Posted by: medicblog999 | May 30, 2010

One quick glance

I feel that this should have been my submission to Steve Whiteheads edition of ‘The Handover’ under the topic of ‘in that one moment’, but alas, tis too late!

Its still worth sharing though (I think)

Now, this isnt one of those” arent I great posts”, I hope that you will all read it and be able to recognise the very same abilities that you have when assessing a patient. I think, that this sort of thing shows experience more than anything else, so if you cant say this has happened to you yet, then dont worry because one day it will!

I was called to a patient who was choking. I am working on the rapid response car and head off at speed to the address that is showing on my computer terminal. Its only a 5 minute drive but that is enough for me to run through things in my mind to prepare for what I am going to do if it is in fact a “Worst case scenario” that I am about to find myself in.

As I pull into the street and start looking for the address I see the flapping hands of a adult female standing by a back gate. Once I pull up alongside the house, I quickly glance over to her to see the look of wild panic in her eyes and think that maybe this is a ‘proper job’

I quickly gather my kit from the boot (trunk for my US readers!) and head into the house. As I pass through the hard I see a boy (approximately 7yr old) crying hysterically and shouting that his “Grandad is dead!”. There are another 3 children in the yard in varying states of distress with one other adult looking shocked and shaken.

Straight into the house and through the kitchen, noticing copious amounts of empty lager cans and cheap wine bottles in the kitchen. The house is in a general state of disarray and has even more people inside, all of which appear intoxicated to a greater or lesser degree.

Getting closer to the front of the house and I hear shouting and groaning….

“Come on!!”

“Uuurggghhh!!”

“Come on you Bas&%rd!!”

“Uuuurrghhh!”

I walk into the front room and take in the scene in one quick glance.

An adult male is standing upright infront of the couch. He is conscious, looks red in the face, and seems to be alert to what is going on around him. There is no evidence of central cyanosis, no apparent respiratory compromise and although he is not talking, he is making a loud “Uuuurrgghhh” noise every time the lady standing behind him on top of the couch is performing a very strong and forcefull abdominal thrust on him.

“Stop that now!” I say loudly.

“But the woman on the phone told me I had to do it”

“I know, but that was for a choking patient. He is isn’t choking”

And there is my point. In total from leaving the car to getting to the patient, took about 7 – 10 seconds. From seeing the patient to the moment when I told the woman to stop doing the Heimlich manoeuvre – about 0.25 seconds.

Isnt it amazing how, over time, you just become accustomed to seeing what needs to be noticed to make a rapid clinical decision. Most of the things that we see, hear or smell are recognised and filed away without us even being aware of it, but if you actually stop and think about it, it is really quite something to see.

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Responses

  1. “Isnt it amazing how, over time, you just become accustomed to seeing what needs to be noticed to make a rapid clinical decision” and isn't it amazing how many times AMPDS ends up making the call taker give inappropriate advise. I have arrived on scene a number of times to find bad A & B management taking place often to the detriment of the patient. A classic is lying patient's on their back who really need sitting up or being in the recovery position.

  2. I agree tricky, I have seen some very odd things happening when I arrive on scene following advice from control, the best one being CPR on a patient who was telling them to get off them.However, I guess control can only advice on what the caller is telling them, and they dont have the benefit of being able to actually see the truth!

  3. AH neat stuff and a great point. Often when I am doing an informal call review with a newly ordained Tech (so what did you see? What did that make you think about? What did you notice about the patient that they did not tell you?) I find that they frequently do not trust their instincts and refer to the protocols in their head over their judgment. I usually end such a talk by reminding them that 'The call you are dispatched to is seldom the call you arrive at (gather your own information)', 'If something doesn't seem right, it probably isn't', and 'follow the protocols, but trust your instincts'. Mark, there is little worse than practicing your craft in front of a semi-sober crowd, I wonder how the rest of the call went. You were alone in deeply inside a potentially hostile environment. I am quite certain you charmed your way through the rest of the job with your engaging smile, wit, and ruggedly handsome demeanor. (I did a job a few weeks back that involved many angry Police Officers, a copious amount of OC Spray, a young man, and a dozen family members and neighbors. Tensions were high.)Capt. Tom

  4. Am new to your blog.. But I like what I see.Will stay around.

  5. Am new to your blog.. But I like what I see.Will stay around.

  6. Tom,As always, we are not meant to be knowingly sent to jobs where people are Intoxicated, when working alone.There are many times when the call taker does not get this information and therefore it doesn't get passed on to me.In this case, the call went well. I think you are always onto a winner when you go to a house and they think one of their loved ones is dying and less than a minute after arriving, you tell them that he will be fine.I ended up transporting him in the car and all was well.

  7. Tom,As always, we are not meant to be knowingly sent to jobs where people are Intoxicated, when working alone.There are many times when the call taker does not get this information and therefore it doesn't get passed on to me.In this case, the call went well. I think you are always onto a winner when you go to a house and they think one of their loved ones is dying and less than a minute after arriving, you tell them that he will be fine.I ended up transporting him in the car and all was well.


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