A few more little nuggets from Intensive Care.

After spending six months within a intensive care environment here are a few more little things I have picked up..

1/ Patient’s don’t remember being super unwell

So when they are back to be alert and orientate they look better to us, but felt rubbish. A load of people telling them they look great when they feel like crap gets pretty annoying I imagine.

2/ When the body starts healing, the mind/spirit needs distraction.

Keeping the mind busy for the long recovery that is needed after the initial danger period has passed. Books, radio, audiobooks, podcast- suggesting this the patients could be helpful, also just shows that care about more than their numbers.

3/ Do the simple things well

Fancy treatment rarely works, but consistent good monitoring of the ABC’s is what really counts.

4/ Nurses do the really important work 

Just like everyone else in medicine, my nursing colleges are the ones that are making the real important difference. The suction that keeps the patient’s airway patent, the noticing and documenting of the gradual improvement or deterioration. Ignore them at your peril.

5/ We have to be cautious about storming in with a second opinion. 

We are never first to an patient; another team of doctors and nurses have been hard at work, usually with many other patients to look after. The things that need doing can appear obvious to a second pair of eyes. The way we phrase this “to do” list is important; it is far to easy to imply, even when we don’t mean it, that the patient has not been looked after well. This is particular pertinent when turning up when an arrest resuscitation has been going on for a period of time.

6/ Educational handovers

We have two types of handover, the focused bullet pointed kind and the much more wandering kind. The first is useful when some don’t know the patients very well (particularly coming onto night shifts). The second, which allows tangents, side avenues and multiple opinions, is not only more entertaining and educational but allows for different ideas and perspectives on those patients that everyone knows as they have been here a few days, but whose trajectories and management strategies are not locked down yet.

8/ Remembering the patient amongst the numbers

With all the numbers available instantly on a computer in a comfy office is  is easy to forgot whose numbers they are. The “end-of-the-bedogram” is still invaluable. As well as, obviously, the wishes and desires of that patient.

Intensive care is not a speciality for everyone. The nature of the work makes it predisposed to anti-social working hours and patient outcomes are frequently grim. But you get to play with fancy toys and stop people dying. Which is not a bad way to spend your days.

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