She's a waif. The bed clothes swallow her, the mattress and duvet look huge around her. The nursing home staff are in a relaxed state showing us to the patient. They inform us she has appeared to be complaining of stomach pain for a couple of days. She usually gets bouts of diverticulitis but this time she seems to be in a little more distress than usual.
Its stupid o'clock in the morning and this has been going on for 2 days. The doctor attended on the first day and recommended keeping her well hydrated and trying to have her eat something.
I step into the room and look at the head buried in the pillow with the duvet up to her chin.
She is a worse shade of white than the sheet she is laying on.
I hold both her wrists to assess her pulse while my colleague gets some oxygen on her and instructs the home staff to find us a chair. Quickly.
The pulses are equal but weak and thready. I remove the bed covers to get a better look at her.
Her body is pale and I can see her ribs moving irregularly as she tries to breath. Her abdomen looks distended in comparison to the rest of her body.
"Does she usually have a big stomach like this?"
The nurse shrugs and shakes her head looking confused at our state of urgency to move the patient. After all she just had a stomach ache.
I look down at her legs, there a different colour in comparison to the rest of her. They look mottled and feel colder then the rest of the body. I check her femoral pulses, it takes me a while before I can locate the weak slow thumping pulse supplying little blood to her legs.
"Ok lets go"
Her daughter arrives as we're moving from her room. I explain that I believe her mother is very ill and we are going to blue light her into hospital. I ask the nurse to have a notes ready and bring it to us at the ambulance.
We get her into the ambulance and settled on the stretcher. Its difficult to assess her condition as she has advanced dementia but the grimace on her face is easy to read.
Her temperature is 35 C. Her blood sugar is within normal limits but her blood pressures are different in each arm. All her signs and symptoms are pointing towards an abdominal aortic aneurysm. One that's been developing for 2 days.
We call it in and run straight to resus.
We hand over and watch as the team re assess her and get lines into her veins. It takes some time and effort as she is in the process of shutting down. Her breathing had improved en route with a little assistance but I made sure all equipment was ready and available in case she crashed.
A doctor walks over to the blood gas machine in the corner. A couple if minutes later and she returns with a heavy look on her face. She reads out 3 numbers one relating to her potassium one to her carbon dioxide and the other is her oxygen levels. The numbers don't mean anything too me until the consultant chips in.
"Unsurvivable blood gases"
Basically her body's activity to try and stop the bleeding and cope with the after effects of her illness has poisoned her to the point of no return.
She is hypothermic with a serious abdominal bleed.
The resus team is firing as much fluid into her as she can take. She's been wrapped in a 'teddy warmer', an air filled blanket to warm her up slowly. They call for her to go to surgery but its unclear as to whether or not they will agree to operate considering her condition. They expect to just keep her comfortable for long enough for the family to get to the hospital.
We do the usual clean up and move on the next job....... a cup of tea back on station.
The next night shift I ask a few questions to see what happened to her.
"She's up in high dependency. She made some progress through the day so they moved her there. Seems to be bit of a fighter that one."