Tag Archives: Drunk

Blood and bloody idiot

There are a couple of terms used to define bleeding in the medical field;

Capillary – this is when the surface of the skin is scratched, but not deeply, and small spots of blood ooze from the damaged capillaries.

Venous – when a vein is nicked and blood will slowly weep from the wound.

Arterial – Blood will spurt out with every beat of the heart, sometimes spraying large distances depending on the size of the artery.

 

That final one, the arterial bleed, is considered to be a catastrophic haemorrhage. That is, if the bleeding is not quickly stemmed, a person will die within minutes.

 

Today, while working from a different station to normal, we were sent to a 25 year old who had punched through a window in a fit of rage, cutting his forearm. We were told the call had come from Police and they would also be attending.

We arrived after the Police and followed the significant trial of blood to a male laying on the floor, with his girlfriend tightly holding a towel around his arm, blood pouring down through her fingers. Thankfully, we had brought our critical haemorrhage kit in with us, so prepared to uncover, assess and re-dress the wound.

My crew mate wrapped his hands tightly around the arm to slow any bleeding while I prepared some gauze, a trauma dressing (more on that later) and a tourniquet.

*This next section is not for the squeamish!*

I slowly removed the towels to find a large would which was deep enough to nearly see bone through muscle and tendons. He had two large skin flaps where he had effectively de-gloved his arm, he had some blood clots within the wound from a venous bleed, and a quite noticeable spurting bleed from his Ulnar artery (one of two which run down the forearm). He had lost around 500ml of blood. The quick actions of his partner prevented him losing any more than that, which would have lead to shock.

We quickly ‘eyeballed’ the wound for any pieces of glass – there was none – and wrapped our trauma dressing around it. The trauma dressing we used has been developed by the military. It is specially designed to apply pressure directly over a section of injury on a limb, without using a tourniquet, which is always the last line of defence in a catastrophic bleed, as the limb may not survive.

While all this was going on, we obtained a quick history of what had happened. An argument with his ‘missus’ caused a fit of rage and he’d punched a window. He was also intoxicated and had been taking cocaine. He was also a bit of a knob head.

He immediately took a dislike to my crew mate (the person applying pressure to his wound to stop him bleeding to death) because he had “one of them faces innit”, calling him a c*nt and saying he would smash his face in. Delightful. Thankfully, I’ve got a knack of getting on with people like that, a trick I learned from an old crew mate of mine. As such, I quickly built up a rapport with him and persuaded him to come to hospital with us. Yes, I had to actually persuade him!

During this, he continued to be verbally aggressive to all of us and stood unaided to show us how strong he was. Now, he clearly worked out, but also clearly used steroids. We advised he shouldn’t eat or drink in case he needed surgery, so he drank a pint of water. We recommended a wheelchair due to the blood loss, so he walked upstairs to find his phone, all the while, using the C-bomb like it was punctuation and swearing at us all and being generally aggressive and intimidating. The Police said they would travel with us and called for backup from the PC they had dubbed the ‘man-mountain’. And with good reason. At 6’2″ and 18 stone of muscle, he would certainly be able to contain our almost equally sized patient – owing to the advantage of a working arm. And pepper spray. And a taser.

He eventually walked to the ambulance and sat in a chair because we’d suggested he lay on the stretcher (am I building up a picture of what this bloke is like?). I inserted a cannula into his vein to give some pain relief through a drip. All the while he told me how shit I was at my job. We swiftly left the scene on blue lights heading for A&E. After around 6 minutes of travelling, he decided he had become board of wearing a seatbelt and sitting in a chair while in an ambulance travelling at speed through a town centre, so he undid it – against mine and the PC’s insistence – just as my crew mate had to reduce his speed for traffic ahead. As such, the unrestrained man now hurtled towards the bulkhead, stopping himself on a work surface, pulling his IV line out as he did so. This angered him greatly, and clearly it was my fault so he began swearing at me and saying how I wasn’t fit to do the job etc etc. We had to stop the ambulance, causing traffic chaos, to re-restrain him on the stretcher.There was no way I was going back near him with a needle, so I offered him some gas and air for the pain, which he accepted….

 

…for 3 minutes before throwing the mouthpiece at me and calling me a smug c*nt. The Police officer all the while provided suitable dissuasion from him trying anything. I was glad of the PC’s presence!

This pattern of threatening violence, kicking equipment and behaving like a general tit continued for the long 20 minute drive to A&E. It was one of the most stressful journeys I’ve ever had while attending a patient in an ambulance, and I’ve dealt with some stuff in my time! During the whole trip, I had to keep an eye on the wound to make sure it didn’t start bleeding through the dressing, I had to check that it wasn’t so tight it was cutting circulation off to his hand and somehow get some vital signs. He declined any vital signs and wouldn’t let me near him. All I could do was document it and make sure the built-in CCTV was functioning.

We handed him over to the A&E nurse with an apology, as they’d have to deal with his very unpleasant manner. I feel I should add that he hadn’t lost enough blood to cause severe agitation like that, he was just drunk, high and angry.

Afterwards, I was washed out and a bit teary. It’s very hard to provide life saving treatment to someone, only for them to call you a c*nt 27 times and throw things at you. I can scarcely believe there are people like that out there. But there are, and I’m sure I’ll meet many more during my career.

 

So, I guess….don’t do drugs. Or punch windows. Or be a prick to people who save your life 🙂

Tagged , , , , , , , , , , , , , , , , , , ,

Regulars and Regulars

There’s a problem faced by the ambulance service.

A problem faced everyday.

The problem of ‘Regulars’.

 

Regulars fall into two categories.

i) The genuine regular: These poor people have chronic conditions that, when they flair up, cannot usually be managed at home. Things like COPD (Chronic Obstructive Pulmonary Disease – a worsening breathing condition), angina or pain associated with cancer etc etc. Though we see these people often, they are for genuine conditions, so crews don’t mind dealing with them.

ii) The time-wasting regular: These people are a hideous drain on the services. Usually (but not always) alcoholics or dug users – yes I’m generalising but when you see these people almost every day, you see a pattern developing – who seem to get kicks from calling 999 and mentioning ‘magic words’ like, “chest pain”, or pretending to have Shortness of Breath.

When I used to take 999 calls in control, in one 12 hour period, we received 36  ‘999’ calls from ONE PERSON who’d claim they’d fallen 3,000 feet and hurt their leg!! Due to the litigious world we live in, these calls have to be triaged as with any other call and dealt with appropriately. It comes to the point where an agreement is made by the medical director, that this person (who has nothing wrong with them, by the way) will get one ambulance per day – ready for this? – just in case. It’s worth mentioning that this particular individual was ALWAYS abusive to ambulance crews and once threw faeces at them while they tried to help. Nice, eh?!

Sometimes, these people phone from a phone box, or pretend to be unconscious in the street, meaning a good samaritan calls 999 out of concern. As the phone number isn’t recognised, an ambulance is dispatched.

This leads me to my point: If you see an ambulance crew called to an ‘unconscious/drunk’ person in street. Don’t be too alarmed to the point of complaint if they look a little exasperated with the individual. It may be the 7th time they’ve seen, and been spat at by them, that day.

 

Apologies if this comes across a little ‘ranty’.

Tagged , , , , , , , , , , , , ,

The great pretender.

My overtime night shift last night was spent mainly dealing with students who’d had a little too much to drink.

“Goodness”, you may think, “on a Wednesday night??”

Well, yes. Sadly, this is becoming more and more normal for the ambulance service. What used to be reserved for Friday and Saturday nights, is now almost a 24/7 burden on the NHS frontline.

One of them got particularly ‘chopsy’ after his “mates” abandoned him drunk on the pavement in the  middle of the city. My crew mate and I, while being perfectly civil, reminded him quite sternly that he had gotten himself into this situation, and if he was grown up enough to go out and get drunk, then he was grown up enough to deal with the consequences and he would do so by showing respect to the healthcare staff that now had to treat him for nothing more than being drunk and unable to look after himself! (and breathe!)

We did consider calling the Police, but they’re busy enough as it is, and as he was unable to stand let alone walk, they wouldn’t want him in their cells in case he choked on his own vomit – a perfectly reasonable concern in my opinion.

The A&E were delighted to have their beds filling with people who’d had their first taste of a lager beer, a red wine or a spirit and gotten a bit giddy to the point they had vomited upon their finest evening wear. Oh dear, what a pickle!

We also had a man who was faking having a stroke. Now, a stroke is a life threatening emergency that we treat aggressively and rapidly. Within a certain time window, there is a good chance that an individual can make a good recovery. While our patient had right sided arm weakness, a facial droop and slurred speech, it was only when he remembered he was being watched (it’s worth mentioning that he was in his 50’s and was also drunk).

It’s not worth not treating it as if it was a stroke, so we gained intravenous access, performed the necessary tests and ‘blued’ him to the nearest A&E. The doctor shared our cynicism but had protocols to follow the same as we do, so went through the motions. I believe he was admitted ‘just in case’. People often pretend to have chest pain, abdominal pain, visual disturbances or anything else we can’t disprove (usually for some attention from an ex’, or for a bed for the night), but a stroke has some very specific symptoms that can’t really be faked.

Tagged , , , , , , , , , , , , , , , ,