Paramedic calls: Sepsis Sunday

Alex shares calls from his weekend shifts, including several patients with sepsis.

Paramedic shift patterns

The second week of placement has seen me and my crew recover from night shifts and move into three 12-hour day shifts. Adjusting your sleeping pattern between days and nights can be a struggle at times and it’s certainly a skill that takes time to master.

London Ambulance Service transport

Our three-day working weekend gave us a semi-dramatic end on Sunday with four blue calls placed in the shift, which kept us on our toes! Our first job of the shift was to a middle-aged gentleman that a doctor requested LAS (London Ambulance Service) to transport to hospital after an over-the-phone assessment. We arrived five hours after the call had been placed, due to the sheer volume of ‘life-threatening’ calls made throughout the night before. We attended the call and walked through the door to find the patient looking very flushed on the bed. After taking a radial pulse and feeling how ‘hot-to-touch’ he was, I could already predict how critically ill this person was. He was extremely pyrexic at 40.6 degrees, tachypnoeic at 42 breaths per minute, tachycardia of 116 beats per minute and had a SpO2 of 92% on air. This patient was presenting with severe sepsis and we blued him in the to nearest hospital.

A patient armchair-bound

After establishing a history of the presenting complaint we found a rash on his left knee where the doctor queried septic arthritis. His wife informed us he recently returned from a Middle Eastern country five days prior to the 999 call being placed. We were quick to establish treatment for sepsis by administering 15L of high flow O2, gaining IV access and administering a 500ml bolus of sodium chloride, 9% and 1g IV paracetamol for the associated pain. Following a swift handover in Resus we left to respond to our next 999 call. This was to an obese patient who has been unable to weight bear and consequently been sat in her armchair for two weeks. She had been incontinent and her legs had swollen a lot according to her full-time carer, who was also her nephew. It was very much a social issue whereby the nephew and neighbour could no longer cope with her healthcare needs, and the patient required more appropriate primary care to be put in place.

Deep cleaning the ambulance

We carried out our checks to find she was hypothermic at 31.2 degrees, hypotensive with a systolic blood pressure of 95mmHg, and was bradycardic at a rate of 45 beats per minute. On auscultation of her chest we suspected there to be a build-up of fluid. Her clinical presentation along with the oedema in the legs suggested CCF, otherwise known as heart failure. We requested a bariatric vehicle from St John Ambulance to transport her to hospital, and whilst we were waiting for their arrival we received a phone call from a team leader. The team leader stated that the hospital suspected our previous patient of having MERS (Middle Eastern Respiratory Syndrome). This was very bad news and meant we had to return to base for a deep clean of the ambulance after we had handed over to St John; which blued her into hospital.

The rest of the day also saw another severe sepsis diagnosis and a paediatric patient who had a very high respiratory rate after having a vacant episode in front of her parents. It certainly has been busy, and in fact I slept for 17 hours after the final day shift, I’m not kidding!

Events and academic work

This week I am attending a Pre-hospital Care Conference and London HEMS Clinical Governance Day, both beside The Royal London Hospital in Whitechapel. As well as this I will be working hard on my Anatomy and Physiology essay and working at Anglia Ruskin’s Open Day on 3 December; I hope to see many of you there!

Alex studies Paramedic Science at ARU. You can find out more about this and other degree courses at one of our Open Days.