Friday 11 May 2012

Blood and Guts

"32 year old female, in labour, 4th child"

When people think of an ambulance they think of blue lights, blood and guts! It's all drama, all Holby City, very Casualty, we climb scaffolding, there are regular explosions and everyone who goes into cardiac arrest is shocked with pads and we get them back. Oh and the helicopter is always there. In reality however there is none of that. There are a lot of drunks, a fair amount of vomit, minimal blood and guts and we rarely get people back to discharge. Oh and the helicopter is never there! Don't get me wrong, there are stabbings, shootings, major trauma and all the things you see on TV but they are few and far between. Today however was one of those 'good days' I often speak about  with 'good jobs'. When we talk about 'good jobs' someone somewhere is either dead or in a lot of pain, life & death is on the line or it is something we have never seen before and probably won't again. To get one in a shift is a rarity. To get two is frickin' awesome!

It was a short shift for a change, we had hadn't done much to be honest, a couple of non-descript bread and butter jobs when this 'in labour' job came down. Normally it is simply a case of get them on the ambulance and pop them off to their maternity unit, hence the tag 'maternitaxi'! The "4th child" rang alarm bells as more often than not, delivery can occur much quicker after a number of children. Then we got the following update:

'4th child. Last 3 have been delivered within 20 minutes of waters breaking. Waters have broken'

OK, so there was a good chance that today I would be playing the role of midwife. We pulled up on scene and grabbed everything and I mean everything; response bag, oxygen bag, entonox bag, paramedic bag, lifepack 12, maternity pack & loads of inco pads. Loaded up like pack horses we trundled in. Sitting on the floor, legs akimbo was our patient....screaming! I waited the 20 seconds until the contraction had passed and introduced myself. No soon as I had done that and off she went again. This baby was being delivered, by me, anytime now. During the following contraction out came the head, followed closely by the rest during the next one! Jobs a good'un! We cut the cord, cleaned up baby and sat back while they shared their first few moments together. The squeamish dad who had been hiding in the hallway came bounding in when the crying started. It's one of the few moments in this job where you can sit back and smile.

Sadly, that moment didn't last long. It became clear that the blood bath on the floor was increasing, she was having a post-partum haemorrhage; so we gave baby to dad and started trying to stop it! She was looking a little pale and in just two minutes her blood pressure had markedly dropped. My crew mate got IV access while I gave a Fundal massage to assist the uterus clamping down and stop the bleeding. Unfortunately it didn't help. We requested a second ambulance and started putting up fluids and administering Syntometrine to contract the uterus. The second crew arrived and fetched our bed from the truck. In cases like this, although a second ambulance seems overkill, we don't want to have to worry about a newborn baby if something goes wrong with mum en route. Similarly we don't want to ignore mum if something is wrong with baby. Two patients, two trucks! Simple! We loaded mum onto the truck, still bleeding heavily, and shot off on blue lights. We arrived at the hospital and left our patient with the doctors and we went to clean up! And oh my, there was a mess!

Having taken the short journey back to the station, to change our uniform and mop out the truck, we made ourselves available for one last job. Annoyingly, we sat there for 20 minutes without a peep coming from our radios so being late off was now a certainty! At last the telling ringing came blaring down our radios!

"30 year old female, had C-section stitches removed today, now bleeding"

Hmmm... like I've said before, jobs tend to follow a pattern in a shift. Clearly maternity and blood was the order of the day. We were only about two minutes away so were there before the call had even finished. As impressive as this was in terms of image for the service, it meant we walked in without the full picture. We went in with the bags we normally take in, nothing extra; what we were confronted with I can safely say I will never forget...

Our patient was sat calmly on the sofa, smiling sweetly and topless. Oh... I should probably point out that her intestines were sitting on her lap. Yep... intestines... on her lap. Her intestines were on her frickin' lap. I starred for a moment and looked at my crew mate for inspiration! 

"Well that's not normal is it?!"

This is not in the book. We have not had specific training on 'intestines on lap' per say but we are trained to improvise, adapt and overcome. My crew mate RAN off to the truck for fluids and extensive wound dressings. After some crashing and banging he appeared with a bed too! How he got it up the three steps on his own I don't know but it was a stellar effort. We soaked a dressing with saline and placed it gently over her 'eviscerated bowel'. I believe that is the technical term for 'guts on lap'! She wasn't in pain; apparently it felt like butterflies in her tummy. She had the stitches removed a few hours ago and the wound started oozing, she then stood up and felt a sharp pain, sat back down, had a peek and phoned 999. Very sensible! In all honesty we really didn't have a clue what we were doing but we blagged it pretty well; after all we wanted a 'good job'! It really is true that life begins outside of your comfort zone!

We rushed off on blue lights having got fluids flowing. We assumed fluids were a good call! 'Intestines on lap' wasn't an indication but was good enough for us. On arrival at the hospital every HCA, nurse, student, junior doctor, registrar, anaesthetist and consultant was waiting. The blue call of '30 year old female with eviscerated bowel, intestines on lap' must have got people talking. No real handover was needed. I lifted up the dressing and said 'she's got tummy ache'! It got a laugh so I left the department sporting a cocky grin! It appears that this job really is all about blood and guts! Home time!


  1. Er, d'you get to know how the cases turn out? I think we'd all like to know!!!!

  2. Sadly not! Very rarely find out the outcome! Very frustrated!

  3. Is it bad that I just proper LOL'd at intestines on lap? :)

  4. You and my No.1 son would get on like a house on fire. Would live to see you crew an Ambo together!!!

  5. I will always remember as a student nurse an elderly chap sneezing post abdo surgery and calling me over with 'ere nurse av a look at this'. No not a flasher but guts in lap. And he was just as calm as yours!
    Love your blog and all that you do


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