Day 16 - Day 10 on the Cruz Verde Norte Ambulancia

(Myself and Chris, the FREUC 5 student from South Africa)

So yesterday I finally decided to take a day off, and watched a few episodes of Narcos on facebook and slept for the majority of the day.

Today was interesting, it was international women's day, and we were all issued with shirts to support the occasion. The first call was to a pedestrian that had been knocked down by a car, however on arrival the patient was nowhere to be found. After searching for the best part of 20 minutes we gave up and headed back to the emergency department.

Soon after we had a call to a seizure, on arrival the elderly man had stopped fitting, according to the family the seizure occurred due to alcohol withdrawal. Upon taking observations, all was normal with the exception of his blood glucose levels which were 230mg/dl. We transported the man to the ED.

Shortly after arriving back at the ED, we were called to the helipad across the road to transfer a police officer that had been shot in the arm. We quickly assessed the patient, in the two minutes that we had him and found that he had also sustained a fracture to the right clavicle. 

Another call came in a little later to a traumatic head injury to a drunken male. A motorcycle paramedic on scene had all ready dressed the wound and due to the combativeness of the patient, I took lead as the younger females working with me were very cautious of his aggression. Thankfully i managed to calm the man and take observations on the way to the ED.

Next we were called to an elderly male who had a brick thrown at him. Thankfully he had managed to stop the brick from hitting his head but had sustained a fracture to his radius instead. We splinted the lower arm and transferred him.

The final job of the day was a resus, the patient arrived by ambulance at the emergency department, where he was quickly intubated and advanced life support was started. After several shocks, the patient returned to normal sinus rhythm, and over the next couple of hours drug therapy was given to maintain output. Intravenous access was extremely difficult, and about 6 of us tirelessly worked to get access. In the end after no success the doctor decided to access via the femoral artery which worked for a little while, however the slightest move and we lost access. The patient eventually deteriorated and was pronounced dead an hour later.

The death of this man presented an opportunity for us to practice our intubation skills, out of the four of us, I was the only to successfully intubate the cadaver first time, and used this as an opportunity to help others learn. Demonstrating the use of cricoid pressure I was able to successfully help the others achieve a patent airway.

(Warning, the images below show the cadaver)