What we really need to teach our trainees!

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Richard Innes considers some of the more stressful decisions critical care consultants have to take and laments the lack of training in these areas.

When was the last time you sat with colleagues worried about how to treat someone with septic shock or ARDS?

A long time ago I suspect.

Much more likely they will be stressed about managing beds: who should have a bed, who should be discharged to let the next patient in,what to do about the patients waiting in recovery or ED who urgently, or not so urgently, needs a critical care  bed? The latter may require you to be pragmatic and  decide that a patient can be  managed outside of ICU as beds are short. If this is the case then you shoulder some, or all, of the responsibility should the patient deteriorate.  After all, you said they were OK to go!

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GMC vs Bawa-Garba responses.

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Dr Gary Masterson, president of the society, reflects on the Intensive Care Member response to the case of GMC Vs Bawa-Garba.

Following the recent judgement in the case of GMC vs Bawa-Garba in the High Court the Society has expressed its concerns to its members and passed on advice from the Academy of Medical Royal Colleges (AOMRC). We’ve received a number of replies from you, all of which offer food for thought.

There is, not surprisingly, serious concern expressed, both from working and retired members.

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Overpressure

 

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Jeremy Groves considers the facts behind the recent Independent article on critical care winter activity and NHS England’s response.

You may have seen the article about critical care in the  Independent a couple of weeks ago.  In it our president, Gary Masterson, outlined the pressure units were under this winter.  NHS England’s press office went into overdrive.  Tweeting via NHS Media they said “It’s simply not true that intensive care beds are full”.  So where do they get their information from?

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Is ICM Training Fit for Purpose?

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Professor Hugh Montgomery considers the evolution of the patients and diseases we manage and worries that training may be too slow to adapt to change.

Some 252 million years ago, the Permian Mass Extinction saw the loss of the 96% of marine life and 70% of terrestrial vertebrate species due to a failure to adapt to their changing environment.

Arguably, the great polio epidemic of 1952 first led to the concept of ‘ICU’, the goal being to deliver life-saving mechanical ventilation. The requirement then was for staff who understood this domain, and that meant anaesthetists.

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Winter Pressures

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Dr Gary Masterson, President of the Society, reflects on the current winter pressures facing those working and being treated in intensive care and high dependency units.

I’ve just completed a week covering my ITU and I suspect that many of you have or are currently experiencing the same sort of chaos I have just endured. There’s no doubt that this winter is intensely busy for us and the NHS in general. Many hospitals are log jammed with sick patients from the front door (ED), through the wards, including critical care, to our discharge lounges. This makes it difficult for all the nurses, AHPs, consultants and trainees working on our units.

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Intensive Care: Lessons from the future

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Will Angus, ST6 Anaesthesia and Intensive Care Medicine, runner up in the Pecha Kucha session at State of the Art 2017, gave the following presentation where he looked back from 100 years hence.

Reflecting on the past century working within the speciality of Intensive Care, from the vantage point of the year 2117, and with only fifty years left before I reach retirement age, I wanted to share some pearls from the future via the medium of t-t-e-mail (time travel electronic mail).

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Organ Donation, opt-in, opt-out?

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On October 3rd the Prime Minister announced plans to introduce an opt-out system of consent for organ donation into England (1), indicating that a consultation on the proposal would be launched before the end of the year.   Dr Paul Murphy, National Clinical Lead for Organ Donation, explains why the time for such a system is right.

Opt-out systems of consent are generally associated with higher donor numbers, although demonstrating a causal link remains elusive.  A consultation on a ‘soft opt out’ system in Scotland earlier in the year showed considerable support for it (2), whilst a system of so-called deemed consent already operates in Wales.  The Welsh system was enacted in December 2015 following an intense period of public education and professional preparation.  Whilst there have been encouraging signs in consent rates, as yet none have reached statistical significance and neither has there been any demonstrable increase in donor numbers.

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A consultation on a ‘soft opt out’ system in Scotland earlier in the year showed considerable support for it

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Advanced Critical Care Practitioners. Time for action.

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Carole Boulanger, an Advanced Critical Care Practitioner (ACCP), discusses the role and how regulation is as equally important to ACCPs as it is to Physician Associates, and therefore the best way forward for the profession.

The Advanced Critical Care Practitioner (ACCP) has become a workforce solution for critical care units and is fully supported by the Faculty of Intensive Care Medicine (FICM) and the Intensive Care Society (ICS). The role developed from clinical need and provides a career option for nurses and allied health professionals (AHPs) wishing to choose clinical progression, rather than management or education; thereby keeping experience at the bedside.

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The Beginning of the End?

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Dr Gary Masterson, President of the Society, reflects on how changes in the way critical care is commissioned may impact on critical care bed provision.

There have always been (and always will be) bed pressures in critical care. I don’t know about you, but I find this the most stressful aspect of my job. However, over the last 20 years of my working life as a consultant, when I have had the misfortune of stumping around my hospital’s general wards, I am always extremely glad to return home to my critical care unit. The general wards struggle: they’re jam-packed with elderly and frail patients with nowhere else to go, grossly understaffed, chaotic and little in the way of continuity of care. You know what I mean. In critical care, we don’t suffer these problems to the same extent and, since the advent of critical care networks and a more regional approach to managing critical care beds, we can usually cope when bed are short.

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The press, medical information, ethics and money

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Jeremy Groves reflects on some of the wider issues arising from the tragic case of Charlie Gard.

I have already written about something the adult critical care community can take away from the tragic case of Charlie Gard; however, I think there are several other issues that we can mull over.  Charlie and his parents’ plight captured the public’s attention and everyone had a view, as I discussed before, informed or otherwise.  To me it was striking how much of the discussion, and presentation of clinical information, took place in the press.

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