Casualty

Thursday 9th July 2020

Figures for 8th July

UK COVID Deaths 126 / Total 44,517

James Cook Hospital – Total COVID deaths – 254

All COVID cases within South Tees Hospitals Trust – 5

James Cook Critical Care COVID cases – 1 ventilated

James Cook Critical Care non-COVID cases – 44

I was at work last night and am pleased to report that we now only have one COVID patient within Critical Care. The patient was originally transferred to us from another hospital and we have repatriated them yesterday. The patient still has an ongoing need for critical care but their condition is slowly improving. We have been down to our last COVID patient briefly about three weeks ago but we soon admitted more. The number of patients within Critical Care Units in the North of England is also low with many other ICU’s having discharged their last COVID patients.

The numbers of COVID patients within the hospital as a whole remains low and the Trust has gone ten days without a death, all of which is very encouraging.

The first few patients I saw last night had all undergone surgery. We are getting more patients that need Critical Care post-operatively. These may be planned cases or they may be emergencies that require surgery in a hurry. The need for critical care after an operation can be due to a number of reasons. Firstly, some major surgery may require Intensive Care to ensure that the patient is properly cared for; the patient may need intensive nursing or monitoring closely to ensure any complications are dealt with in a timely manner. Secondly, some operations are so complex and take so long that waking the patient up immediately is not an option. Some neurosurgery operations, for example, require the patient to remain sedated, intubated and ventilated in order to prevent dangerous brain swelling.

The other reason for admission to Critical Care following surgery is as a result of the patient’s medical condition. It may be that the condition requiring surgery has rendered them extremely unwell and that Intensive Care is needed even before the operation, let alone after it. Other patients may have complicated, chronic medical problems, meaning that even routine surgery is a challenge for them. Admitting them to ICU may be necessary to minimise the risk of cardiac or respiratory problems in the post-operative period.

As well as the patients who were admitted last night from the operating theatre, there were plenty who came our way from other parts of the hospital. A trip down to A&E reminded me just how busier this part of the hospital has become of late. It’s easy to forget how quiet the Accident & Emergency Department was back in April. Now when I visit, it’s the old familiar feel of hustle and bustle, of busy waiting areas and patients shuttling to and from X-ray. I usually have to bypass these patients and head straight for the resuscitation room. I find that my perception of A&E is biased toward the more life-threatening end of the spectrum of patients.

My view of the rest of A&E is therefore perhaps a little outdated. I grew up reading the Beano and this has left me with a somewhat tainted view of ‘Casualty’ as it was called back then. I would still like to believe that this part of the hospital is visited by children with toy soldiers stuck up their noses and adults who have slipped on banana skins. Any serious injuries are usually as a result of running carelessly whilst holding scissors or ‘nearly having someone’s eye out’ with any variety of implements. Other causes of peril included inadvertently swallowing chewing-gum; I remember believing that it somehow ‘stuck to your insides' and could prove fatal.

Of course, such cases are small beer when compared to most of the trouble that comes crashing through the doors on a Saturday night. Television would like you to believe that there’s nothing more exciting than a major trauma, delivered by helicopter to the Trauma Team, the situation drowning in drama. But honestly, just for once I think I’d prefer to arrive in the Resus Room to discover something more mundane, like a child with a saucepan stuck on their head perhaps?