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‘Of course there’s a black side,’ Jane said gloomily. ‘A mere sprinkling of white dust and the whole city grinds to a halt. Cars slither, people slither, bones are broken…’
‘Well, we’re stuck here, anyway, so we may as well have some customers.’Lara heard the siren and gave a nod. ‘Here we go. Lights, camera, action.’
The paramedics took the unconscious man straight through to Resus and seconds later Christian joined them.
Jack, the paramedic, helped transfer the patient from their stretcher to the resus trolley. ‘His name is Gordon Baxter. He’s fifty-five, lives with his wife. She went out shopping this morning and found him when she returned. Apparently there was a note telling her not to call the ambulance.’
The team listened to the handover as they worked.
Without delay, Christian intubated the patient and Lara helped Penny insert a line into the patient’s vein.
Jack moved the stretcher away and retrieved his blanket. ‘He’s been treated by the doctor for depression but there were no empty bottles lying around. We looked.’
‘Is his wife here?’
‘Just giving his details to Fran in Reception.’ Jack looked at the man on the trolley. ‘Apparently he lost his job six months ago and he’s been depressed ever since.’
‘Poor man,’ Lara murmured, monitoring his pulse rate. ‘It’s a hundred and forty, Christian.’
His mouth tightened. ‘He’s taken something. We just need to work out what. Can someone go and question his wife in more detail? Were any of his tablets missing?’
‘I’ll talk to her,’ Jane said immediately, and Lara reached for the ECG machine.
‘Let’s do a trace.’
‘Yes.’ Christian was examining the patient, checking his eyes. ‘He has a divergent squint and his pupils are unreactive. Penny
—we need to check his blood gases.’
Lara attached the ECG leads to the patient and Penny stared at the machine. ‘He’s in VT.’
‘No.’ Christian studied the trace. ‘It’s sinus tachycardia with prolonged conduction. Look…’ He drew a finger along the trace. ‘The P wave is superimposed on the T wave. That’s why it looks like VT.’
Lara stared at the ECG and wondered if she would have spotted the same thing. Maybe. ‘Tricyclic antidepressants?’
‘Possibly.’ Christian nodded. ‘Very possibly. Can someone ring his GP’s surgery and find out what he was taking, just to be sure?’
Penny looked at them both. ‘How do you know it’s tricyclics? It could be anything.’
‘Not anything,’ Christian said calmly as he tested the man’s reflexes. ‘The signs are there if you know what you’re looking for. Lara, you should train as a doctor.’
‘I wouldn’t know what to do with the salary,’ Lara said cheerfully. ‘I’ve been living on nothing for so long.’
At that moment Jane hurried back into the room. ‘He’s been taking amitryptoline. His wife couldn’t find the bottle when she looked in the cupboard so it could be that.’
‘We can safely assume that it’s amitryptoline. Lara, did you send those bloods off?’
‘Yes.’ She looked up at him. ‘Do you want to give him activated charcoal?’
Christian shook his head. ‘Only if it’s within an hour of overdose and we’re way past that. Jane, do you know if the formulation he was taking was sustained release?’
‘It wasn’t. I asked.’
‘Good.’ Christian gave a nod of approval. ‘So let’s give him 8.4 per cent of sodium bicarbonate. Hopefully, by correcting the hypoxia and acidosis, we’ll treat the arrhythmias.’
Lara reached for the ampoule. ‘One hundred mils?’
‘We’ll start with that. Sometimes it produces a dramatic improvement.’
