Wednesday, 28 April 2010

CFR x2 Part 2


She sits in the car, her boyfriend driving. They are off for a celebratory meal - she has just been promoted at work. Suddenly, the traffic slows, and a flash of blue lights up ahead tells her that something is amiss. As they crawl past the wreckage of the car, she notices that there is no ambulance - a lone Paramedic struggles in the rain. Just past the accident, she instructs her boyfriend to pull over. She jumps out of the car and rushes to the boot, from which she pulls out her Community First Responder jacket and Response Bag. She has only been a CFR for a few months, and has never dealt with trauma before, but the sight of the single yellow-jacketted soul brings back so many memories of wishing there was someone else there with her.

She runs over to the para. He looks up with a smile of such relief that the cold and wet become insignificant. She looks down. The driver of the car is already out. How he has crawled from the tangled metal she has no idea. She gasps in horror as she sees the swelling on the left side of his chest, which rises and falls with every breath; in as he breathed in, out as he exhaled. Her mind jumps crazily to her childhood, of sailing with her father. His ribcage looked ... billowy, like a sail flapping in the wind!

"What on Earth is that!?" she exclaimed.

"It's called a flail chest, and it's going to kill him," her new partner tells her, between gritted teeth.

A flail chest, where two or more ribs are broken in two or more places. Yes, she remembers reading about them. But this doesn't look like two broken ribs. More like 10!!

She does as instructed: she places her hand FIRMLY against the flail segment, pushing it in, so that the expansion of the ribcage can at least get some air into the rest of the lung, the area that hasn't been crushed to a pulp as his car flipped end over end over end. He doesn't like that one bit, and tells her so, in language that, under any other circumstance would have earned him a slap round the face. Not here, not now. Now, he hears the gentle voice, calming him, telling him he is going to be ok, telling him she won't leave him.

Double sirens in the distance herald the arrival of an ambulance and a BASICS doctor. She starts to move out of the way, only to be told, quite firmly, to stay just where she is, as she is undoubtably keeping him alive. She is asked to take her hand away very gently, so that the BASICS doc can have a little look. He pales and his jolly demeanour is suddenly replaced with a flurry of activity. His voice is filled with tension, as he quietly tells the ambulance crew, who have by now packaged the patient, that we are leaving NOW.

"What about me?" she asks. He looks at her: "Can you stay - we need you." She gets one of the police to tell her boyfriend, and the doors close.

In the ambulance, she sits by the patient, chatting to him as she presses the flail segment, now with her fist, as her hand has cramped up. The BASICS doctor has a laryngoscope and tube in one hand, and a scalpel blade in the other. He tells her it's "just in case." She begins to pray.

Moments later, they arrive at the hospital, and she rushes, bent double, next to the ambulance trolley, as the patient is wheeled into the resus room.

"Don't leave me now," he whispers. "You said you wouldn't leave. I'm scared I'm going to die."

She stays with him, still with her hand pressed against his chest. She can't feel her fingers, but nothing else matters. She is draped with a lead apron as x-rays are taken; she listens as anxious conversations ensue between the BASICS doctor and the anaesthetists: do we intubate and then put the drain in, or put the drain in while he is awake.

Finally, a decision is made. The drugs are given, and, at a word from the BASICS doc, she releases his chest. A slash of metal, and the chest drain is in. His eyes close, as he is anaesthetised.

She sits down, job done, and waits for her boyfriend to take her to dinner. "Double celebration", she thinks.

Thank you to all the CFR's out there. You do a fabulous job. These two cases happened within 24 hours of each other. This man survived, and all thanks to the CFR.

Monday, 26 April 2010

CFR x2


He was just on his way to work, this Community First Responder. He couldn't keep going, not when he can see the cyclist lying there, his bike a tangled wreck beside him. Sure, this isn't what he would normally deal with; cardiac arrests are his usual callout. But he'll be able to do something, before the ambulance arrives.

He stops his car and jumps out. His car is protecting him and the casualty, so that's sorted. He bends down to assess the chap, and realises that this one is a bad one. He is not moving, has no pulse and is not breathing. He quickly checks to make sure that an ambulance is on the way, and then proceeds to make use of the bystanders who have also stopped, getting a team together to turn him carefully onto his back, still keeping the spine immobilised, before starting chest compressions and breathing for him.

A few minutes later, the ambulance arrives, and he stands, to make way for the experts. They know a useful resource when they see one, however, and he continues with CPR, while the crew get their lines and monitors attached.

A few minutes after that, the BASICS doctor arrives. Once again, the CFR feels the need to move out of the way, and, once again, is encouraged to continue helping. He works around the "experts" as the patient is intubated, as the chest wall is incised, to ensure that there is no collapsed lung. And all the while, the patient receives expert CPR.

"Hello, I'm a Consultant Anaesthetist, can I help?" A curt "No thanks" sends him away, as the team of five men and women struggle in vain to save the young man's life.

A little later, and the team debrief at the side of the road, the shrouded body of the cyclist a silent reminder of what, this time, had been the result of their endeavours. Once again, the CFR tries to walk away, to leave the experts to their debrief, and, once agin, he is pulled back. The team is incomplete without him.

Debrief over, handshakes all round, he gets into his car and drives to work. be continued...

Thursday, 1 April 2010

The Handover Carnival

Well, folks, another month and another Handover Carnival. Head on over to Life Under The Lights, and see if you can find my guest appearance - co-written with InsomniacMedic. Lots of really good stuff, here. Enjoy!!