Ra Ra Rasputin
Updated: Apr 25
Thursday 9th April 2020
COVID Figures for 8th April
UK Hospital Deaths 938 / Total 7907
James Cook Hospital – Total deaths – 73
James Cook cases in Critical Care – 22 / 11 ventilated
My night shift last night wasn’t too hectic. In fact, once it got to the early hours of the morning it was sufficiently calm that I headed home to sleep in my own bed. I was the third resident Consultant and my other two colleagues were happy to man the fort without me. This is better than trying to sleep in one of the on-call rooms and the hospital then doesn’t have to pay me for staying in overnight. A win-win situation.
We had a number of straightforward COVID patients requiring our attention. The Acute Assessment Unit (AAU) called us about a middle-aged gentleman that had a high oxygen requirement. They described him as ‘breathless and looking like Rasputin’. We weren’t sure whether this was a novel way of describing coronavirus respiratory failure but it peaked our interest sufficiently enough for my colleague Lucasz to investigate.
Lucasz returned shortly afterwards, disappointingly reporting that the patient in no way resembled Russia’s Greatest Love Machine; rather just a ‘bloke with a beard’. He had recommended that they try CPAP to improve his oxygenation but the ward were worried that this wouldn’t work.
Whilst our patient’s beard was not impressive enough to grace the Royal Court of Czar Nicholas II, it was still a barrier to the application of a CPAP mask. These masks require a tight seal and any beard growth in excess of ‘wispy teenager’ will interfere with the seal causing a leak and loss of pressure. We normally have a stock of CPAP ‘hoods’ which are essentially a soft plastic goldfish bowl which sits over your head. There are straps that sit under the armpits to hold it in place and a soft collar to provide an airtight seal. For patients who can’t tolerate a tight-fitting face mask, they are a very useful alternative.
Now Middlesbrough is not the sort of place that Hipsters tend to congregate. However, there are still enough men with beards to warrant us keeping a good supply of these hoods. Unfortunately, the ones in Europe are manufactured in Italy and the Italian government has banned their export until the pandemic is under control; God knows they need them there.
We are investigating ways of sterilising and re-using the hoods but for now they remain single-use. I offered to lend the patient my Remington Beard-Away but he wasn’t keen. I had a vague recollection of seeing a hood in the locked Outreach Nurses office (I know the code as they often hide cake in there). Sure enough, the last hood in the hospital was squirrelled away on a top shelf.
A few hours later, our so-called ‘Mad Monk’ was looking much better. Fingers crossed, he was going to avoid intubation and ventilation.
One of the other reasons why patients don’t tolerate the usual tight-fitting CPAP face-masks is that they really don’t want to. They can be very uncomfortable, especially if you are wearing them for days at a time and some patients would rather be breathless than put up with the discomfort. If I’m honest, the problem appears to be that they don’t seem to believe us when we tell them that without the mask they could stop breathing.
With the pandemic that has all changed. I have never seen so much compliance with CPAP. Prior to admission, patients have been at home with not much else to do except watch endless news updates. They know that COVID pneumonitis kills and they don’t doubt us any more when we tell them that they REALLY do need to keep the mask on…
Beard-free application of a CPAP Hood
(Image courtesy of the StarMed/Intersurgical website)