gavin denton
@DentonGavin
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Gavin. nurse and advanced critical care practitioner ACCP
Joined November 2013
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Last Seen Profiles
@RealDeniseWelch
ICU in Birmingham is filling up Denise. We’re seeing plenty of people in their 40s, I’ve been looking after pts younger than me on ventilators with covid19. Blood pressure medication has no effect on covid19. This disease still kills 40% of ICU patients that have it.
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@sophielouisecc
Yep. We even looked after our colleagues on ventilators who weeks before worked along side us. We even watched some of them die. We were so privileged. We should be more grateful .
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253
Whisperflow valves have been around for years, why this is some sort of innovation is beyond me. Most CCUs and ITUs will have these hidden in a cupboard somewhere.
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Independent intra-hospital transfer of ventilated patients by Advanced Critical Care Practitioners?
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Can advanced critical care practitioners provide safe advanced airway management?
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@PolitlcsUK
@T_Haynesy
-They tell people not to have kids if they can’t afford them.
-Cap child benefits.
-Won’t feed kids in school.
-Do their best to keep wages down.
-most expensive child care in the world.
-Then complain that we don’t breed enough.
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Drug assisted endotracheal intubation skills in an Advanced Critical Care Practitioner team.
Heartlands ACCP team.
See presentation recoding below-
Hopefully published soon.
#DAS2021
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Can advanced critical care practitioners safely transfer ventilated patients without direct consultant supervision?
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Fingers crossed, publication submitted. In the mean time.
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@K_G_Andersen
@MackayIM
I’m waiting for the false positive brigade to chime in. Surely the CT threshold was too low, all these mink had pre-existing conditions, this is just a mink-demic. I won’t believe this until mink end up in hospital, how many mink got flu, PCR is just finding mink flu?
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Welcome to Birmingham’s 4th wave, about 30 covid19 inpatients two weeks ago, 78 last week, now 150. We peaked at about 700 last time. My guess, that will take about 4 weeks, maybe less. Expect post EUROS surge next week. But hay, ur all free from Monday.
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1/ I think the NHS needs to drastically scale back elective surgery NOW. We can’t get ward ready patients out of ITU now and have undifferentiated type 1 respiratory failure patients with no red flag travel or contacts in open areas. No ones fault it’s just how we work now.
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The safety profile of central venous catheterisation by advanced critical care practitioners.
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Thinking aloud. Professional boundaries have never been more blurred in critical care. I wonder what this might mean for ICU over the next 20 years. Will professional tribalism dissolve, particularly between HCPs/advanced practice and medicine?
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@HaggsBoson
@rupert_pearse
@RoyalLondonHosp
This is probably half this hospitals intensive care capacity. What do think they’ll do with all the strokes, post cardiac arrest, pneumonia, septic shock, drug overdoses, trauma patients, liver failure, renal failure, COPD patients that would otherwise occupy those beds.
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Experience of ventilating covid19 in theatres.
1) depending on size, 2-3 patients per theatre.
2) Gas machines aren’t great in the sicker cases, use ITU vent in cases that you prone.
3) if u take the anaesthetic machine out of theatre, u also loose your O2 and suction & need-
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Advanced airway management and drug-assisted intubation skills in an advanced critical care practitioner team
#ACCPAIRWAY
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The culture of medicine in the UK seems to becoming really toxic at the moment, in SoMe at least. It seems to be turning on everyone, including its own. It’s really depressing given what we’ve all been through in recent years. PAs/ACCP & all manner of advanced practitioners,
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A year. We had a short respite last summer between 1-2 wave. But, east Birmingham has now had a relentless year of continuous high covid19 pressure on NHS services. The hospitals are falling to pieces, the staff are knackered, staffing gaps are growing and we know another
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@AshleyBanjo
A form of protest. No matter how peaceful that protest is, people are told this is not the time or the place for it. The vitriol and barely masked racism from some white people in this thread is truly pathetic.
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@clare_eliza
@rosieICM
I think a huge part of the resentment towards advanced practitioners and other HCP stems from this.
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Is it me, or is ultrasound, especially cardiac echo addictive. It’s like having Dr Who’s magic screwdriver. It’s a rabbit hole once you start learning.
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A narrative review of the training structure, role, and safety profile of advanced critical care practitioners in adult intensive services in the United Kingdom
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@MarcTennant
The risk of death from falling from a height of above 10000 is raised by flying in a plane, we need to close this gap compared to walking at sea level. FFS.
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One of our ACCPs got to work Saturday night, he just got home for the first time this morning. On site for 60 hours to cover 3 nights shifts on ITU. Proud to be part of this MDT.
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Experience of burning covid19 surge,
Running out of pumps.
Running out of power cables for pumps
Periods of running out or propofol.
Running out of alfentanil, switching to morphine and back to alfentanil when the morphine runs low and alfentanil is back.
The logistics are-
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Drug assisted endotracheal intubation skills in an Advanced Critical Care Practitioner team.
Heartlands ACCP team.
See presentation recoding below-
Hopefully published soon.
#vDAS2021
#AdvPracWeek21
#AdvancedPractice
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@fuktheflux
@vagina_museum
The point is that sex and gender is complex despite people insisting that it’s binary. This is one example of likely hundreds of chromosome and neuro-endocrine variations that present in humans that influence sex and gender. Facts don’t need to make points, they are just facts.
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@BBC
@BBCiPlayer
our English lit class. No one had any ambition for us, no one asked if we had any. 🖕🏿two degrees and a Masters, maybe a PhD some day. My dad to this day still thinks he’s inherently stupid, those teachers voices have never left him. I’m not suppose to be where I am, but many are.
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@nicky_NoPasaran
@OwenJones84
You’ve no idea mate. 20 years of ITU and my second pandemic, never seen anything like it. I’m use to ventilating pts all over the hospital when we run out of icu beds, it’s a regular occurrence, Christmas being the worst periods. This is something else entirely.
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2nd most downloaded paper from the journal of the intensive care society from a little bunch of upstart ACCP from an average DGH. It’s not all about ECMO, LVAD and transplant. Most ICU delivered at the DGH.
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Would be good to see ACCPs promoting their work, team, publications and projects on Twitter under the hash tag
#AdvPracWeek18
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First published audit on aspects ACCP practice. Are ACCPs safe and effective clinicians in the delivery of critical care? Transfer of ventilated critically ill patients, CVC insertion and team based airway management?
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@K_G_Andersen
@MackayIM
These mink aren’t dying from covid19, they died bc they were culled, and they would have died from their pre-existing conditions. There are no excess deaths in mink. These policies are draconian and the liberties of mink must come first. How can we destroy the fur coat industry-
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Drug assisted endotracheal intubation skills in an Advanced Critical Care Practitioner team.
Heartlands ACCP team.
See presentation recoding below-
Hopefully published soon.
#vDAS2021
#AdvPracWeek21
#AdvancedPractice
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Thanks for promoting our teams work. I’m very flattered. Just in case you’ve missed any ACCP publications, here’s a definitive list:
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@RCollEM
@EMTAcommittee
@EMSAS_RCEM
@RCEMACPForum
@RCEMpresident
@RCEMdean
@RCEMPolicyVP
@RCEMmembersVP
@dsdarbyshire
@RCEMACPChair
@RCEM_VP
@6bd20de2260e4ea
-prone positioning and ventilation. Mentored lung and FICE trainees. Identified cardiac function changes with FICE. It’s been a quiet week. I’m an ACP in critical care.
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Very proud of my ACCP team today. The night shift arrived full well knowing they could not get home and slept on sight and work tonight. The day shift took 3 hours to get to work and are sleeping on site to work the next day.
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Qualified 8a ACCP post city/Sandwell hospital Birmingham.
New hospital and shiny new ITU next year.
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The provision of central venous access, transfer of critically ill patients and advanced airway management: Are advanced critical care practitioners safe and effective?
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@marcuschown
@mrjamesob
Isn’t it remarkable how the wonders of market forces and free market capitalism becomes very inconvenient and requires central control and subsidy. That magic money tree frequently materialises for certain parts of society, socialism for the wealthy is alive and kicking.
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@ShaunLintern
@LivHospitals
This is like the week before the first lockdown, government in denial. At this rate we’ll be looking at national suspension of elective surgery.
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@carolyndeng1
Never insult someone serving you food, never insult someone with propofol and muscle relaxant. Rules for life.
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Adding to the Heartlands ACCP practice audit. External transfer of ventilated patients. Hope to publish when we hit 200 cases next year. Poster presentation at the ICS today.
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A narrative review of the training structure, role, and safety profile of advanced critical care practitioners in adult intensive services in the United Kingdom.
#AdvancedPracticeWeek2023
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#ICSSOA
if your interest in how ACCPs can contribute to your ICU service come to room 5 11:15 on ACCP led transfers of ventilated patients.
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@DoctorDoolittl6
@ShaunLintern
@drjawalsh
@NHSEngland
That is an out and out lie. I’ve nursed pts on vents in their 70-80s with covid19 for weeks. The publicly available ICNAR audit data shows this and we’re admitting more older patients than the first wave. You make these claims, you SUBSTANTIATE THEM
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The provision of central venous access, transfer of critically ill patients and advanced airway management: Are advanced critical care practitioners safe and effective?
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@katiewiskar
@ArgaizR
As fascinating as the echo is, at this age, with this heart, surely care based on comfort and dignity is the most appropriate approach here.
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ACPs at Heartlands, Solihull, Goodhope showcase there academic work, audit and QI projects.
#AdvPracWeek18
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@em_j_b
It’s amazing how many people replying to your positive experience insist that you’re not listening to their negative experience and therefore invalidating it. Impressive level of circular reasoning.
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@coollyndz
6x more likely to contract covid19, HCPs make up 10% hospital admissions, at least 600 dead health care workers in NHS. High rates of asymptomatic infection amongst HCP looking after highly vulnerable pts which they may pass it too.-
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ACPs at Heartlands, Solihull, Goodhope showcase there academic work, audit and QI projects.
#AdvPracWeek18
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@GoughCJ
Me neither, covid19 Itu full, the tail end of this is months away and we are deliberately making things worse. Wife noting the 1000 yard stare when I come home again. We’re all so frustrated with a unit with unvaccinated pts.
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@spennymoor4us
@LBC
@mrjamesob
The class snobbery in that statement beggars belief. That you think that a black man from a highly likely working class background can’t think and articulate in the manner that he has speaks volumes.
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What has become so toxic in medicine that means that some Drs feel the need to make anonymous accounts to sling their poo at ACPs. This is not trainees voicing legitimate concerns. This is using anonymity to bully and silence people. I won’t going away, I won’t put my head back
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@allisonpearson
@sophianictract
@BBCr4today
Utter crap, our hospitals in Birmingham have been rammed. ED attendance is at pre Covid levels and has been for 6 weeks and now our ITU is filling up with covid19.
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#ICSSOA2017
ARDS probably more prevalent on our units than we think, are we measuring it on our units? We under-diagnose it, only 60% ADRS pt recognised. We don't prone enough. We need a big APRV study. Consider driving pressure optimisation.
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@LukeJohnsonRCP
The majority of covid19 icu pts are between 50-70. Most of them are just like You. The majority don’t have severe comorbidities, the majority are completely independent. My unit is full of men like YOU. Good luck, hope you never meet people like me.
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@JustTheFacts37
@CT_Bergstrom
They pregnancy tested 100 men, all false positives. Someone’s making a fortune. The more men we test the more false positive pregnancies we get. Guess what when these men end up in hospital, they’ll be labelled as pregnant on admission, even though they’ve just turned up pissed
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@Ian_Fraser
@jdpoc
There must be some sort of interplanetary clone army facility where they breed these odd looking beasts.
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@mandy_odell
@BACCNUK
Critical care without walls was never about delivering level 3 care, it's about discharge support, admission prevention, education,
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surge is coming in a few weeks. The light at the end of the tunnel keeps getting further away. > 90% of our patients are unvaccinated and they just keep coming. I think we’ve now become resigned to the unnecessary loss of life.
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James Haslam, probably the biggest clap of the conference. Very emotional speech from someone who clearly hates public speaking, but obviously felt that the story needed to be heard regardless of his anxiety. Pravtsclly standing applause. Novichok
#ICSSOA2018
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@NoStaticAtAll
The Rcn removed derogations, and it bought the government back to the negotiating table. BMA is learning a lesson from nurses.
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@AnnaKFlink
@WeNurses
The question is, does the person handing out pills understand the rocket science behind the pill. Those that don’t are a clinical risk to a patient. Otherwise all we need are dispensing machines, not nurses.
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@gruntdoc
@credland_nicki
Expensive higher education is a political decision. It applies across all education. Not specific to nursing. If we want working class people to have access to higher education then we need the political will for that to happen.
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The influence of non-medical prescribers on antimicrobial stewardship: a national evaluation of the prescribing of antibiotics by non-medical prescribers in England from 2016 to 2021 (part 1)
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@ShaunLintern
@samueljlovett
UHB one of the biggest ICU services in the country, 50% of our beds are occupied by COVID19 patients.
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Evaluation of the safety of inter-hospital transfers of critically ill patients led by advanced critical care practitioners
@TraumaCareUK
#ACCTS
#criticalcaretransfer
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@PaulAqua2
@carolvorders
@ITV
@doctor_oxford
Patients don’t sign DNAR forms. Signature from a patient/relative is not required. The national RESPECT DNAR form has no box for patients/relatives to sign. There is no legal requirement for a patient or relative to sign a DNAR form. They never have. Your lie is very obvious.
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Advanced airway management and drug-assisted intubation skills in an advanced critical care practitioner team
#DAS2022
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@MessiLingard14
@dr_emmacoombe
@Brexitcast
@doctor_oxford
@jdportes
The US isn't self sufficient and is the most expensive health care system in the world, they've had staff deficits for decades. Growing elderly population and increased complexity outstrips our ability to keep pace with demand. In western counties, not a U.K. Centric problem
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@zackferguson
I’m an 8a ACCP. I earn way more than an F1. People see 2-3 year additional training and think it’s unfair. They don’t see that it took me 21 years to get my 8a with all the training experience that my 2-3 year advanced practitioner training was built on.
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What we know is coming is difficult enough for our NHS. I’ve just thought what it would be like to nurse my colleagues again and watch them die, which immediately bought me to tears. I’m dreading caring for more health care professionals on ventilators, I don’t know how we’re -
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@rallybird2
@Stuart__Maddock
@DrHelenAnderson
@alisonleary1
@BeverleyHarden
@HyperfineMedia
I think we need to move away from “this is a medical model” this a “nursing model” and think about what a patient needs and who can meet that. Professional identity politics serves no purpose but to divide. Find it surprising how many people seem to view medicine as the enemy.
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@WelshGasDoc
Why have we become a population of sociopaths? It seems there are many people who seem to think life is cheap as long as it’s not their life. Our economic thinking and politics has truely commodified our lives.
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-incredible.
Sick pts don’t like gas machines, they certainly don’t like breathing spontaneously through them.
The learning curve is huge, even for the experienced.
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The Heartlands ACCP team have a vancancy for a qualified ACCP at band 8a. Inter-hospital transfer of critically ill patients, FICE and CUSIC would be part of your scope of practice.
…
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@ClaireKeene9
Got luck teaching 150 icu nurses how to use an anaesthetic machine in under a week and teaching all your theatre staff how to care for ARDS pts. If I’ve learned anything this week, the enemy of good is perfect. Do the best you can and mitigate risks as you find them.
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@KirstieMAllsopp
It would be great if you could do “love it or leave it” on my ICU. Its about 40 years old, it’s full of COVID patients, the open plan design is not really practical for modern COVID19 living and for the second time this year we’ve simply outgrown it. Please can I design it-
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8a ACCP Advanced Critical Care Practitioner posts. Sandwell & West Birmingham Hospitals.
NHS Jobs reference number 381-SS-6006698
Job Advert ()
New hospital opening next Autumn. Amalgamation of ICU City and Sandwell Hospitals to new state of the art unit.
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For all the idiots claiming that the current covi19 levels are only affecting the young, I expect our covid19 ITU will be full by the end of the week.
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@COVID19actuary
@ActuaryByDay
@john_actuary
@AdeleGroyer
@longevitymatt
@NicolaMedical
@DanRyanCoios
@lrossouw
Where will be 2 weeks post freedom day? I dread to think.
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@AnnaKFlink
@WeNurses
Quite right, you can teach a child to hand out pills. That child won’t know that giving an ACE2i to a patient with a low normal blood pressure, who lost a litre of blood intraoperayively, with a epidural running and a background of HTN may precipitate renal failure.
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Looking at doing a survey. How would you delineate between an advanced practitioner and someone in a CNS/specialist role only using 4 questions? Four pillars is useless for this, far too vague.
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@HaggsBoson
@rupert_pearse
@RoyalLondonHosp
This is being mirrored in all our cities, when someone in your family needs an ICU bed after their heart attack, or after their bowel surgery that caused by a cancer leading to a rupture, where will they get their best chance of survival.
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