Updated: Apr 7
Monday 6th April 2020
COVID Figures for 5th April
UK Hospital Deaths 621 / Total 4934
James Cook Hospital – Total deaths – 48
James Cook cases on wards – 130
James Cook cases in Critical Care – 22 / 11 ventilated
Critical Care North of England (North of Leeds) current cases – 104 / 62 ventilated
Back at work today and holding what my colleagues call the ‘Bat-Phone’. This is the phone that any medical team in the hospital can call if they have a patient that they think might need Critical Care. This is a direct line of access to an ICU Consultant and is usually reserved for them to contact us if someone needs our help in a hurry.
Nowadays a lot of the sick patients come to us via the Outreach team, a group of specialist nurses who care for, provide advice and monitor the sickest patients on the wards. Outreach will let us know about any patient they are worried about and we will review them. In the current climate, we are joining Outreach every day as they review all the patients on CPAP in the Tower Block, the older part of the hospital where all the COVID patients are admitted. The Outreach nurse with me today is Jane, back at work after only just recovering from contracting the coronavirus herself.
This is the first time I’ve been on the wards in over a week and I’m pleased to report that there is an air of calm that I didn’t expect. Like us, they have not been overwhelmed yet and everyone is in good spirits. Dr McCarron, one of my physician colleagues is ebullient as ever – kind of like a Scottish Tigger with a stethoscope. We discuss the patients he is worried about which include a 50-something gentleman we discharged from the ICU a few days ago. Despite some initial improvement he has subsequently made little progress and remains in respiratory failure on CPAP. This could easily still be due to COVID but could also be due to a secondary bacterial infection. We decide to play it safe and move him back to the ICU.
Jane and I are reviewing the rest of the patients when I get a phone call to tell me about a patient who has just arrived into the AAU (Acute Assessment Unit). This is next door to A&E and is now where the COVID patients are being brought by ambulance. The gentleman who has just arrived is in his late 70’s with the usual COVID symptoms. His CXR has typical COVID-esque appearances and he has oxygen saturations that are in his boots. He responds to oxygen and then CPAP but it’s clear that he’s not going to last as he is.
We decide to intubate and ventilate and I get to summon the Anaesthetic Airway Emergency team. This is a bit like summoning International Rescue but not as much fun as having Thunderbird-2 show up. To be fair to the team, the degree of professionalism they display is exactly what you would expect from the Tracy brothers - Scott, Virgil and the other two boring ones – is it Trevor and Colin?
Once he is in better shape, we take the patient up to the GHDU into one of the isolation rooms until we can confirm whether he is COVID positive or not. I then get another call about a patient in his 50’s who has been admitted with a massive pulmonary embolus (a blood clot within the lung blood vessels). He needs a drug treatment to attempt to dissolve the blood clot and this is normally done on the Coronary Care Unit (CCU). However, the CT scan that confirmed the embolus also showed patchy changes in the lungs that they are worried are in keeping with COVID pneumonitis. I agree, and we decide to admit the patient to HDU until such point that we know for sure.
We are getting reports that the COVID patients are very prone to blood clot formation; it’s entirely possible that coronavirus infection has caused this gentleman’s blood clot.
Back at ‘Command and Control’ I am delighted to hear that, in an attempt to keep track of all the Ventilator/CPAP machines that are now scattered about the wards, they are to be named after characters in the Disney franchise. So, you can now be ventilated by Mickey Mouse, Dumbo and Daisy Duck. Fun of course, but you could also be ventilated by Buzz Lightyear or members of The Avengers which are infinitely preferable in my book. Although, one shudders to imagine quite how much damage The Hulk would do to your lungs, given the chance…