Recently we got dispatched to do a routine code 3 transport. We get to do these when the private company that has the contract to handle these jobs is too busy or is “unable to meet the timeframe” – this seems to happen quite a lot. Normally this means the patient needs to get to dialysis or some other appointment and does not need an emergency ambulance. This particular patient was scheduled by her doctor to go and have a CT scan due to a week of severe headaches. We are usually required to be there within an hour of dispatch – this means you can at least finish your cuppa at branch and don’t exactly need to run to the truck :)
On arrival my partner and I were met at the door by the patient’s husband (who only spoke a little English) who led us to the lounge room where we walked in to find a young woman sitting on a couch, wearing a nightie and being supported by some other family members. I introduced myself and got no response from the woman; she didn’t meet my gaze and just stared off into the distance vacantly. I asked her husband what had been happening today - I already knew we had been called to take her down to her appointment but I wanted to find out a little more. After a long and unproductive attempt at conversation involving several elderly family members I finally resorted to conversing only with the primary school age child who was there. She was able to give me really good yes and no answers – kids are great like that.
It turns out that this woman had indeed had a history of headaches and vomiting for about a week and her doctor had decided it was time to do a scan to try and rule out anything sinister like a tumour or a bleed of some kind. She’d had a baby about 4 months ago and had been in good health since. However she’d been completely non-conversant since getting out of bed in the morning and had been found standing in the kitchen “with her eyes going all crazy” or just sitting on the couch staring like she was now. My partner and I both looked at each other realising that this woman was possibly quite unwell and we would be taking her to an emergency department and not to her appointment. I tried to assess her but she would get really irritated and resistive, letting out some horrible guttural screams whenever she was touched by anybody. I was beginning to think she had possibly had a cerebral event of some sort – that might fit with the recent history of headaches. She appeared to have full use of her arms and legs when pushing me away and there was no obvious facial droop – so the classic stroke symptoms weren’t there. That of course did not rule out anything. As we loaded her into the ambulance I’m watching her carefully trying to observe anything that might give me a clue as to what was happening; stroke? drug use? psychosis?... no sign of trauma… hmm... fake symptoms? hypoxia? metabolic cause? Was she hypoglycaemic?….nope. What was going on here?
With a lot of effort I managed to get a baseline set of vital signs an oxygen mask on her for a total of about 3 seconds, then she rolled onto her stomach on the stretcher and despite repeatedly turning her back over she kept screaming out when touched. She had adequate blood pressure and pulse and was breathing well. Eventually I figured I’d leave her alone and just hold the oxygen mask right near her face – I was sure if she was having a cerebral event then the effort of fighting our attempts to assess her would be doing her intracranial pressure no good at all. Hospital was nearby so it was fortunately a short trip. When we arrived I got that look from the triage nurse as which said; why are you bringing in an altered conscious state patient lying on their stomach? I explained how combative she had been and as the staff tried to help us move her off the stretcher it soon became evident to them too. I left them with a diagnosis of “Sorry, I just dunno” – I guess that’s why we brought her to hospital.
Late in the shift when we went back to the same hospital we checked back to see how she was doing – I was surprised to see she’d been sedated and intubated. They’d done a scan of her head and found nothing, checked her blood and spinal fluid and again found nothing. The doctors were talking about possible postpartum psychosis, but they too were scratching their heads. I came back the next day and again asked if they had found anything. But they had transferred her to another hospital when they found after extubating her she was worse, even more irritated and combative. I really hope she was ok.
2 comments:
Over here, we get these as 'urgent removals', and these have a four hour time frame on them. They try to use dedicated vehicles for them, but during quieter periods, use frontline vehicles.
I find they're quite often the most serious and ambulance worthy calls of the day because they have already made the effort to see their doc instead of just phoning an ambulance and their doctor thinks that they're genuinely and do require hospital treatment.
Four hours! You could even put the kettle on a second time ;)
Thats a good point about the ones that have been assessed by a doctor, and you are right they can often be very unwell - however those are usually given to us generally as Code 2 transports (Dr request within 1 hour or 25 mins etc.)
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