FICM – FICMLearning

My Year as a clinical fellow in Intensive Care Medicine

Fiona Walker

Last year I had the privilege of being an ICM clinical fellow at the Royal Infirmary of Edinburgh, and I absolutely loved it. The city, the patients and the staff made it a year I’ll never forget.

As a bit of background, I wasn’t always planning to work in ICM. My initial plan was to specialise in Oncology, and I very much dreamt of spending the rest of my life wearing fabulous outfits and avoiding chaos as much as I could… Alas, a couple of medical school placements and a foundation job later I was a convert. Turns out scrubs and crocs are a much comfier combination anyway.

Case of the Month #25

Rick Bell

A 61 year old lady presents to hospital with lethargy, generalised aches and pains, cough and 2 episodes of loose stool. She has a past medical history of type 2 diabetes, hypertension and obesity.

Music, the ICU and me!

Liz Thomas

I have sung in choirs since I was 10 years old. I remember my first concert – singing treble in some choruses of Messiah with the senior school choir, from that concert on I realised that singing was important to me. I considered a career as a professional musician, but my mother pointed out to me I didn’t really practice enough, it was a very tough field to get work in and I could probably get a lot of enjoyment from music as a hobby with income from a different career. So, I followed her advice and went to medical school.

Palliative Care in Intensive Care

Carol Davies, David Harvie & Rob Chambers

Welcome back to FICMLearning Podcasts.

This month we have two fantastic episodes on Palliative Care. Gareth Thomas speaks with Dr Carol Davies (Consultant in Palliative Medicine at Southampton), Dr David Harvie (Higher Trainee in Anaesthetics and Intensive Care in Wessex) and Dr Rob Chambers (Consultant in Intensive Care in Southampton).

ISARIC 4C: Lessons from >200000 in-hospital patients with COVID-19

Annemarie Docherty
ACCP Conference 4 Jun 2021

At our 2021 ACCP Conference we had a brilliant lecture from Dr Anniemarie Docherty on ISARIC 4C . Over the last 9 years ISARIC have been preparing for a major outbreak worldwide. In the wake of COVID-19 their team deployed immediately and has been collecting data and samples since the first cases were reported in the UK.

Nutrition Protocols Won’t Treat a Patient as an Individual but a Dietitian Can

Samantha Cook

Leaving school I had little idea of what I wanted to be “when I grow up,” so I pursued my interests and choose to study BSc Biochemistry at the University of Birmingham. Fast forward to my final year of study and I was little the wiser as to where I wanted my career to take me. During finals my father underwent a Coronary Artery Bypass Graft and as part of his rehabilitation saw a dietitian – cue light-bulb moment…

Case of the Month #24

Grace Hoey

A 53 year old male currently on the Haematology ward is referred because of type 1 respiratory failure. He was diagnosed with acute myeloid leukaemia (AML) 3 months ago following a brief, non-specific illness where a spurious blood test demonstrated pancytopenia. He has no other health problems and his performance status is 1.

Lessons from Defence

Andy Johnston

At our 2021 Annual Meeting we had an excellent lecture from Lt Col Andy Johnston, the Lead for Intensive Care Medicine for the UK defence medical services on how Defence trains people in leadership and how and why is works.

FICM & CICM joint Webinar: Impact of the COVID Pandemic on Critical Care Staffing: lessons from the UK

FICM & CICM joint Webinar
Various Speakers

A joint webinar with the Faculty of Intensive Care Medicine and the College of Intensive Care Medicine of Australia and New Zealand.

Mentoring: What’s in it for me?

Liz Thomas
Faculty of Intensive Care Medicine Annual Meeting 6 May 2021

At our 2021 Annual Meeting we had a brilliant lecture from Dr Liz Thomas on the value of mentoring and why being a mentor is so rewarding.

Case of the Month #23

Stuart Edwardson
Arlene Wise

A 34 year old primigravida of Asian ethnicity at a gestation of 36+4 and BMI 24 has presented to obstetric triage. She describes a persistent cough for the last 4 days which is getting worse and has been advised by her GP to attend for further investigation. She is otherwise fit and well, and has had a low-risk pregnancy with no concerning features.

Clinical Informatics in the ICU in A Pandemic

Jon Sturman

Previously through the SSUAG website, I’ve detailed some of the pros and cons of an electronic clinical information system (CIS). In North Cumbria we use such a system in both ICUs (38 miles apart!), the chosen system being IMDSoft’s “Metavision” system.

Artificial Intelligence

Hugh Montgomery

Welcome back to FICMLearning Podcasts.

This month we’ll be talking to Prof Hugh Montgomery about Artificial Intelligence (AI) and the potential application of it in critical care and the wider healthcare environment. Hugh is a Professor of Intensive Care Medicine at University College London (UCL), where he also directs the Centre for Human Health and Performance. He has a research interest in Artificial Intelligence as applied to Health and has worked with Google Deepmind and Google Health.

Who wants to live forever? The future of and limits to longevity

Hugh Montgomery
Faculty of Intensive Care Medicine Annual Meeting 6 May 2021

At our 2021 Annual Meeting we had a fascinating lecture from Professor Hugh Montgomery on the future of longevity, could humans live forever? Would we want to?

Top Tips for Exam Revision from a Trainee ACCP

Stevie Park

When I first started my trainee ACCP journey, I had not idea what was in store for me. I felt pretty confident as an experienced critical care nurse and I have always said some of my top qualities are being organised and good at time management. Then came the time to start preparing for our end of year OSCE and MCQ exam.

Registrar Ruminations

Gilly Fleming

I was recently awarded an Outcome 6, and by the time this Blog goes live, I’ll have taken up a consultant post in the unit I’ve wanted to work in since I was a medical student. I’m very fortunate to have had an excellent training experience, which I know has prepared me well for this transition, but to be honest, it’s all a bit surreal and it has rather crept up on me. It’s the strangest mix of excitement and absolute terror, all in the same breath.

Case of the Month #22

Christopher Shaw

A 60 year old man is admitted to the intensive care unit with spontaneous bacterial peritonitis on a background of alcoholic liver disease. He is treated with appropriate antibiotics. However, following admission to the unit he continues to deteriorate and requires intubation. He becomes hypotensive requiring fluid resuscitation and vasopressor support, oliguric and requires high ventilatory pressures. Examination reveals decreased air entry bibasally, with a firm, distended and tense abdomen.

The Patient Perspective

Grant McIntyre
ACCP Conference 4 Jun 2021

At our 2021 ACCP conference we were privileged to hear Professor Grant McIntyre discusses his experience as a critically ill COVID patient during the pandemic and his ongoing recovery after 128 days in hospital.

Environmentally Sustainable Intensive Care

Heather Baid

Climate change is now considered to be a climate crisis because of the health emergency occurring from increasing carbon dioxide levels, rising temperatures, climbing sea levels, more frequent extreme weather events, worsening air pollution and loss of biodiversity^{1, 2}.

Case of the Month #21

Rose Mudie

A 55 year old man presented to hospital with acute onset shortness of breath, cough and a multiple episodes of small volume haemoptysis. The patient reported several months of rhinitis, sinusitis, arthralgia, myalgia, fever and weight loss. Past medical history includes hypertension for which ramipril is taken.

I Hate This Part

Hafsa Abdulle

My mind is consumed with thoughts that I am unable to filter appropriately without entering a rabbit hole that I can’t see an end to. I think I’m losing it…The ability to make small talk has completely disappeared.

What do I wish I had known?

Matt Morgan
Segun Olusanya
Alex Scott
Ben Jones
Ben Ivory

Welcome back to FICMLearning podcasts. This month we have recorded a series of responses to the question ‘What do I wish I had known before becoming a new Intensive Care consultant or trainee?’

Matt Morgan, Segun Olusanya, Alex Scott, Ben Jones and Ben Ivory deliver some interesting and useful thoughts and reflections from their own experiences of pursuing a career in Intensive Care Medicine. Whilst these aren’t the things that you would read in evidence-based journals and they may not necessarily help you pass the FFICM exams, they do provide some useful insights into the art of being an effective clinician and leader in Intensive Care Medicine.

We hope you enjoy listening and gain some ideas on how to re-engage and re-invent yourselves in this challenging yet rewarding career.

Why do I mentor?

Liz Thomas

Hello! I’m Liz Thomas – a consultant in anaesthesia and intensive care medicine and I am part of the team running FICM Thrive – the faculty’s new mentoring scheme.

Shining The Light Onto Radiology Requests

Derek Smith

As is often said of critical care teams, radiologists are another group who can be considered in the small cohort of the last few “true generalists”. Depending on the size of your hospital your radiologist will be doing anything from checking line placement on a CXR, removing a disabling MCA clot in an acute stroke patient, assessing a post-transplant liver in the unit on ultrasound, reducing a paediatric bowel intussusception, be scrubbed in securing a TEVAR in a aneurysm, or a combination of the above…

Case of the Month #20

Ben Peirce

A 40 year old female presents to the Emergency Department with acute onset breathlessness, palpitations and haemoptysis. She is in acute respiratory distress and an ICU review is requested as she remains hypoxaemic on high-flow oxygen.

FY1 Meets Intensive Care…in a Pandemic

Sarafina Bailey

I think I speak for myself and fellow doctors who graduated in 2020, when I say “it was not what we were expecting”! My graduation from St George’s Medical School after six years of studying there consisted of me watching an online ceremony in my living room while the world wrestled with rising coronavirus cases. There I was on 25.06.21 no cap or gown, no celebration with my classmates or tutors but somehow ready to start working as an F1 doctor with the added realisation of having to work in a pandemic and on intensive care for four months.

Case of the Month #19

Rathai Anandanadesan

A 60 year old woman was admitted to hospital with a one week history of increasing confusion and malaise. She was discharged from hospital 2 weeks previously after receiving treatment for a non-ST-elevation myocardial infarction (with aspirin and ticlopidine). Abnormal findings on clinical examination are a low-grade temperature (37.4°C), GCS 12 (E3V4M5), jaundice, and petechiae over her arms and legs.

Putting Pen to Paper

Sneha Narayan

My name is Sneha and I’m currently a CT3 in ACCS – Acute Medicine, having worked in Intensive care and Anaesthetics during the first wave of the pandemic last year. I studied in London and trained in Southampton before moving to Hertfordshire for my core training. Outside of medicine my passion has always been in the arts, ever since I was a young girl and learnt various art forms from my Grandmother. Ever since then, art has become my escape and my solace outside of my day job.

Knowing Your Team – Part 5

Nicki Credland
Alex Scott
John Cully

Welcome back to FICMLearning Podcasts.

This is the final part of our podcast series on ‘Knowing Your Team’ where we aim to gain a greater understanding of the roles of the different members of the critical care team. This month we will focus on the role of the Critical Care Nurse and the Advanced Critical Care Practitioner (ACCP).

We will start by talking to Nicki Credland who has almost 20 years of experience in critical care and outreach nursing and is now a senior lecturer at Hull University and the Chair of the British Association of Critical Care Nurses (BACCN).

This is followed by a joint discussion with Alex Scott and John Cully who a both Advanced Critical Care Practitioners at the Liverpool University Hospitals NHS Foundation Trust.

Power of the Team in Staff Support

Sara Robinson

I love Emergency Medicine, possibly not the most appropriate start to a FICM blog, but it is true. I love the variety, the pace, but most of all I love the people, be they patients or staff, and the teamwork.

Case of the Month #18

Lucy Powley

A 35 year old woman presents to the Emergency Department with 1 day history of fever, urinary frequency and left loin pain. She has a urine dip positive for leucocytes, nitrites, protein and blood and raised inflammatory markers. She is diagnosed with pyelonephritis and started on IV amoxicillin and gentamicin. 24 hours later she reports diplopia, dysphagia and breathlessness. On further questioning she describes a 2 month history of diplopia towards the end of the day which she put down to needing new glasses and too much screen time.

Words from our WICMEL fellows Part 1

Caroline Ferguson
Debbie Kerr

We’re thrilled to be able to run WICMEL again for 2021 (application window closes 30 May.) We had 4 fabulous WICMEL fellows from our 2019 programme and we wanted to share their thoughts on the programme. In part one we’ll hear from Dr Caroline Ferguson and Dr Debbie Kerr.

Establishing an ICU follow up service and the COVID response – Tea & cake to Teams!

Lucy Hogg

“I could take a look at that!” were the fateful words I uttered which led me and my colleagues on a journey of discovery into ICU follow-up and ultimately in us establishing a new service in our hospital.

Case of the Month #17

Matthew Wright

A 74 year old gentleman is admitted to the critical care unit following a 3 week admission on the medical wards with pyrexia, malaise, lymphadenopathy and thrombocytopenia. A diagnosis of sepsis of unknown origin has been made and he has been treated with multiple courses of antibiotics. No clear focus of infection has been ascertained. He has now developed multi-organ failure with a worsening transaminitis, an acute kidney injury, an increasing CRP and a pancytopenia.

Who I Am Not

Catriona Felderhof

Who I am: Catriona / Cat / Treen Felderhof, final year dual registrar in Anaesthesia and ICM in the West of Scotland and Deputy Trainee Representative for FICM, mother to three very active boys.

Who I am not: Superwoman (I have the mountain of washing and chaotic house to prove it) and nor should I need to be…

Knowing Your Team – Part 4

Andrew Davies
Sarah Clarke

Welcome back to FICMLearning Podcasts.

This is the fourth part of our podcast series on ‘Knowing Your Team’ where we aim to gain a greater understanding of the roles of the different members of the critical care team. This month we will focus on the role of the Intensivist and we have been fortunate enough to be able to talk to both Dr Andrew Davies and Sarah Clarke about this.

Serving up Constructive Feedback – How to avoid those Inauthentic Sandwiches

Gillian Fleming

Giving effective feedback is a core skill for medical professionals and the ability to do it well is a hallmark of a good teacher and colleague.

Case of the Month #16

Oliver Robinson

A 22 year old woman presents to hospital with a 3 day history of abdominal pain and vomiting. Examination reveals that the patient is jaundiced and acutely confused (GCS 14/15). Blood results demonstrate pH 7.25, lactate 6.7, glucose 2 mmol/L, Na 135 mmol/L, K 3.2 mmol/L, urea 2 mmol/L, creatinine 69 μmol/L, ALT 7050 U/L, ALP 132 U/L, Bilirubin 82 μmol/L, INR 7.

From Intensive Care to Aviation Medicine

Vanesa Garnelo Rey

My passion for aviation was born when I was little. Every August I used to watch a magnificent Harrier display in the North West Coast of Spain where I grew up. Standing next to my dad with ear defenders, I said ‘Dad, that is so cool! How do they do that’? But a TV cartoon series called ‘Once upon a time life’ captivated an entire generation of children who would later become doctors including myself.

Eyes on the Prize – Why is Eye Care Important?

Duncan Philp

Many patients in the ITU are unable to look after their own eyes so it is vitally important that we take care of them on their behalf. They are at higher risk of eye damage both as a result of their acute illness and due to the treatment they receive on ITU.

Knowing Your Team – Part 3

Lauren Maher & James Bruce

Julie Highfield & Dorothy Wade

Welcome back to FICMLearning Podcasts.

This is the third part of our podcast series on ‘Knowing Your Team’ where we aim to gain a greater understanding of the roles of the different members of the critical care team. This month we will be looking at the roles of the psychologist and occupational therapist in the management of critically ill patients. I hope you will enjoy listening and continue to learn about the real benefits of creating a well-integrated critical care team.

Case of the Month #15

Claire Adams

A 48 year old woman recently commenced chemotherapy for a new diagnosis of acute myeloid leukaemia. She attends the Day Bed Unit to have routine bloods checked prior to her next dose of chemotherapy. Since her last assessment, she sprained her ankle and is taking regular ibuprofen.

Alternative Career Paths in ICM

Jacqueline McCarthy

In the earlier stages of my training, I disliked the discomfort I felt when patients deteriorated to a level beyond my skill set. The ICM doctors who arrived at such times clutching bags of impressive sounding drugs and equipment before whipping them away with an air of proficiency impressed me. I applied for ACCS training, hoping to join their ranks. Vocalising an interest in ICM prompted a range of responses from colleagues. “Are you sure?”….

POCUS and the Sceptics

Alex Scott

As I was saying at the odd conference before we were so all so rudely interrupted, Point of Care Ultrasound is finally coming of age in the UK. It has taken a while – the first diagnostic use of ultrasound was in the 1940s by a neurologist, a comparatively rapid pickup from the first demonstrations of Non-Destructive Testing for metals using ultrasound in 1928.

Case of the Month #14

Chris Allen

A 34 year old woman presented to the Emergency Department with a two day history of progressively worsening double vision, followed by ataxia and slurred speech. She reports a diarrhoeal illness eight days ago, though this has now resolved. She is normally fit and well and takes no regular medication.

Knowing Your Team – Part 2

Paul Twose & Gareth Cornell

Susan McGowan, Helen Newman &
Rachel Jones

Welcome back to FICMLearning Podcasts.

In the second part of our podcast series on ‘Knowing Your Team’ we will be looking at the roles of physiotherapy and speech and language therapy in the management of critically ill patients. It is so inspiring, listening to how these specialists have an enormous amount to offer in both the acute and long-term rehabilitation of critical care patients.

Being a Dual EM & ICM trainee…My Experience

Mishti Oberoi

Night 1… 3 AM:

I am standing in one of the resuscitation bays of the emergency department holding a patient’s airway open while pre-oxygenating them, as we are running through the RSI checklist…

Recruitment Blog Double: Getting a job during a time of change & Recruitment as an IMG

Liz Thomas
Shashikumar Chandrashekaraiah

A recruitment blog double from Dr Liz Thomas and Dr Shashikumar Chandrashekaraiah.

Liz discusses getting a job in a time of change and Shashikumar tells us about recruitment as an IMG.

Random Patient Generator

John Wilkinson, Janet Wilkinson, Sarah Redford, Matthew Faulds

Following on from Gilly Fleming’s blog in November where she gave a fantastic update on some of the ways teaching can adapt to the challenges of the pandemic, we wanted to share with you our experience of developing a new learning tool and applying it in such an unusual time.

Knowing Your Team – Part 1

Greg Barton,
Ella Terblanche,
Danielle Bear

Welcome back to another year of FICMLearning Podcasts.

This is the first part of a podcast series we will be running to raise the profile of the critical care multidisciplinary team. We hope that this will highlight the vital contribution that each member of the critical care team makes to the complex management of patients on the intensive care unit and how effective collaboration between team members helps to ensure successful outcomes after critical illness.

Coroner’s Court – My Experiences of Giving Evidence

Liz Thomas

We are very lucky to have a well developed and longstanding coronial service – I’ve just been listening to the FICM podcast with Derek Winter and have found out it can be dated back to at least 1194. Something not covered in the excellent podcast is how it feels to be in the stand – giving evidence, so here is a blog on my experiences.

Case of the Month #13

Colin McAdam

A previously well 48 year old male, presents to ED with a 48 hour history of severe epigastric pain radiating to his back. On surgical examination he is extremely tender with guarding.

Clinical Lead Conference 2020

On 30th November 2020 the Faculty held its annual Clinical Leads Conference. all attendees had access to pre-recorded lectures which where then discussed in the Q and A session held on the 30th. We would now like to give access to these pre-recorded sessions and they can be access below. The recorded Q and A session is available below, we suggest watching the lectures first.

My path to critical care pharmacy and the FICM Pharmacy Sub-Committee

Emma Taylor

I originally chose to study pharmacy after being inspired by some family-friends who owned their own community pharmacy. I studied at Nottingham University, and only changed my mindset towards hospital pharmacy at the very end of my degree and managed to secure my Pre-Registration Pharmacist year in my local district general hospital. My training was excellent, I loved the clinical aspects of the job, and I was encouraged by the team to progress my career in hospital pharmacy.

The Coroner – Part 2

Bev Frankland

This month James Sira talks to Bev Frankland about writing a statement for the coroner, as well as preparing and giving evidence at the coroner’s inquest.

Bev is the Risk & Inquest Manager for South Tyneside and Sunderland NHS Foundation Trust. She is primarily responsible for looking after the ‘top-end’ of the investigation spectrum e.g. inquests, serious investigations and police matters. She has several years experience supporting medical staff through the process of an inquest and in these podcasts shares some key advice.

WICM: Inspiring Careers in Critical Care – Dr Laura Allan

Jasmine Medhora
Laura Allan

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team. During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

Laura Allan, Emergency Medicine and Intensive Care Medicine Registrar

WICM: Inspiring Careers in Critical Care – Dr Roxy Bloomfield

Jasmine Medhora
Roxy Bloomfield

Introduction from the interviewer:

Dr Jasmine Medhora

Roxy Bloomfield, Consultant in Anaesthesia, Intensive Care, Prehospital and Retrieval Medicine

Accidental Leadership

Liz Thomas

Were you the person who ended up leading a cardiac arrest on the ward? Did you stumble upon a car crash in the street and had to take control? Is there an area of your career you didn’t expect to have? Have you ever found yourself leading when you didn’t expect to?

WICM: Inspiring Careers in Critical Care – Dr Deborah Owen

Jasmine Medhora
Deborah Owen

Introduction from the interviewer:

Dr Jasmine Medhora

Dr Deborah Owen, Intensive Care Medicine Registrar

WICM: Inspiring Careers in Critical Care – Dr Caroline Lacey

Jasmine Medhora
Caroline Lacey

Introduction from the interviewer:

Dr Jasmine Medhora

Dr Caroline Lacey, Intensive Care Medicine Registrar

Case of the Month #12

Andy Martin
Lucy Priestner

A 65 year old woman has a cardiac arrest at home. She is in VF and receives 2 DC shocks by the paramedics before return of spontaneous circulation (ROSC) is established. She is intubated at the scene and is taken to her local hospital.

WICM: Inspiring Careers in Critical Care – Alice Coulson

Jasmine Medhora
Alice Coulson

Introduction from the interviewer:

Dr Jasmine Medhora

Alice Coulson, Trainee Advanced Critical Care Practitioner

WICM: Inspiring Careers in Critical Care – Dr Louise Hartley

Jasmine Medhora
Louise Hartley

Introduction from the interviewer:

Dr Jasmine Medhora

Dr Louise Hartley, Consultant in Intensive Care Medicine

The Online Revolution: Playing your part as a Virtual Educator

Gilly Fleming

The COVID-19 pandemic is a global healthcare emergency and the NHS is facing an unprecedented crisis. During the first wave in March and April 2020, the immediate priority was understandably on clinical delivery of safe and efficient care for patients presenting with a novel disease process. This led to the suspension of many “non essential, non-covid” services, and included widespread disruption to medical education at all levels, from undergraduate to postgraduate.

WICM: Inspiring Careers in Critical Care – Nicola Clark

Jasmine Medhora
Nicola Clark

Introduction from the interviewer:

Dr Jasmine Medhora

Nicola Clark, Physician’s Associate, Intensive Care

WICM: Inspiring Careers in Critical Care – Dr Joanna Thirsk

Jasmine Medhora
Joanna Thirsk

Introduction from the interviewer:

Dr Jasmine Medhora

Dr Joanna Thirsk, Anaesthetics and Intensive Care Medicine Registrar

The Coroner – Part 1

Mr Derek Winter DL

This month is the first in a two-part series looking at the work of the coroner. James Sira talks to Derek Winter about the role of the coroner, medical examiner, and the coroner’s inquest.

Derek is HM Senior Coroner for the City of Sunderland and was appointed as one of the two Deputy Chief Coroners of England and Wales in 2019. He has conducted a wide range of cases in the 15 years he has spent as a coroner and has modernised the Sunderland coroner service.

Most intensive care doctors will at some point in their career be required to provide a statement for or give evidence at a coroner’s inquest, and this can be a daunting experience.

Being a Trainee and a Chair during COVID-19

Sally El-Ghazali

It has been an odd few months… when I initially planned to write this blog it I planned to write about something somewhat different – but then along came COVID-19…

Case of the Month #11

Louise Hartley

A 40 year old male was admitted to intensive care unit requiring intubation and ventilation for community acquired pneumonia. He developed acute respiratory distress syndrome (ARDS) and on day 2 commenced an atracurium infusion for worsening hypoxaemia.

Despite two sessions of prone ventilation he failed to improve and required high ventilatory pressures. On day 5 he was placed on venovenous extracorporeal membrane oxygenation. (VV ECMO).

Dealing with Dual Training

Colin McAdam

You must be mad! The usual response from single CCT colleagues in a now increasing frequency – more exams, more portfolios, longer training, increased cost – all to start on the same pay scale.

Max & Kiera’s Law

Dale Gardiner
Phil Walton

On the 20^th May 2020, the legislation relating to consent for organ donation changed to an opt out system. As critical care plays a pivotal role in the organ donation process, these two podcasts give a clinical perspective on the importance of the new legislation and how it impacts on the discussions we have with family members about consent for organ donation.

There are also some interesting anecdotes & lessons learnt from the awareness campaign and implementation strategy used in Wales when this law was first introduced in 2015.

October – New Academic Year and A New WICM Chair

Liz Thomas

New academic year – new blog post!

Hello – I’m Liz Thomas – a consultant in intensive care medicine and anaesthesia and I am delighted to have taken over the role of Chair of the WICM committee from Dr Rosie Baruah. I have been on the WICM committee for almost 12 months.

Case of the Month #10

Martin Smith

You are asked to review a 25-year-old female office worker who has presented to ENT with a sore throat and a progressive dysphagia.

She is apyrexial, haemodynamically stable and fully concious. A full examination reveals extensive wounds across her thighs due to subcutaneous heroin injection.

Max and Keira’s Law – The Bill That Was Pulled Out Of A Bowl

Claire Williment

Max and Keira’s Law came in to force on the 20th May 2020 and brought renewed hope to the thousands of people on the UK transplant waiting list. The legislation introduced ‘opt out’ as the legal basis for organ donation consent in England and is expected to lead to an additional 700 transplants a year. However, the path to getting the new legislation in place was far from smooth.

Frailty

Simon Conroy

This month Matt Bromley talks to Simon Conroy about frailty and its implications for critical care. Simon is a professor of geriatric medicine in Leicester and the clinical lead for the specialised clinical frailty network.

He has a particular interest in translational research in the acute care setting and has made significant improvements in the recognition of frailty amongst older people presenting acutely to hospital and how this can be used to inform decisions about clinical management.

Case of the Month #9

Tarni Duhre

You are called urgently to A&E to assist with a patient who is 36 weeks pregnant with a low GCS. She collapsed in front of her husband after complaining of severe abdominal pain.

Bias and Change

Dr David Baglow

In this blog, David describes bias and how it can have a profound effect on people’s lives. Implicit or unconscious bias may be described as attitudes that affect our understanding, perceptions, actions, and decisions without us having an awareness of their effect on us.

Case of the Month #8

Adam Marshall

A 63 year old man with a history of hypertension and ischaemic heart disease has been admitted to the intensive care unit with refractory hypotension due to severe sepsis. Inflammatory markers are raised and CXR has revealed a right lower and middle lobe pneumonia.

FFICM Exam Webinar August 2020

Update – Management of Stroke and Subarachnoid Haemorrhage

Colin McAdam

This blog aims to present a brief update on the management of stroke and subarachnoid haemorrhage (SAH), with particular reference to critical care.

They’re worried about us…

Som Sarkar

We were approaching the end of April. We had just come through a CQC inspection, COVID was in full swing on our 13 bedded unit, running 3 times our capacity having spilled out into our main theatres, anaesthetic rooms and recovery.

Preparing for the FFICM (final) examination – an examiner’s view

Victoria Robson
FFICM Exam Chair

FFICM is a ‘high stakes’ exam taken by ICM trainees, and is mandatory before entry it stage 3 training. This article aims to give some tips and pointers to trainees who are preparing for this exam, written by an experienced FFICM examiner.

How I passed the FFICM

Matt Bromley

Post graduate exams are hard. They have a huge impact on the candidate’s life. It can be difficult to put the rest of your life on hold for 3 months to focus on revision, but this is unfortunately necessary. The revision should become intolerable after a few months or you are not revising hard enough.

Coffee afternoons, baby yoga and a masters?

Samantha Batt-Rawden

As a dual trainee who had never jumped off the training treadmill, I was looking forward to my maternity leave. I had pictured long coffee afternoons with other new mothers, taking up baking and trying my hand at baby yoga. Heck, I had thought I was going to be so refreshed by what I thought would be a break I might even sign up to do a part-time Masters in my ‘time off’.

Simulation Part 2

Andrew Jacques, John Fletcher, Manoj Wickramasinghe

Welcome back to the simulation series.

In this second part Matt Bromley, a senior intensive care medicine trainee, talks to a number of simulation enthusiasts about the practicalities of setting up and delivering simulation training on intensive care.

Andrew Jacques is a consultant in intensive care medicine in Reading and has been instrumental in developing in-situ simulation training on their intensive care unit. He is also the simulation lead for the education sub-committee of the Faculty of Intensive Care Medicine.

John Fletcher is an advanced critical care practitioner in the Leeds Teaching Hospitals NHS Trust who has many years of experience as an ICU nurse and educator. He joins their Simulation Fellow, Manoj Wickramasinghe, in talking about the development of a high-fidelity intensive care simulation course that has a strong focus on MDT involvement.

Case of the Month #7

Rathai Anandanadesan

A 74 year old female with a background of hypertension presented to the emergency department with gradually increasing breathlessness and pleuritic chest pain following a recent long haul flight.

Vancomycin

Pete Hersey

Nine things you didn’t know you wanted to know about Vancomycin….

Planning for an invisible enemy

Sarah Marsh

Back at the start of the year, we all watched the news with curiosity about a place called Wuhan, and a new coronavirus that was ravaging the city. We continued to watch with further interest as it made its way towards Europe.

Case of the Month #6

Laura Kocierz

An unresponsive 76-year-old male is admitted to the intensive care unit. He has a past medical history of bipolar affective disorder (treated with lithium and valproate), self-harm and previous suicide attempts.

Working as an International Medical Graduate with a BAME Background during COVID-19

Shashi Chandrashekaraiah, Sushruth Raghunath, Avinash Jha, Arif Akbar, Ikenga Samuel & Mohammed Elshamy

International Medical Graduates (IMGs) account for approximately 25% of the current UK trainee doctor workforce and are predominantly of black Asian and minority ethnic (BAME) backgrounds. There has been a lot of discussion during the current COVID-19 crisis about IMGs and their contribution to the NHS, VISA/Immigration health surcharge and the more important topic of increased mortality among BAME doctors from COVID-19.

Decision Making Part 2

Dominic Bell

Welcome back to the difficult decision making series of podcasts.

In this second part James Sira, a consultant in intensive care medicine, talks to Dominic Bell about how to approach decisions around admission to critical care using a framework based on a clearer understanding of futility.

Dominic has been a consultant in Intensive Care Medicine for more than twenty years. He has a degree in medical law and has been an expert witness for the Court of Protection on end of life decision making, and for the GMC on fitness to practice investigations. He has also worked as an assistant coroner and has been an expert witness for the police.

Who still believes in Santa and science?

Matt Morgan

As I look through my office window at yellowing patches of summer grass, it may seem strange to talk about Christmas. But these are strange times. I remember being told that there are three stages of life – first you believe in Santa, then you don’t believe in Santa, then you are Santa.

5 Things I wish I’d known before COVID…. (pt. 5)

Ella Terblanche, Anand Krishna, Rosie Baruah

COVID-19 has presented challenges unlike anything we have faced before. In this blog, colleagues share their experiences by describing five things they wish they had known.

Case of the Month #5

Colin McAdam

A previously well 76-year-old male presents to ED having been found on the floor at home by a relative. Collateral history reveals ‘flu-like’ symptoms and headache within the last week.

On arrival he is soiled, agitated and combative with a GCS of 9/15 (E2 V2 M5). There are no obvious localising neurological signs. Pupils are equal and reactive. Temperature is 39.0.A basic delirium screen in ED is negative (urine dip and chest x-ray). As you continue assessing the patient, he has a short-lived generalised tonic-clonic seizure.

What is your differential diagnoses?
How would you investigate further?

5 Things I wish I’d known before COVID…. (pt. 4)

Ollie Cohen, Hannah Grafton-Waters, Greg Barton

COVID-19 has presented challenges unlike anything we have faced before. In this blog, colleagues share their experiences by describing five things they wish they had known.

The academic response to COVID-19

Tony Rostron

For those of us who contribute to patient facing research, there were signals in early March that our working lives were about to change. The safety implications related to recruitment of and sampling from patients in studies who were potentially infected with SARS-CoV-2 needed to be considered. As a result many NIHR portfolio studies, supported by their funders, decided to pause recruitment.

Case of the Month #4

Pete Hersey

A 67 year old man has been admitted overnight to the intensive care unit. He presented with flu-like symptoms and a non-productive cough. His wife reported that he had been ‘seeing things’. Investigations revealed hypoxaemia, lobar consolidation, neutrophilia and a raised lactate dehydrogenase.

You suspect the patient may have Legionnaires’ disease.