Unequal and Unreactive...
... When your eyes have a torch shone in them and this is the eye pupil reaction, start to worry.
One man who we went to today had the same pupils. He's now on a life support machine in ITU.
During the previous night he'd allegedly been mugged/beaten up in an alley close to his home. At the time his friends called for one of our ambulances to attend. They arrived and duly bandaged his head and inspected his body for other wounds, contusions and lacerations. Now, it's important to state at this juncture that the man was slightly the worse for wear, in terms of sobriety. He refused the crews advice to attend A&E for his wounds and possibly unseen injuries.
Now, as I've stated in previous posts we are not allowed to take patients to hospital against their will. Technically it's called kidnap. The patient was adamant he was not going to hospital.
Fast forward 12 hours and the same man is now lying unconscious on the floor of his friend's living room carpet. Several hours previously he had started to behave erratically, was twitching involuntarily and was being generally 'not himself'.
By the time we arrived he was twiching once every minute or so, he was breathing stertously (snore-like) and was not looking in generally good shape. Our observations of him told us that all was not well.
His pulse was racing at 130 and his blood pressure was falling - signs of possible blood loss somewhere. The clincher was his eyes.
They say that a person's eyes are the window to the soul. It's true in many ways. I've seen people who are just about to do something drastic ie. arrest, faint, collapse or fit, and the eyes always tell you the necessary information seconds before the event.
Our patient's eyes were unequal and unreactive. Even normally unconscious patients have pupil reaction to light and are equally reactive to it. Anything else is a 'big red flag' that all is not well with the neurological balance in the brain.
Coupled with the initial observations and physical appearence of our patient we both decided it was time to get him to hospital. Quick. We have a term for the level of quickness for these jobs, it's called GLF - 'Go Like F**k'.
One minor obstacle lay between our patient and the ambulance - the lounge which he was lying on was located on the fourth floor. And no, there weren't any lifts. Fortunately our patient was not heavy. He was soon in the vehicle.
I sent a quick radio pre-alert to the hospital to tell them a brief history and nature of injuries sustained by the patient, followed by an ETA (estimated Time of Arrival). I told them 8 minutes. I did the journey in 6.
We called in to the Emergency Room later on during the shift, to find out how our patient was. His condition had deteriorated and he was being transferred to a specialist neurology unit at another hospital. A machine was breathing for him.
99 times out of a 100, when we attend a patient who has been mugged/assaulted all that results is a few lumps, bumps and a split head, nothing worse. This was the 100th job. The one where the patient doesn't wake up the next day with a fuzzy head and the UBIs (Unexplained Beer Injuries).
And there's probably someone out there who could now be facing a manslaughter charge...
One man who we went to today had the same pupils. He's now on a life support machine in ITU.
During the previous night he'd allegedly been mugged/beaten up in an alley close to his home. At the time his friends called for one of our ambulances to attend. They arrived and duly bandaged his head and inspected his body for other wounds, contusions and lacerations. Now, it's important to state at this juncture that the man was slightly the worse for wear, in terms of sobriety. He refused the crews advice to attend A&E for his wounds and possibly unseen injuries.
Now, as I've stated in previous posts we are not allowed to take patients to hospital against their will. Technically it's called kidnap. The patient was adamant he was not going to hospital.
Fast forward 12 hours and the same man is now lying unconscious on the floor of his friend's living room carpet. Several hours previously he had started to behave erratically, was twitching involuntarily and was being generally 'not himself'.
By the time we arrived he was twiching once every minute or so, he was breathing stertously (snore-like) and was not looking in generally good shape. Our observations of him told us that all was not well.
His pulse was racing at 130 and his blood pressure was falling - signs of possible blood loss somewhere. The clincher was his eyes.
They say that a person's eyes are the window to the soul. It's true in many ways. I've seen people who are just about to do something drastic ie. arrest, faint, collapse or fit, and the eyes always tell you the necessary information seconds before the event.
Our patient's eyes were unequal and unreactive. Even normally unconscious patients have pupil reaction to light and are equally reactive to it. Anything else is a 'big red flag' that all is not well with the neurological balance in the brain.
Coupled with the initial observations and physical appearence of our patient we both decided it was time to get him to hospital. Quick. We have a term for the level of quickness for these jobs, it's called GLF - 'Go Like F**k'.
One minor obstacle lay between our patient and the ambulance - the lounge which he was lying on was located on the fourth floor. And no, there weren't any lifts. Fortunately our patient was not heavy. He was soon in the vehicle.
I sent a quick radio pre-alert to the hospital to tell them a brief history and nature of injuries sustained by the patient, followed by an ETA (estimated Time of Arrival). I told them 8 minutes. I did the journey in 6.
We called in to the Emergency Room later on during the shift, to find out how our patient was. His condition had deteriorated and he was being transferred to a specialist neurology unit at another hospital. A machine was breathing for him.
99 times out of a 100, when we attend a patient who has been mugged/assaulted all that results is a few lumps, bumps and a split head, nothing worse. This was the 100th job. The one where the patient doesn't wake up the next day with a fuzzy head and the UBIs (Unexplained Beer Injuries).
And there's probably someone out there who could now be facing a manslaughter charge...
posted by PikeNovice at
8:51 PM
2 Comments:
That's interesting, I've just done a short law & ethics course for Ambulance & we are allowed to treat a patient who is deemed not competent to make a rational decision.
Intoxication and confusion are two points that can be used to determine competency.
By
CD, at 9:17 PM
Hi cd,
We have recently received a very ambiguous document from management which supports your statement. The truth is, the unoins support us in our suspicion of just how far management would ACTUALLY support us if the patient was to take legal action against us.
Don't get me wrong, I and my colleagues would love to have the absolute authority to determine the competency of the patient to make informed decisions but there are too many legal loopholes. Not even the Mental Health Acts are of much use in these situations.
By
PikeNovice, at 1:48 AM
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