It was a lovely night, getting paid double time with another experienced paramedic to provide medical coverage to a community concert. There were some great bands playing, set in a nice park, lots of police and security, and best of all, it was a dry event (aka, no drunks. Well at least that was the intent).
I was really looking forward to this event and the live music.
An hour in, a well-dressed middle aged lady comes down to the ambulance.
"Sorry to bother you, but my friend is a dialysis patient and a diabetic. I think her sugar might be low, she's fainted a little bit. Could you come check her out, please?"
Not a problem. It was our job. Sounded like a hypo (hypoglycaemic - low blood sugar level).
Just in case, we took a few things - our ALS backpack with drugs, oxygen and a response kit.
She guided us through the rather thick crowd and into the park. It was getting rather dark, it we were quite glad she was guiding us as we would have never found her.
Sitting on a rug amongst the crowd was a middle aged woman, being supported up by some friends, head flopped back against her friend's shoulder. She was clearly out of it.
As I set up to take a blood sugar, I noticed her skin was extremely diaphoretic. Very diaphoretic. It wasn't a hot night.
Plus she was very tachypnoeic.
A few second later, 22.8mmol/L read the glucometer.
Obviously not a hypo.
I looked at my partner, whom reflected a near identical quizzical look back at me.
"I'll get the stair chair..."
"I'll get some oxygen and a line in..."
Sounded like a plan.
I weaved my way back towards the ambulance. It was near impossible to get to get a stretcher in, especially though the thick crowd and the mass of people picnicking on the grass. Thankfully, we have a nifty little fold up wheel "stair" chair which was quite good to get around in.
Passing a security officer, I informed her we needed some assistance and pointed to where my partner was.
Quick as a flash (well not quite, maybe like 3 minutes later), I was back. Walter had a high concentration mask on already and a tourniquet on one of her arms already, obviously preparing to cannulate. By now, we had accumulated a few bystanders whom was willing to help, though no security turned up (or ever turned up for that matter for the entire case).
While she wasn't exactly big, her current state meant that she was very "floppy" and resulted in a dead weight. Grabbing a foot each and a giant bearhug, a few bystanders and ourselves managed to get her onto the stairchair. Securely strapped in, we enlisted some bystanders to be bag holders and again, weaved our way through the crowd and into the ambulance.
Walter climbed in while I put away some of the assembled bags before climbing in to assist.
Oxygen changed to the ambulance supply, cardiac monitor dots attached, probe on finger, NIBP cuff on, cannula out and a vein located. Ordered chaos ensured for the first minute or two.
Walter looked into her pupils as we completed a set of observations.
"Andy.... could you check the pupils for me please?" he asked, even though he had just checked them.
I got my penlight torch out and looked.
They weren't overly large, but there weren't any reaction to the light.
* Raised eyebrows *
First complete physical observations: PR 112, RR 32, BP 185/110, GCS 7, ECG Sinus Tachycardia, SpO2 100% (on 15lpm via high concentration mask), BSL 22.8, Temp 36.7C (Tympanic), Pupils were a size 4 and unreactive.
There wasn't much we could do in this environment. She needed to go to the hospital, and quickly. However, as we were providing a community event coverage, we couldn't leave, so we had to call another ambulance crew in to transport. Ironic huh?
I got on the radio as Walter attempted to put an oropharyngeal airway in, albeit unsuccessful. She had some trismus.
"We don't have anybody at the moment, but we'll get one there as soon as we can" came back the reply from Communications.
Meh.
By now, she was grunting a little bit but still no improvement in her vital signs.
Walter provided some supportive suctioning using a yankeur suction catheter while I tried to get further information from the original friend whom had got us.
Apparently, she was just sitting, watching the concert and suddenly collapsed. She had been well before, did not complain of anything, had no alcohol nor drugs today.
A secondary survey didn't reveal any other injuries or anything of significance.
Some sort of cerebral event, a CVA, we concluded.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Our backup ambulance crew arrived 20 minutes later, and rushed her Priority 1 to hospital.
I was really looking forward to this event and the live music.
An hour in, a well-dressed middle aged lady comes down to the ambulance.
"Sorry to bother you, but my friend is a dialysis patient and a diabetic. I think her sugar might be low, she's fainted a little bit. Could you come check her out, please?"
Not a problem. It was our job. Sounded like a hypo (hypoglycaemic - low blood sugar level).
Just in case, we took a few things - our ALS backpack with drugs, oxygen and a response kit.
She guided us through the rather thick crowd and into the park. It was getting rather dark, it we were quite glad she was guiding us as we would have never found her.
Sitting on a rug amongst the crowd was a middle aged woman, being supported up by some friends, head flopped back against her friend's shoulder. She was clearly out of it.
As I set up to take a blood sugar, I noticed her skin was extremely diaphoretic. Very diaphoretic. It wasn't a hot night.
Plus she was very tachypnoeic.
A few second later, 22.8mmol/L read the glucometer.
Obviously not a hypo.
I looked at my partner, whom reflected a near identical quizzical look back at me.
"I'll get the stair chair..."
"I'll get some oxygen and a line in..."
Sounded like a plan.
I weaved my way back towards the ambulance. It was near impossible to get to get a stretcher in, especially though the thick crowd and the mass of people picnicking on the grass. Thankfully, we have a nifty little fold up wheel "stair" chair which was quite good to get around in.
Passing a security officer, I informed her we needed some assistance and pointed to where my partner was.
Quick as a flash (well not quite, maybe like 3 minutes later), I was back. Walter had a high concentration mask on already and a tourniquet on one of her arms already, obviously preparing to cannulate. By now, we had accumulated a few bystanders whom was willing to help, though no security turned up (or ever turned up for that matter for the entire case).
While she wasn't exactly big, her current state meant that she was very "floppy" and resulted in a dead weight. Grabbing a foot each and a giant bearhug, a few bystanders and ourselves managed to get her onto the stairchair. Securely strapped in, we enlisted some bystanders to be bag holders and again, weaved our way through the crowd and into the ambulance.
Walter climbed in while I put away some of the assembled bags before climbing in to assist.
Oxygen changed to the ambulance supply, cardiac monitor dots attached, probe on finger, NIBP cuff on, cannula out and a vein located. Ordered chaos ensured for the first minute or two.
Walter looked into her pupils as we completed a set of observations.
"Andy.... could you check the pupils for me please?" he asked, even though he had just checked them.
I got my penlight torch out and looked.
They weren't overly large, but there weren't any reaction to the light.
* Raised eyebrows *
First complete physical observations: PR 112, RR 32, BP 185/110, GCS 7, ECG Sinus Tachycardia, SpO2 100% (on 15lpm via high concentration mask), BSL 22.8, Temp 36.7C (Tympanic), Pupils were a size 4 and unreactive.
There wasn't much we could do in this environment. She needed to go to the hospital, and quickly. However, as we were providing a community event coverage, we couldn't leave, so we had to call another ambulance crew in to transport. Ironic huh?
I got on the radio as Walter attempted to put an oropharyngeal airway in, albeit unsuccessful. She had some trismus.
"We don't have anybody at the moment, but we'll get one there as soon as we can" came back the reply from Communications.
Meh.
By now, she was grunting a little bit but still no improvement in her vital signs.
Walter provided some supportive suctioning using a yankeur suction catheter while I tried to get further information from the original friend whom had got us.
Apparently, she was just sitting, watching the concert and suddenly collapsed. She had been well before, did not complain of anything, had no alcohol nor drugs today.
A secondary survey didn't reveal any other injuries or anything of significance.
Some sort of cerebral event, a CVA, we concluded.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Our backup ambulance crew arrived 20 minutes later, and rushed her Priority 1 to hospital.
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