Blue light reflections

At times this week, I have genuinely wished I had done this placement before I accepted my medical school place. Much shorter training, more immediate patient responsibility, opportunity to give immediate treatment, on-scene trauma work (not that I've seen this yet), and the whole adrenaline rush of driving on red :D And the thrill of giving immediate emergency care doesn't seem to wear off. The EMT I was with on my night shift was shaking as much as I was on our last case.

I know that if I actually trained as a para, I'd eventually want to go back to med school and be a doctor, but in the immediate future... I can't help but wish. 5 years is a lot of debt.

Emergency med is looking increasingly appealing. I've read all the warnings that A&E is becoming just a triage site for the specialties, but there are hopes that EM will move out into pre-hospital care, and that potential future excites me more than the current state of EM. Pre-hospital gives the chance to use the usual skills of resuscitation and stability of the emergency patient, but without the huge amount of back up a hospital A&E provides. More initiative required. More improvisation. Dealing with a patient with DIB with a trache, the trache didn't have any fixtures for attachments to add o2 lines or a BVM or a neb, so a pedi mask was altered with various bits of tubing and tape to fit over the trache to administer o2 and nebs.

I'm awaiting an email from the ambu manager about potential placements with their anaesthetics reg who does voluntary BASICS work with them. Also air ambulance, for more experience with sicker patients and (fingers crossed!) trauma.

I have learnt so much from this week. Not just about how the ambulance service works, and how it fits in with the other professions and the overlap of care, but also about patient care. I can do basic obs with more confidence, and in the back of a moving vehicle. I've got more tips on how to cannulate, when I'm eventually let loose on patients. I can identify warning signs of major problems. I've learnt about BP lowering on the left in an AAA. About the decision process of pharmalogical intervention, in the case of adrenaline, atropine, and adenosine/amiodarone (I'm not entirely sure which one I mean, since it's just 'that one beginning with A' to me...), and morphine/entonox, plus pre/post morphine use of cyclizine (50mg diluted in 10ml water/saline). Immobilisation of fractures. Assessing for injury.

And that old chestnut - everyone lies.

Not a creature was stirring, not even a mouse...

Night shift was awful/awesome (delete as appropriate depending on clock-reading).

2100hrs - 80YOF - allergic reaction to angio dye. Massive hives for 3/7, then reacted to first dose of prednisolone - swelling of face, limbs, etc. Unreadable Sp02 to start with, but was fine on 02.

2200 - Miles out into the countryside to an 80YOM - off legs. Ca lung, smoking like a chimney. Didn't want to go to hospital cos they wouldn't let him 'sneak out for a fag'. 45 min handover at hosp = lifestory of every hospital escaped from to have a fag. Giving the nurses hell when we left...

0000 - 17YOM - transfer to our local hospital. Car V Ped, knocked out by wing mirror. #base of skull, orbit, ankle. Beautiful 'eye-shadow' bruising. Talked like a steam train all the way in.

0130 - did something. Night shift amnesia. [EDIT - standby at far-north station. Woke me up a bit, having drifted off several times on the drive, whacking my nose and chin on various metal boxes arranged around my seat. Didn't spend long there, as got sent back to hospital to stand-by there]

Slept from 0230 til 0400.

0430 - 50YOM - constipation. Excruciating pain, relieved on Entonox. Learnt that taking a patient to A&E pain-free (due to morphine, etc) means no treatment.

0530 - 71YOM - Multiple convulsions. Evidence of CVA. GCS 3 on arrival at scene. Massive fit on loading into the truck. Stopped without pharm intervention. BVM 02, switched to face mask for transport. Cannulated. Rang ahead to A&E to prep resus. 2mg lorazepam on arrival as starting fitting again. Another line in. U&E, FBC, Clotting, Group&Save bloods, and ABG done. OPA inserted as decerebrate-ness (?) implied inability to hold own airway. ABG came back as acidosis (6.9) - no idea whether resp/met, but prob resp as COPD? Dunno, all first year exam material has gone. Pupils fixed/dilated. Shit prognosis. Bit of an oxymoron on quality of life - lived in complete squalor, but was king of his castle. Could get around fine normally, only seen by 999 every few months for COPD (another insistent smoker!). I think the para's were sad to see him at his end - the "cantankerous old git"s are sometimes highlights of the day/night.

I hung around in resus for quite a while (not entirely sure whether this was out of medical student curiosity or the hottie F1 - shame on Jelly). Got some awesome teaching off the F1 too, about basic management, assessment of GCS, analysis of ABG results, etc.

It was a strange shift, overall. A great end, experience-wise, in terms of it being the only blue-light run into A&E I've witnessed, with treatment en-route, and teaching too, but obviously a shit end as well. I daren't inquire as to how the guy is, cos I already know the answer, and I don't like it.

Why do I want this career so much?

Yelp, Wail, HiLo, *snap*

Another day with the nee-naws :D This time on teh Community Response Car, so I've only seen 4 calls in 14 hours.

89YOF - angina, dizziness, nausea. Relieved with GTN and cyclizine. Transported by truck.
87YOM - welfare check for fall yesterday (refused transport to hosp). Demented as a duck, but physically fine.
60YOF - tripped over doorstep ?#tib/fib. Swollen ankle with anterior protuberance. I wanted to poke, but restrained myself. I did the BP by myself though! :D
89YOF - fell off chair. Unharmed. Picked up. Put back in chair.

So... I learnt that old people fall a lot. And that drawing up saline syringes for cannula flushes is harder than it looks. Also that doing anything with soggy saline'd gloves is almost impossible.

And doing ANYTHING with a patient is terrifying! I got left alone to do obs on our #ankle while our CP went to the car for entonox, and even connecting the cuff up to the machine was tricky! The only pulse I could find in her feet was my own.

Fingers crossed for a busy night shift tomorrow. I still have half a billion different cases to tick off my mental list. Old faller, haematemesis, fracture, and convulsion don't make much of a dent in it...

Quite glad I didn't do this placement before I started med school, or I think I'd have dropped out and gone to para school instead.

Blue light taxi

Woo! 12 hours on an ambu shift! I am shattered.

36YOM - kidney stones. 200yds from the front door of A&E.
85YOM - Known AF. Palpitations.
85YOM - Needed catheter replacing.
86YOF - Fell in bathroom. Denied anything medically wrong. Denied all pain. Ended up with a shattered shoulder. Old women and their hospital phobias....
42YOM - Alcoholic liver disease - haematemesis. H/O CVA.
85YOM - Care home. Low sats. Vomitting ++.
41YOF - Fitting in public place. First episode. Post ictal on arrival.
39YOM - ?Fell/assaulted. Lac to head. Active bleeding through 3 dressings. ETOH. Found by police with metal bat.

Got tomorrow off to recover, then back on for another 12 hours, then 24 hours off til night shift.

Whistle as we work

Ooh, I also have my research placement another step closer! Meeting with my supervisor at the end of this week (hopefully - otherwise it'll be next week, and I'll be semi-comatose with exhaustion).

And EMPLOYMENT! Well, one evening of it, but 4 1/2 hours of pay is better than none!

NEE NAW!

I am going on an ambulance :D

For 36 hours.

Over the space of 4 1/2 days.

2 days, 1 night.

2 double-man crews, 1 Community Response Unit.

And I am unbelievably excited!!!!

Summer has... started?

Greetings (to myself, clearly, since my blog readership = nil).

Since last time... Earnt £114 selling strawberries. Got extremely tanned doing so. Went to York with the boyf to celebrate one year together! Had an awesome time doing the round of museums and places like Clifford's Tower & The Minster, and then spent the day itself out at Brimham Rocks, which I ADORE. Been going to Brimham since I was a kid, and R loved it just as much, scrambling up 30ft boulders without a care in the world. Amazing views right across the Dales, too. Anyway, 1 year down, many more to go, I hope :)

Got a few employment options to pursue now.
There's shifts going as a factory packer in the city, which honestly sounds like the suckiest slave labour ever. Gonna inquire about wages before I even consider that, I think.
Option 2 is ringing up the events company I worked for at the show and asking what they have. My friend who also did the show is spending the weekend at York races with the company, so looks like work IS available. And £50/day isn't at all bad...
The third choice is actually sending out my forms for the Independant Hospital! They've been in my handbag for weeks cos I can't ever get round to finishing them!

I have progress on the CV-relevant funtimes too - the ambulance service is all sorted, and I'm going in on Monday to meet my placement supervisor and chat about what I'll actually be doing, and then the following Monday I'm in!
I got a consultant from my work experience times (07!) to agree to let me tag along for a week with him too, so that's my Ortho experience for this summer totally sorted! I'm pretty psyched for this - it's been two years since I've seen theatre and I cannot wait to get scrubbed, and this time I might get to assist, or at least stand by the table! Woo! :D
As for the rest... Well. Research Supervisor is currently unresponsive. And I can't confirm my audit back in UniTown until some of these placements start dropping into place and I can actually offer firm dates.

A flat to stay in while doing my audit would be uber-helpful, too. I'm actually looking into 1-beds right now, as a 'just-in-case'. We've bid on 3 properties, and so far - zilch. Mum & I have kinda set a mental deadline of end of August before we start panicking! Gah! We just need this place to be perfect, since it's a sale, not a rental, and therefore it's gonna be our (me, K, & E) home for the next 3 or so years (until K gets married, and I intercalate).

Chill, Jell-o. Pour out another glass of the Vin-o and chill-o.