Sir, I am a Paramedic!

Written for Jin Zhanhe

Even though I have ORD almost two years ago, it seems like my medic skills are still being put to good use.

Last month I attended a workshop. During one of the sessions there were bright flashing lights and loud music. Suddenly one of the participants collapsed. She was immediately surrounded by the trainer and several facilitators. They were crowding around her and did not seem to know what to do.

I could not stand it any longer. So I walked to the other of the room quickly and started what we medics do best: PAM (Patient Assessment Model). The trainer looked at me and said, ‘Are you medically trained.’ I said, ‘Sir, I am a Paramedic.’ ‘Oh you are EMT…’ (On hindsight EMT seems to be a more appropriate title for the level of training I have, but this is Singapore.)

The patient was a female in her thirties, and she was found lying on the ground clutching her chest. Patient responded to pain when inflicted via trapezius squeeze (P on AVPU). There was no distortions or disability in her neck, though she could not sit up without assistance. After a few minutes two more participants came to help out. One was an old staff nurse and another was NS Medic too. Yay, backup!

She was breathing slowly, and could respond to my questions in a rather weak and slow voice. Radial pulse was hard to feel. Capillary refill on her fingers was prolonged. She couldn’t feel sensation when I pressed onto her nails. She was a lady, so I didn’t bother with the Rapid Body Survey. Her skin was pale, cool and clammy. She was still able to respond to my questions at the point of time. Pulse at the ankles could barely be felt.

Her complaints were chest pain, and ringing in the ears. She said that she does not have medical history of heart disease, so I decided to rule out chest pain of cardiac origin. She was not taking any medication either. She said that she had similar fainting spell a few months ago, by the roadside. I didn’t check about the cause back then. There were bright lights and loud sounds, coupled with emotional stress, so that could have possibly been the trigger. In this case the underlying cause was quickly identified: she had not slept the night before. I concluded that she fainted due to physical exhaustion.

By this time we were able to make her sit up with the assistance of the other two participants, and she was able to take small sips of water. She was able to stand up with the help of the facilitators, who took her to a separate room for a short rest. Fortunately she was all right for the next few hours of the workshop.

Phew! Not too bad, but among the things I can improve one are:

1) I forgot to check for allergies.
2) I totally didn’t know that the ringing in the ears is a symptom of Vasovagal Syncope (According to Wikipedia it is). Vasovagal Syncope should have been the more accurate diagnosis. Hey I didn’t learn this at SMTI!
3) I had no idea on the most comfortable position for this kind of patient, since she was not unconscious we did not put her into the recovery position.

Okay, this case didn’t seem very life threatening so I shan’t gloat with the customary ‘One life saved!’

Yesterday there was another opportunity for some action. I was on the NEL on the way home, when there was this schoolboy sitting opposite who had a nosebleed. So I went to sit next to him to see if he was all right. Oh interesting, he was a Sec 1 Marist.

I didn’t do much. Just advised him to pinch the bridge of his nose and lean forward. Gave him my packet of tissue paper and a plastic bag to store the soiled ones. I asked if it has happened before, and yes, he said that it happened often. I advised him to see a doctor. There were some considerate passengers who offered wet tissues. It was at Hougang when I noticed him, but the bleeding stopped when we arrived at Punggol.

Marists can take care of themselves so I didn’t accompany him out. Still, it’s on days  like these that I am thankful for being a medic.

For your reading pleasure:

Wikipedia: Vasovagal Syncope
Wikipedia: Nosebleed

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