a quick ambulance. To the student, it was a chest pain lying on the floor and so the history taking began! 

To their credit it was an excellent example of history taking for a patient with chest pain. Unfortunately, they were concentrating so hard on trying to establish the history via the dementia patient's carer and his confused responses that they neglected to focus on what I felt was glaringly obvious. Not wanting to rain on the parade I allowed it to continue for a few moments. I turned to the carer and quietly asked her to get me a few things that I would be needing! (All will be revealed)

"So, from the top, tell me what we have?"

"Frank had an unwitnessed fall, unknown loss of consciousness and now has some discomfort in his chest, not radiating anywhere, says it feels heavy."

"Anything else?"

"Should I do an ECG?"

"Yes, that's probably a good idea. However, perhaps address the fact that his EAR isn't attached to his head first."

The student glanced with horror towards the patients head, and clearly for the first time, realised that lying next to his head in a small pool of blood was his ear. Completely severed. The look I was given was of distraught fear. On cue the carer arrived with 2 sandwich bags, 1 empty and 1 full of ice that I'd asked for.

"Can you pass me the ear please?" I said with a smile on my face. 

I thought it was about to be an ear covered in vomit! Apprehensively the ear was picked up and handed to me. 

So, there I was, standing in a care home, a student kneeling in front of me almost in tears, a patient lying on the floor grinning like the cheshire cat having a whale of a time and I was holding his ear in my hand. I couldn't help but think I was just a cut-throat razor away from Reservoir Dogs! It was most surreal. I popped the ear onto a sterile non stick dressing and put it in a sandwich bag. I then put that in the bag of ice.

"OK, from the top, what's the plan now?!"

"A dressing?"

"Excellent!"

Our patient, who was in no discomfort, was promptly wrapped in a bandage and thoroughly checked for more injuries. I couldn't help but ask the student to check for any more missing body parts to which they just glared at me. The ambulance arrived, an excellent handover was given and we left for a debrief in the car! 

The student felt awful. Part of me felt cruel for allowing it to go on as it did. The other part thoroughly enjoyed it! We have all been there when we were new and naive. It's easy to miss the blindingly obvious when our minds are telling us to look for something else. The first thing that went through my head as I entered the room was "WHY THE F**K IS HIS EAR ON THE FLOOR AND WHY DIDN'T THEY MENTION IT?!". Clearly, the first thing on the students mind as we walked through the door was "Chest pain, chest pain. chest pain!". 

It served as a valuable reminder that looking AT the patient is always a good place to start. Things are rarely as we expect to find them and despite being taught to expect the unexpected, the student fully expected to find a man with chest pain, not a modern day Vincent Van Gogh. I have no doubt, missing body parts will never be overlooked again! 

It's a MAD time of year!

Well well well! It appears that the MAD Blog Awards have returned! How is that possible?! I'm sure I was only at the award ceremony last week?! Last year was amazing! I was humbled to be nominated in the Best Writer category and completely blown away to be one of the 5 finalists. Unsurprisingly, and rightly, the award went to the fantastic @Mammywoo. It was a great evening where I met loads of fantastic people and I'd love to try again this year!

Nominations are now open for the MAD Blog Awards 2014 and obviously I need nominations! So please please please take a few moments to fill in the form! You can only nominate once but you can vote for each category! This year I've been told I've been nominated again for 'Best Writer' and also 'Most Entertaining' so I'd very much appreciate if you could nominate me for both of them! Obviously, 'Blog of the Year' would be nice! 

Follow the link below, give your email address, nominate a 'Blog of the Year' and then nominate me in the categories you think I deserve by simply adding my URL www.tryingmypatients.co.uk ! Nominations are open until 14th March and then voting begins!

Thanks again for all your support! 

Ella x

NOMINATE NOW!!!