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Despatches From The Front Line Part Six: Arrested Developments 22:29 - May 7 with 3585 viewsBlueBadger

*All names and locations have been changed*

Now, where were we?

Last time I wrote, I promised you I'd be completing my account of My Busy Day in ' a few days. Long story short, real life got in the way a bit but I'll give you one more highlight of that day shall i?

You might recall that the morning had been somewhat hospital politic-heavy which tends to take more of a toll on me than clinical work but I'd recovered my mojo thanks to the kind words of a man who makes a living by impersonating malfunctioning food mixer for a living.
He's since messaged me back a few times and my initial impressions appear correct, he's an absolute sweet heart.


Lunch finished, my two calls have since turned into three via the MedicBleep app(think WhatsApp only audited and more secure) that we use in place of old-skool bleeps.
I personally quite like MedicBleep for times like this, because I can screen, triage and priortise my calls more effectively as well as messaging back with 'things to be getting on with' if I'm unable to attend immediately. It does however, tend to encourage a 'message and run away' culture amongst the initiative-challenged, but I digress.

Call 1: Ward C3 have someone with a high NEWS score who's just landed from ED - notable features are an increasing O2 requirement, low blood pressure and increased heart rate.

Call 2: An ENT(Ear, Nose, Throat) consultant - he's got a young patient he'd like me to keep half an eye - an attempted hanging with some mild swelling around the neck. He's 'not worried' but can I 'be aware'. 'Can you be aware' is one of the most pernicious phrases of my job, it is quite often short hand for ''This is actually my responsibility but I am trying to make it yours'. I usually respond to these with a curt 'what would you like me to do with them?' before, if they don't take the hint and actually do their jobs, suggesting that they make a plan and call me with what they WOULD like me to do. However, professional etiquette and the clinical background of the patient(young and therefor likely to 'go off' suddenly with a potential for airway-related fun) means that I should probably take a gander.

Call 3 : ED. They have been pre-alerted someone in their 70's with COPD exhibiting covid symptoms who has a high O2 requirement and 'the consultant has asked if you can help'.

10 minutes' flipping through the note son the screen and my order of business is in place:
1. C3 get first call - I tend to prioritise the wards over specialist areas as they tend to have less easy access to senior medical input after morning ward rounds are finished and have a lower staffing ratio. Plus, C3's nursing team are not generally used to *this* kind of sick yet - give them someone with a complicated liver-and-kidney multi-organ dysfunction and they're well away, but they're still finding their way with the more respiratory-based approach that covid necessitates.

2. ED will be next - a consultant is already in attendance, plus the nurse making the referral is well known to me and is savvy enough to crack on whilst I work elsewhere. I message them back to say when I'll be there and ask for them to do sensible, basic things such as optimising oxygenation(COPD, particularly if the patient is prone to CO2 retention, usually means 'give less O2 than you usually would, too much will ultimately hurt more than it heals') and target O saturations of 88-92%(standard practice in CO2 retaining COPD), ensure bloods are done, take an ABG, chest X-ray, etc, etc

3. Brian, my colleague for the day kindly offers to go and 'eyeball' the ENT patient to buy me time. Brian will shortly be going off-site to do some teaching for a group of community nurses and won't be back on site till later but this will buy me time.

Plans made, I head for C3. A before-I-Go-See-Them chat with K, a second generation Sri Lankan FY2 who's endless enthusiasm for her job is only match by her fondness for Mrs Badger's cakes is on duty today. K has been intending on 'clerking' patient A for about 40 minutes now but has been hamstrung by a lengthy and difficult phone call to another patient's relative and the fact that ED have, as is their wont, sent C3 up 5 patients within 20 minutes of each other and is working her way through a list, she is immensely please when I offer to go see 'A' to do some initial management of this individual so she can catch up a bit.
Before I can do this however, the emergency buzzer goes off, so all plans are well and truly out of the window.

The call is originating from one of the side rooms. The patient in there is in their 50's, having been admitted overnight following a collapse of unknown cause, followed by a fall down some stairs and a minor head injury. They are also grey-looking, stiff and gasping. On feeling for a carotid pulse I can find no pulse.
As is traditional in these situations a mental 'oh f*ck' crosses my thoughts before training kicks in and I have to go into 'ALS Mode'.
ALS stands for 'Advanced Life Support' - everyone on the Outreach team holds and ALS qualification and it essentially gives you licence for a few things: at cardiac arrest, you are expected to be able to 'lead' the team, directing interventions and assessing for reversible causes and you are allowed to run a defibrillator on 'manual' mode. 'Manual' mode on a defib allows for a much quicker assessment of cardiac rhythm than having the machine do it and allows for quicker delivery of shock(if needed) and less time 'off chest' as a result - both of which are the two key interventions at at cardiac arrest.
My first instruction is 'Donna, can we put a call out please' to the nurse in charge - 'a call' means the cardiac arrest call to the arrest team - in roughly 30 seconds' time everybody who is expected to attend a cardiac arrest(me, the medical registrar on call, the FY2 on call, the anaesthetist on call and the ITU on-call) will be getting an old-fashioned bleep(we still use those for emergency calls, bleeps are clunky, communications-wise but in this situation a blunt instrument is needed) and will be expected to down tools, grab emergency kit and attend C3 ASAP. This will, of course, take time, so I'm in the chair for now.
Next instruction is 'can we start some compressions please' shortly followed by 'no, wait'.

Why wait? Well, because as will all things in hospital life, covid-19 has interfered with CPR practice as well.
There are currently mixed guidelines on CPR in covid-19. public Health England say 'this is not an aerosol generating procedure, no PPE is needed get on that bloody chest NOW'. However, the Resuscitations Council, who know a few things about CPR say(and I'm paraphrasing somewhat where) 'don't be stupid, we all know all sorts of disgusting fluids are flying about at an arrest, get kitted up then on the chest'.
Thankfully, senior management at [redacted] hospital are following Resus Council guidelines and have said 'no compressions until you're kitted up' and made sure that all the wards have a sealed box of dedicated 'arrest team' PPE.
This of course means that the numbers of people you can have at the arrest are limited.
Having stalled briefly(because I've had to stop and think rather than just let 'the drill' take over) I'm back into the flow - I ask Donna to act as 'bouncer' to the side room and only issue PPE to the appropriate people. In the room itself I ask Gemma, the nurse who discovered the patient to apply defibrillates pads(RC guidelines recommend 'pads on and shock if needed' before donning PPE), ask everyone else in the room to hear out, shut the door and kit up myself.
After roughly 45 seconds in which I put on gown, gloves, mask and visor I look up, preparing to start compressions if Gemma isn't able to yet, and the patient's 'look' has changed - they still look grey and dreadful but they are now exhibiting clear signs of having a seizure.
'Stay off the chest ten seconds' please, I tell Gemma and check again for a pulse - it's there, I don't know why I couldn't feel one before - perhaps the patient's spasms were masking the pulse.
'OK, we have a pulse' I announce and attempt to secure the patient's airway with first an oral airway and then, because because their teeth are clenched due to the seizure, a nasal one.
Following this, Gemma then applies an oxygen mask and has a very valiant attempt at taking some observations.
By this time, the arrest team are now arriving and starting to get kitted up themselves. I leave Gemma to her observations and stop the team from donning(and ultimately wasting) yet more precious PPE.
First on scene are the ITU and anaesthetic guys, so I brief them on the story ask them to come and cast an eye over the patient's airway - the seizure is now starting to self-terminate so they ask 'are you happy here BB' in the hope that they'll be able to depart as ITU is rather busy.
As it happens, I'm definitely happy because Anuj is here. Anuj is the medical registrar for the day.
Anuj is a medical registrar who is most definitely The Housewife's Choice. He's a cardiologist, is that particular flavour of Indian who speaks in immaculate, cut-glass RP English, has a superb bedside manner, is eminently approachable, professional and helpful and on top of all this is good-looking and the object of crushes from nearly all the women in the trust and a fair few of the blokes as well.
Anuj takes charge from me and I gratefully and slightly gushingly(you'd understand if you met him) to document on my role in events and reflect on the changes to working life that covid continues to bring.
As I depart, Anuj rather graciously remarks 'well, I think you've saved us a job finding out why they collapsed and fell' and gets on with organising a head CT scan, takin bloods, starting anti-convulsant medications and conducting a full examination of the patient.
Later, my other jobs dealt with(the ENT patient was perfectly safe, but in desperate need of a mental health bed, the patient in ED was practically 'fixed' by the time I got there and the patient I originally intended to see was acutely dehydrated due to his likely covid-19 absolutely flattening them for 5 days) I will return to C3 to 'debrief'. Usually this is for the benefit of the ward staff who may not see this sort of thing very often(turns out, it was only the second-ever time Gemma was involved in a call like this) but this time, I need to 'talk it out as well as I could have exposed both myself and others to a higher risk of infection due to my instincts kicking over my brain.

Seems like there's a still plenty to learn where covid is concerned.

Stay safe out there, you lot.

Extra reading:

The Resuscitation Council: https://www.resus.org.uk



Previously...

Part one: https://wwww.twtd.co.uk/forum/478292/despatches-from-the-front-line-part-one/#0

Part two : https://wwww.twtd.co.uk/forum/478646/despatches-from-the-front-line-part-two-a-s

Part three : https://wwww.twtd.co.uk/forum/478885/despatches-from-the-front-line-part-three-w

Part four: https://wwww.twtd.co.uk/forum/479197/despatches-from-the-front-line-part-four-id

Part Five: https://wwww.twtd.co.uk/forum/479404/despatches-from-the-front-line-part-five-ho
Abbreviations and explanations : https://wwww.twtd.co.uk/forum/478292/4576782/common-terms-practices-and-abbrevia
[Post edited 8 May 2020 14:02]

I'm one of the people who was blamed for getting Paul Cook sacked. PM for the full post.
Poll: What will Phil's first headline be tomorrow?
Blog: From Despair to Where?

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Despatches From The Front Line Part Six: Arrested Developments on 07:06 - May 8 with 3342 viewsSteve_M

Morning BB, reading that I'm reminded of the time that <redacted> tried to mock you on here because of your job. And just how laughable that was.

Poll: When are the squad numbers out?
Blog: Cycle of Hurt

3
Despatches From The Front Line Part Six: Arrested Developments on 08:54 - May 8 with 3290 viewsMullet

Despatches From The Front Line Part Six: Arrested Developments on 07:06 - May 8 by Steve_M

Morning BB, reading that I'm reminded of the time that <redacted> tried to mock you on here because of your job. And just how laughable that was.


Who would do that and why?

Poll: If Cook had the full season where would we have finished?
Blog: When the Fanzine Comes Around

1
Despatches From The Front Line Part Six: Arrested Developments on 09:50 - May 8 with 3272 viewsBlueBadger

Despatches From The Front Line Part Six: Arrested Developments on 08:54 - May 8 by Mullet

Who would do that and why?


It was a weird episode that came to a Crunch with this particular gang getting sent home in a Taxi by Phil.

I'm one of the people who was blamed for getting Paul Cook sacked. PM for the full post.
Poll: What will Phil's first headline be tomorrow?
Blog: From Despair to Where?

0
Despatches From The Front Line Part Six: Arrested Developments on 10:00 - May 8 with 3268 viewsBlueBadger

Despatches From The Front Line Part Six: Arrested Developments on 07:06 - May 8 by Steve_M

Morning BB, reading that I'm reminded of the time that <redacted> tried to mock you on here because of your job. And just how laughable that was.


Still, Phil rose to the occasion when it came to the Crunch...er...I believe he banned them for all sorts of stalky weirdness.

I'm one of the people who was blamed for getting Paul Cook sacked. PM for the full post.
Poll: What will Phil's first headline be tomorrow?
Blog: From Despair to Where?

0
Despatches From The Front Line Part Six: Arrested Developments on 10:42 - May 8 with 3250 viewsKeno

Thanks BB

amazed by what you do

Poll: What the penalty given last night because
Blog: [Blog] My World Cup Reflections

2
Despatches From The Front Line Part Six: Arrested Developments on 08:11 - May 9 with 2859 viewswitchdoctor

Despatches From The Front Line Part Six: Arrested Developments on 10:00 - May 8 by BlueBadger

Still, Phil rose to the occasion when it came to the Crunch...er...I believe he banned them for all sorts of stalky weirdness.


c’mon..mention the wedding pics...you know you want too..😂😂
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Despatches From The Front Line Part Six: Arrested Developments on 21:09 - May 9 with 2692 viewsSpruceMoose

Despatches From The Front Line Part Six: Arrested Developments on 08:11 - May 9 by witchdoctor

c’mon..mention the wedding pics...you know you want too..😂😂


Can we mention that you're a bit of a dïck for finding it amusing?

And it's 'to' not 'too'.

Honestly, it takes some nerve to insult someone online for working in the NHS when you're barely literate yourself.
[Post edited 10 May 2020 5:13]

Pronouns: He/Him/His. "Imagine being a heterosexual white male in Britain at this moment. How bad is that. Everything you say is racist, everything you say is homophobic. The Woke community have really f****d this country."
Poll: Selectamod

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Despatches From The Front Line Part Six: Arrested Developments on 21:17 - May 9 with 2683 viewswitchdoctor

Despatches From The Front Line Part Six: Arrested Developments on 21:09 - May 9 by SpruceMoose

Can we mention that you're a bit of a dïck for finding it amusing?

And it's 'to' not 'too'.

Honestly, it takes some nerve to insult someone online for working in the NHS when you're barely literate yourself.
[Post edited 10 May 2020 5:13]


mention what you like...bit pot/kettle though...😂😂😂
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Despatches From The Front Line Part Six: Arrested Developments on 21:20 - May 9 with 2682 viewsSpruceMoose

Despatches From The Front Line Part Six: Arrested Developments on 21:17 - May 9 by witchdoctor

mention what you like...bit pot/kettle though...😂😂😂


I'm not sure you understand how to use that phrase correctly but ok!

Pronouns: He/Him/His. "Imagine being a heterosexual white male in Britain at this moment. How bad is that. Everything you say is racist, everything you say is homophobic. The Woke community have really f****d this country."
Poll: Selectamod

0
Despatches From The Front Line Part Six: Arrested Developments on 08:42 - May 10 with 2579 viewswitchdoctor

Despatches From The Front Line Part Six: Arrested Developments on 21:20 - May 9 by SpruceMoose

I'm not sure you understand how to use that phrase correctly but ok!


👍
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Despatches From The Front Line Part Six: Arrested Developments on 08:26 - May 12 with 2134 viewsHerbivore

Despatches From The Front Line Part Six: Arrested Developments on 08:11 - May 9 by witchdoctor

c’mon..mention the wedding pics...you know you want too..😂😂


You utter jeb-end.

Poll: Should someone on benefits earn more than David Cameron?
Blog: Where Did It All Go Wrong for Paul Hurst?

-1
Despatches From The Front Line Part Six: Arrested Developments on 09:57 - May 12 with 2114 viewsBlueBadger

Despatches From The Front Line Part Six: Arrested Developments on 08:11 - May 9 by witchdoctor

c’mon..mention the wedding pics...you know you want too..😂😂


'Someone persistently stalked, threatened, harrassed and posted up private details of someone they've never met in a public forum. LOL'

I'm one of the people who was blamed for getting Paul Cook sacked. PM for the full post.
Poll: What will Phil's first headline be tomorrow?
Blog: From Despair to Where?

0
Despatches From The Front Line Part Six: Arrested Developments on 11:22 - May 12 with 2086 viewswitchdoctor

Despatches From The Front Line Part Six: Arrested Developments on 09:57 - May 12 by BlueBadger

'Someone persistently stalked, threatened, harrassed and posted up private details of someone they've never met in a public forum. LOL'


badger.....first of I’d like to say that I think you and your colleagues are doing a fantastic job in these difficult times...my remark was in response to you calling out folk who you had fallen out with in the past and if it caused you offence then I apologise...
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Despatches From The Front Line Part Six: Arrested Developments on 11:43 - May 12 with 2077 viewswitchdoctor

Despatches From The Front Line Part Six: Arrested Developments on 08:26 - May 12 by Herbivore

You utter jeb-end.


😗
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