in the ambulance

various thing have been missed. certainly my person's need for beta blocking was discussed at handover but it wasn't done. and when i finally get to ccu they're stressed because 'they've been wanting a review' and while they say they've paged my colleague they haven't paged me, which they always do if they know i'm on.

anyway my mi person, who's been thrombolysed, had good resolution, has decided that the bowels need moving and that valsalva action has got his st's all elevated again. time for a speedy transfer for some angioplasty type action. and he's not looking well, tho better than he does by the time he gets to the ambulance by which time he's gone all bradycardic and dropped his pressure. a swift call to my senior ensues. er, i'm not liking the look of this at all.

we stop his nitrates and give him some atropine. it works a treat. if we have problems my senior says, stop at an a&e along the way. we all look at each other. stop at an a&e say the ambulance guys. blue light i say and no hanging about.

we have various monitor and iv fiddling about to do as the ambulance gets off. sometimes i feel like i'm in a sort of space capsule, the darkness outside and all the world compressed into a point of time inside. you look at the monitor watching for any change in obs. does your person look a bit peaky. normal stuff like breathing you just can't hear over the noise of the van. i realise way too late that i haven't used the monitor/pacing box for weeks and i can't remember quite how it all works. not good.

but my person is fine and the ambulance crews know what they're doing. plus if the worst does come to the worst resuscitation is something we can all do almost without thinking. it's the peri arrest phase that's complicated and difficult. that said when we finally get to the destination and our person is delivered we're all relieved. i have a conversation with the ambulance guys about the importance of not being stressed, or at least the appearance of it. this, i say, is not what we're paid for. so you were calm when we were leaving they ask. we nearly didn't leave i say, smiling and we all laugh at this.

so, finally i get back and find the ccu staff discussing whether their patient might have prinzmetals rather than an mi, a left field bit of diagnosis from them that suggests something overheard rather than reasoned and maybe it's a bit of compensation for not escalating the situation quick enough. whatever. i start working on responding to the shouty anaesthetist who's not happy about some overnight care that somehow he's decided i'm responsible for. maybe he has a point, it's easy to be wise after the fact (or if, in this case, you haven't read the notes!)

it's all in a day's (night's) work. people somehow think i like being in the back of the ambulance but it's not true. if i could send someone else i would but we don't have the staff so more often than not it comes down to me. it's a self reflexive exercise. am i good enough? is there anybody better? what are the risks? if it was me who would i want in the back of the van with me?

for now it's me but there's never a moment when i don't wish that i wasn't sitting back in my office, feet up, reading a book, everybody well, me not needed. bliss indeed!