As we arrived at the address the street was still dark. This was not a wealthy part of town. The houses are usually 1950s cement sheet construction (often Fibro), low-rent government housing and very basic. At that time of day there is probably a hint of dawn in the sky but this time I didn't really notice. The smell of hot brakes wafted up us as we climbed out of the truck and went to get our bags. My partner was pulling his gloves on as I retrieved the monitor and our drug box. The sliding door always sounds so loud in a quiet street. I wonder sometimes if people curse us the way I curse the garbage truck on my days off...
The crew on scene were obviously into it, the sound of their monitor alarms could be heard coming from the half open front door. Everything seems to beep at you in ambulance, but the cardiac monitor usually starts to really complain when the heart rate is too high, too low or absent altogether. I hate persistent alarms and although we have the ability to silence most of them for a while, it is always important to address the reason the alarm is sounding, not just get rid of the annoying noise. I went to push the door open with the monitor and was met with resistance. Squeezing side on around the door I was able to get a look at why. There was a hall table behind the door preventing it opening. My head took a moment to gather what I was seeing. Everywhere I looked there were other hall tables and display shelving with literally thousands of china and porcelain plates, figurines, teacups. Oh and teaspoons, don't forget the racks and racks of teaspoons. This was a lifetime of collecting.
"We're in here" called one of the crew and I went into the front bedroom. Nanna was a big lady and was in trouble. She looked what we like to call pre-arrest. A friend of mine calls this "circling the drain". One of the ALS crew was kneeling on the bed behind nanna trying to hold her upright and hold a 100% oxygen mask over her mouth and nose. The other crew member was trying to wrap a blood pressure cuff around a huge arm. Both crew members looked flustered and red faced. I noted nanna's trunk-like ankles with pressure stockings around them, the grey purple hands, the sweaty skin, greasy hair and faint smell of incontinence. I could hear the gurgling of her breathing even through the mask. I was simply told "She's full". I turned to my partner and saw him already heading back outside to get what we needed. Good man.
Firstly we pulled nanna further upright and got her legs set on the floor then we jammed more pillows behind her to hold her body upright. I plugged her into our monitor and placed a probe on her finger to measure her current oxygen saturation. It came up as 76%. While these very low readings are not often accurate, it showed she was not getting what she needed through her wet lungs. I clipped and tightened a tourniquet around her forearm noting her clammy skin. She had her eyes closed and was clawing at the mask on her face. I grabbed one of the medication packets off the bedside table and found her first name. When I called her name, her eyes opened and she focused on me for a moment. Good, that's a start. "Squeeze my hands" I demanded loudly in her ear, she weakly obliged.
My partner returned and set about getting the CPAP device ready, (for those that aren't familiar, in crude terms this piece of kit blows a small but steady oxygen stream into the mask providing a reduction in the work of breathing and an increase in the efficiency of gas exchange in the alveoli) this device works wonders compared to trying to achieve the same principles through manually assisting the patient's ventilation.
After many attempts, Nanna's gargantuan arms finally gave up their fiercely protected blood pressure readings - 165/105. Right then, nitrates please, to reduce her blood pressure and give her heart a chance to catch up. I managed on my second attempt to get IV access in a tiny crooked vein on the back of her thumb. It was a pathetically small IV, but any port in a storm will do!
I'll write more in the morning... right now I need to sleep.
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