I’ve been meaning to join my Trust’s bank for months, and this week I’ve finally got round to it. For those who are unfamiliar with temporary staffing in the NHS, staff who want to do extra shifts can join their Trust’s ‘staffbank’ which is large directory of staff who can sign up to cover shifts unfilled throughout the Trust’s hospitals.
I thought that with potentially a med school interview or two on the horizon it would do me good to be able to talk about the role of medical professionals outside of A&E.
I did my first shift today and it was in the Labour ward! I was really excited before I arrived; I thought that I would be able to help out with the cannulation (not of the newborns, just the mothers!) and observations of mother and child, and work closely with the midwives and doctors and pick up knowledge of a speciality very far removed from my A&E experience.
My day was actually incredibly dull and disappointing. The healthcare assistant role on the Labour ward isn’t actually a health or a care role. You’re a cleaner; you mop bloody floors and change bloody sheets after mum and baby have vacated rooms. And that’s it. There’s nothing wrong with being a cleaner, but that wasn’t the role I’d signed up to do. It was mind-numbing and frankly pretty disgusting (which in itself is often a natural part of the HCA role, but when there’s no patient interaction with it, you don’t get that fulfilled feeling inside). When I was coming to the end of my eight hour shift, they asked me if I’d stay on and do a 12.5 hour shift instead – I politely declined. It is a very necessary job, but not one that I would recommend for anyone who is looking to assist with health or care. I’ve cancelled my shift there tomorrow.
I’ve signed up to work a shift in a Cardiac Catheter Lab next week which should be really exciting! Pretty much every patient they see there has had an myocardial infarction of some sort I think, I’m going to give them a ring before I go though because I want to understand what the role entails before I go – I don’t want it to be another experience like today was.
After tax, I probably made £50-60 today, which is worth having, but I could have made it somewhere else where I was actually making a direct difference to the patient experience. I will try not to make this mistake again.
Above you can see a colleague of mine holding a bit of an anaesthetic circuit with a pink mask on the end. This was the attempt of an adult only A&E to make a spacer for a child with breathing difficulties who’d initially gone to the wrong place.
Now this (directly above) is what a spacer should look like. And the replacement provided by the adult A&E, apart from making us all laugh, was actually a little dangerous as it gave the impression that the child had had a proper dose of salbutamol when in reality the inhalor hadn’t made a proper seal and the ridges in the tube were probably catching quite a lot of the inhalor.
Anyway, thankfully the kid was fine after a night in hospital 🙂
Building on my last post, I’ve found this youtube playlist of some short videos of infants in respiratory distress. From my year, so far(!), in Paeds ED, sepsis and respiratory problems have been the two most common medical reasons for admitting kids to PICU (ie the reasons why kids are big sick). And as winter comes round, there’ll be more and more bronchi kids
It’s really important to be able to recognise the seriously ill child, and if you can pick up on on these respiratory signs you’ll be doing pretty well. Before I add the links, just a quick point; we in the UK call the sucking in of various bits of the chest ‘recession’, but in the US they call it ‘retraction’.
So, here goes:
This is a really good example of ‘tracheal tug’; where there’s a big sucking in around the trachea. Really pronounced tracheal tug can be a sign of very severe respiratory distress. In adults with respiratory distress something you look for is someone who can’t speak in full sentences – this baby clearly cannot ‘speak’ in full sentences either.
In really small infants they ‘head bob’ because their neck extensor muscles are weaker than older kids.
This one’s particularly grim; it shows a small infant with horrendous sternal recession and tracheal tug. Sternal recession generally shows respiratory distress at a more advanced stage than intercostal and subcostal recession alone. These kids are often pretty sick. You can really hear the stridor as well
This video’s similarly unpleasant; it shows an older child with pretty much his whole chest sucking in (you can see this better at 00:14). This video appears to show the child being bagged.
None of these videos are particularly nice to watch, but they are very informative for any students doing paediatric placements.
And to make you feel better, here’s a video of a happy infant with puppies 🙂
A little while ago we had a little one come in who seemed unwell, but not horribly sick. She was only a couple of weeks old, but she was a bit snuffly and wasn’t feeding very well because she found it difficult to breath and feed at the same time.
We didn’t have any immediate concerns but were going to admit here to help with the feeding and give her a bit of a suction when we were free to clear her out.
An hour or so late, obs were done on the child and she was found to be in severe respiratory distress with sternal, subcostal and intercostal recession (see video below for an example), and oxygen saturations in the low 80s.
She didn’t respond to positive pressure, and when an infant of this age has to work so hard they tire quickly and their respiratory distress can turn into respiratory arrest. Before she got that point we had to assist her in her breathing by bagging her (using a bag valve mask) and then by breathing for her by intubation her. She was admitted to PICU and made a full recovery, but even so, to go from concern for feeding to severe respiratory distress in an hour without someone paying much attention is a little worrying.
Good on the parents for bringing this kid in. If they’d waited another few hours, the outcome could’ve been very different.
Today the UKCAT deciles were released and while I know I’m not going to make the grad courses, it’s given me a lot of hope for the 5 year ones 🙂
My 687.5 is apparently in the top 20%! So, I now think I might make an interview at Durham, but we’ll see!
An interview at Durham would actually be preferable compared to Glasgow. An offer from Glasgow would be contingent on me completing my MSc possibly at a high grade, whereas Durham would most likely be an unconditional offer as I already have a 2:1!
Winter has really kicked off in in paediatric a&e.
It’s still just about warm enough for kids to be out and about getting into accidents and being trauma called, but on top of that the winter wheezers are coming in too, and they’re pretty sick.
As ever, there’s a long wait to be triaged and having multiple kids sitting out waiting to be seen with their sats in their boots is not good.
The deluge has begun.
This morning was UKCAT morning; it was five years coming and it finally arrived. I ended up getting a pretty average 687.5, I think this probably rules me out of Warwick, but I’ll still put an application in there because it looks really nice. The plan now is to apply to two five year courses, Durham and Glasgow. Durham traditionally has a pretty high UKCAT requirement, so that’s probably not going to happen.
But, I possibly have a very good chance with Glasgow – they require a science degree from graduates, but the admissions tutor on the phone said she thought they’d accept my MSc as a science degree; rather than than a first, undergraduate, degree. The only other possible issue there is the classification of the MSc – I’m not expecting it to be too hard to pass it, but if they require a Merit overall, that will be a bit difficult.