A/N: You do not need the definitions included at the end of this chapter to understand what's going on. They are purely there for interest.
27/10/07
7:25 AM
An ambulance, parked at the Eurotunnel Terminal
"Patrick, you drive." The bald paramedic said, as they set the man down inside the ambulance. "I'm not sure this one's going to make it to A&E alive."
"Do you think he's hypovolaemic or dehydrated?"
"I think he's possibly both. Look at the way his skin tents. Once you see past his colour and his bruises he's very pale, and very cold. I think he's shocky too. Do you want to try for a vein?"
"I'll try once."
"Let's see if I can actually raise one for you, eh?" The bald paramedic grabbed the man's arm, twisted the bruised flesh gently and held it. Patrick pulled a catheter out of a bag and opened the packaging. He swabbed the man's arm with alcohol and drove the catheter in, slowly, shallow angle. "I think it's just there, just to your right." Blood filled the hub, slowly, but definitely venous blood.
"Thanks Rob." Patrick started taping the catheter in to place.
"No problem. It's not easy to get a vein first time in a patient this flat."
"500 mil saline?"
"Absolutely, and do we have eye lube?"
"Yeah, it's there." Patrick set a fluid line up and attached it to the patient's catheter. Rob applied a clear jelly to the patient's eyes.
"Very small pupils." He remarked.
"He looks almost… Tiny pupils plus vomit, plus not breathing that well and cold… he almost looks like a heroin overdose."
Rob sighed. "I know what you mean – help me get his legs propped up – but if it is that it isn't only that, he doesn't look like a druggie, he looks too well." Patrick snorted. "Not right now, obviously, but he's not thin, his veins aren't shot to bits, his hair's cut, he looks like he works out. What's inside his mouth like?"
Patrick looked. "Bloody, he's missing teeth."
"The thing is, for his injuries, I'd want him to have opioids anyway, so part of me wants to hold off the naloxone."
"What if he arrests?"
"I'll have it drawn up and keep a hand on his pulse."
"You know that's no-"
"Let's get him to hospital then. Throw me the fluid-pressure-sleeve-thing."
A&E: Accident and Emergency, the British term for ER
Raise: To raise a vein is to block its outflow, so it fills and becomes prominent so it's easier to get a catheter into
Hypovolaemic: Having insufficient blood in the body, usually but not always a consequence of bleeding.
Shocky: Medical slang for hypovolaemic and not coping with it
Opioids: The powerful class of painkillers that includes morphine and also heroin, which can cause a patient to stop breathing
Naloxone: The most effective antidote for overdose of drugs like heroin, including most powerful painkillers.
Arrests: Stops breathing or heart stops beating. If the latter happens, the man's chances of surviving this would be under 5%.