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A blistering case

Posted Nov 21 2008 4:26pm
Eight emergency calls; one assisted-only, one no trace and six by ambulance.

A 19 year-old gay man was left lying on the cold, wet pavement of a busy Soho street by his ‘friends’ because he was so drunk they couldn’t cope with him any more. He had been there for an hour before anyone stopped to ask if he was okay. Barely dressed and freezing in a foetal position, I had to cover him with my jacket to keep him warm whilst I waited for an ambulance. He was very apologetic and ashamed of his condition and I felt a pang of sympathy for him, even though his circumstance was brought on by his excessive alcoholic binge, his friends should never have abandoned him in such a potentially dangerous area – shame on them.

The rain was falling very hard tonight and this puts all of us in a less than light mood when we have to struggle with wet, drunken people in public places. So, when a 35 year-old Polish man balled his fist and threw a punch at me, I pinned him to the bus shelter he was leaning against until he relented. His face dropped because he thought he was going to land one on me for free, courtesy of the NHS. He was wrong and although I kept him restrained, I caused no harm to him.

Eventually he became a friend to all of us; me, the MRU technician who was on scene when I arrived and the crew when they turned up. This was mainly because one of my colleagues – the multi-lingual paramedic – conversed with him immediately in his Communist-era tongue (Russian). He was happy now – no more BS from foreigners!

That particular drunken Pole was left to sleep at the bus stop shelter – he declined to go to hospital, which was probably just as well for our definitive care colleagues.

I arrived at a betting shop next. The rain was unrelenting and I stepped out into the morass of litter and puddles to help a 65 year-old man who had ‘drunk too much’ and ‘can’t get up’. Oh and just to make sure we arrived, he told the staff he had chest pain, which he denied when I got there.

His soaking, sleeping figure was slumped on one of the tables laid out for the punters and I had to shake him a lot to get him to open his eyes and talk to me. He was Scottish and homeless…and very drunk on cheap booze. He just wanted to get out of the rain and since he knew that, inevitably, he would be exorcised from the betting shop, he decided on plan B – call an ambulance. Again, I sympathised with his plight; it was a horrendous night and it wouldn’t be fair to chuck him out into it, so when the crew arrived, provided he behaved, he was promised a trip to hospital. He was cold and too drunk to walk properly…or so he said. We believed him but he almost sprinted to the ambulance. My colleague had to tell him to slow down. I was reminded of a lazy dog that drags along on the leash until he sees a park. Or another dog. Or food.

A 40 year-old woman with a history of faints required my attention when she passed out in a theatre (people do that a lot). She is taking meds for hypertension, so it could have been her pills that brought about a crash in her BP, thus the faint but it’s better to be safe and so she was taken to hospital for further checks.

A strange call next for a 50 year-old man claiming to have chest pain, shoulder pain and DIB…oh, and spots on his back. This combination made me suspicious, so I went to the little flat and entered at the behest of a child with some doubt and a defib at hand. He was flopped over his sofa and looked to be in some discomfort, unlikely to be the fault of a dodgy heart. On his back there was a hand sized cluster of blisters; I thought he had been deliberately burned because they were fresh. He shouted something at his wife, who was shy to appear at first and she shouted something back – none of it in English. In fact I had to rely on the commentary of one of their daughters, a ten year-old, to begin to understand what was happening here.

Nobody could explain the blisters – they had just appeared apparently and he had associated shoulder pain. Then he showed me more on his chest which had just erupted. I had never seen anything like it. I was initially stumped with this one and I called Control for advice. I couldn’t be sure I wasn’t looking at a contagious disease or a chemical contact, so I needed to be very cautious about moving him or exposing anyone else to whatever it was.

I described what was going on to the HEMS team and they consulted a doctor who came back with a ‘it’s probably not contagious, whatever it is’ answer and that just wasn’t good enough. I instructed the family to wash their hands in case any of them had touched these, now spreading, blisters and they went away to scrub up. I felt foolish because something was niggling at me and I couldn’t put my finger on it. The eruptions reminded me of something.

The man worked with chemicals for cleaning, so I had to assume there might be a connection but then he explained that he only worked with lemon juice products, not seriously caustic stuff. That ruled that theory out then.

Then I had an inspiration. While I waited for an ambulance I took a close look again and realised that what I was remembering was a case of adult chickenpox.

‘Have you ever had Chickenpox?’, I asked.

‘No’, he said.

‘Has anyone in the family ever had it?’

‘No’.

‘Are you absolutely sure?’

‘Yes’.

The crew had been sitting outside for about ten minutes but I didn’t know that until I got the call back detailing the doctor’s advice. They had been told to stay put until given the all-clear because there was possibly an infectious disease or chemical substance involved. If there was I was well and truly stuffed, wasn’t I?

I took him and his family downstairs and into the ambulance. The crew had never seen anything like it either and the rash of painful looking blisters continued to form and spread in front of our eyes. When we got to hospital the nurse asked the man a single question and my earlier instinct caused a click in my head (that should be a light bulb but I don’t deserve one of those on this call).

‘Have you ever had Shingles?’, she asked.

‘No’, he said, as usual.

Now I know that you can't get Shingles unless you have already contracted the Chickenpox virus, Varicella Zoster. The man had already vehemently denied having this disease, even in youth, so it wouldn’t be possible for him to have this complaint but it all made sense: painful erupting blisters on one side of the body only (his were back and front on the right side), with associated pain from the affected nerve bundle. If the Zoster virus was active in his shoulder nerve, the Shingles would manifest in precisely those areas I think.

I never found out for sure what this man had but I was right to get the family to clean their hands; the blisters carry the virus and so can be contagious if touched. Maybe not a big deal for the kids, who should be exposed to it as soon as possible but it can be dangerous for an adult and his wife said that she’d never had it. This was an interesting call that made me feel inadequate and smart at the same time. I’ve never seen Shingles, so I think my reaction to this initial sighting, if that’s what it was, was justified.

If your relative faints, don’t carry her out to me as I arrive. A whole Chinese family were piggy-backing her out the door when I pulled up (again in the pouring rain). I had to ask them to put her back where they had found her. They turned on their heels and dropped her onto the hallway floor in a very smelly part of the building.

The 35 year-old wasn’t unconscious; she was trying to be. All her obs were normal but she had abdominal pain. She ‘passed out’ again as I completed my checks. Getting the story was a nightmare because I had to go through two different translations but it soon became clear that she may have been pregnant and had now miscarried. The crew arrived at that conclusion when I handed over because, although I had established her last menstrual period was recently, they found out that she hadn’t had one for 50 days before that.

A fast drive from south London to the north for a RTC in which a bus had hit someone, causing an eye injury next. Unfortunately, the facts were shady and the caller stated that he had seen all this ‘from a distance’. When we got on scene there was no trace of this alleged victim. The police were there and a crew had completed an area search; it was a long drive for nothing again.

At just about going home time, I went to a block of flats for a 25 year-old female with a PV bleed, abdo pain and back pain. She was 35 weeks pregnant and had evacuated ‘pink water’ when she urinated. It was unlikely to be anything serious and the crew were right behind me, so I made my way out and towards the sparkly lights of sleepland. You know where that is, don’t you?

Be safe.
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