Tuesday, June 19, 2007

Fresh Air

Here is a job from early this morning: My partner was driving and I was in the “jockey seat” which meant I was going to be assessing and attending to the patient when we got inside. As we were going to a child who was short of breath, we discussed the normal values for a child of this age on the way (repiratory rate, heart rate, weight etc.). Its only a rough guide and every child is different, but at that time of the morning it also helps to keep you awake.

The grass in the front yard was knee high and there were two cars in the drive, one of which had no engine and some cardboard for a back window. I could see my partner’s breath on the cold air as we waited for the door to be answered. In this area, the fences are all chainmesh and the houses are old Government Issue, made from cement sheeting and originally built for the 1956 Olympic Games. Many are now pretty sorry looking examples of public housing.

The guy who answered the door was talking on a mobile phone and waved us into the lounge room before walking out into another room to continue his conversation. It was hot inside and the cigarette smoke was thick making it seriously hard to breathe after the chill of the air outside.

The girl was maybe 5 years old and we’d been sent to assess her for an exacerbation of her asthma. She was sitting on the couch with her mother and another smaller child. She was coughing and sniffling and looking miserable. I asked her if I could have a listen to her breathing and she nodded. She flinched when I put it on her back and I realised how cold the stethoscope must have seemed after being chilled outside. I inwardly kicked myself. Sorry sweetie that must have been freezing. She was moving good amounts of air and did not seem to be putting a huge effort into her breathing, but she did have a clear wheeze when she breathed out. She was running a temperature and looked quite pale. Every few moments she let out a hacking cough that belonged in an old person’s body.

Her mother appeared to be nodding off to sleep while I assessed the little girl and woke with a start when I repeated my question a little louder; Have you given her anything for her asthma? She had apparently been given “heaps” of puffs on her Ventolin but was not getting any better. She had been coughing on and off ‘for weeks’ and tonight she would not stop. My partner made a comment about how smoky it was in the house and that was certainly not helping the girl get better. She sat up, looked at my partner and said defensively; “we never smoke in the house”. I looked at the full ashtrays on the coffee table, the bong (pipe) on top of the TV and the cigarette packets on every surface and made a poor attempt to hide my disapproval. I asked had she seen a doctor about the cough – and she hadn’t, so I said well she really needs to be seen by a doctor.

She probably had a chest infection and an exacerbation of her ‘asthma’ from the environment she was in. It was not going to get any better where she was. I treated the girl with some Oxygen, Ventolin and warm blankets as we went to hospital.

I took the nurse aside at the Children’s Hospital and explained about the smoke – she told me she could smell it on us all when we walked in. I sniffed my jacket, she was right. Rancid. She promised they would try and educate the parents about smoking in the house. I doubt it will make any difference. Yeah maybe the girl could have waited to see a doctor in the morning and she was inevitably going to be back in that environment in a few hours. But we left knowing we had given her and her little brother a few hours of smoke free air.

Friday, June 08, 2007

Two Fingers

I have been a little lax with my updates. I will try to be more regular - note to self "Eat more fibre".

Last night was finger night. I'd hardly call 2 similar jobs a run of work, however when you don't attend a certain kind of work for ages and then suddenly you are off to two in a row - it does seem a little odd.

First was to a chap at a house that was being renovated. I think they were working back late on it and it looked like all the cousins and brothers were gathered to help. The place was well lit with those double builders lamps on stands and it was looking good with polished floors and fresh paint going on all the walls. Nice. The trail of blood led down the hallway to the bathroom where we found 70ish year old "Joe" who had sliced himself a beauty while cutting a piece of ceramic bathroom tile.

Joe was on wafarin to "thin his blood" and as a result he was not clotting very well. Still actively bleeding despite a handkerchief and a filthy tshirt wrapped around the wound. Joe had a deep slice running the length of his index finger and curving into his palm. It was going to need more than a few stiches to repair. We cleaned and rewrapped his finger using a big pad and bandage then wrapped him up like a boxing glove to try and stop the bleeding. Joe was asked to try and keep his hand elevated above his head, but he was so busy waving his hand and telling all the relatives how to paint, how to tile, where to put the rubbish etc, that I was contemplating tying his hand to the roof of the ambulance. Anyway despite his protests, we dragged him off to hospital where the hand specialists would need to have a look at him to decide how to put him back together.

Next we went to "Frank" the mechanic although he pronounced it "Frunk". I'm still not entirely sure how Frunk crushed his finger, as he had driven himself his doctors clinic going past 2 hospitals on the way. It seemed he had been working on a car when something (a chunk of engine maybe) had dropped on the back of his hand, which crushed and sliced the middle two fingers on his right hand. Frunk could close his hand into a fist with a great deal of pain, but was unable to then straighten his fingers again. This meant likely tendon damage in itself but when I inspected the wound with a torch I could see right through to the bones and damaged internal structures.

Frunk was in for a long night at hospital while the surgeons attempted to reattach his tendons and get his hand back into some kind of working order. I could see he knew he's messed up and this was going to impact on his work for a long time - if not permanently. It was of course up to his hand surgoen to tell him the prognosis. I gave him some pain relief, took the indecypherable letter from the GP and we walked out to the ambulance. On the way I tried to get more of a story as to what happened, but Frunk just talked round in circles. Sometimes you just never find out.