Lockdown Legacy

Thursday 25th June 2020

Figures for 24th June

UK COVID Deaths 154 / Total 43,081

James Cook Hospital – Total COVID deaths – 254

All COVID cases within South Tees Hospitals Trust – 10

James Cook Critical Care COVID cases – 2 (2 ventilated)

James Cook Critical Care non-COVID cases – 37

Another scorching hot day today. Fortunately the ICU’s are air-conditioned, otherwise wearing PPE would have been truly unbearable today.

An ongoing theme has emerged amongst the non-COVID admissions over the last few days. It started with a number of people who fell down stairs following excessive alcohol consumption. Most of these patients suffered brain injuries, some of them requiring urgent neurosurgery to evacuate blood clots within the lining of the brain. Otherwise, these blood clots will increase in size, causing a build-up of pressure within the skull, leading to further brain damage.

Other patients have drunk steadily over the past few weeks and have become jaundiced due to liver failure. One alcoholic patient eventually became so unwell that they couldn’t continue drinking. They then developed acute alcohol withdrawal and started fitting, requiring intubation and ventilation in order to control their seizures.

Today we are called down to the Accident and Emergency Department. The Resuscitation Room is busier than Bournemouth Beach and we are asked to assess two young patients who have been found unconscious. It would appear that both of them have unintentionally taken overdoses of recreational drugs. We’re not exactly sure what these drugs are but the treatment of such overdoses is usually fairly straightforward. It involves sedating and intubating the patient in order to protect their airway. This means using the breathing tube to occlude the trachea so that should they vomit or regurgitate, they do not inhale their stomach contents. This can cause a chemical burn to the lungs or block airways and can prove fatal in some cases. The next step is to ventilate them, resuscitate and support their circulation and wait for the effects of the drugs to wear off before waking them up and sending them on their merry way.

Of course, if they have taken opiate drugs like heroin or morphine we can give them an antidote to speed up the process. The trouble with this is that the antidote is short-acting and they may have taken a long-acting opiate drug. If this happens, the antidote can wear off before the overdose drug and they quickly become comatose again. Under these circumstances it’s usually safer to admit them to Critical Care and administer the antidote continually until the long-acting opiate has worn off.

One of the patients has been lying deeply unconscious on the floor for somewhere in excess of 18 hours. For some reason, the patients ‘friends’ didn’t think it important to seek medical help during this time. I try to not be judgemental but I don’t try very hard and I fail. I’d like to use this opportunity to offer some medical advice to everyone: If one of your chums has fallen unconscious, instead of repeatedly stepping over them on your way to the toilet, how about poking them with a sharp stick? If you don’t get a response, it’s probably time to call an ambulance. Just a thought.

This particular patient is rather unwell. Whilst comatose, the patient’s own weight has been compressing their muscles. This pressure-related damage resulting from lying on the hard floor has caused their muscle cells to die. This is called rhabdomyolysis. The dead muscle releases a protein called myoglobin which can block the tubules in the kidney causing kidney failure. In severe cases this can be fatal. The same situation can occur in earthquake victims who are trapped under fallen rubble for some time.

Our final patient for the day has been discovered in some woods by a dog walker. Initially mistaken for dead, the patient was instead found to be deeply unconscious by the paramedic ambulance crew. He was brought to hospital and we began trying to piece together what might have happened.

I suggested that maybe he had been trying to gate-crash a Teddy Bear’s Picnic and had got an unwanted awfully big surprise. There were no signs of trauma or injury however, so it seemed unlikely that he’d received a good kicking from every bear that ever there was. We mulled over the possibility of various strange, interesting diagnoses before someone announced that he had been found with a bag containing various empty packets of prescription drugs.

So, the whole day appears to have been spent dealing with the consequences of substance abuse. The legacy of lockdown I suppose. Not the most rewarding day I’ve ever spent. Perhaps I should have phoned in sick and gone to the beach instead…