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"PC: Suspected flecainide poisoning, Infant, time of ingestion 8:00. Case open 8:07."
How does this case, bear semblance to an event on the Hudson River, NY on 15th Jan 2009?
@captsully
@tomhanks
#writerscommunity
#medtwitter
#TwitteRx
@MedacyClinical
1/
"PC: Suspected flecainide poisoning, Infant, time of ingestion 8:00. Case open 8:07."
How does this case, bear semblance to an event on the Hudson River, NY on 15th Jan 2009?
@captsully
@tomhanks
#writerscommunity
#medtwitter
#TwitteRx
@MedacyClinical
1/
I think we can all remember where we were that day.
"On January 15, 2009, US Airways pilots Captain Chesley "Sully" Sullenberger and 1st Officer Jeff Skiles board US Airways Flight 1549 from LaGuardia Airport intending to land at to Charlotte airport.
https://twitter.com/i/events/1085654956458225666
2/
"On January 15, 2009, US Airways pilots Captain Chesley "Sully" Sullenberger and 1st Officer Jeff Skiles board US Airways Flight 1549 from LaGuardia Airport intending to land at to Charlotte airport.
https://twitter.com/i/events/1085654956458225666
2/
"3 minutes into the flight, approx altitude of 2,800 ft (850 m), the Airbus struck a flock of Canadian geese, disabling both engines. Without engine power & judging themselves unable to reach nearby airports Capt "Sully" emergency lands the aircraft on the Hudson River, intact."
"The crew and passengers of 155 evacuate without any fatalities.
The press and public hail Sullenberger a hero, but the incident leaves him haunted...."-Wiki.
There is no comparison of my case to landing an airbus on the Hudson with 155 souls alive.
4/
The press and public hail Sullenberger a hero, but the incident leaves him haunted...."-Wiki.
There is no comparison of my case to landing an airbus on the Hudson with 155 souls alive.
4/
Watching the movie "Sully" @captSully, made me resonate with the intricate value of timing and refined experience.
Of foresight, of appreciating calm action to the very end, to preserve life.
“155, that’s my number.” Captain Sully.
My number is just one.
5/
Of foresight, of appreciating calm action to the very end, to preserve life.
“155, that’s my number.” Captain Sully.
My number is just one.
5/
One youthful infantile life, just starting out.
Vulnerable to every decision being made.
08:11 with my handwritten flecainide overdose calculations, I am conflicted having read @Toxbase.
Then I come across "Clinical features may occur quickly (after 30 minutes)…"
6/
Vulnerable to every decision being made.
08:11 with my handwritten flecainide overdose calculations, I am conflicted having read @Toxbase.
Then I come across "Clinical features may occur quickly (after 30 minutes)…"
6/
“Baby seems fine, usual self.” Mum with infant.
Trying to predict variables at 11 minutes post-dose is like trying to land without edge lights on a runway.
We’ve all played that flight simulation game too overconfidently, and fibbed when we crashed without warning.
7/
Trying to predict variables at 11 minutes post-dose is like trying to land without edge lights on a runway.
We’ve all played that flight simulation game too overconfidently, and fibbed when we crashed without warning.
7/
This is no simulation. All I have is the infant’s weight.
I consider calling NPIS (national poisons centre) for guidance, but there’s a time levy of 3-5 minutes.
Will it add value to what I already sense?
[“We may end up in the Hudson.” Captain "Sully"]
8/
I consider calling NPIS (national poisons centre) for guidance, but there’s a time levy of 3-5 minutes.
Will it add value to what I already sense?
[“We may end up in the Hudson.” Captain "Sully"]
8/
I’m still moving variables around in my head, like new with old furniture, trying to find a fit, a predictor.
My notes; Paed factors, unpredictable kinetics/dynamics, unlicensed prep, telephone triage, Mum’s ability to manage any crisis, and a fundamental lesson
9/
My notes; Paed factors, unpredictable kinetics/dynamics, unlicensed prep, telephone triage, Mum’s ability to manage any crisis, and a fundamental lesson
9/
in tox management. Guidance documents are just that. One size doesn’t fit all.
For @captsully switching on the APU was step 15 on the protocol but completed much earlier.
“I’m going to have a paediatric nurse join this call."
It’s not protocol.
"Ok" Mum mildly perturbed.
For @captsully switching on the APU was step 15 on the protocol but completed much earlier.
“I’m going to have a paediatric nurse join this call."
It’s not protocol.
"Ok" Mum mildly perturbed.
“Keep talking to us Mum… tell us what’s happening.” Nurse M.
08:17 without M, I may not have been coherent enough to pick up the pattern change in the infant’s cry. Mum describes a change in behaviour & colour.
“My patient” Nurse M steps in, discharging with instructions.
08:17 without M, I may not have been coherent enough to pick up the pattern change in the infant’s cry. Mum describes a change in behaviour & colour.
“My patient” Nurse M steps in, discharging with instructions.
“Your patient” I confirm then, with silent acquiescence dial 999.
I can't believe it's happening.
08:18: CAT1 Ambulance ETA of a few minutes.
“Is there a rapid responder in the area?” Again, not protocol but we’re all on the same page.
“Dispatched.”
12/
I can't believe it's happening.
08:18: CAT1 Ambulance ETA of a few minutes.
“Is there a rapid responder in the area?” Again, not protocol but we’re all on the same page.
“Dispatched.”
12/
"Help is on the way." Nurse M, my co-pilot.
A source of comfort, helping me navigate this fast and unravelling terrain.
08:23 The rapid response unit arrives first, followed shortly by the Ambulance.
Nurse M leaves the call, relieved, and screen messages me.
13/
A source of comfort, helping me navigate this fast and unravelling terrain.
08:23 The rapid response unit arrives first, followed shortly by the Ambulance.
Nurse M leaves the call, relieved, and screen messages me.
13/
“Did that really just happen?... How did you know?”
I don’t reply.
08:25. I close the call and experience a fine tremor in my hands. The adrenaline.
What did just happen in 18 minutes?
Recapitulating tox numbers still doesn't make any sense.
14/
I don’t reply.
08:25. I close the call and experience a fine tremor in my hands. The adrenaline.
What did just happen in 18 minutes?
Recapitulating tox numbers still doesn't make any sense.
14/
I’m haunted by them for the rest of the shift, within the deep abode of my mind.
“...it’s all about timing Larry, you can accomplish anything if you’re never in a hurry.” @Captsully
20:23 I call the attending at A+E. She’s very thoughtful, grateful even.
15/
“...it’s all about timing Larry, you can accomplish anything if you’re never in a hurry.” @Captsully
20:23 I call the attending at A+E. She’s very thoughtful, grateful even.
15/
“Yes infant was hypotensive, ECG/Echo done but with cardiology now so they've taken over. I wouldn’t have thought baby would have symptoms at that tox strength but ...
How long have you been a Pharmacist?”
“21 years this year.
My whole life.”
16/
How long have you been a Pharmacist?”
“21 years this year.
My whole life.”
16/
My screen message still open to Nurse M catches my eye as I start closing down access. She’s still showing “online.”
“There was no time for calculating, I had to rely on my experience of managing the altitude & speed on thousands of flights over four decades.” @Captsully
17/
“There was no time for calculating, I had to rely on my experience of managing the altitude & speed on thousands of flights over four decades.” @Captsully
17/
This case made mountains of anxiety rise,
continents of cadence shift under my feet.
After 21 years, I’m still learning.
I'm resigned to the fact that one can never really know everything, but know your ability.
Some cases will never be so clear cut & test our vigilance.
continents of cadence shift under my feet.
After 21 years, I’m still learning.
I'm resigned to the fact that one can never really know everything, but know your ability.
Some cases will never be so clear cut & test our vigilance.
As leave the building to go home, I carry some exit wounds under the night sky as a reminder.
And my thoughts over my reply to Nurse M.
“Flecainide happened. At low altitude.
But we saved a life. We all did it, together.”
19/
#NHS
#NHS111
#pharmacists
And my thoughts over my reply to Nurse M.
“Flecainide happened. At low altitude.
But we saved a life. We all did it, together.”
19/
#NHS
#NHS111
#pharmacists
“Fatalities have occurred at doses:18 mg/kg (Forrest 1991) but complete recovery has been reported at 166 mg/kg (Hanley 1998).” @toxbase
“Everyone forgets that Icarus also flew.
I believe Icarus was not failing as he fell,
but just coming to the end of this triumph."
-J Gilbert.
“Everyone forgets that Icarus also flew.
I believe Icarus was not failing as he fell,
but just coming to the end of this triumph."
-J Gilbert.
