Cynic

As far as I am aware it is impossible to work in healthcare without eventually becoming a cynic. Here are a few of our more regular experiences.

Drunks who have fallen into the gutter and as a result are covered in minor abrasions and have suffered a possible head trauma. Observe them for four hours, take blood, hook up to a big bag of sober-up-juice(saline) take GCS every half hour, listen to them explain how they only had one pint.

Women who have been beaten(and occasionally raped) by their spouses, several broken ribs, lacerations to the face and possible skull and limb fractures. X-Rays to all effected areas, GCS every half hour, ECG to rule out cardiac damage as a result of thorasic trauma, listening to them explain how they either fell down some stairs or how their spouse is a good man and wouldnt have done it if they hadnt set him off.

Parents who when faced with a child suffering a high temperature, vomiting and diaorrhea decide that they dont need a doctor, they need homeopathic herbs and spices. By the time the child reaches us they are massively dehydrated with a blood pressure so low it can barely push blood around their body and a pulse so fast that the chambers of the heart barely have time to fill. Listening to them explaining how medicines are poisons and pollute the body and soul*.

Parents who are themselves vegans or vegetarians and are forcing such a diet on their infants, as a result the infant is now in the lowest survivable body mass index and will probably suffer permanent damage to all their bodily systems.

As a result of this I think its understandable that I have become a little more pragmatic and cynical. I still treat every patient with respect and ensure whatever dignity they have left is maintained. I perform tests both based on what they tell me and what I suspect to be the truth knowing that the day I refuse to believe a patient is the day I am wrong. It also appears that I can be a cynic and an optomist.

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*The comedian Tim Minchin has an eternal place in my memory for this line - "Alternative medicine is either not proved to work or proved not to work, do you know what they call alternative medicine that is proved to work..............medicine".

Bank

I have been working bank shifts as a healthcare assistant in my trust. Just to earn a little extra money. At first it was liberating having next to no responsibility. All you have to do is worry about washes, feeds and obs, everything else is the nurses job. This soon became quite frustrating a patient becomes breathless or starts desaturating and as a student nurse I would shove them on oxygen. I cant do this as an HCA I have to ask the nurse. A patient complains of chest pain I cant just put them on high flow o2, do an ecg and show it to a doctor, I have to wait until a nurse appears so I can ask her if its ok.

I was in a bed space yesterday with a nurse and the patient starts vomiting large quantities of blood, the nurse asked me to get a doctor or another nurse in there as quickly as possible. I go out to the nurses station where the doctors are discussing their rounds and I shout, "we have a problem with a patient, we need help NOW!" everyone, every last one of the doctors and nurses in sight said "find someone else, i'm busy". So i go back to the bedspace and hit the resus alarm, this gets some fairly immediate attention. Despite the fact this tactic worked in the face of overwhelming stupidity I spend the next two hours being shouted at for misuse of the alarm and making the senior sister look like an idiot.

When I'm qualified and running a ward if I EVER see a member of staff ignoring an urgent call for help I will see to it that even if I cant fire them the only favourable option available to them will be to quit.

The patient survived, just about.

Oh Dear!

In the course of research for an assignment I discovered that the most common sources of heparin come from porcine(pig) intestinal tracts. This normally wouldnt bother me, most of the medications I administer (or occasionally take myself) come from animal sources. However we use a modified version of heparin, enoxaparin as prophalaxis and treatment for blood clots in whats probably 70% of the patients in my hospital. Its very commonly used.

My problem is that I had no idea it was procine based, most of the staff I work with had no idea it was porcine based. I have certainly had jewish patients in the past. I must have at some point administered enoxaparin to them. Normally I give little consideration to religious elements of care, I appreciate they are important but I prioritise the body over the soul, I let the hospital chaplains worry about that. However this is a fairly heafty rule in the jewish belief structure we are unwittingly breaking.

Busy, Oh So Busy!

In the last month or so I've moved house, passed the placement from hell and been working in all the free time I have to pay the bills. I think things are settling down now but sometimes its hard to tell. I had intended to write up a load of posts and time release them. I'm guessing i've lost a large portion of my reader-base but hey, thats not why I started doing this.

Swine Flu

In 2007 over five thousand infants and elderly people died from "human" influenza. The every day, run of the mill flu. This statistic is actually a vast improvement on the previous years, largely thanks to the greater use of the flu vaccine in vulnerable people. Why is this not reported in the news every year? because it happens every year and thus it is not news. However a few hundred people die from a virus that is almost indistinguishable and certainly no more fatal and the media use exercise their ability to cause mass hysteria. Whilst these deaths were indeed deeply tragic the majority of them came from nations with undeveloped healthcare systems where the general populous live in third world conditions. In the nations with more developed healthcare systems, including the UK, most diagnosed cases took place largely due to clinical and professional assumption. Currently one in every two hundred "confirmed" cases of H1N1 have been laboratory confirmed and they are symptomatically identical to the "human" flu.

The Department of Health current risk catagories for this "pandemic" is word for word identical to that of the yearly flu risk publication. The very young, the very old, and anyone with a chronic condition. Chronic Condition is a very broad term for any disorder or disease that can not be cured. This however does not mean it is fatal and can not be managed. This could be something as reletively harmless(if well managed) as Diabetes or a rapidly deteriorating disease like Motor Neurone Disease(MND). Several chronic conditions will not effect a patients vulnerability to influenza, however many conditions like Systemic Lupus Erythematosus(SLE) and other auto immune conditions require treatments that will effect a patients immune system(immunosurpressants mainly).

My arguement is not that swine flu is not a serious condition(it certainly can be). It is that it is no more serious than the annual flu and all this media and public hysteria may well draw attention away from the seriousness of the annual flu, many may not get vaccinated this year(or only get covered for swine flu) and a massive unnecessary loss of life may ensue.

Patient: Abdominal Wound

Bob, normally healthy 23 year old male presenting with abdominal stab wound. Unconscious, Pulse 150, BP 60/30, Resps 27. Appears diaphoretic and ashen.

This is a patient we saw(minus a few identifying facts) in A&E. I thought I would outline how we treated him.

He was clearly in hypovolemic shock. His blood pressure was incredibly low so his heart couldnt pump the oxygenated blood to his cells. To attempt to compensate for this his pulse increased. We start getting concerned when a patients pulse exceeds their systolic blood pressure, its a sign of acute shock. In order to keep pace with the heart and oxygenate the increasing blood flow(increasing at first) his breathing became shallow and rapid. However long before this he would have passed out, Its not clear weather this is another one of the bodies failsafes or just coinsidence but an important step in immediate treatment of shock is to lay the patient down, preferably with their feet up so as much blood as possible is flowing to the brain. His blood vessels would contract in order to attempt to compensate for the plumetting blood pressure this would have caused the ashen appearance.

Going back to basics.

Airway/Breathing - the patient had a patent airway but his oxygen intake from the shallow breaths was insufficient so we placed him on highflow oxygen(15litres via non-rebreathe mask).
Circulation - We applied a heavy dressing and applied as much pressure as we could in order to slow down the blood loss. We obtained venus access. This was particularly difficult as he was peripherally shut down. We then pumped as much saline and gelofusin into his veins as possible increasing his circulating blood volume and taking blood for typing. Short term its important to increase the circulating volume with anything we have at our disposal, it will increase the blood pressure and hopefully decrease resp and pulse rates. Long term however the lack of red blood cells will cause hypoxia(among other things) despite the high flow oxygen. At this point several units of blood for transfusion appeared and he was deemed stable enough to risk surgery to repair the damage caused by the knife.

All this happened in a very short period of time, the patient survived(surprisingly).

Downtime

Its been an insane week. Many stressful situations which are thankfully now resolved. So I am now sat in my living room, alone(my fiance is on nights). Drinking a blended whiskey(I am normally a single malt man but this isnt a bad one). With my entire music collection on random(thats a lot of music). So I thought in the interests of pure laziness and at the risk of a massive blow to my standing amongst my loyal readers I would post bellow ever song that comes on. In bold you'll see any excuse I wish to make. May the comments begin!

Iron Maiden - Face in the Sand
Deep Purple - Black Night
Dreamevil - Book of Heavy Metal
Queen - Mad the Swine
Nirvana - Opinion (I have no idea how this got on here)
Luke Kelly - The Town I loved So Well
Corrib Folk - Wish it was Sunday
Anastacia - Secrets(I have no idea how this got here either)
Johnny Cash - The Wall
Hammerfall - Take the Black(Nothing like hammerfall for destressing)
Iron Maiden - Seventh Son of a Seventh Son(Parts of this song sound very Greek)
Van Halen - Running with the Devil
Toad the Wet Sprocket - Somethings Always Wrong(I love this song)
Savatage - Handful of Rain(My usual drinking song with a good video)
Ludovico Einaudi - I due Fiumi
Thin Lizzy - Jailbreak
Bad Company - Bad Company
Iron Maiden - Intro:Churchills Speech(One of histories greatest speeches)
Sonny Rhodes - Firefly Theme
Skyclad - Spinning Jenny(A truely Filthy Song!)
Elexorian - Dryads and Trolls(Hillarious lego video available on youtube)
Plain White T's - Every Second Counts
Skyclad - Any Old Irony?
Tyr - Ormurin Langi
Bon Jovi - Wanted Dead or Alive ("Bon Jovi Rocks....On Occasion")
Amateur Transplants - Anaesthetists Hymn(Medical Spoof Band, Highly Recommended)
Thirteen Senses - Into the Fire
Bruce Dickinson - Inertia
Free - Wishing Well (One of my Favourites)
Lynard Skynard - Freebird(This was my fathers song)
Iron Maiden - The Trooper
Kansas - Fair Exchange
Led Zepplin - Immigrant Song
Kenny Rodgers - The Gambler

Ok I'm going to end it there, that wasnt nearly as bad as I was expecting.