I really want to write about the Ireland-England rugby match of last Saturday, but apart from a few comments on Brian O’Driscoll’s hamstrings there isn’t much of medical interest there. (I could indulge in lots of gloating about the victory, but that wouldn’t be my style.) (Snigger.)
The dreadful head injury that John Terry suffered in Sunday’s Carling Cup final gives more scope for medical musings. For those of you who didn’t see it… Terry was attacking, in a good scoring position and launched himself head first at a cross from the wing…and connected full on with Abou Diaby’s boot. There was no foul play, just one head and one boot going for the same ball.
Terry fell to the ground and lay motionless – truly flaccid, not in that silly way some players do when their hope for a free kick is much stronger than their acting ability. No, Terry was knocked out. What we saw next appeared a model of good practice in dealing with a collapsed patient.
The players called for help; the paramedics saw their patient was unconscious and made sure his air tubes were clear – on TV you could see one of them holding the patient’s jaw forward* – then they checked for breathing and a pulse in the neck. Next they made the sensible assumption that there might be a neck injury too so they didn’t use the ‘recovery position’ but held the jaw forward and fixed their patient’s neck in a splint; and added some oxygen reduce the possibility of brain injury. Finally off to hospital.
Could we do the same?
First-Aiders know that the steps for management of a collapsed patient are now standard throughout Europe. There are two ways – the right one and the others. Whether your patient has tumbled from a horse Rathlin Island or from a bus on the Champs Elysee, the procedure is the same. The Resuscitation Council has a good website - See http://www.resus.org.uk/SiteIndx.htm - and here’s a summary: I remember it as Dr ABC
1. Danger! Is it safe to approach your patient? Traffic? Fire? Bare cables?
2. Response; shake your patient by the shoulders and ask “Missus, are you alright?” (If you ask John Terry this and he doesn’t thump you…he’s not alright!)
If no response – Get Help. Don’t be shy. Raise one hand and shout “I need help here!” Send someone to ring 999. “There’s a collapsed patient at…”
*3. Airway; the air tubes are mouth, nose and throat. Are they clear? Look and see. If there’s food, hoke it out. The famous ‘swallowing his tongue’ really means being so knocked out that the tongue falls backwards and blocks the throat. To avoid this, push the jaw forwards from behind, or just pull the jaw up by the lower teeth.
4. If your patient is Breathing, roll him into the Recovery Position, on his side/tummy. If not, you’re into resuscitation measures – you have learned these, haven’t you? If not – back to the first-aid book or website for you.
Like John Terry, you just can’t tell when these skills might be useful. Learn them today.
And like John Terry, your patient may benefit from proper on-the-scene care, and be up and about in no time. Best Wishes to John for a full recovery. (Even if he’s not an Irish rugby player; did I mention the rugby match?)
Tuesday 27 February 2007
Thursday 22 February 2007
There Can Be Humour in Death
An average General Practitioner looks after about 1800 patients, and of these about 12 die each year. Some die at home, some in hospital amd hospices, others out and about in other places. I suppose most of would like to die at home in the company of our loved ones but that isn't always easy to arrange...
I have been working in my local hospice recently and have been touched by the strength and humanity of many of my patients there, all of them knowing that their deaths are not far away. I was particularly entertained by a story from Bobby, who was well enough to enjoy his 80th birthday but died some days later.
Bobby had worked for a time as an undertaker's assistant, and as he noted that it might not be long until he was in the hands of the undertaker himself he remembered being a young man going to a house to lay out the deceased. It was the nineteen forties and there was no electricity, so he brought his candle for light. As he worked at the final dressing he accidentally pressed on the deceased's tummy; this expelled some retained air from the lungs and blew out the candle...
Some time later his colleagues went to find out why Bobby was taking so long... they found him in the dark, still fainted, lying face down across the legs of the deceased! Fainting seemed reasonable enough to me - I wonder how I would have reacted if I felt the corpse had blown out my candle?
Bereavement and grief are very powerful emotions; many of us have experience of the severe pain from the loss of someone we love. Here in Northern Ireland we help one another through this pain with our funeral procedures. We have the custom of the wake and the church service followed by the burial - or more recently, cremation - and it is understood the process takes three days or so. It's not the same in England, where the funeral is often held a week, even a fortnight after the death.
I was reminded of this twice recently - once when an Englishman domiciled here for thirty years died and his sister who had never been to Northern Ireland had come over to be with him. She was astonished - and delighted - at the social support she and her brother had in his illness, and then for the funeral. She couldn't believe how smoothly the arrangements could be made and how many people came to pay respects.
The second time was when I attended a talk by the Coroner for Northern Ireland, Mr. John Leckey. John was explaining that there are new arrangements for the signing of death certificates, and he felt he would have great difficulty applying them to Northern Ireland. "They may well work in England, but maybe not here" he felt.
The new stuff follows from the report on the infamous Dr Shipman - more about him shortly - which demands more checks and cross checks on the death certificates doctors issue. These checks will take time and may delay funerals. The custom of the three-day funeral is so embedded in us that we won't want to delay matters just so the coroner can get the paperwork done (even if the paperwork is really to protect us all from another Shipman)!
Shipman was such a devious character that I think even he would be able to get around the new checks, but let me wait until the new system is in place before discussing it fully.
By the way, do you remember the initial reaction to the Shipman accusations? A group of his concerned patients began a group in support of him, unable to believe such a 'fine doctor' could be accused of mass murder. The group disbanded as the evidence mounted - for example his practice had many, many more deaths per year than the average twelve I mentioned at the start. Later one of the group commented: "He seemed such a good doctor in every way. He was available to speak to, spoke to me without jargon, seemed caring and concientious. Except he murdered my mother." Makes you think, doesn't it?
But Shipman was a rarity. There some forty thousand GPs in the National Health Service, with very few bad ones. That's thirty nine thousand and many hundreds of good ones.
I'll write about how we test the good ones another day.
I have been working in my local hospice recently and have been touched by the strength and humanity of many of my patients there, all of them knowing that their deaths are not far away. I was particularly entertained by a story from Bobby, who was well enough to enjoy his 80th birthday but died some days later.
Bobby had worked for a time as an undertaker's assistant, and as he noted that it might not be long until he was in the hands of the undertaker himself he remembered being a young man going to a house to lay out the deceased. It was the nineteen forties and there was no electricity, so he brought his candle for light. As he worked at the final dressing he accidentally pressed on the deceased's tummy; this expelled some retained air from the lungs and blew out the candle...
Some time later his colleagues went to find out why Bobby was taking so long... they found him in the dark, still fainted, lying face down across the legs of the deceased! Fainting seemed reasonable enough to me - I wonder how I would have reacted if I felt the corpse had blown out my candle?
Bereavement and grief are very powerful emotions; many of us have experience of the severe pain from the loss of someone we love. Here in Northern Ireland we help one another through this pain with our funeral procedures. We have the custom of the wake and the church service followed by the burial - or more recently, cremation - and it is understood the process takes three days or so. It's not the same in England, where the funeral is often held a week, even a fortnight after the death.
I was reminded of this twice recently - once when an Englishman domiciled here for thirty years died and his sister who had never been to Northern Ireland had come over to be with him. She was astonished - and delighted - at the social support she and her brother had in his illness, and then for the funeral. She couldn't believe how smoothly the arrangements could be made and how many people came to pay respects.
The second time was when I attended a talk by the Coroner for Northern Ireland, Mr. John Leckey. John was explaining that there are new arrangements for the signing of death certificates, and he felt he would have great difficulty applying them to Northern Ireland. "They may well work in England, but maybe not here" he felt.
The new stuff follows from the report on the infamous Dr Shipman - more about him shortly - which demands more checks and cross checks on the death certificates doctors issue. These checks will take time and may delay funerals. The custom of the three-day funeral is so embedded in us that we won't want to delay matters just so the coroner can get the paperwork done (even if the paperwork is really to protect us all from another Shipman)!
Shipman was such a devious character that I think even he would be able to get around the new checks, but let me wait until the new system is in place before discussing it fully.
By the way, do you remember the initial reaction to the Shipman accusations? A group of his concerned patients began a group in support of him, unable to believe such a 'fine doctor' could be accused of mass murder. The group disbanded as the evidence mounted - for example his practice had many, many more deaths per year than the average twelve I mentioned at the start. Later one of the group commented: "He seemed such a good doctor in every way. He was available to speak to, spoke to me without jargon, seemed caring and concientious. Except he murdered my mother." Makes you think, doesn't it?
But Shipman was a rarity. There some forty thousand GPs in the National Health Service, with very few bad ones. That's thirty nine thousand and many hundreds of good ones.
I'll write about how we test the good ones another day.
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