BED 12 – Review

Julie Cahill, who has been an intensive care patient and is a member of the Society’s Patients and Relatives Committee, reviews Alison Murdoch’s book ‘Bed 12’.

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When renowned Buddhist and radio contributor Alison Murdoch’s husband falls suddenly and severely ill with viral encephalitis her entire world is turned upside down. As Simon spends five weeks in a London ICU, Alison soon realises that the hospital has become her own, sanitised world within a world, and that she is merely ‘visiting’ the rest of her life in her brief moments of respite from her husband’s bedside.

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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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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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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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Life support for critical care staff

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Dr Linda Jayne Mottram, Intensive Care Consultant at Belfast HSC Hospital discusses the crucial importance of maintaining clinicians mental wellbeing in the current medical culture.

Basic life support algorithms start with the premise that clinicians check for danger before approaching the patient.  The rationale being that if you are injured by something in the environment, you will be of little practical use to a patient in extremis.   The same logic applies to scene safety in prehospital medicine. No one questions your commitment to the patient by protecting yourself first, because it makes common sense to do so.  You have to be free from injury in order to provide any meaningful assistance.

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A lesson from little Charlie

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Dr Jeremy Groves reflects on one implication that the case of Charlie Gard has in adult critical care.

The Charlie Gard case has been the dominant medical story over the last few months.  One cannot but have extreme sympathy for Charlie’s parents who fought valiantly to give their son a chance in life. It was a personal tragedy, played out on social media and in the press, where the pope, presidents, politicians and pundits all had a view and expressed it, informed or otherwise.

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The Medical Training Initiative – a personal perspective.

The Medical Training Initiative enables overseas graduates to come to the UK for experience in intensive care. In small and large units with posts and training capacity the scheme can be mutually beneficial. Dr David Odaba, currently working at the Cumberland Infirmary in Carlisle, gives us his view on the application process and the benefit of the experience he gained. – Jeremy Groves

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