Monday 27 February 2012

Getting Egged.........

"25 year old male, burns whilst cooking"

We were due to finish work in ten minutes, so getting sent a job wasn't greeting with joy if i'm brutally honest. In fact, it was greeted with expletives the words 'stich-up'! Nevertheless we set off on the 11.3 mile journey to the far reaches of the city fully expecting to be cancelled for a nearer vehicle. Wishful thinking! We pulled up outside already x-ray (our shift was finished), grabbed our stuff with the addition of the burns kit and headed in to the flats. The flat was crowded to say the least, 10 or so 20 something Romanian guys filled the corridor leading to the kitchen. I could hear our patient groaning in pain and swearing in Romanian as I got to the door. Drama queen was what I was thinking, how wrong I was!

This guy had been cooking dinner for his friends. Spaghetti Bolognese to be precise. He had cooked the sauce in a huge industrial pan, and I mean huge. For some strange reason he had been cooking in just his boxer shorts. Whilst transferring the pan from the hob to the table he had slipped and the entire contents of the boiling pan had gone over him. He was scalded on his face, neck, chest, arms and hands covering 40% of his body. The hot oil in the sauce made it worse too, his skin was bubbling and peeling everywhere and he was in agony. With burns we always advise running under cold water for 10 minutes but invariably different cultures have different ideas. There are old wives tales for what is best thing to do with burns, most commonly potato skins or butter are what we find! Trust me, neither are a good idea! Today however I saw something new and completely bizarre. Our patients friends were under the impression that the best thing to do was crack eggs on the burns. So they did. 24 of them to be precise. Quick question: What happens when you add raw egg to heat?! Just sayin'!

That is how we found our patient. Lying on the kitchen floor, just wearing boxers, surrounded by bolognese sauce, badly burnt and covered in fried / scrambled egg. It looked like he was mummified in an omelette! We helped him up and marched him (slowly) to the bathroom and sat him in the bath where we showered him in cold water for 10 minutes trying to get the bolognese soufflĂ© off his body. Once dry we started the arduous task of dressing his burns as best as we could. After the first futile attempts we decided to wait until on the truck to dress them properly. We carried him downstairs and got him on the bed. The adrenaline was wearing thin and he was in a lot of pain. He was chuffing away on the Entonox but it was having little effect. He needed Morphine and lots of it. Our main problem was he had circumferential burns to both arms where we would normally cannulate and burns to his hands and wrists. Our only other option was his foot, something that is very rarely done but on this occasion had to be. We got fluids running to combat the likely hypovolemic shock that would occur from this percentage of burns and loaded him up with morphine. We now started to dress the wounds with water-gel burn dressings and cling-film. 

Ambulance services in this country work to guidelines. That basically means we work to a set rules but at our discretion can deviate from them. If it works it was a justified deviation, if it doesn't, well, do the maths! Hung out to dry springs to mind.  In this case there is a guideline about only using water-gel dressings to cover a maximum of 12.5% of burns as there is a possibility of causing hypothermia. We had been reminded of this by CSD but they were not with us or with our patient. They couldn't see the pain he was in and the relief he was getting from the water-gel. We covered all of his burns on the basis we can keep him warm with blankets and monitor his temperature but there is nothing else we could do for the pain. Friday night rush hour traffic for 14 miles to the nearest trauma centre could take 35-40 minutes. I for one wasn't going to deny him an opportunity to be in less discomgort. Fluids flowing, Morphine in, burns wrapped and dressed, blue call placed, we headed off. 42 minutes, 2 bags of fluids, 2 cylinders of Entonox and 20mg of Morphine later we arrived at the hospital. I handed him over to the waiting trauma team, explaining the soufflĂ© mishap that had occurred and our ignoring of guidelines. The staff were more than happy that we had dressed all the wounds and said the guideline we had ignored was pre-hospital health and safety nonsense! We felt vindicated. Regarding the eggs......

"Eggs?! Are you bloody serious?! 

People do the strangest things to treat medical problems and I will never cease to be amazed. Needless to say, we were almost 4 hours late off but I didn't care one bit. Very few ambulance staff would care for that matter. It was a great job. If someone genuinely needs us, being late off is the least of our worries. 

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