Hitting the Wall

It was the middle of a night shift, around 3am. The time I usually struggle. I was sat on standby with my crew-mate; he was driving and I was in the attendants seat. I could feel my eyes beginning to close.

“DMA001, please respond to 1 Night Street, Nosleep village”

The radio sprang to life. I jumped and the sudden surge of adrenaline brought me to my senses. I leant forward and pressed the button to say that we had received the job and were mobile.

This job was a category 1 job – the highest category. Usually reserved for potential cardiac arrests, major haemorrhage or unconscious patients. The MDT showed that the patient was unconscious.

As we headed toward the job more information was coming through as the call taker was receiving it. We now knew that this was a 52 year old male who had been unconscious and now was conscious but very confused.

Night shift fatigue is a very real thing. Most ambulance staff work off of coffee and sweets, riding a sugary caffeinated high throughout the shift – not particularly healthy, but effective. However, regardless of my sleep pattern or diet; I always hit “the wall” at around 3am.

Luckily, it would seem that between the adrenaline from the initial jolt that the radio gave me plus the fact that this job sounded serious woke me up and would provide the boost I needed for the rest of the shift.

We arrived outside the house. Upstairs, one of the lights was on and we could hear shouting as we approached.

“Calm down!” a woman’s voice cried.

We approached the door, and knocked.

“We’re upstairs!” The voice cried “The doors open, I can’t hold him much longer!” A voice cried.

My crewmate and I looked at each other, eyebrows raised. We stepped forward and opened the door.

The house we stepped into was nice, the hallway lined with photos and the air perfumed with the smell of the air freshener that was on a table by the front door. We shut the door behind us and head upstairs, wandering towards the light that had been left on in one of the bedrooms.

We walked in to the strangest sight.

On the bed was a pair of legs, flailing around as the person face down underneath tried to get free of the thing pinning them down. That thing…..was the patients wife.

“Oh I’m so glad your here” the middle aged wrestler said to us.

“It’s my husband Don, he’s having a hypo” She quickly explained

“Geerrrrroooffff me!” The man under her screamed and bucked, in a scene that can only be described as the same way a bucking broncho would. The patients wife holding on for dear life.

I walked round the other side of the bed so I could get a look at the patient, watching out for the flailing arms and legs as I went.

Hypoglaecemia is a condition where the patients blood sugars can fall to low. It leads to agitation, confusion and ultimately a coma. If untreated it is fatal. Usually diabetics have these episodes, which are referred to as “hypos”.

The wife quickly explained that the patient has recently been having hypos as his insulin dose had been increased. She went on to tell us that each time he has one he becomes confused, agitated and wanting to fight everyone and anything.

The patient was naked, extremely sweaty and fighting hard. I quickly restrained a hand and took a blood sugar reading – finding it to be 1.2mmols (the normal range is 4.0-8.0). The patient was definately having a hypo.

As a paramedic, there are four treatment options available to me in order to manage a patient suffering from a hypoglaecemic episode:

1. If the patient is able to, encourage them to eat something sugary and follow it with some carbohydrates (the short term boost from the sugar is then reinforced by the carbohydrate)

2. Administer a tube of Glucogel. This is a sweet smelling paste that the patient absorbs into their gums when it is squeezed into their mouth. It gives enough of a boost of glucose to allow further treatments to be used.

3. Intramuscular Glucagon – this is a vial of powder that is mixed with fluid and injected into the arm. It is good as a last ditch attempt as it stops the liver from storing glucose – if it is given the patient must be taken to hospital

4. Intravenous glucose. IV glucose is given through a cannula in the vein. It allows the body a supply of glucose to then regulate the blood sugars. It is fast acting and effective.

The fact that this patient was so combative meant that getting a cannula in would be difficult. However, I quickly explained to the wife that this would be the fastest course of action in order to boost the patients sugars. She agreed and said that this was what had been done before.

We started planning what we were going to do in order to make this safe for everyone. Luckily for us, the patient was pinned down in a sort of star fish type shape. This meant that it was easy to get to an arm in order to put in a cannula.

Between us all we managed to get the patient into a position where movement was difficult and limited. As I placed the cannula in the patient started fighting more intently. I thought to myself about how well this wife was managing to restrain her husband considering the force he was fighting with.

Cannula in and secured, I started pushing through some IV glucose. The first 50ml went in with no change. However, by around 70mls the patient had started to relax and the wife managed to get up off the patient. This was the first time we had managed to get a good look at the both of them. The wife left the room for us to carry on our assessment.

The patients wife was around 5’10, and of a slight build. She looked flushed and was out of breath. Looking at the patient it was amazing that she had managed to hold on so long and stop him from either hurting himself or from her.

The patient was a little larger, he was around 6’2 and probably weight 20 stone. He was dripping in sweat and looking around extremely disorientated.

Luckily for us, the glucose was working and the patient was slowly returning to normal. I quickly covered him up with a blanket that was on the end of the bed for his dignity as we set about assessing him fully. As we were doing so he was becoming more co-operative, apologetic and starting to ache all over.

The patients wife returned carrying a plate full of jam and toast. She explained that she knew we would ask for it next as it is what normally happens. She obviously knew exactly what to do.

For the next twenty minutes we sat with the patient and his wife. The angry man that was fighting on the bed was gone, and the patient was now extremely apologetic.

After we referred the patient onto the diabetic team at the hospital and printed out our notes for the patient we left. Stepping out into the sunrise.

“I’m glad she was there” Said my crewmate, referring to the patients wife.

“I couldn’t think of anything worse than having to pin him down at 3 am” he continued.

The adrenaline from the job fuelled us, as it did her. We were lucky it was there. It helped us break down what felt like a very big wall.

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