As we flew past Jacketsville* station my stomach grumbled at the sight of 2 vehicles parked up. They were on their dinner breaks so we were headed to an emergency call in the next road with empty stomachs.
A young girl stood at the end of the path waving to us and directing us to the house.
I plod up the stairs with the response bag on my back and the oxygen cylinder in my hand. I enter the bedroom and survey the scene in front of me.
The patient is lay flat on the bed in just his boxer shorts. He appears to be trying to get up. One side of his body won't work.
I move forward and take his wrist to assess his pulse while looking at the rate and quality of his breathing. His pulse is good and strong. His breathing is regular and adequate enough but with tell tale puffing of the cheeks and lips as he breathes out.
"Hello there!" I try to be as cheerful as the situation allows, if I'm calm then it may seep into the room and lower the tension for the family.
"What's been happening then?"
His wife steps forward and tells me he had been complaining of headaches for a couple of days, particularly to the back of his head. He was ok this morning, apart from the headache still being present. Within the last half an hour he complained of the headache getting worse and when she checked on him 15 minutes ago he was as we see him.
"Hello Simon*. My name is Louise. I'm going to ask you to do a few things for me. Can you stick your tongue out?"
I see he is trying but not getting far. At least this confirms he can hear me and understand instructions. Its just the insult to his brain won't allow him to act on them.
"Can you smile for me?"
A lopsided effort comes back. I shine a light into his eyes. His left pupil is slightly bigger than his right. Everything is coming together to point towards a stroke of some sort.
"Can you squeeze my hands for me?"
His right hand remains flaccid in mine as the left one makes a good effort at the instructions. All this time my colleague is giving him oxygen*, and getting blood sugar and blood pressure readings.
"Can you lift your arms in front of you?"
Again a valiant effort with the left arm but the right remains stubbornly by his side.
"Once you've got those, can you go and grab a chair and call for help getting him out, he's a big lad and I like my back the way it is now!"
"Simon, I know your having trouble with some of the things I'm asking but can you tell me how old you are"
He opens the left side of his mouth but the words just appear as a gurgling noise.
"Ok, Simon. Right, we're going to get a quick run down the hospital. I think you may have had a stroke Simon, we'll get you over there nice and quick ok?"
I turn to his wife and explain that another crew is coming to help up move him. A man of his size with one side not working can be very difficult to move so an extra couple if hands will help. I can see his size is mainly muscle bulk. His wife informs us he works in the building trade. 'Yep' I think 'lugging a few bricks around could help'
"How old is your husband?"
'That's young' I think to myself
"Does he have any other medical conditions?"
"Any problems with his blood pressure in the past?"
"Attended the doctor for any complaints recently?"
"So normally a picture of health"
"Yes. I've never known him take a day off sick. Ever. He'd usually be heading for the gym but he wasn't feeling well enough"
Our assistance arrives and we man handle Simon onto the carry chair to roll him down the narrow stairs. Luckily the door leads straight out from the stairs. No corners to contend with.
A quick call to let Holy Hospital we'll be with then in 5 minutes with a suspected CVA. GCS of 13.
On arriving I'm surprised to see the bay empty and no waiting to help us. I'm pretty sure I conveyed how ill he was. I give a quick toot on the horn.
A nurse comes out. She looks flustered.
"This is our stand by I expected someone to be here"
"Well roll him through to majors. Christ! I thought he'd arrested or something"
"Well no. But is really rather ill and I didn't fancy rolling him through the waiting room for everyone to see"
I get 'the look'. The look that says "Aye, ok love, whatever"
I ignore it and carry on handing over my patient to the doctor waiting for us
We finish up and clear to head back for something to eat, well needed energy for the rest of the shift.
A couple of hours later we arrive with another patient and I take the opportunity to find out how Simon got on. The doctor informs me he had a Sub-Dural Bleed. Looked like it had built up over a couple of days and the pressure got to him this morning. He was transfered to Big City Neuro Hospital. They seemed to think the prognosis was good.
Good prognosis or not I'd be surprised if he's able to resume his life as it was before.
* * * *
* With regard to the discussion of Oxygen therapy in CVA patients. I've found the new guidelines that were being discussed last time. They are available for anyone to access and download from the JRCALC website.
However, no one in the service up here seems to know anything about it. That is frightening. Its been a new guideline since April 2009 and underpins A LOT of what we do, especially as a technician, oxygen has been our main tool against many of the ailments we may deal with without a paramedic present.
There are a lot of people attending post proficiency courses at the moment. We have to attend these once a year to update skills and address new guidelines. There is no sign of these guidelines being addressed in this training. Also I believe the training college are also going with the old guidelines.
So that should answer the question of why I know nothing about it! I will maybe shout a bit about it at the training college when I go and see what they say!