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National abdo pain day

Posted Nov 21 2008 4:27pm
My first of the day was a young woman who was in a lot of pain and my suspicion was that she probably had appendicitis. Tender, painful right lower abdomen with nausea and a high temperature pointed in that general diagnostic vicinity. All my other questions (you know the ones about being pregnant and going to the loo properly) drew a blank and it was a reasonable assumption but her pain was the priority and so I dealt with that whilst she sat on the floor of her workplace. I gave her a little morphine and waited for it to take effect. She didn't seem to like it though because she said she felt 'strange' and began to glaze over. She was going to faint. Her BP had dropped too quickly and so I set about reversing the effects of the morphine by giving her Narcan and that did the trick, although her pain score only dropped one point as a result.

When the crew arrived I explained what I had done and there was a concensus on the appendicitis theory but confusion over her reaction to such a small amount of morphine. It was entirely possible that the morph had nothing to do with her 'reaction'. Maybe her appendix had perforated. She was in a stable condition when she went to hospital but her BP remained low.

My next call was to... wait for abdo pain. Another young female. This time she was screaming out in pain and the problem was on her left side. Another responder was on scene and had done all the obs and so it was down to me to administer pain relief, if she wanted it. Amazingly, she did.

I gave this dose of morphine very slowly and watched her every move. The pain went away and all she was left with was an uncomfortable feeling as if a 'bubble' was in her groin. I thought about this and asked her if she had been on any flights recently. She had. I also asked her if she had injured her legs recently. She had. The other questions had been asked and so there were only a few realistic possibilities left. Thrombosis was one of them.

Now I don't go around second-guessing diagnoses and I don't try to dramatise people's conditions but if I don't use my brain to make educated guesses based on evidence and/or possibilities then I have wasted my years of training. I also enjoy working out what might be wrong with a patient. Even if I get it wrong, I learn something from it. It's the way I like to work.

During the shift I attended another couple of abdo pains but they amounted to discomfort rather than pain. I dealt with a few faints today as well. Perhaps fainting and abdo pain deserve their own commemorative plaque in the hall of 'common problems for which an ambulance is called'. At least that plaque would have a genuine place, unlike its friend 'too drunk to get home' which rests shamefully next to it.

I saw a frequent flyer who had me race to his aid last year for chest pain he never had. I hadn't been on the car long and we were under a lot of pressure. That was my first introduction to him and he called at our busiest time (March is a nightmare month as we have to reach our Government targets and so we run out of ambulances on an almost daily basis). He did it again today and I only knew him when I saw him. I recognised the area I was in to be honest and that triggered the memory. This time he had back pain and DIB. He had to add the DIB to get a blue light response - them's the rules.

This gentleman is nice enough. He doesn't shout at me or abuse medical staff as far as I know. He just calls for the company and to be taken to hospital where he can say hello to all his friends (the staff know him and are all on chatting terms). Fair enough but I decided to take him by car as I didn't feel an ambulance should be wasted. It was a short journey of around 10 minutes and he talked every inch of the way. He swore and belched his way through a conversation that cycled around his hatred of 'stupid people' (including the control staff who didn't know where he lived apparently) and his need to cut down on salt in his diet.

"And what about that woman who killed her kid with salt?" He declared, referring to the recent news item.

I tried to explain to him that she had not killed her child and that he had a medical condition that led to his death. When I tried to explain the condition I was referring to he got confused and changed the subject.

"So, the father killed the boy then?"

I gave up just as I reached the hospital.

I took him to the nurse and she glanced at us once and sent us packing to triage and reception where I booked him in.

I went back a few hours later with another patient and he was still sitting on the same chair waiting to be seen, poor sod.

Thanks to all of you for wishing me well again. I had flu. Man flu probably. I'm over it and am busily passing it on by cough and sneeze to anyone who gets in my way.

Be safe.
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