…Enter ‘Prostitution’ Mode…

So I got my copy of Blogged: 2005 last night, indeed I am in it, but had I not been, I still would have bought it for myself.

The blogosphere is a wide and varied place, and Tim Worstall does an excellent job of collected some varied posts from mainly UK based blogs to highlight some of the news events of the year.

It covers most big events of the year from the Iraq war (pro, and anti), ID cards (all anti, but then is anyone besides the government in favour of them?), the July 7th bombings, the election (both here and in America), all the way to shaving your man-spuds in preparation for a vasectomy.

One of the main strengths of the book is that if you don’t like the writing of the article, then the next one is only a few words away, and while the majority of the book is based on the political side of things (obviously, as most of the big news events of the year are political) there is still room for bits from non-political bloggers.

I sat up all last night and read it through, cover to cover and I suspect that there are going to be a few new blogs added to my daily reading list.

In a slightly Doh! moment (at 4 am mind you), I wondered why the book stopped at October…

And yes, I’m one of the contributors, and so is Nee Naw (who kept very quiet about it).

Having talked to the publishers (The Friday Project), I can report that they are very nice people who ‘get’ the whole idea of Blogging, so I hope this book does well, both for them and for Tim.

…Exit ‘Prostitution’ Mode…

The EMT (Emergency Medical Technician – like a Paramedic, only not paid as well…) was very relieved to see the familiar yellow form of an ambulance pull up outside Joan’s house.  He went and opened the door, and mimed pushing a wheelchair to the crew getting out of the vehicle.

There are a couple of ways to lose your job working for the ambulance service, one of these ways is to walk a ‘chest pain’ out to your ambulance.  The patient goes on our carry chair, and straight onto the trolley in the back of the ambulance.

The EMT finished telling the crew all that he had discovered, the crew, not being stupid, also only needed to take one look at Joan to realise that she was seriously ill.

They wheeled her quickly to the ambulance, where they explained that they were going to take a look at what Joan’s heart was doing.  Joan didn’t care that they wanted to put sticky dots on her naked chest, she was feeling too ill to worry about being topless.

One of the things that we in a London Ambulance Service can do is a “12 lead ECG”, this is a detailed electrical reading of the hearts activity.  We need to get the patient topless, then stick a number of electrodes to the front of the patient’s chest.  The machine then prints out a pretty little picture of what is happening with the patient’s heart.  Joan’s looked a little like this.

The real skill comes from understanding what all those squiggly lines mean.  We run a two day ECG reading course, where we are taught to recognise the seriously bad things that can happen to someone’s heart.  When we first trialed the reading of ECGs there was a test between the ambulance crews and the junior accident and emergency doctors.  The ambulance crews got more ECG interpretations right than the doctors.

Twice…

In Joan we are looking for something called the ‘ST Segment’. 

In a normal healthy ECG this part of the line should look like this.

In Joan that part of the ECG looked like this.

         

Can you see how the rightmost part seems raised?  This is one of the signs of a heart attack.  For us it is a ‘red flag’ that tells us to get the patient to hospital in as quick a fashion as possible.

The ECG machine spat out a pink piece of paper.  The ambulance crew both read what it meant immediately.  Joan was having a confirmed heart attack.

The driver went through the cabs dividing door an sat in the driving seat, she started the engine and hit the ‘priority’ button on the radio.

“J201 calling priority, go ahead”, came the voice over the radio.

“Afternoon”, the driver said into the mike, “Can you show us Blue into Newham hospital, we have an eighty two year old woman with confirmed MI via ECG, BP is 88 over 50, pulse is 40, O2 sats are 99 on O2, BM is 5.2 and our ETA is two minutes”.

The radio operator repeated it all back to the driver, and finished with, “that’s being done for you now”.

The ambulance attendant was sitting in the back, keeping a watchful eye on Joan, while explaining that they were going to use the sirens to get Joan to hospital, and that when they got there she was going to be the centre of attention for a lot of doctors and nurses.

The ambulance pulled away, blue lights flashing and the driver gave a quick wave to the Rapid Responder who was finishing up both his paperwork and the cup of tea he had in a travel mug.

Now that ambulance crews can interpret the heart tracing of an ECG we have two options as to which hospital the patient can go to.  We can run them to the nearest hospital, where they will receive a drug to break up the clot in their heart, or we now have the choice of taking the patient to the nearest hospital that provides a primary angioplasty service.  An angioplasty is a medical way of opening up the blocked heart artery.

…but more on that tomorrow…

The FRU pulled up outside Joan’s house, the (stunningly good looking, heroic, intelligent, and did I mention GSOH) EMT stumbled out, grabbed his bags and made his way to the front door where he rung the doorbell.

He was met by a woman in her eighties, she was pale, she was sweaty and she really didn’t look too well.

“Sit down luv”, said the EMT, “and tell me why you’ve called me”.

“Well”, she said between breaths, “I’ve got this pain in my chest…”

People who are having a heart attack sometimes look like they are having a heart attack, what I mean by this is that they go into shock.  Shock is defined as a lack of oxygen to the tissues and organs of the body, often this is what happens when you lose a lot of blood, and there isn’t enough blood in you body to adequately keep your organs fed with oxygen.  Sometimes however, you get cardiogenic shock, which is a failure of the heart to pump sufficient amounts of blood to your organs.

Roughly 1 in 10 heart attacks result in cardiogenic shock, they are often heart attacks that affect the large left side of the heart.  The left side of the heart is the part that pumps blood all around you body, so it has quite a lot of work to do.  When the supply of oxygenated blood to that side of the heart is blocked, then the pump starts to falter and die.

This then results in the classic ‘look’ of a heart attack.  The patient is pale and sweaty, they breath rapidly, and look blue around the lips (cyanosis).  Their fingers are often stone cold, and they may be a bit confused.  All this is the bodies response to a lack of oxygen.

The (did I mention heroic?) EMT listened as Joan told him about the pain starting about an hour ago, and that it seemed to travel down her arm.  While he was listening to her he started to assemble an oxygen mask.  Putting it on Joan, he explained that it would make her feel better.

Oxygen is important to the organs, so we want to make sure the patient is getting plenty, this is why we put the patient on oxygen.  It can often make them feel better, although I’m not too sure if this is because of the oxygen, or because someone is ‘doing something’.

While reassuring Joan, the EMT (did I mention he is tall dark and handsome?) checked through her previous medical history, he had a little look at the tablets that she took, and found that she was on a minor treatment for high blood pressure and nothing else.

“Any allergies Joan?”, he asked.

“Only Penicillin”, she replied, “it makes my stomach upset”.

“Alright Joan, I’m going to give you some medicine”.

There are two medicines that we give ‘on the road’ to patients who we think are having a heart attack.  Aspirin and GTN.

Aspirin was discovered to reduce your chances of death from a heart attack by 23%, it works by making the parts of your blood that want to stick together to form a clot (which will then go on to block an artery) less ‘sticky’.  So we give 300mg of aspirin to pretty much anyone we suspect of having pain related to the heart.

So aspirin is given unless the patient is allergic to it, or if they are on a better ‘anti-sticky’ drug.

It is important for me to say, that most patients don’t know what ‘allergic’ means.  An allergic reaction is something life threatening, and will make you incredibly ill.  An allergy is not “it gives me an upset stomach”.  It is really important for the medic on scene to determine if the patient is truly allergic, or just doesn't like taking the drug.

Trust me, 23% reduction in death is worth an upset stomach.

While Joan chewed the aspirin the EMT checked her blood pressure, 88/50, not good.  The other drug that he wanted to give would have to wait.

The other drug we give is GTN (glyceryl trinitrate).  The GTN we give is a little spray bottle, and is again used when we suspect that the pain a patient is feeling is related to their heart.

GTN works by relaxing the blood vessels in the body, it makes then a bit more ‘floppy’ and by extension they get a bit larger.  We are hoping that the blood vessel gets large enough that a bit more blood can flow around the clot, and supply the tissues of the heart with the much needed oxygenated blood.

Unfortunately, the drug has a side effect of dropping a patient’s blood pressure.  so the patient needs to have a fairly good blood pressure to start with, otherwise we might lower their blood pressure so much that the brain wouldn’t receive enough blood and the patient faints (or worse).  In the case of Joan, her blood pressure is too low, so the EMT can’t give the GTN.

The treatment done, all that was left was to wait for the ambulance.  The EMT was getting a bit nervous.  This woman needed to be in hospital, not in her living room.

He breathed a sign of relief, if he listened carefully he could just about hear the familiar sounds of a siren approaching.

Here is the reasoning behind me writing Joan#1.  Every so often I have a week off work.  That often means that I don’t have anything ‘real life’ to write about, and if you look at my archives you may well work out exactly when I have those weeks off…

So the post ‘Joan#1’ is supposed to fill in the gap. Don’t worry, I’m not about to take this blog off in a wildly different direction, I’ll keep writing about the stuff I normally write about – I promise.

I’m back at work on Friday night, so the ‘regular’ stuff will start again then, until then I’m going to inflict two more ‘Joan’s’ on you.  The idea behind the ‘Joan’ posts was inspired by the Michael Crichton book ‘Five Patients’ which describes, in-depth, five patients and the treatment that surrounds them.  It was written in the 60’s, so is a bit out of date now.  I’m trying to do something similar in my usual “short posts, scribbled down, barely edited” style.

So, it’s either ‘Joan #2’ or I’ll inflict on you another post about how I’m getting screwed under the ‘Agenda for Change’ paydeal.

Yes…that is a threat…

Joan was in the garden hanging out the washing, she did the laundry as regular as clockwork.  Her life was normal, and had been so for the last twenty years.  She was looking forward to seeing her grandchildren later that week.  It was a sunny summer afternoon, so the clothing would be dry in no time.

Joan felt a twinge of pain in her chest, it seemed to run down her arm.

“Hmmm”, she thought, “I must have stretched a bit too far”.

Joan, like many of my patients is starting to feel cardiac (or heart) pain, but like a lot of people who get it for the first time, she doesn’t recognise it as such.  Instead she puts it down to overstretching, a touch of indigestion, or something that will go away on it’s own.  Like many of my patients Joan doesn’t consider herself to have any problems with her heart – it has beat healthily for nearly 80 years without a fault, why should it be failing now?

Little does Joan know, but she is going to be one of the 275,000 people in the UK to have a heart attack this year.

But what is a heart attack?  The heart is a muscular pump, that continuously works to pump blood around the body.  All the muscles and other organs of the body need a constant supply of oxygen.  Blood carries the oxygen around the body to the organs, the blood then returns to the heart where it gets pumped to the lungs to pick up more oxygen, before going back to the heart to repeat the process.

Without oxygen, the tissues of the organ die.

As mentioned, the heart is a muscle, and the heart itself needs oxygenated blood.  So as the oxygen carrying blood leaves the heart, some of it is used to bring oxygen to the heart tissue itself.  Should the heart get it’s supply of oxygenated blood cut off, then the heart itself starts to die.

What happens in a heart attack is that one of the arteries carrying oxygen rich blood gets blocked off, and the heart muscle around that artery dies.  The medical term for this is a ‘Myocardial Infarction’.

Myocardial means the muscle of the heart, while Infarction means a reduced blood supply leading to tissue death.

For short we call it an M.I.

We used to think that it was just the lack of oxygen to the tissues that caused the injury, but what actually happens is that the lack of oxygen activates disease fighting white blood cells and these then release a range of toxic substances (mainly free radicals) into the tissue, thus damaging and killing it .

Joan’s pain was getting worse – it was as if someone was sitting on her chest.  She’d had a cup of tea, but that hadn’t helped at all.  She was considering a sip of brandy, the bottle had been untouched since Bill, her husband had died five years ago.  Maybe it would go away if she ignored it.

Perhaps a cigarette would calm her down, she swore she only smoked ‘for her nerves’, so perhaps it would help get her through the pain.

But what causes one of these arteries to get blocked?

Early in life we get small blobs of fat sticking to the inside of our blood vessels, with a healthy diet these don’t get much larger.  With an unhealthy diet these blobs of fat (called Atheroma) get larger and larger, often collecting up different types of material.  These effectively narrow the blood vessels of the body, causing a decrease in oxygenated blood reaching the tissues supplied by the affected blood vessel.

What can happen to cause a heart attack, is that this atheroma plaque can break off the wall of the blood vessel, sending a clot (or thrombus) around the body.  Blood starts to clot around the fatty plaque and the clot gets bigger.  If the clot ends up blocking one of the arteries of the heart, then the blood flow is blocked, the part of the heart supplied by that artery gets no oxygenated blood, and it dies.

Joan is a smoker, which means that she is at least five times more likely to have heart problems caused directly by her smoking.  Smoking reduces the bloods ability to carry oxygen to the organs that need it, partly because the carbon monoxide that is part of cigarette smoke is 400 times more likely to be carried by the blood than the oxygen that the organs of the body crave.

Also, smoking increases the one of the proteins that causes blood to clot, so the blood becomes more ‘sticky’, this helps form the plaques that can burst, sending them floating around the body all ready to cause a heart attack.  Smoking also increases the amount of ‘bad’ cholesterol in the blood.  It is this bad cholesterol that attaches itself to blood vessel walls in the first place to cause the atheroma plaques.

The cigarette wasn’t helping too much.  The pain was still there, and she was finding it hard to breathe.

“Perhaps I better call an ambulance”, she said to herself, reaching for the phone.

…to be continued…

 

 

End of Joan, part 1.  Please let me know what you think, it’s hard to balance heavy medical stuff with making it easy to understand, and there are probably medical people reading this, tearing their hair out at what I’ve just written…

You see, sometimes I make mistakes.

Thankfully not yet of the fatal kind.

However, yesterday I did link to the wrong person.  I can only blame the incoming brain-rot that affects all public service staff.  So in a bid to right this wrong in an honourable fashion I will now direct you to the proper link, and inform you that Tim Worstall is indeed a fine writer, and often makes me go, “Urh?”.

This is a good thing.

Now, time for a cup of tea, then clean my flat, and then to make a start on part one of a series of posts about Joan.

While Sony seem intent on being evil, Microsoft do the right thing (although I don’t think that this will help their ambitions on being media providers/resellers).

You may have noticed a new addition to the sidebar on the right of this page.  It’s an Amazon Associates link to a book.

A book on the best of Blogging in 2005.

I may, or may not be in it...

Do feel free to buy it, and get exposed to some blogs you might otherwise not know about.

If lots of people pre-order it before Friday, then it might enter high up in the Amazon.co.uk charts.

For some reason if this situation occurs it would make me happy.

My writing on this blog will be better if I’m happy.

Feel free to blame Tim Worstall for this advertisement.

Who I am and where and what I am, for those just joining me.

My name is Tom Reynolds – except, that this isn’t the name written on my cheque book.  It’s a pseudonym that I cooked up years ago, and when I started blogging I thought that a bit of anonymity would be a good idea.  Lots of people, even those who know the truth call me Tom, which is fine by me.

I work for the London Ambulance Service (in the UK).  I’m an EMT-3, which means I’m one of those people in a green uniform who looks after sick people.  At the moment I am a solo responder working on an FRU, or ‘First Response Unit’ (or is it ‘Fast Response Unit’?).

I drive around in a fast car, getting to the sickest patients as quickly as possible.  At least, that is the idea.  Often my patients aren’t that sick at all.  My ‘patch’ at work is pretty much all of East London.  It is 33 miles in circumference – which is from where I live to Southend.  There are a lot of people in that area.  I am a very busy person.

I’ve been writing this blog since July 22nd 2003.  So that’s coming up on two and a half years.  It seems much longer.  I now consider it my second job.  This is not a bad thing.

L.A.S. management know that I blog, they also know who I am.  No it doesn’t make me worried.

There are various ways of contacting me, all of them can be found here.  Email is the most reliable way to talk to me, because if I’m not at work, or on my computer, then I’m normally asleep.

I love getting comments – I know this makes me someone needy looking for validation.  But that’s fine.

There are things going on in the world that make me angry – I used to write about them here, but for the past two years, I consider it ‘going off topic’, so now I stick to ambulance stuff on the whole.

I have a secret blog that no-one knows about.  I dream of writing fiction, or comics.  These two facts may be connected.

Actually…I dream of getting paid to write.

I’m thirty-something, and was born on the 28th of November.  I have a brother (1), a mother (1), and no idea where my father is (1?, 0?).  I like my bachelor lifestyle – but would like to become someone’s stalker.

I am currently preparing my next big post – which might take a day or two, but will hopefully be worth it.

Warren Ellis did this, so I thought that with my new-found desire to write stuff, that it’d be a good idea for me to do it as well.

I’ve been having a think recently, a dangerous thing for me to do I’m sure you will agree.  I’ve not been thinking about the state of the world, how to solve global warming or even just how to stop bloody idiots from pushing their prams out in front of the fast moving car making all the noise and lighting up the street with blue flashing lights.

No, dear reader, I’ve been thinking about ‘Blogging’, more specifically the ‘Blogging wot I do’.

It seems to me that I currently have two part-time jobs, each of which take up more time than any full time job.  So on one hand I work 38 hours a week or so racing around the streets dealing with the sick (or supposedly sick).  On the other hand, I maintain this blog, as well as keep up with what is going on in the ‘blogosphere’, answer emails about this blog, and try to come up with new ideas.  While I haven’t timed myself, I have a feeling that I do spend a considerable fraction of my time blogging, and doing the work around blogging.

Except for this weekend, when I took some time off both my work activities.

Please realise that this isn’t a moan – work can be enjoyable, and in my case it is, I love my paid work, and I love blogging (or at least I do when I haven’t got writers block).

I just think that I have made a transition from ‘blogging’ to ‘writing’. Don’t ask me when this happened, I have no idea, but I’m thinking that I am now a writer who writes in a blogging format.

So blogging (at least for me) has now become a style rather than content.

It’s at times like this I wish I’d done something more academic in college, rather than learning to reflect on how to best wipe someone else’s arse.

There also came a point where I started considering myself a ‘professional blogger’.  Again it’s something that I can’t quite put my finger on – but it may just be because writing this blog has become such a big part of my life, and because I’m now considering myself unpaid  Public Relations for the LAS.

So, what does all this waffle mean?  Ultimately very little.  I love blogging, and will continue until I completely run out of things to say, or get the sack for saying something I shouldn’t.  Maybe I’ll start writing on some different subjects, maybe even on completely different formats.  Whatever happens I’ll be sticking with the tried and true on this site.

Working on different subjects/formats means that I’ll be working more hours on my ‘second job’.  Work that I don’t get paid for.

Am I bloody mad?

Apologies to you all, I’ve had this rattling about in my head for some time, and I just needed to get it out ‘there’ to clear some room for some other stuff.  It gets crowded in my head sometimes.

So on Friday, I went into London to meet up with some of the folks who blog while working on the Underground.  Once more I found myself in a strange pub looking for people who I only know from their writing (and it is writing, but more on that in my next/previous post depending on how you read this blog).  Somehow though, we did all manage to find each other, and a very enjoyable time was had by all.

Discussion ranged from safely blogging about work, picking up stalkers and how we seem to have these little microcosms of blogging circles all the way to how badly our jobs suck, and the fun we can have at work despite the best attempts of management.  I also gave career advice to two people.

I now command you to go to the blogs of the people that I remember being there (and if you were there, and I haven’t linked to you – please do let me know).  And why do I command you?  Well, it does my ego the world of good to get emails from people who I link to telling me that their pagehits have gone through the roof.

And this is why I should never hold any position of power…

On The District

Ninja In A Bowler Hat

The Station Log Book

London Underground Life

Version 3.1

Some more posts to come today, maybe even something medically based…

'Two month old child - Not waking up'.

"Shit!", I thought (actually I may have said it).

'Not waking up' could mean that the child was dead. There was something about the way the job was written up on the terminal screen that made me fear the worst.

I raced around there, brakepads burning and swearing loudly at bus drivers who thought that it might be a good idea to pull out in front of me.

Two minutes thirty seconds later I screeched to a halt outside the house, bounding from the car, grabbing my kit and running into the house.

The baby was crying.

The ambulance crew turned up about 30 seconds later.

I was smiling, the crew were smiling, the mother was smiling.

The only person not smiling was the crying baby.

But I was happy at that.





Babies sometimes do strange things like stop responding to stimuli, it's scary, which is why I don't mind going to jobs like that. It's better than the alternative...

Well that's the last time I say that I haven't had an interesting job all shift...

My final job of the day was to a 'collapsed male in the street'. Unfortunately Control were having a bit of a computer failure, so the job was given to me the 'old fashioned' way, by someone at Control telling me where to go.

"Collapsed in the street... he'll be drunk then", I joked.

No matter, I still raced to the scene as quickly as possible (I've mentioned this before, that what I get called for, and what is actually wrong with the patient are often two very different things - so I always try to get to the job as quickly as possible).

The location wasn't exact, so I spent a bit longer than I would have liked peering down dark streets, looking for a man collapsed on the floor. Some people driving towards me told me that the patient was a bit further down the road.

My heart sank when I saw a huge crowd of people standing around a man laying flat on his back. My heart sank even more when I saw a man doing CPR on the patient.

I jumped out of my car, grabbed my bag and trauma shears and started cutting the patient's clothes off. A quick look at his face, and I didn't hold much hope for him.

"He was jogging, and just collapsed", said one of the men who had been performing CPR, "he hit his head, we've been doing CPR at 100 compressions a minutes".

"Are you medically trained?", I asked.

"No", he replied, "I'm a teacher, but I've done a first aid course".

"Well", I said, after glancing at the monitor, and noting that there was no activity in the heart at all,"You were doing really good CPR, so you have given him the best chance he has for survival".

I just wanted them to know that they were doing the right thing. I knew the patient had pretty much no chance of surviving this event, but that these strangers were trying their best renewed a bit of my faith in human nature.

The ambulance arrived only a few moments after I did, and as I looked at the driver, I could see by the expression on his face that he also realised how serious the situation was.

There was no time for any playing around, so we loaded the patient on the back of the ambulance, and took off for the hospital. I was 'bagging' the patient, while the ambulance attendant was continuing the CPR.

We arrived at the hospital, but there was nothing that they could do.

As he was out jogging, he didn't have any identification at all. We had also taken him to a different hospital than you would expect - it wasn't the closest hospital by distance, but it was the hospital that we could get to the quickest.

...So somewhere, there is probably a family wondering why their husband, or their father, or their brother, or their lover hasn't come home. They'll ring the local hospital, and they won't have heard of him, and it will only be when they go to the police that they will find out the truth.

I'm also aware that the bystanders who were doing CPR would probably have this event haunting them - I deal with sudden death a lot, but for these people, it was probably the first time they ever had someone die in front of them. I wish there was some way that I could have stayed and made sure that they were alright, and that I was proud of them and that they should be happy that they did the best that they could.

So, a traumatic event for everyone except for us ambulance and hospital staff. And to think that people ask us how we deal with jobs like this...

No proper posting today because...

1) I'm entertaining friends around my house tonight (as I do every Tuesday evening).

2) I only had one interesting job today and I want to save that for later in the week, when I'm planning on writing someslightly special posts on my week off.

3) Need...sleep... (Or Red Bull)

So as an apology, I give you Leather Pants.