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Crikey, thanks.
I'll say it again, you lot are a cut above.
I don't really like false modesty, I appreciate all the thanks and gratitude.
In some ways I'm at a great advantage in that I suppose I've been training for this for the last 30 years, so I've got the skills and can try to support other people. There is a certain under-siege mentality that creeps out, rude words on stickers applied to peoples backs, love and hate as 'tattoos' on the knuckles of gloves, lots of swearing and so on.
Indeed Crikey - the public image of nurses as "angels" would take some battering if the public knew what went on behind closed doors!
As for me - out of isolation this week. Being moved to another hospital with a possible opening up of palliative care wards there next week which will be my first time working since this really struck.
Because I have not been at work I don't know what else is happening. I guess if it comes to it and they ask what skills I have I will have to confess to my out of date ITU skills. I am hoping I can remain where my core skills are - and palliative care is something I do and do well. I'll go where I am needed but I ruddy well hope its not at the pointy end!
That sounds horrible Crikey.
I start my redeployment on Monday. Been assigned to a social work team arranging hospital discharges to free up beds.
8-8 hrs and at moment just the 3 shifts a week so can't complain.
All but one of the 20+ cases allocated to me are covid positive .. all are very old, so this presents issues not just the typical issue of finding POC availability, but getting their families to support them too. You may be surprised how a lot of families think there is an endless supply of carers available.
I think it should be emphasised again and again that pretty much the whole NHS has dropped everything they can to support ..er me/us.. but we are only a small part of the entire picture; rehab, discharge, transport, ongoing care, palliative care are all equally important and will be operating at full stretch to keep the process from clogging up, plus the emergency and cancer stuff which will hopefully be maintained as well as possible.
The unofficial motto for us is 'We got this...' that we is everyone involved.
I'm off to moisturise my face again.... 🙂
Mrs Davesport working in High Dependency. PPE sounds identical to Crikeys. I'm humbled by the coping response of frontline staff in this setting. If one thing comes out of this after the storm it is that there's a rethink on funding for the NHS. They need more than a bit of clapping on a Thursday night.
Crikey, thank you to yourself and your colleagues for all your hard work.
It is easy to tell the ITU nurses; we swear better than everyone else.
That never wears off - hence 'Doodle****s'
@maccruiskeen It's not me, but he is describing a very similar set up and the same issues.
It’s not me,
I realised it wasn't but it was an odd feeling of Deja Vu!
My best friend an OT wrote this yesterday morning:
This wk has been crazy with split shifts, tying up things with my old job, having to make sure all my old patients are sorted, as well of those of my team and deal with management things I do.
The ward I've been sent to is not designated c19 ward. It's a 25 bed ward where people (mostly elderly) are sent from the hospital when they are medically optimised. I'm not sure I'll stay clear of CV because its spreading fast, but for now I'm dealing with critically ill patients.
That said the patients are extremely complex and in some ways more of a challenge in that we have to get them home.
It can take a whole day dealing with just one patient.
It has been a baptism of fire... new area of work, new staff, new documentation and new systems that are changing day by day due to C19.
The place is not well managed and from a therapy point of view and had hardly any staff with loads of issues.
I have been made team leader and told to sort it and been given staff from off site who have never done this work before.
Its an absolute nightmare and I'm feel I'm flying off the seat of my pants all the time.
To top it all I'm getting my boss mithering me for stuff via email and now text!
We have also gone to 7 days working, so have been tasked with the job of getting a very reluctant group of people to work their hours over 7 days.
There was no cover this weekend so I am in both today and tomorrow... alone.
Totally shitting my pants as still don't feel up to speed!
Anyway, will get on with it and shout if feel unsure. Going to be a very stressful few months and the coming weekend and days will see pressures on the hospital services that we have never seen before.
I'm sure I will have to cover some of the critically-ill work over at the hospital at some point, but we shall see.
I am so worried about her, she is shattered, tired and has 2 children and a useless, lazy estranged husband. I don't know how to help her.
Bunnyhop - is she nearby? cook her a dinner and leave it on her step. ( but tell her yo have done so)
If you can help her by taking the kids for a long walk?
I moan about my job but I get to go home and relax; people with kids at home in this situation are working much, much harder than me and have my admiration and respect.
Can you plan a night time thing?
I've suggested to my neighbour, 3 kids, separated from husband, that I fire up the chiminea in our garden and let them sit around the fire and do stories and stuff. I'll be keeping out of the way.
Thanks TJ and Crikey - unfortunately I am self isolating, not going out at all, except for a tandem ride (away from people, which we can do as we're semi rural). Hubby is having to self isolate with me. He went out last week to give blood. All his clothes thrown into the wash and a full shower and hairwash.
Thank you to everyone, you are just too amazing for words. bunnyhop x
Atm I'm going to be making nurses uniform laundry bags. They're designed to throw the uniform into bag after a shift, then bag gets emptied into washing machine, along with bag itself. Then hopefully I'm going onto sewing scrubs. We're just waiting for more fabric and instructions for those. My sewing workroom is at home so I feel safe in doing this.
Thats me back to work tomorrow after almost a month off - holiday then isolating 'cos my other half got a temp. Going to a new ward where I have never worked - rehab tho so a familiar area to work in but with a view to be helping open mothballed wards in the same building if required.
Not really at the pointy end but I have no idea where they are with PPE and if they have any positive patients.
I am shitting myself - mainly 'cos I hate starting a new workplace - all those names to learn and finding my way around.
This occasionally involves waiting for people to calm down, to wipe tears away, then carrying on. ITU is very, very different to working elsewhere, and no one is expecting people to cope straightaway.
Have a big thumbs up for this simple humanity to the new starters on the frontline. Stay safe all of you.
As an aside the GE consultant I throw funnies at across Twitter calculated that the 'huge' amount of PPE delivered was. . . A WEEKS WORTH.
The imbalance of FFP3 to surgical masks was stunning on the breakdown (too few FFP3 masks, too may surgical masks).
This was doing the rounds yesterday. Allons y et courage mes braves
I'm told that the criteria for 'at risk' and 'high risk' have been changed so eg asthmatics are being downgraded and placed in more exposed roles. If this is a war, as all those Biggles types in government would have you believe, it's more like the Somme.
We're doing ok.
It's a fine balance between letting people out for 30-60 minutes a day for a walk around the grounds and watching people go stir crazy.
Most service users have come from prison or from a very secure hospital environment, so are used to a more restrictive regime, but self harm and minor challenges to authority are on the rise.
Most SU's in our place have a diagnosis of paranoid schizophrenia, so all our experience is going towards managing the issues associated with that, which have been exacerbated by the current regime.
Social distancing amongst SU's is non existant, constant reminders soon become counter productive.
We can't keep a distance between staff and SU's.
The food provided is poor and obviously the gym and social activities have been kyboshed, which doesn't help.
We are very lucky. The situation in local general hospitals is about as bad as you'd imagine and it's beginning to hit care homes on a frightening scale.
Love to all.
I've just done my third shift behind the 'red' door at A&E doing triage assessments on admissions. I was in the community as an ANP, but have got over 20 years of working A&E under my belt. The full PPE does make for an uncomfortable shift. But if I survive this, I will be minted!!
Just in awe at the amazing courage and modesty of staff on the front line and those supporting them. Reading these posts is humbling.
Mrs Devbrix is a respiratory Sister and is running the C19 ward which is effectively a step below ITU, they work closely with ITU stepping patients up and down, ventilating with CPAP.
It’s been hugely tough on her very experienced and capable team. She spends a lot of time trying to keep staff morale up, dealing with panic attacks and (unbelievably) on occasion stroppy relatives. She was ringing relatives on her day off yesterday. She is now permanently exhausted and more stressed than I have ever seen her and she is very tough mentally and physically. They are constantly thinking through PPE and as Crikey says it’s a tough gig wearing all that for 12 hours. Patients are of all ages including some healthcare workers which makes the team even more fearful. What she finds most hard is the lottery that patients go off in a big way so suddenly.
It’s had a massive impact on our home life as she is anxious about giving it to the family. The arriving home cleaning and disinfecting routine she has now is of military precision. The hugs from me and the kids have been stopped. I’ve said to her she has a choice to work there but there’s absolutely no way she would leave her team. This morning before she went off to work she made me promise if she got sick I would not allow her to be ventilated.
I’m in the wrong specialty to be C19 front line at the moment and continuing to plod on with the usual clinical work in a bizarrely quiet and empty hospital, running the operational planning for the ‘surge’ and what we are going to do when we have our own C19 patients and all those sick patients who have been staying away get really unwell.
It’s been a tough few weeks for a lot of staff and their families and we have months of this ahead.
I'm an ICU Doc in South Wales, our ICU's are now pretty much full although we haven’t yet started to fill up the extra capacity that has been made but thats going to be happening pretty soon – we are gaining about 3-5 patients a day and they are really sick and not getting better. I’ve never seen an ICU with so many really sick patients, and normally they have a reason that they are there – they have had accidents or cardiac arrest or post operative etc – these are nearly all previously fit and well, or with one or two comorbidities and they are all in their 30s, 40s and 50s and 60s or they are nurses.
Its honestly like nothing I’ve ever seen, and we don’t really know how to treat them effectively. Initially we were adopting an approach like we do in Acute Respiratory Distress syndrome, but that doesn’t seem to be working in the longer term, they are also getting lots microvascular complications, cardiac issues, coagulation issues and renal failure, its really multisystem. Its so odd having a whole ICU where every patient is suffering from the same disease. We spend a lot of time on every shift proning (turning on their face) people – which does seem to help – you look around the unit and nearly half the patients are prone.
I spent a long time looking after a patient who came in with an out of hospital arrest at the wheel of his truck – covid swabs were negative so no enhanced PPE and was placed on the non covid ITU, he then started to get sicker the next day – a bronchial asparate was sent off and comes back with covid so thats another problem that keeps happening - we keep getting exposed through false negative tests.
Sorry thats a bit of an essay, but I enjoyed getting it off my chest
Us mere mortals are in awe of all that you are having to find a way to cope with.
MrsMC is a child protection social worker. All visits were stopped a couple of weeks ago, but DV is on the rise and they are trying to get guidelines on if, when and how they step in. And they have absolutely no access to PPE.
One of her colleagues has had to get a kid placed in the nearest secure unit, 300 miles away. Police did the initial transport, but he had to do a 600 mile round trip yesterday to do statutory visit, nowhere to stay over
Its honestly like nothing I’ve ever seen, and we don’t really know how to treat them effectively. Initially we were adopting an approach like we do in Acute Respiratory Distress syndrome, but that doesn’t seem to be working in the longer term, they are also getting lots microvascular complications, cardiac issues, coagulation issues and renal failure, its really multisystem
That is a rather worrying statement, has there been no guidance and best practises coming down the pipeline from where it has already struck (Italy, China etc? Surely there must be lessons learned that can be applied even as advise to those now at the front-line in what treatments have been effective or not.
I don't want to disrail the thread by getting too much into politics, but i do despair that with the worldwide focus there has been on this, that frontline medical staff are still in the same position now as those in China were all those months ago.
That is a rather worrying statement, has there been no guidance and best practises coming down the pipeline from where it has already struck (Italy, China etc? Surely there must be lessons learned that can be applied even as advise to those now at the front-line in what treatments have been effective or not.
Yeah we have taken all the advice on board - and we are changing practice daily - problem is there is no magic bullet (at least yet) nothing is really working that well - these people are really sick. The Chinese and the Italians haven't worked out what to do exactly either yet.
We're now expecting peak demand to start on the 17th; hopefully the availability of PPE and scrubs will have improved by then
Just done my ICU refresh day. Just played with setting up the ventilator. Working out the predicted settings. Were probably opening up recovery as a clean ICU. Were lucky further west as we've had more time to prepare. Waiting to hear when we do 12 hour shifts. We are going to use anaethsetic machines till the new batch of ventilators arrive. Still not that many ffp masks around. Still haven't been tested.
That is a rather worrying statement, has there been no guidance and best practises coming down the pipeline from where it has already struck (Italy, China etc? Surely there must be lessons learned that can be applied even as advise to those now at the front-line in what treatments have been effective or not.
Good article in the FT on this. CV-19 is really baffling all ITU consultants, they don't yet know how best to treat patients.
Dialysis machine shortages lay bare wider threat from Covid-19
Memo to senior London doctors points to damage virus can do to other organs and strain on intensive careApril 6 2020
Leading London hospitals are running short of vital equipment in intensive care wards, including blood dialysis machines needed to treat patients suffering from coronavirus-related kidney failure, according to a leaked memo.The shortages, which go far beyond concerns about the lack of ventilators and protective equipment, emerged from a conference call of some 80 senior National Health Service doctors. They illustrate the way Covid-19 can damage much more than the lungs and respiratory system in patients who become seriously ill — affecting the kidneys, heart and occasionally even the brain.
The 1,000-word memo, seen by the Financial Times, is written by Daniel Martin, head of intensive care for serious infectious diseases at the Royal Free Hospital. It paints a picture of doctors and nurses still scrambling to develop treatments for coronavirus as the shortages bite.
Paul Hunter, professor in medicine at the University of East Anglia, told the FT that, although the public generally views Covid-19 in terms of respiratory failure, hospital doctors are experiencing it as a multi-organ disease. “Once you become really ill, more than your lungs will suffer,” said Prof Hunter. He did not take part in the conference call.
Analysis at the weekend by the Intensive Care National Audit and Research Centre found that of 690 UK patients admitted to critical care with confirmed Covid-19, 25 per cent needed advanced cardiovascular support, 18.5 per cent required renal support and 4.5 per cent received neurological support.
The summary of the NHS hospitals call, which was written by Dr Martin, said Covid-19 is not simply a one-organ disease that attacks the lungs, but is also causing “high rates” of acute kidney failure as a result of complications in treating the disease.
The summary of the call, which was designed to share information about how best to treat coronavirus patients, warned nurse-to-patient ratios are at six-to-one in intensive care wards with hospitals using everyone “from med students to dental hygienists” to absorb the overload.
Dr Martin warned “overzealous” use of diuretics such as Frusemide were leading to “unnecessary” kidney complications and related blood clotting issues.
He also flagged the “higher-than-predicted need” for kidney treatments, while noting that several London hospitals, including King’s College Hospital, are running short of blood-filtration machines.
He wrote that King’s was “running out of” CVVHF blood-filtration machines and an unnamed centre had “run out of pumps” used to administer some drugs.
The note, designed to share insights and develop best practice among colleagues, painted a picture of the pressure on the NHS as hospitals race to train sufficient doctors and staff wards that are already facing shortages.
“Most centres now getting towards 1:6 nursing ratio with high level of support workers on ICU [Intensive Care Unit],” Dr Martin wrote. “Training has largely fallen by the wayside as it is too large a task. People are being trained on the job,” he added.
He also chided colleagues that they need to catch up with other hospitals in seconding staff, and noted some “non-medical staff” were refusing to enter intensive care wards — a practice that needed to be tackled.
“We need one support worker per patient. Other centres are using everyone they have. From med students to dental hygienists. We are behind the curve ‘++’ with this,” he wrote.
“Last time I was on a night shift, theatres were full of non-medical staff refusing to help ICU — this is unacceptable,” he added.
The account of the call emerged as the NHS across London braced itself for the “peak” of Covid-19 admissions, around Easter, with government models expecting this in the next seven to 10 days.
Dr Martin’s note to colleagues also revealed the extent to which doctors are still learning about treatments for the virus, despite all the information being passed back from China and hotspots hit earlier in the pandemic in Europe, such as Lombardy in northern Italy.
He warned, for example, to avoid ventilation too early in the intensive care process as this “may be harmful”, while noting patients were having to go back on to ventilators if taken off too early.
“Not many patients have reached extubation yet in London,” he wrote, before adding “re-intubation seems to be common” and his doctors should “wait longer than usual before extubating”. “An extubation protocol is needed immediately,” he added.
Editor’s note
The Financial Times is making key coronavirus coverage free to read to help everyone stay informed. Find the latest here.
Another evolving area of coronavirus care is the question of “fluid balance” among patients, and how far they should be hydrated. “All centres agreed that we are getting this wrong,” he wrote.Dr Martin concluded with a final note of uncertainty, arguing that colleagues “desperately need to look at our own data to understand whether we are getting this [treatment] right or not”.
A spokesman for the Royal Free Hospital declined to comment on the communication. A request for an interview with Dr Martin was declined, citing his work commitments in managing the response to the virus.
@catnash - what flow rates are you going to be using on the anaesthetic machines?
Interested to know what the clinicians are being told to use as this will help us estimate condensate levels
Haven't a clue. I'll have to ask as the anaethetists were teaching the regular ICU staff whereas I was getting to grips with the draegers. I do know they're using 2 HME's per vent and probably SIMV. I do know the scavengers in ICU were being checked for efficiency. I'll be predominantly in recovery. I'm hoping the regular ventilators will be delivered by then.
@catnash – what flow rates are you going to be using on the anaesthetic machines?
Interested to know what the clinicians are being told to use as this will help us estimate condensate levels
I think they are thinking about 6l on our ones - Drager Primus, although we haven't got the point of needing to use them yet. I have grave concerns how a circle system is going to cope with minimally sedated spontaneously breathing patients when the time comes to trying to do any weaning. Fine when people are sedated and paralysed.
My sister and BIL both senior (Director and Consultant) for NHS London, both tested positive, out the other side and back on the front line. Really proud of them both.
We have a standard size primus and the smaller ones for the anaethsetic rooms.
If it gets really bad they may use recovery for vented covid patients and the theatres for clean emergencies.
covid swabs were negative so no enhanced PPE and was placed on the non covid ITU, he then started to get sicker the next day – a bronchial asparate was sent off and comes back with covid so thats another problem that keeps happening – we keep getting exposed through false negative tests.
That’s interesting, the first COVID death in our Trust came back negative, only after death was it found to be COVID. At the time (now 3 weeks ago) there was a lot of scrutiny on the Trust for ‘doing something wrong’ with the tests.
We are expecting our spike to hit in the next few days for the next 3 weeks 😔
In the last week or so a number of colleagues have had the virus and been genuinely very sick at home. It really does hit home though when you see a work colleague in a hospital bed, very unwell. You might expect to see a colleague occasionally due to accident or illness, but when you know they have ended up in that bed due to doing their job, that is something else
Been redeployed to hospital discharge this week, and to be honest it has been very .. very quiet 1st week.
All but one of people on list are C.19 positive, so unable to be discharged. Already some of the bright ideas from those at the top have made from the safety of their own homes WFH have failed miserably .. I have been required to go onto C.19 wards wearing my flimsy little surgical mask and goggles.
What surprised me too was the mountain of freebies coming in for NHS staff: pizza; Indian & Chinese takeaways; cakes & biscuits, and the senior nurse told me they are expecting a load of iPads donated soon too. All great - but when compared to the care/nursing home I visited just before that still hadn't received the recommended PPE it really emphasised the continuing lack of recognition and value of those working the front line of C.19 outside of the NHS.
I will be unable to do my job if the care agencies and care homes can't increase their contribution in this, and asking an already undervalued workforce to take on even more will be very difficult - that will mean there will be nowhere for vulnerable people to be discharged to, so hospitals will likely be put under even more pressure.
To be honest it's all feeling a shit storm ready to hit. And I not slightest bit confident those WFH are the best people to be making decisions on the safety of us at the front. Donkeys leading lions.
I think they are thinking about 6l on our ones – Drager Primus, although we haven’t got the point of needing to use them yet. I have grave concerns how a circle system is going to cope with minimally sedated spontaneously breathing patients when the time comes to trying to do any weaning. Fine when people are sedated and paralysed.
6l will produce less condensate than low flows but will interested to see how well that works with patients on the machines for long periods. I'm not familiar with the Primus but I know our machines don't have the vent modes suitable for spontaneously breathing machines. I share your concerns but like you we haven't started to use them yet.
I will be unable to do my job if the care agencies and care homes can’t increase their contribution in this, and asking an already undervalued workforce to take on even more will be very difficult – that will mean there will be nowhere for vulnerable people to be discharged to, so hospitals will likely be put under even more pressure.
We were speaking with Sandwich Jr last night, he's a charge nurse in a care home with learning disability clients. It's going to be an abbatoir in his place of work. He has clients that do not understand what is happening and short of restraining them can not be isolated. He has a management team that have been unable to source sufficient PPE and are recommending that he wears it between rooms in the home when tending the infected. Walking in the common areas whilst wearing contaminated equipment! He's steaming mad about the incompetence being shown by his leaders and his support workers are on the point of walkout as a result.
If anyone has a care home nearby find out what they need and get donating. A civilised society takes care of it's weakest and least able as well as the able. If we abandon these people we sacrifice our humanity and civilisation.
Sandwich - unfortunately speaking to my colleagues from other teams it seems what your son is describing is the norm.
Whilst I support businesses and individuals donating things to NHS hospitals, I also feel those working the front line in the community need their contribution recognised .. maybe they can be encouraged to make dance videos on Tik-Tok too? But some how I don't think they will have as much spare time during their working day.
Mooman. He's working 55 hour weeks currently and could work more but I suggested he hang back as he's been ill with the virus. I expect that in around a fortnight to 3 weeks he may have to live in and possibly grab sleep when he can whilst being the last man standing.
The lack of focus from everyone except (notably) Lewis Goodall should be a source of national shame.
Soz - deleted.
Sandwich - your son is one the many unsung heroes during this crisis, and you and your family should be very proud of him, and also yourselves, for your part in making him the person he is.
Mooman - I'm prouder than I have any right to. My son has a highly developed sense of community service, somme from me some from Mrs Sandwich. We worry that he may be in danger of the secondary infection wave.
My daughter and son-in-law are running a community hub from the pub kitchen providing hot meals and supplies for those around them. It's currently that most sad of things a pub with no beer!
They are both fantastic young people (Mrs Sandwich did most of the early heavy lifting when they were younger, I apparently blossomed as they got into teenage years according to herself).
Our next door neighbour, Dr at Addenbrookes, is obviously very relaxed about the whole thing as they're currently having a house party (it's her B'day apparently).....
Part way through my shift today the powers that be decided we all had to go into ppe. I see no reason for this in my ward.
However my respect for those at the pointy end just went up another notch. It's effing horrid to weara mask gloves and pinny continuously. Full PPE must feel utterly awful
I heard that the NHS were looking for IT workers as volunteers. Anyone know why or what for? Looking for ways to help.
At the risk of sounding trump-esque, I've read that China, Italy, France and the US (and others) are using that malaria drug alongside some antibiotics as an early treatment, before people get really sick and also trying some antivirals on trial. I've not heard anything about the UK giving treatments like this, or anything at all. is there a reason why? Are we trying anything as treatment or is it only a ventilator / o2?
China seemed to have decent death rate stats so I wonder why are we not using their protocols?
I known nothing about medicine which is probably obvious from my post