Day out with the ambulance

One of the most memorable days in my attachment with A&E is my day out with the ambulance. I joined a two man crew for the whole day, J and S - a paramedic and a technician respectively. They were proper gentlemen and took care of me well. It was a fairly busy day, one job after another. I thought riding in a blue light ambulance would have been a thrill, and it was – only that I was busy focusing to look far ahead out the window to prevent myself from getting sick. We had the sort of routine collapse, chest pain etc.

After lunchtime, we received a call for an unresponsive baby. We arrived very quickly, within minutes. The sense of urgency loomed in when we actually saw the baby. The father was holding an extremely pale two month old baby. It turned out that the baby had been like that for half an hour. At that point we knew we really need to speed up and get to the hospital quick. J quickly asked mum to get into the ambulance. The other baby she was holding cried as she passed him on to dad, and mum said she would call dad. Until that point, my role with the crew was only as an observer. But the paramedic could really do with another pair of hands in this life-threatening situation. So I connected the oxygen and did the chest compression while J dealt with other things. S alerted the ED and drove off. I was nervous. I have read about it, but I have not been formally trained in immediate paediatrics life support. J just taught me how to do it then and there. That was helpful as this allows J to concentrate on maintaining a patent airway. The airway was really good – there was good bilateral chest expansion, but only after we manage to make a mess of the vehicle because J couldn’t find the oropharyngeal airway of the right size. I caught a glimpse of the teenage mum wiping her tears. ECG was disappointing, asystole all the way. After a few minutes of roller coastal ride, we made it to the ED and lots of doctors and nurses were already anticipating at resus. J delivered the baby and gave a brief history. I watched the team commence the resuscitation for a minute or two. Then J and S went out of the resus, so I thought I better follow. We went back to the vehicle, J and S started typing the ambulance report and tidying up. They were not very chatty but pretended to look fine. I stood at the side and also kept quiet. J asked if I was alright, and said I can have a brew if I wanted. I said OK. But in fact I didn’t go for a brew. I felt shaken, I went to my locker and have a gulp of water. Then I went back to resus expecting the worst. The registrar was walking out, so I asked him how the baby was. He just shoke his head. I was speechless. I went back to the ambulance to tell them. They both carried on doing what they were doing. Then the ED consultant came up to the ambulance to check if we were alright. After about half an hour we went back to the ambulance station. The three of us sat down to have a chat. It was the first time for S to encounter death of an infant too. He said he just felt strange. J had been a paramedic for 30 odd years and had seen quite a few of these before and had never seen any survive. But I still saw him staring at the television, not watching the programme but contemplating on something else. The other ambulance staff was really understanding. They showed concern and tried to cheer us up. Was there anything that we could have done differently? Possibly, but it probably wouldn’t have changed the outcome. The three of us sat there quietly with our thoughts until the next call.

It was an interesting day. I felt more acquainted with the crew and learnt quite a bit from them. But I cannot deny that I was rather traumatized by the death of the baby. I didn’t know the baby’s name, didn’t know whether the baby was a girl or a boy. I knew the baby was still warm when I did the chest compression. And sadly it is no longer the case. Like the others I pretended that I was fine in front of everyone. It was only when I was alone in my bed room that it all sunk in. We have not managed to save the baby. And we had left the mum, dad, baby brother and grandparents very heartbroken indeed.

Swimming

My sisters and I always enjoy swimming. Our family don't go to the swimming pool regularly. We only get to swim when we stay in a hotel which the facility is offered or a pool based theme park. Our family travel a few times a year for holiday, and when we were younger we would always pester our parents to book in a hotel which has a swimming pool. We often spend hours in the pool - the whole morning until it's too sunny that we'd get horrible sunburn and the whole evening until the pool closes.

None of us had swimming lesson. We taught ourselves how to swim. We look at how other people swim, do it ourselves, drown and choked ourselves with chorine water and try again until we can float and move ahead. Yee Leng was the first to master the skills. She's just so good. While most of us prefer to stay at the shallow end (about 4 feet deep) she would wander off by herself at the deep end. Wan Cheng is not too bad in her swimming as well, I mean she is usually ok following Yee Leng around to the deep end. I am petrified of the deep end. I can do breaststroke and freestyle reasonably well but I just get panic when I know I can't touch the floor anymore that I cannot control my breathing well. Futhermore my stamina for swimming is absolutely rubbish (which is weird because I can jog for an hour without getting very short of breath). When Wan Lee and Wan Teng were a bit younger they were quite annoying because I have to take care of them. But I remember that they really like me hugging and piggy backing them in the water. They still linger around the shallow end with me but they are fast learners and are definitely getting there.

Mummy and papa never swim. They usually sit at the pool side reading. We are always keen to show them how well we have swim or tricks that we learnt. Sometimes they'd do some armchair critics. They have to drag us out of the pool almost everytime we swim because we never have had enough.

Week 3

Monday
Headache hx, Physio cervical spine injury assessment, Ankle joint manipulation (physio), Spinal exercise, ACL exercise, Trigeminal neuralgia, Venupuncture, Venflon (Pink and green!), Hx and examination for head laceration and wrist twist

Tuesday
Abdominal pain (Twisted ovarian cyst), Headache hx (Photophobia), Asthma and management guidelines, ACS management (aspirin – clopidogrel – clexane), Venflon (Grey!), Venupuncture, ECG, Rashes in children, Idiopathic cardiac arrhythmia, Diabetic ketoacidosis and management (Hydration-insulin+atrarapid±antibiotic), CXR interpretation systematic approach, Chest pain hx

Wednesday
Archilles tendon rupture (Simmond’s test), Head injury hx and examination, Abdominal pain ?appendicitis, Venupuncture in difficult patients, OD hx, Epistaxis hx, CVA, Apnoea – breath holding spell in infant, Wrist injury – important to know the dominant hand, Abdominal exam & describing lump, ACS, Sudden loss of vision, Sudden blurring of vision

Thursday
ABG, Venflon, TB, Acute exacerbation of COPD, Hyperglycaemia in DKA or HONK, Head injury (clerking and management, criteria of major head injury), Glandular fever – amoxicillin – rash, ECG description and interpretation, CV exam, Meningitis and febrile convulsion, CVA

Friday
Foreign body in the eyes, Slit lump and describing things in the eye, Accidental vs non-accidental fall in hx, Facial injury, Epistaxis and nose pack, Venflons (1 pink 1 green), Venupuncture, ECG, Hx headache, PE risk factors, Clerking OD, fall and pleuretic chest pain, Costo-chondritis, Paracetamol OD, Heart block , Subcutaneous injection, Fundoscopy, Whiplash injury, Diabetic presenting with back pain and incontinence – autonomic neuropathy, Methadone OD reversal with naloxone, Neurological examination. I was a star apparently.

Saturday
Blood culture, Management of acute exacerbation of COPD, Ankle dislocation – unstable – reduction – x-ray, Suturing, Ureteric colic, Unwell baby, Collapse hx, Chest pain (PE and oral contraceptive pill), Pubic rami fracture, Asthma management in emergency

Sunday
ACS, MI, Side effects of thrombolysis, Neurological exam, Subarachnoid haemorrhage, Lumbar puncture, Viral meningitis, Encephalitis, Shoulder reduction, Wrist reduction, Heart block, Venflon, ECG, Catheterisation, Dipstick machine, LBBB and RBBB, Hypothermia, Bradycardia management, GCS, Severe/Life threatening COPD exacerbation, Thoracocentesis for cardiac tamponade, Pneumothorax and cannula test, Ankle reduction, Anaesthetic induction in ED (cricoid pressure), 28% O2 for COPD, DIGAMI, My fourth cardiac arrest here.

Tired. But happy.

Second week

Monday - Day out with the ambulance. It was exciting, being the first health professional on scene, when ABC are absolutely practical. We had a baby who was pulseless and white. I did chest compression on the baby, but we did not manage to save the baby. I felt quite upset.

Tuesday - Night shift in ED. Saw a few alcoholic fits, put in a venflon, saw ABG, learnt to take headache history. A doctor and a nurse was physically assaulted by a patient but I didn't see it, just saw the police restraining the patient after. Overall uneventful.

Wednesday - Supposedly my day off, but considering that I didn't learn much on tuesday I came in after lunch to make up for it. It was such an amazing day. Put in one venflon, did lots of ECG, saw three MIs (ST-elevation and non-ST elevation), helped in two dislocated shoulder reduction (which was rather embarassing because I was so weak....), took history from ambulance and family in presented in resus, saw a boy who presented with stridor and listen to a heart of a man with patent foramen ovale who survived till his 70s,.

Thursday - MAU was fantastic learning place. Saw lumbar puncture, an ECG with all features of hyperkalaemia (K was 7.2! scarry, the patient could have arrested anytime). Clerked three patients. One was an overdose patient who had manic depression, and talking to him was, umm, interesting. I ordered investigations (took blood and fill in x-ray card) before presenting my case, made me feel like a real doctor. Also tried ABGing but unsuccessful.

Friday - Slightly frustrating morning, had doctors who just won't let me do anything. Won't let me take a history and examine patient, won't let me take blood, won't let me glue a wound. Afternoon was slightly better, I decided that I would do febrile convulsion for my case report.

I am starting to really really enjoy the placement. But I kept avoiding the case report. I'm starting it tonight. Hope I can finish it soon so I don't have to worry about it anymore.