Nightshifts as a COVID Cardiologist | Doctor's Vlog

the Sun is setting on a another very pleasant day but obviously like everybody else I was stuck inside all day however unlike most other people I get to leave in evening because I'm on my way to work I'm doing a set of night this week and so I thought it might be useful if I maybe a document some of that for you you've probably seen a lot of news reports coming out of intensive care and explaining what happens there and my friend Edie hope on his YouTube channel has been doing a fantastic job vlogging his experiences as an emergency department doctor so what I hope to do with this video is explain a little bit about another side of the hospital chiefly what happens to inpatient teams outside of intensive care of the emergency department and in my case obviously I'll be concentrating on cardiology and how we've been affected so already I can tell you that cardiology departments have changed like all other departments in the hospital's unrecognizably for the last few weeks all elective procedures have been canceled so these are planned operations and procedures and those patients are now in a kind of limbo I I've talked about them in my last video which is about the indirect victims of covert 19 people whose health has not been affected directly by viral infection but by the chaos caused by the virus but the cardiology department also deals with patients coming in acutely so my job is to see patients coming straight through the door brought in by the paramedic crews with high-risk unstable heart symptoms like heart attacks or heart failure where they have difficulty breathing and and that's a medical emergency or abnormal dangerous rhythms and they are direct admissions to us from the community so just also an opportunity to give a shout-out to the paramedics or EMTs as they're called in North America who are heroes of this whole pandemic doctors and nurses tend to get a lot of dimensions but paramedics are going into people's houses and exposed to a lot of risk and the guys that I chat to whenever they bring patients in here it's clear a lot of them are not getting adequate PPE either so hats off to the paramedic crews so that's one group of patients that we're obviously still seeing and then other patients that I'll see on this this set of nights I'm going to be receiving referrals from hospitals all over the region we're this specialist Kodak's I'm the on-call doctor overnight so all advice or things like that called will come to me from those other hospitals and if patients are unstable then I'll accept them as transfers here so those are the kinds of patients I'll be seeing this week let's see if the numbers truly are reduced as I mentioned in that previous video across the world we're seeing heart attack numbers drop which is not a real reflection that heart attacks are reduced but we think it's because patients are dying at home all because patients are reluctant to come into hospital and are ignoring or suppressing their symptoms and not acting on them because they are worried they are going to be exposed to covered 19 if they come to hospital well not the best start to a shift it's past two o'clock now I ordered some pizza after taking handover from my day colleague that was a foolish mistake because at the exact same time the pizza arrived to emergency patients arrived one was a really long case which I've not finished that long ago and all emergencies through the door now the UK guidelines for minimum PPE is that all acute admissions like that should be treated as a query covered status so you can probably still see the imprint on my face although we finished about 35 minutes ago and then been seeing other patients on the ward who are unwell my pizza and two premium sites are ice cold now and hopefully I'll get to eat a little now so enough from me well it's 10:00 a.m. now I'm about to go home I apologize I didn't really get a chance to film anything at all it was perhaps a little bit optimistic to bring all my camera gear to work it kind of makes me wonder how all those other medical channels managed to make long vlogs while on a shift I can only really conclude they don't have any work to do I'm kidding of course overnight tonight we had a few emergency admissions but actually the main busyness was on the ward with patients who were unwell some covered patients some just conventional cardiology patients and that the main patient that I spent most time with was suspected kovat and it was mostly respiratory issues I'm at least glad that I managed to get a few slices of pizza that was really my only break I didn't finish the pizza obviously I would ordered an extra-large I mean that just makes financial sense I finished the chicken wings I mean that goes without saying but I still had this big box so I had to do the walk of shame as I left the ward this morning past cardiac patients who've seen their cardiologist wag his finger at them I don't really do that as saying eat healthily to avoid another heart attack and then they see this man and they can only assume that I'm eating pizza for breakfast although technically it's my dinner and they'll be thinking a physician heal thyself I bet this guy took the hypocritical oaths no they probably got better senses of humor than that but nevertheless I'm just gonna blame Kovac for my unhealthy eating it is difficult honestly I think we all have to get out of this with our sanity and if we're eating less healthily than normal particularly if you are unable to get out and you're stuck at home I wouldn't beat yourself up about it it's much more important to try and stay active keep moving as much as you can I actually brought my skipping rope to work I'd rather you didn't punish yourself too much about eating or at least that's what I'm telling myself just to justify this horrendously unhealthy meal but as I've said before on this channel calories on a night shift don't count [Music] [Music] day number two or night number two it's half past eleven I've just sat down to have a bite to eat it's been a busy shift first three and a half hours but manageable maybe a bit more so than yesterday thank you very much to a local Indian restaurant for donating my dinner that's very kind of them we've also had some donations of strange energy drinks one made by coke which I've never heard of and it was disgusting and then this thing called food just reminds me of doof which is lovely one of the things I've been dealing with this evening is a cardiac arrest of a young patient I'm not going to go into too much detail about any of the specifics of cases that I see but a general overview of cardiac arrest in the covin 19 here I thought would be an interesting one to start with cardiac arrest as I'm sure a lot of you know is something where the survival is particularly poor especially ones that occur outside hospital it's somewhere in the ballpark of about 10% of patients surviving to a good outcome from care icarus that occur outside hospital about 20% in the hospital which isn't very good and when I say good outcome I think that's a key point to take home movies and TV teach us not only that does kinda arrest almost always results in getting a person back pretty quickly that's not my main objection it's more the binary nature of the outcomes that are depicted in fiction so a patient either dies or they make a full recovery but in reality it's a lot more blurred than that and that's something that I think can be a struggle to communicate to patients and their families in particular we talk about something called downtime when patients have a cardiac arrest and before they regain their output that's defined as their downtime and different people have a different tolerance for how much downtime they can sustain oh dear where was I cardiac arrest not having a binary outcome yes downtime so the longer someone goes without an output the greater the risk of damage to their brain and that's really much as it pains me to say as a cardiologist the main organ we worry about is the brain in a cardiac arrest because the heart you can try lots of things to get it back sometimes you'll never be able to restart a heart sometimes you can but there's been such damage that's occurred to the brain you're you're likely to have a very poor neurological outcome and I think a lot of people when they understand that it's a much more complicated picture than just live die then maybe have different thoughts about resuscitation that's that's a video in itself or many many videos my point is that the shorter that downtime is the better and you can mitigate that damage to the brain by starting chest compressions early now in the era of covered 19 patients suspected of having kovat or paper-covered positive patients chest compressions and cardiac arrest is defined as a high-risk procedure aerosol generating procedure meaning that there's a high risk of infecting people around so it's imperative that for a high-risk kovat cardiac arrest everybody is in full PPE so level two PPE that's an FFP three or n95 respirator filtered mask a full gown head covering eye protection gloves this is for cardiac arrest only doesn't imply that needs to be for all patient care what that means is that if you have a cardiac arrest on the on the ward for example people have to Don that PPE before going in and that takes time and a video came out recently involving some of my friends who'd made a very educational video for health professionals about what the procedure should be for a cardiac arrest and it's a very strange thing to watch as a clinician because your first instinct whether you're a doctor nurse or anybody who works in the hospital with someone who's unwell is to try and help them straight away but in covert nineteen era that's not the case and you've got this very strange process which I've now experienced on a few occasions where you don't do anything for the first few minutes except put all this gear on and that means the patient there their downtime without compressions is significantly elongated and and that's something that's really unavoidable one way round would be to have everybody in full PPE all the time but as I'm sure you don't need me to tell you that's something that just isn't possible at the moment I realize that might scare some people so I want to emphasize that this is not all patients this is those positive fur coated 19 or thought to be at high risk and hopefully ideally those patients would be being nursed by nurses in full PP already so they could start the process the chest compressions and everything and this is why PPE is so important it's not just a case of healthcare professionals being protected but it's also these kinds of scenarios where patients are being affected by the lack of PPE as well and as I think I mentioned yesterday cases that we take to the cardiac catheter lab so unstable patients heart attacks and that kind of thing we're now in full PPE from the start because those patients tend to have cardiac arrests reasonably frequently but I'll talk more about that next time I see but I'll talk more about that next time I sit down with you right now I've got to go back to work [Music] [Music] I just had to break some bad news via the phone which is something that I've always sought to avoid doing through my career because if you're going to tell a person that their loved one is very sick or is has died then it's better to do that in person and that's what we always try and do and this is one of the big changes that I thought I'd explained is the complete lack of families and visitors in the hospital for the last month or so and it kind of gives a weird atmosphere because Ward's may be extremely busy every bed is full with very sick patients but when the doors are closed to the patient rooms the ward feels almost quiet because you don't have the hubbub of visitors and family members and particularly patients who've been there a while you know you get to know their families and it's it's this is something that is very unusual cause bykova 19 and talking to families is part and parcel of being a medic particularly in areas where death is a regular occurrence like intensive care cardiology palliative care care of the elderly and it's a part of the job that most doctors really relish having that interaction with families it's what sets Medicine apart from just a cold science and so doing these things over the phone is is a new experience and it made me think of in an interaction I had a few weeks ago before the lockdown before in the sort of early days of coronavirus when I had to tell somebody that her husband had died he'd died on the table this lady stood up to give me a hug and then kind of pulled back and said oh you don't want to hug me do you and I didn't understand what she meant at first and then it took me a few seconds to realize she was referring to social distancing and the kind of advice people are getting to avoid physical contact and it was just a really thing to here and obviously sister in charge of the water was there with me and I both gave her a big hug and we had a normal human interaction and it stuck with me afterwards that it was it was something that I'd never imagined I would hear and I hope that the human interactions don't get lost for medicine physical contact for a physician I mean it's the same etymological origin as part of our career not just holding a patient's hand to console them but laying on hands to examine a patient is part of the whole ritual of going to a doctor rather than just standing at the end of the bed and ordering a CT scan that that's already I guess you could say some of the humanity has already been lost but you know when I teach examination skills to doctors about recognizing different physical findings all the luminaries that have gone before us in medicine who have eponymous signs named after them you know that's art that's our tradition and history and heritage so I really hope all that doesn't get lost and and that kind of interaction with patients and their families but I don't know this could be a permanent legacy of koban 19 there are some changes to medicine that may be more positive we are definitely reducing unnecessary tests so in cardiology there's a test called an echocardiogram which is an ultrasound scan of the heart everybody just requests it without even thinking it's become a subconscious process this patient has a heart they need an echocardiogram if you decapitate some of these doctors at the level of the brainstem they will still be able to order an echocardiogram a lot of time is completely unnecessary in something like a CT scan where there is a risk to the patient radiant radiation but for a ultrasound there's very minimal risk but now there is risk maybe not to the patient but to the operator excuse me all right throw her in cardiology yeah that's fine so now we have to think about risk to people doing the scans whatever tests it is and particularly in echocardiography you're almost hugging the patient four out for now are doing that scan so we're really limiting the scans were doing to ones that will actually make a difference to the patient's management and we've cut down massively on the numbers and you know what it hasn't made a great deal of difference to management we're still doing the important ones of course so maybe that's a positive then I can try and leave this segment on a slightly uplifting note I thought I'd take this opportunity to talk about how covered 19 has changed the going home process and the considerations that we have for avoiding taking this infection home so when my shift finishes I'll have a shower at work and go home which I didn't previously used to do I'm averaging anywhere between three to five or six showers a day because when we come out of a case which is potentially contaminated we shower straightaway changing to a fresh set of scrubs that's also meant that we've had to buy new scrubs so there lots of brand new scrubs here there were shortages all over the country I saw that a medical fetish website actually donated some medical supplies like scrubs that's a website for well pretty obvious thankfully the kids seem to have been fine I did mention my baby had a temperature around the time I did he seems to have been okay I mean he produces industrial quantities of snot anyway but I think that's just his default setting so he doesn't seem to have changed unfortunately my wife does appear to have got it worse than me she's had a cough now for two weeks at least temperature was up again yesterday she's feeling really lousy body aches much more typical symptoms than I had actually and what to make matters worse she's got a husband who is currently of no help looking after the kids because I'm sleeping all day and out all night which sounds worse than it is she's got a symptom that a lot of people are asking me about the loss of smell I didn't experience that but she has got a NAS Mia yesterday she couldn't smell any of the baby's dirty nap dirty nappies you know now I say it out loud I'm wondering if was actually a ploy but I wouldn't begrudge her because she's been doing all the work with our kids so hats off I mean Surgical hats off to my wonderful wife [Music] you [Music] as you can tell I'm actually quite a shy and retiring type you can see from my choice of lens these are supposed to protect my crown jewels from x-ray radiation I think it's all a hoax designed by people that sell these kinds of bits and pieces I mean I've never seen any radiation have you frankly I think it's all invented oh no wait a second I'm thinking of a virus my stint of nights is almost coming to a close the last 24 hours at work or so have been dominated by covert cardiology not necessarily from patients that I'm looking after here but calls from other IT use asking about patients that they've had intubated for a while and treating forc Ovid who developed strange cardiac manifestations of the disease unfortunately there's very little that we can offer them at present as I mentioned in my previous video we're seeing fewer heart attacks coming through the door across the country and it certainly felt that way this week at work with fewer emergency admissions however I've been very busy with patients inside the hospital who I think are perhaps sicker than they normally are and that's a combination of patients suffering from kovat and it's complications but also patients presenting with whatever medical problem they came to hospital with later than they would have ordinarily done so I'm sure this videos going to turn out pretty long so if you've got this far thank you very much for sticking with it I've not made a video like this before so please do tell me your thoughts I'm looking forward to going home soon because my wife is really not looking well she's had that classic second wave so she got a bit better and then has deteriorated significantly and I'm a little concerned about her when I got home yesterday she was fast asleep breathing really rapidly like Sigourney Weaver in ghostbusters but hopefully she is now past the worst it's not a very nice feeling to know that I'm responsible for her getting sick in fact that reminds me that a wonderful nurse I used to work with in another hospital I learned recently got very sick with covered 19 and then her No medical husband also got sick and he's died so frontline workers in health care and all the other essential industries have rightly been getting some attention but behind them there's an army of spouses partners family members who are not only supporting them but are also exposed to some of the same risks just by being in the same household so please stay strong we're already seeing progress in the UK in the last few days new cases have appeared to Plateau so that's good news and you are all responsible for that it may feel like you're not doing much but you're all having an effect and believe me those of us in the hospital can see that already so please just stick with it a little bit longer and we will get through this I've I've not actually planned how to in this video

Channel: Medlife Crisis

Views: 182,076

Rating: 4.9700418 out of 5

Keywords: Medlife Crisis, Medicine, Science, Education, Comedy, Doctor, Cardiology, Medical School, COVID-19, Coronavirus, Hospital vlog, Cardiologist, Nightshift, On call, Emergency, Heart attack, Cardiac arrest, NHS, PPE, PPE shortage, Healthcare workers, Key workers, Nurse, Paramedic, EMT

Id: whC-NkYhEgg

Length: 24min 7sec (1447 seconds)

Published: Fri Apr 17 2020