Hot Tamale

         Summer had announced itself in abrupt and rude manner this year. Many were not prepared, oblivious, or simply at the wrong place at the wrong time. Summer solstice had not even officially taken place but it was well over 100 degrees (38 C) outside. For one man it would almost cost him his life. He was in his early 20's and a labourer from Pakistan, surely driven to UAE for its pay and in hopes of a better future while building up his bank account. Fueled by the sweat on his brow and the epitome of working class ethic he did his job day in day out like a well oiled machine. However, on this day he would not be working outside, but in a confined space. A small room with no ventilation, a variable hot box from a wartime torture camp of days gone by. This was his office for the day and he didn't even bat an eyelash as he carried out his duties within it. Like a dog or a child left in a hot car in a searing summers day by its obvlious owner or negligent parent. It was wasn't even noon by the time he collapsed.

I found him confused and disoriented as I took him into our air conditioned ambulance. As I slide the thermometer deep into his ear canal I eagerly awaited the reading. The thermometer let loose the familiar audible tone and I gazed down at the reading in disbelief... 107.6 F(42C). It be must wrong I thought as I rechecked and confirmed it was indeed correct. At this temperature his brain was beginning to cook and if he was not cooled down he was gonna have a bad day, and could even die. 

       The man's heart was racing and I began to remove his clothes and cover him with ice packs. Ultimately  I had now done everything I could to lower his temperature by removing him from the hot environment, taking his clothes off, covering him in ice packs, and turning the air condition on max, so I now needed to move on to his other problems. He was complaining of chest pain and I connected the cardiac monitor to him and watched his heart gallop along at 150 beats per minute. I hoped by cooling him down I could reverse the problem.  I tried apply more ice packs to his face and neck which in addition to cooling him down can also sometimes lower the heart rate by triggering the mammalian diving reflex. However, despite my best efforts this also did not work.

        I pulled out an 18 gauge intravenous catheter and hoped to god I wouldn't stab myself with it; the back of the ambulance rocked back and forth as it raced down the street at 160 Kph (100 miles per hour). At this speed performing any procedure can be extremely difficult, I yelled at the driver to slow down, but to no avail. I grasped the needle as firmly as I could and just went for it. I pierced a large vein on his left arm. As I slid the teflon catheter deep into his vein I simultaneously retracted the steel needle. Blood began to liberally drip out of the IV confirming I was in. I connected some fluids to the IV and watched as they poured into his hungry veins. His tank was on empty and he needed the fluid badly. Our ambulance tires screeched into the Emergency Department entrance as I unloaded him. On arrival thee hospital rechecked his temperature and  our reading was indeed correct. They continued our cooling methods and also monitored his heart rate. He was the first heat casualty of Ramadan on my shift, but certainly not to be the last.

Take my breath away

If you're one of the few people who read my blog, my apologies for my recent absence as I was on vacation. I will be adding extra content this month to make up for it.

I stood over him in the back of the ambulance, grasping the 14 gauge steel needle in my hand. It looked more like a large metal straw for a frosty carbonated beverage than it did as a needle. He was completely helpless and I had an uncomfortable amount of power while he was at one of the most vulnerable moments of his life. I felt empathy for him and just wanted to help, but its hard to explain that to someone when you might have to perform a barbaric act on them. I had a certain level of anxiety that one gets before they are about to stab another human being in the chest. I did my best to put on a straight and calm face while I explained the procedure to the patient. If his condition got worse before we made it to the hospital, I would need to decompress his chest.

It all started 15 minutes earlier. A small grey sedan was mangled beyond all recognition. Where the trunk once existed was now an empty void, what remained of the trunk had been pushed into the back seat of the car. The durability and resilience of a human body amazed me as I saw the front seat passengers of the vehicle milling about with no injuries and speaking with police. The car looked liked it had entered the earth's atmosphere at terminal velocity and landed on its backside. The sheer kinetic energy of this entire incident was mind boggling considering how well everyone who was involved in the accident appeared. However, looks can be deceiving as I would soon find out.

As I scanned the scene and walked through debris  I came across a young man 10 meters from the car lying in the grass. He was in his 20's and his big brown eyes made contact with mine as we encountered each other for the first time. He had apparently been dragged to his current location by his associates in the car. My partner had already began treatment of another individual near by, and after searching the area for additional patients I returned to the young man in the grass. I ordered some hesitant bystanders over for help and gave them directions on how to hold the young man's head and neck while I returned to the ambulance for more equipment.

He had pain along his spine when I touched it and difficulty walking so we had to backboard him as a precaution. We immobilized his entire body to a long plastic backboard, strapped him down with Velcro, and placed a collar around his neck. He would need an xray or ct scan at the hospital before he could be cleared to rule out any spinal injuries. As I loaded him into the ambulance, the young man began to develop some minor difficulty breathing. I loosened the straps from around his chest, but it didn't seem to help much.

I looked at the oxygen monitor I had connected to him and watched as his oxygen levels began to slowly decline as be began to complain about pain in his chest.  As the ambulance began to move I listened to the young man's lungs and he had diminished breath sounds on his right side, his oxygen saturation levels where now beginning to teter on the edge of below normal and his chest pain and difficulty breathing became worse and worse with every passing minute. He likely had a collapsed lung aka "simple pneumothorax." With every breath he took air filled the pleural space around his lung, as air in this spaced increased with every breath it would become more and more difficult for the lung to expand and for him to breathe. If his condition continued to deteriorate it could get ugly. If his injury remained the same, I would simply reassure him, but if it got worse, action would need to be taken. The treatment for this injury can be pretty invasive and involves stabbing the patient in the chest with a very large needle to decompress the chest and relieve the pleural space of air around the collapsed lung. We only do this outside of the hospital when the collapsed lung develops into a life threatening condition known as a "tension pneumothorax." Unfortunately this patent's condition was continuing to deteriorate and the possibility I might have to ram a 14 gauge needle into his chest was becoming a possibility I needed to consider more and more with every passing minute.

I took the large needle out and it showed it to the guy as I explained the procedure. I then thought to myself where and how to carry out this if I needed to. I had to plunge the needle into the second intercostal space at a 90 degree angle to the chest, just over the top of the third rib, or was it he 2nd rib? Its been awhile I silently thought to myself. I was happy the guy couldn't read my mind... It had to penetrate deep into the pleural space on the right side to release the trapped air. Its not something we do very often  but I had to sell it to him  like I did it every day. As I continued to monitor him, his condition was getting worse and he began to teeter on the edge of possibly needing a chest decompression.  Soon, it would be my big moment to shine, but it would have to wait for another day as we pulled in to the hospital at that moment and his vital signs remained stable... Alas, another day...