Image by JackBetty on Flickr

I saw a lovely patient this week, he was a very shy young man who didn’t speak much English but sadly he had just been mugged. There were three of them and only one of him – so violence really wasn’t necessary, but still they punched him in the face a number of times as they ripped his mobile phone from his hand.

Some women were standing at a bus stop nearby and witnessed everything. Immediately one called the police. Additionally, the other woman had the incredible presence of mind to capture the attack on her mobile phones. It was a brave thing to do, had the men seen this they most certainly would have wanted to get the phone containing the evidence from them and I doubt they would have had any qualms about using force to achieve this.

The police arrived very quickly, but the men had already fled the scene. However, the women handed over the footage on the mobile phone and very shortly afterwards the group were spotted and arrested for the crime.

Even though the victim would soon have his mobile phone back, he was in a lot of pain because he had sustained a broken jaw bone and needed to go to a hospital with Facial Maxillary facilities for surgery. But I would like to say well done to those Good Samaritans who can feel very proud of themselves. Without their selfless quick thinking the cowards may have very well got away with it.

Image from madehow.com

My first patient a couple of weeks ago was worried because following a routine visit to the dentist’s surgery she had come away with rather more than she bargained for.

The dentist was working on one of her molars and during the procedure the drill bit came loose and was swallowed before the dental assistant could suck it up.  Dental drill bits are commonly formed from tungsten carbide particles and are usually less than 3 cm long. Luckily she swallowed rather than inhaled the bit as things could have been a lot more serious giving rise to some serious breathing difficulties. We reassured her that nature would take her course and that there were unlikely to be any adverse incidents as the bit passed through her digestive tract. We advised her to seek medical attention if she had any new or worrying symptoms. The dentist had given her instructions too; he had asked her to look out for the bit so that she could retrieve it and return it to the surgery – apparently they are quite expensive! Say arhhh!

Lysa was asked at short notice to appear on Sky News today to talk about ‘Mad Friday’ – the busiest night of the year for office Christmas parties. Ambulance Services, Police Forces and Hospitals all experienced an increase number of calls last night related to people who were inebriated.

Lysa appeared on Lorna Dunkley’s show at around 12:15 this afternoon and discussed her many years of experience dealing with intoxicated individuals at this time of year.

The photos below were taken by Lysa in the Sky News studios.

Lysa in make up at the Sky News studio

The Sky News Green Room

The Sky News studio as seen from the Green Room

Image by aeu04117 on Flickr

It must be something in the air at this time of year. One of my recent shifts was like a groundhog day. It consisted almost entirely of patients who had either vomiting or diarrhoea or vomiting and diarrhoea. These were all otherwise healthy young people; all had a pair of legs in good working order – perfect for walking to the ambulance with. None had had their symptoms for more than about 6 hours and none had considered contacting their GP before calling an ambulance.

Excuses for not contacting the GP were various and included; “I don’t like my GP” (well change your GP then!). “He’d have just sent me to A&E” (most unlikely). “I can’t get to the GP because I have to work from 12.00- 18.00hrs” (Well perhaps you could have gone in the morning). “I couldn’t go to the GP because I can’t walk” (see comment above about patients all being in possession of a pair of fully functioning legs) and my personal favourite “Well I had this once before 5 years ago and now it’s happened again, so I think I should have it checked out properly.”

Similarly, I did a shift in a hospital recently where I saw three patients with minor head injuries. None had been knocked out or had any visible laceration, bump or bruise (well apart from one who had a rapidly fading slightly pinkish patch where where his head knocked on the frame of some gym equipment that he had carelessly walked in to). None had vomited or even felt a bit sick; there were no visual problems, convulsions, loss of memory or co-ordination, headache – no anything in fact between the lot of them. (This list comprises of some of the things that we may worry about in head injuries – see NICE guidance on Head Injury if you want to find out more).

One guy even told me that he had actually bumped his head a whole week before and although he had no symptoms whatsoever, then or now, he decided to come to hospital simply because a bloke down the pub told him he should definitely get a check up and probably needed an X-ray – that ‘bloke down the pub’ has a lot to answer for in my mind – I have seen an awful lot of patients who pitched up following his expert medical advice now I think about it! Forget ‘Street Doctor’ let’s have a TV series called ‘The Bloke Down the Pub who is not a Doctor’ – because that guy really knows what he is talking about – NOT!

When it comes to dislocation of the shoulder, rapid treatment is best to eliminate the stretch and compression of nerves and muscles in the area; it also reduces the muscle spasm which can make getting the shoulder back in to the correct position more of a challenge if left for greater lengths of time. Not least, early treatment resolves the not insignificant problem of unnecessary pain that the patient suffers.

In the hospital setting the patient is usually lightly anaesthetised and/or given a muscle relaxant. These medications are very powerful and therefore the patient will need constant monitoring in the resuscitation or high dependency area during treatment. As a student nurse and again while I worked in the Emergency Department as a staff nurse, I was occasional witness to what looked like tortuous efforts on the part of doctors to reduce (put back) dislocated shoulders. These eye watering procedures usually involved a lot of pulling while some doctor’s be-socked foot would be pushed in to the armpit region as a sort of counter-traction as they pulled the arm. Numerous methods to achieve the desired end exist, often deservedly named after the clever doctor who had spent long hours devising it.

Beautifully depicted here showing what appears to be a random child providing counter-traction is the Hippocrates Technique!

Despite the numerous methods, all with their relative merits, sadly, little has been written about or developed for application in the pre-hospital arena. This means that as paramedics we simply give the patient analgesia, stabilise the affected arm and convey to hospital navigating bumpy highways and byways en route which only add to the discomfort.

Luckily for me, during my placement in the ED for my Emergency Care Practitioner training, a kind and helpful registrar taught me a wonderfully easy technique to reduce a simple dislocation of the shoulder (by that I mean those dislocations where there is no suspicion of a fracture) and now I am pleased to say that so far 6 patients have benefited from the technique – all of whom have been very grateful!  The Stimson’s Technique doesn’t involve any torture and is relatively stress free. Personally, I’ve found that it has never taken more than 5 minutes for the shoulder to ‘pop’ back to where it should be. If I can get them to really relax or even better, have a laugh about something, it seems to help speed up the process. I’ve performed it on a pub table, the back of a sofa (x2) and a canteen table amongst other places! (Telling them just that often makes them laugh funnily enough!).

However, with one of my patients, the process seemed to be taking longer than expected; I rubbed and manipulated the joint for an age and still no ‘pop’. Finally, admitting failure, I said to him that I would have to refer him to a medical colleague for further treatment and he said.

‘Oh no, it’s ok,  it went back in ages ago’
‘Really? Why didn’t you tell me?’ I asked
‘The massage felt nice’ was his cheeky reply!

Another success story at least – even if he was a bit naughty!

These patients will still require good analgesia and a trip to hospital for a follow up x-ray but the ‘time to treatment’ is vastly reduced – which has to be a good thing for the patient. I would love to see it brought in routinely for pre-hospital use so more patients can benefit.

I’d put my name down to work at the Notting Hill Carnival a few weeks ago, well before the London riots hit the news. I usually enjoy working at these big events (you may know that I have also worked at the London Triathlon, the London Marathon and in the centre of town on New Year Eve). These are fabulous opportunities to meet up with ambulance staff from all over London, who I wouldn’t normally bump in to, as well as work closely with the other emergency services. We also end up taking the patients to hospitals outside of our usual patch, which makes a bit of a break from the routine. Following the press coverage of the chaos and disruption on the London streets during the recent riots, I briefly thought about pulling out, but am so pleased that I didn’t.

I was glad that Boris Johnson decided to go ahead with the carnival; I felt that it sent out a positive message to the world and supported the fact that the majority of revellers were simply decent people intending to have a good ole party!

Unlike last time, this year I was crewed with a student paramedic to work on an ambulance; last time I was based at a Treatment Centre. We collected all our kit and checked the ambulance over, then after being fed and watered along with thousands of police officers in the dinner hall of a local school, we took up our position on a side street  close to the procession while we waited for the first patient of the day – as you might imagine with approximately 1 million visitors, we didn’t have to wait long – and once it started it was non-stop!

With a constant throng of carnival music as the backdrop we treated good natured folks with cuts, bruises and head injuries, most, but not all, had alcohol on board but remained in good spirits none the less. We took them to hospitals near to the event, some of which I had never visited before! For a south Londoner like me, being flung so far north made me feel a little disorientated at times – thank heavens for sat nav! It had been an exhausting shift, sleep was calling me and not a minute too soon, 16 hours after signing on, I was finally back home on south London soil where I think I was asleep before my head hit the pillow!

Anton's broken leg, by Frankenstoen, on Flickr

I had to feel sorry for one of my patients last week. She’d been sent in to the Urgent Care Centre (UCC) for an x-ray to her right leg by her GP. Sadly at the beginning of the year, she had lost a close relative under tragic circumstances and was still feeling very low in mood, so having read that exercise can help beat depression she decided to take up running six weeks earlier. Aged 50 she hadn’t done any exercise for years and although she was normally on no medication and in very good health, she wisely decided to take it gently to start with. However, by the 2^nd run her right leg was starting to be painful and after her 8^th the pain was so unbearable it kept her awake at night. She went to the GP the next day and even though there was nothing in the history to suggest a bony injury, he sent her for an x-ray and told her to return a week later for the results. However, during the x-ray, the radiographer detected an abnormality and asked the patient to come directly to us in the UCC.

The x-ray showed a fracture clean across the fibula of her right leg. It appeared that the fracture was possibly 4-6 weeks old and already starting to heal. She told me that because of the way she had been limping to protect her painful right leg – the left one was now also becoming painful. I made a decision to get that one x-rayed too. Unbelievably it showed that the fibula of her left leg was also fractured! The most likely cause for these types of fractures is osteoporosis (which her aunt and mother also suffered from). I then had to tell her that both of her legs were broken; it was the last thing that she was expecting to hear and she became very distressed. I needed to call her daughter to come in and collect her. In the long term, she will be followed-up by her GP and the orthopaedic doctors.

I amazed that this woman had been running on TWO broken legs – incredible! Once again we see the irrefutable proof that a woman’s pain threshold is higher than that of a man’s – discuss!!

Once again I got roped in to taking part in a local Junior Citizens Scheme. Well if I’m honest I actually offered as it’s a lot easier than a tough day on the road as far as I’m concerned and I really enjoyed last time. There is also an abundance of cake and biscuits available all day for the long suffering workers to pick at, and that definitely helped sway my decision to volunteer.

In case you haven’t see the previous post about the JC Scheme have a look here: Junior Citizens 1.
Colleagues from the police, fire brigade, Transport for London as well as the ambulance service were at the venue. This time however, we set up our ‘stalls’ at Selhurst Park Football Stadium. I had a fine view over the pitch, from one of the Executive Boxes no less, and for most of the week we have had some bright if not very breezy weather.

Each visiting school is split up into groups of 10 pupils aged about 9 and 10 years old. They take turns to move through the various stalls and learn about keeping safe in different situations. They must listen carefully, behave well and participate in each of the situations and we award them points for their efforts to add a bit of healthy competition.

As an introduction, I always ask the children if they recognise my uniform and I ask them what they think I am – I give them a clue of course – I say it begins with a ‘P’ (the answer is Paramedic just in case you weren’t sure).
Among the guesses this week were;
‘Policeman’
‘Paediatrician’
‘Parasol’ (? really not sure where that one came from) and my personal favorite…..
‘I know, I know…..are you a Paracetamol?’
‘All good answers’ I say supportively ‘But, No I’m actually a paramedic’
‘Aw, I was just going to say that’ is the usual sighed response!
‘You can’t be’ one little Herbert piped up authoritatively – because they only have paramedics in America’
‘I can assure you that I am a paramedic’ I said, I told him about my certificate stored safely in a drawer somewhere and the epaulettes on my shoulders that proved it to be the case – yet still he looked unconvinced as he shook his head and rolled his eyes. I was sure that I heard him mutter ‘Clearly deluded’ under his breath…….

Image by cybershotking, on Flickr

‘Continuous Fitting’

This type of call always comes up as a high priority, and a paramedic will always be sent in case the patient needs a medication called Diazepam to help stop the fits. But things aren’t always what they seem at first glance…

I arrived ahead of the ambulance and found a young lady of 16 years called Neela lying on the bed of a small guest house crying. Her anxious boyfriend, who was a couple of years older than her, was tearful as he explained to me what had been going on.

He told me that they must see each other secretly because she is Bengali and he isn’t; her parents are completely unaware that she even has a boyfriend. It would, he told me, put Neela at great risk of harm from her family should they discover what was going on between them.  The family were also quite unaware that she was 20 weeks pregnant.

It transpired that social services had assisted Neela and her boyfriend to travel to London and helped them make the necessary arrangements for a late medical termination of her pregnancy. This procedure is only carried out in two centres in the UK and the young couple had undertaken the arduous train journey to London, arriving early that morning. The first part of the procedure had already taken place with the final element due to take place the next morning, only a few hours before the long return journey home. I was curious how they had engineered the situation so that her family wouldn’t suspect anything; Neela told me that they thought she was at a ‘sleep-over’ at a friend’s house in her home town when in fact the were holed up in a guest house over 120 miles away.

However, it would seem that the enormity of having the termination was now weighing heavy on their young consciences and during a heated discussion that evening, the girl had began to have a ‘panic attack’ (and not some kind of fit as was first thought). Rather than being treated for a medical emergency, what these two needed was a lot of support and TLC. After a quick assessment I cancelled the ambulance and started to get some details from Neela to see how I could help.

As we were chatting, her mobile phone rang.

‘It’s my mum.’

‘You should probably answer that’ I suggested gently, ‘Otherwise she’ll begin to suspect something is wrong.’

‘I just can’t speak to her at the moment’ she replied sobbing, ‘I’m too upset and she’ll hear it in my voice’. It rang another five or six times but still she couldn’t answer it. Then she saw that the next call was her friend Mili’s number – the friend she was meant to be at the ‘sleepover’ with – quickly she answered the phone. It was worrying news.

‘Your mum’s phoned here looking for you because you didn’t answer your mobile, she knows that you aren’t here, I had to tell her because obviously I couldn’t get you to speak to her, she is getting really angry and so I said you’d gone to the shops, but it’s late so I don’t think she believed me you’ve got to ring her now Neela’ Mili said.

When she hung up Neela appeared really worried, she looked at me and asked what she should do next.

I knew that if she was found out she would be in grave danger of reprisals from her family and I really wanted to help but I was at a loss for a better idea and I could only suggest that she rang her social worker for advice. Before she had a chance to do this though, the phone rang again and this time it was her mother. As Neela let it ring she turned to face me and pleaded,

‘I know, you can speak to her, pretend you are Mili’s mum, just tell her I was out at the shops please’

‘Isn’t Mili’s mum Bengali though?’ I asked

‘Yes, but her accent isn’t strong it’s more like a UK accent, it’s a bit Welsh too actually.’

‘I really can’t, I’m sorry, I’m absolutely rubbish at accents – I wouldn’t be able to pull it off.’ I wondered what sage advice and guidance my Professional Code of Conduct would offer me for this particular situation (mental note to self – carry the Code of Conduct on person at all times from now on).

‘Please, she’ll kill me, please help me? ‘And then she answered the phone before I could protest again. As the conversation went on between them she said suddenly, ‘You can talk to Mili’s mum if you don’t believe me, she’s just here.’

Oh no! I thought, please no! I shook my head furiously. Thankfully Neela’s mum chose not to take up the offer to speak to ‘Mili’s mum’, having at last got hold of her daughter she seemed temporarily satisfied with the situation and agreed to pick up the discussion when she got home the next day.

With the situation now calmed down and Neela’s social worker updated there was nothing more that I could do really apart from offer some advice about calling us back if we were needed. No medical assistance was required so I left the young couple to support each other. The next day the social worker kindly got back in touch with me to let me know that they had both got home safely.

Image courtesy Dr Xeno, on Flickr

I was working in a very busy Urgent Care Centre in the ‘triage’ room. I’d been there for four hours and the flow of patients never stopped. One chap with not much more wrong with him than a dose of ‘man flu’ left the room to sit and wait to see the doctor and asked “Do you know how long I’ll have to wait now?”

“Sorry no” I said  “I haven’t been out of this room since I started my shift, but the ladies at reception may be able to give you an idea”

“Just roughly….”

“Honestly, I don’t have a clue, I’ve been stuck in here for hours, I really don’t know what it’s like out there” I said again.

“Oh go on, just give me a clue, one hour, three hours, four hours, just roughly please?”

“Well I could say something but I’d be making it up” I reasoned.

“I don’t mind, just a rough idea will do”

“OK, well three hours, but remember I’m making it up!”

“Great cheers. I’ll have to put some more money on the car  then cos I only put in for two hours!” He trotted off with his imaginary time frame in mind perfectly happily.

A little later, when finally released from the triage room, I was able to see and treat my first patient; a wonderfully polite older man who been savaged by a squirrel!

The rat with a fluffy tail had gotten his head stuck in a bird feeder, and my patient had been nobly attempting to rescue the ungrateful animal. By way of a thank you for his efforts the pesky creature turned around and bit him on the hand. After treatment he left the department and I recounted the story to one of our GP trainees.

“I’ve never liked squirrels” she sneered, “They always look at you like you owe them something.”

“I’d never noticed that” I replied.

“Oh yes, they are the ‘delinquents’ of the animal kingdom” she added wisely “You can never trust a squirrel.”

Love it!