Tuesday 31st March 2020
COVID Figures for 30 March
UK Hospital Deaths 180 / Total 1415
James Cook Hospital cases – 97 / Total deaths - 11
James Cook Hospital Critical Care cases - 21 (3 suspected) / 12 ventilated
Another day on the High Dependency Unit (HDU). We have now changed the HDU into an Intensive Care Unit for COVID patients. Essentially the difference is that we now have ventilators in each bed space and there is one nurse for each ICU patient instead of one for every two HDU patients.
The HDU has been screened off and, after the ICU 2/3 ‘Berlin Wall’ fiasco, the Estates Department have decided to erect a more temporary lightweight screen to isolate the unit.
Once again, we are indebted to new nursing staff who have come from other critical care units throughout the hospital, from the military or have returned to work following retirement or sickness.
One of our Outreach nurses has been off for a few weeks with a ruptured anterior cruciate ligament (ACL) in her knee. The operation she needs has now been cancelled and so she has returned to work and is hobbling around on a crutch, seeing patients. Respect.
I was working with one of the paediatric ICU nurses today who, since we took over the paediatric ICU, has moved to look after adults. Considering the size of the obese patient she was looking after, I can only imagine the culture shock she is experiencing. You could easily hide four children under the patient’s bed covers and not find them again…
Meanwhile, the hospital is admitting more and more COVID patients. The older part of the hospital, the wards in what is called the ‘Tower Block’, have been turned over exclusively to COVID patients. Staff there are working very hard to cope with the demand.
On HDU we are dealing with a number of patients who were admitted overnight, one of whom is the patient in his 20’s who has worsened. He is on CPAP and, looking at his chest x-ray and blood tests, I am worried that he is likely to need ventilating in the next few days. Even so, he should do well, given his age, but will recover quicker and spend less time in hospital if the CPAP works and he can avoid intubation and ventilation.
In the afternoon we admit three suspected COVID patients in quick succession, all for CPAP. Just when we are beginning to feel that we are back in control we are given another three patients, two who have come in from A&E with rapidly worsening respiratory failure and who are almost certainly COVID positive. There is also an intra-venous drug abuser who has an infection from an injection site. He may also be COVID positive but this is not his primary problem.
Nicky has had a decidedly less pleasant afternoon than I do as she has been looking after another of our COVID ICUs; she has had to make the decision to stop and withdraw intensive care support on two patients. They are not getting any better and in fact are worsening despite our best efforts. I will write more about that tomorrow but now it’s time for a stiff drink before bed.
The HDU before...
And after...