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).
Continue reading “Case of the Month #11”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.
Dale Gardiner
Phil Walton
On the 20th 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.
Continue reading “Max & Kiera’s Law”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.
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.
Continue reading “Case of the Month #10”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.
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.
Continue reading “Frailty”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.
Continue reading “Case of the Month #9”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.
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.
Continue reading “Case of the Month #8”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.
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.
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.
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.
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’.
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.
Continue reading “Simulation Part 2”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.
Continue readingPete Hersey
Nine things you didn’t know you wanted to know about Vancomycin….
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.
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.
Continue reading “Case of the Month #6”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.
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.
Continue reading “Decision Making Part 2”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.
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.
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.
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.
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.
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.
Continue reading “Case of the Month #4”Zoe Brummel, Andy Breen, Peter Shirley
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.
Jack Parry Jones, Nicki Credland, Guy Parsons
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.
Helen Singh, Joel Meyer, Richard Benson
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.
Sarah Clarke
One of the difficult jobs during this pandemic is not only our dedication and commitment to best care of our patients, but the supervision and support of those less familiar to the Critical Care environment. This may be our own trainees, but also others for whom the decision to come to our ‘space’ hasn’t necessarily been their own; and includes other specialty trainees, senior medical staff, nursing colleagues and allied health professionals.
Danny Bryden, Dale Gardiner
In the first part of this series, Danny Bryden and Dale Gardiner give their views on decision making, particularly with respect to admission to critical care. They also discuss wellbeing, and the impact of COVID-19. Danny is vice dean of the FICM. Dale is a consultant in anaesthesia and ICM in Nottingham, and is the national clinical lead for organ donation with an interest in medical ethics.
Continue reading “Decision Making Part 1”Rosaleen Baruah
A 54 year old woman with a history of hypertension presented to the emergency department with a sudden onset severe headache. Her GCS was E3 V3 M6 on arrival, but deteriorated over the next 2 hours to E3 V2 M5. A CT brain demonstrated an intracerebral haemorrhage and a CT angiogram confirmed a ruptured middle cerebral artery aneurysm. She was intubated and ventilated for transfer to the regional neurosciences unit where she underwent a successful endovascular coiling procedure the following morning. On sedation hold she is now GCS E1 VT M1.
What are the potential causes of her reduced level of consciousness?
Continue reading “Case of the Month #3”Andrew Jacques
The following is a guide to help you set up an in-situ simulation (ISS) program in the intensive care unit. It is not an exhaustive guide but drawn from my experience of establishing a program on our unit and some of the problems and solutions along the way.
Paul Bedford, David Grant
The series of simulation podcasts is going to be released in two parts. This first part contains conversations with Paul Bedford and David Grant, and also includes links to some of the research and resources that they mention.
Continue reading “Simulation Part 1”Kyle Gibson
A 40 year old male was found unresponsive in the garden. Initial GCS was 9 (E3V2M4) which deteriorated to 7 (E2V2M3) on arrival to the emergency department. ECG and CT brain were both normal. An ABG demonstrated a high anion gap metabolic acidosis (pH 7.0) with an increased osmolal gap (>10mOsm/kg). In view of unexplained decreased level of consciousness along with high anion gap acidosis and high osmolal gap, ethylene glycol toxicity was considered to be the most likely diagnosis.
Q1 – How does ethylene glycol ingestion present?
Continue reading “Case of the Month #2”Debbie Kerr
The final years of training can be somewhat of an emotional roller-coaster – you’re excited to finally see the ‘reward’ for all those years of hard work, but anxious about taking on a new post and responsibilities. Perhaps one of the more difficult considerations is where you want to work as a consultant, and how this will influence your career progression after training… it certainly was for me! In this blog, I wanted to share my thoughts about finding a consultant post, and why becoming a district general ICU consultant was the right choice for me.
Catherine White
What may be the end of the story for critical care healthcare professionals is usually the beginning of a long, difficult and sometimes very lonely journey for patients and their relatives.
Kate Rimmer
Consent is the voluntary permission of a patient to be given a treatment. Consent must be obtained wherever possible before all treatments and procedures, reflecting the importance of individual patient autonomy in healthcare.
Kate Rimmer
The issue of mental capacity in the critical care environment can be fraught with difficulty and can cause anxiety to staff working in these environments. It is important for all staff involved in the care of the critically ill to understand the law in relation to capacity and consent and have knowledge of the process of making a capacity assessment.
Brian Pouchet
Since the invention of blogs in 1994, blogging has exponentially expanded into every sphere. There are millions of blogs on the web representing a spectrum of interests, ideas, ideologies and information sharing.
Alison Pittard, Matt Morgan, Sarah Marsh, Rosie Baruah, Segun Olusanya
This series of podcasts takes a closer look at the concept of resilience through a series of interviews focusing on challenging times. The interviews were recorded at the FICM ‘Striking the Balance’ meeting in September 2019.
Continue reading “Resilience”Kate Flavin, Sarah Marsh, Liz Thomas, Christine Watson, Danny Bryden
Welcome to Part 2 of January’s WICM Blog .
Rosie Baruah, Sammy Batt Rawden, Stephanie Cattlin, Nish Desai, Ingi Elsayed
In order to commemorate FICM’s 10th Anniversary, WICM have produced a collaborative blog celebrating 10 role models of 10 WICM members.
Rosie Baruah
In September I had the experience of speaking at 3 meetings in 3 weeks. I find speaking at meetings quite daunting and so I’ve put together 12 points as a ‘note to self’ to remind myself of what works for me.
Alison Pittard
Who’s going to stop me!?
Freddie Mercury is singing “I’m going slightly mad….” in my ear! He’s been at it all morning. I keep saying “yes” when I know I shouldn’t. My OCD is struggling to keep up with my diary. So how did I end up here?
Nish Desai
The time has come; Striking the Balance our first ever WICM meeting on 27 September 2019, on a rather wet Friday at the Royal College of Anaesthetists. In all the excitement leading up to the event, I recall speaking to Lucy Rowan at the Faculty the day before to discuss the day and shared my rather nervous feelings about writing this blog.
Sarah Marsh
A 25 year old male is admitted to critical care following a motorcycle accident. He hit a car travelling at 60mph, was thrown over the roof and skidded 20m down the road. His injuries include a fractured pelvis, unilateral rib fractures from 6-10 on the left, and a fractured lateral malleolus also on the left.
Continue reading “Case of the month #1”Stephanie Cattlin
‘A journey of a thousand miles begins with a single step’
Lao Yzu
Sarah Marsh
This time my maternity leave was quite different…
Sarah Marsh
As I write this, the baby is finally sleeping upstairs and I have a small window before setting off for the school and nursery run. Ah, the peace and quiet.
Rosie Baurah & Mark Hughes
On the 2nd of June I had the pleasure of attending the inaugural Woman In Surgery Scottish Meeting at the Royal College of Surgeons in Edinburgh. The programme was packed full of enthusiastic and informative speakers – and one of them, Mr Mark Hughes, an ST8 in neurosurgery who I have the privilege to work with at the Western General Hospital in Edinburgh, also happened to be male!
Charlotte Summers
Those of you familiar using social media may have seen #thisiswhatascientistlookslike, which aims to highlight the diversity of the people working in science, and break down the stereotypes many of us have regarding scientists.
Rosie Baruah
I’ve written a blog on implicit gender bias for WICM, focusing on the problems female doctors can face as a result of the implicit bias that doctor = man, I thought it might be interesting to look at nursing, where there is a strong implicit assumption that nurse = female…
Katie Flavin
Whilst revising for the Final FFICM viva, I found myself rather frustrated with the lack of suitable material to assist and direct my revision. I promised myself (perhaps rather foolishly) that, should I pass the FFICM on my first attempt, I would make it my mission to publish an SOE revision text book.
Rochell Velho
The intercom crackled and it became difficult to decipher the words on the other end of the line. The Flight Director informed me as the Chief Medical officer that there was a medical emergency.
Manni Wariach
After two amazing years at Southampton Neuro ICU and 50,000 miles on the clock, I am moving back to London to be closer to my girls. Thinking about succession planning for my post has allowed me to enthuse to the Wessex ICM trainees about how rewarding my job has been here. So why should they consider applying for my job?
Samantha Batt-Rawden
It is probably not an exaggeration to say that social media was a lifeline for me whilst on maternity leave.
Rosie Baruah
There is increased awareness amongst the medical royal colleges of the challenges of returning to work after a long period away, and the need for this to be a structured, managed process. The Faculty is developing its own Return to Work (RTW) guidance, which will be a synthesis of the guidance provided by its constituent colleges.
