Whether the public call for any ambulance is quite another question.
Having called for an ambulance the dispatcher should send an ambulance
response and the ambulance system should transport, provided the patient
will go of course.
What doctors do or say may be different.
Regards
Dave
----- Original Message -----
From: "McCormick Simon Dr, Consultant, A&E" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, November 17, 2006 10:30 AM
Subject: Re: 48 y/o male 1st fit
So, are we saying that in any case of fit (unless a known epileptic) the
correct course of action is to call an ambulance? Or are we saying that
if an ambulance attends they should always transport? Or, if a member
of the public calls for advice and says, I have a person here who has
fitted but 'seems' to have recovered fully, should I bring them to
hospital myself or should I use an ambulance an ambulance should always
be sent?
Simon
-----Original Message-----
From: dave.j.fletcher [mailto:[log in to unmask]]
Sent: 17 November 2006 09:51
To: [log in to unmask]
Subject: Re: 48 y/o male 1st fit
I agree. Not to transport was unacceptable.
Whilst an elevated pulse rate at 1 hour may suggest a cerebral event
there
are many non-cerebral causes of seizures including arrhythmias.... that
include self-terminating VF.
I remember bringing in an AMI to Rowleys hospital many years ago who
arrested just outside the A&E. It was a 20 second tonic-clonic event
where
blood shot out of his nose and hit the back doors of the ambulance 5
feet
away! Following successful defibrillation, the following day in CCU he
had 2
most impressive peri-orbital haematomas! Hardly the 'classic'
hypoxic/anoxic
fit.
A pulseless VT with minimal cerebral perfusion can cause seizures for
over a
minute.
Seizures - cause unknown - transport!
Regards
Dave Fletcher
----- Original Message -----
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, November 17, 2006 8:12 AM
Subject: Re: 48 y/o male 1st fit
> What was the cause of his seizure?
>
> The most likely reason he vomited blood was he had a fit. There is
> always a differential diagnosis, and with a tachycardia he may easily
> have had a GI bleed sufficient to drop his blood pressure so that the
> fit was as a result of a poor brain perfusion. A pulse rate of 120 AN
> HOUR after the fit is not usual. I acknowledge his blood pressure was
> now normal, but he has had an hour to compensate and I bet it was not
> performed standing.
>
> I find nothing to criticise in the crew's actions until bizarrely,
they
> decide not to transport. Although I understand the rationale of making
> the ambulance clear for further calls in my view it is at the expense
of
> this patient - the one they already have.
>
> Perhaps the most worrying feature is that nothing they did explained
the
> fit, and the risk of subsequent fitting is high in this acute phase.
> Expecting a member of the public to protect the airway is quite
> unacceptable. I do not find they acted safely or in the patient's best
> interest.
>
> /Rowley./
>
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