Caroline Leech
@LeechCaroline
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Emergency Medicine Consultant & AMD @nhsuhcw 🏥 HEMS Dr @Helimed53 @helimed54 🚁 @wmasmerit 🚑 @NIHR Research Scholar @WarwickCTU 📚
West Midlands, England
Joined December 2013
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Every NHS worker in the U.K......
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Imagine a job where you break up for work on Friday (with a few cheeky Christmas drinks at lunchtime), and you don’t have to go back until the New Year. Got that image? OK, now come back to reality! Big love to all my 🏥🚑🚓🚒🚁colleagues!
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Every time a patient arrives with a pelvic binder placed over clothing, a little part of me dies inside 😭😭😭
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*NEW* NHS Major Incident Triage Tool (MITT) to be used by all NHS responders
Ten Second Triage tool (TST) to be used by anyone providing care to casualties prior to the arrival of the NHS clinical response
Read more at
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Direct pressure for external haemorrhage control. Why one finger is better than a hand and why bandages on an actively bleeding wound are really unhelpful. 1. We need to compress a bleeding wound to overcome systolic BP e.g. 120mmHg. This is equivalent to 16,000N/m2.
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Exciting news! I am very honoured to have been successfully appointed as the next Major Trauma Lead for
@nhsuhcw
. Looking forward to working with an amazing team.
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Oxygen flow is read from the centre of the ball on the flowmeter (Fig 1 = 15LPM). If you open the valve fully and the ball is higher (Fig 2) the flow of oxygen can be in excess of 45LPM 😳 Keep your eye on the ⚽️ to avoid wasting O2!
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There are lots of ‘glamorous’ photo’s of pre-hospital care in social media, but this is the truth. Before and after an arduous
#PHEM
case.
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New
@ResusCouncilUK
guidelines for anaphylaxis:
⭐️ Adrenaline IM is priority
⭐️ Fluids if low BP or no response to 1st adrenaline
⭐️ Salbutamol neb if wheeze
⭐️ No routine antihistamine (only if itchy rash)
⭐️ No routine steroids for treatment
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Do you train bystanders to remove the bra and place AED pads correctly including under (not over) the left breast?
#FPHC2023
@drrichardlyon
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Betty rings up to find out how her husband is getting on in ED. She tells me he will be “92 in March if he survives that long”, they have been married for 70 yrs & the secret to a long marriage is “patience”! I report bank to Ron & his beaming smile lightens up my shift❤️
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Even as an experienced PH doctor, coming into a massive trauma team handover in a different hospital can be very daunting. It’s essential we have a system to use to make it slick & quick! ATMIST is my preferred tool.
@RCEMevents
#RCEMPHEM
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So today on
@Helimed53
we’ve been filming a little slot on
@OperationOuch
! Great to work with
@DoctorChrisVT
and thank you for making my 9 year old son think I’m a tiny bit cool!
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THIS is the definition of Team ED.
Me on a ridiculously busy weekend shift: “Where is *insert name of ED SHO*?!”
Registrar “He’s gone to Starbucks...” Me silently in my head “What the actual...we are sooooo busy”
Registrar “....we thought you REALLY needed a coffee”
Me 😍
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Used ChatGPT to ask a research question. It found 2 papers that I hadn’t seen before in my systematic review! 😱Amazing! Then I found it had made the papers up & they couldn’t be found in any literature! 😭
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Thanks for all the personal messages of concern for the team. The crew are safe and uninjured. A good reminder of the importance of visors down and aviation emergency of the day training.
This afternoon, the crew of the Derbyshire, Leicestershire & Rutland Air Ambulance were forced to make a controlled, emergency landing in the Peak District after the helicopter suffered a bird strike after attending a mission. Read more here
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Talking to colleagues about how healthcare workers are feeling universally disheartened and fatigued. Lockdown is tough for everyone but the knock on effects in work are never ending. We came up with some key principles:
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Should we routinely check for tracheal deviation in the trauma primary survey? I’m going to say no…..😱. Hear me out…..
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Why it may not be helpful to describe RTC mechanism as a combined speed of impact....
If you hear this handover, what does it tell you about the mechanism of injury and the forces applied to the patient? Can you predict their severity of injury based on this information?
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If anyone is looking for expert speakers on the importance of diversity in the emergency services, Geoff is your man 😘
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Twenty years ago today 🎉 I started my first HO job in Respiratory Medicine at Sandwell Hospital. I drove to work in my Citroen AX listening to MJ Cole, Artful Dodger & Craig David! So much to be thankful for in my career since!😄
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Lots of RTC’s today. This patient elf-extricated but as you can see he has a right sided ICH with a raised icy-p. Elf puns only accepted in replies....
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It’s 2023 and I hear today that people are still telling female trainees they can’t do PHEM if they have (or plan to have) children. I can provide evidence that it’s simply not true. If you hear someone saying this shit, please call them out.
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Today one of my T&O Consultant colleagues said “I’m ready to come and work in ED. I’ll dust my stethoscope off and see anyone you need me to. As long as I’ve got your support”.
#solidarity
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On
#IWD2021
celebrating my inspirational pre-hospital colleagues at
@Helimed53
and
@Helimed54
🙌🏻
#FEMinPHEM
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Anyone seen this patient wristband before? It’s post vitrectomy 👁 surgery where a gas bubble has been used to keep the retina in place whilst it heals. Patients have to avoid changes in altitude but relevant to PH/EM the use of Nitrous Oxide (Entonox) is also contraindicated😬
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Two public education strategies that would make a MASSIVE difference to patient outcomes:
🌟 Identifying cardiac arrest (even if agonal breathing) & starting CPR
🌟 Moving pt’s after RTC/injury (helmet off, open airway, roll into recovery pos etc) instead of worrying about spine
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The monitor starts alarming for the heart rate on your trauma MHP patient…. What’s the diagnosis? 🤔
Answer below!
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The KED is dead. I totally agree with
@Obidoc
. And if you really feel the need to use one, please scoop the pt off it at scene. Nightmare for ED management, & uncomfortable/risk pressure sores on the corrugated material for pt.
#TRAUMACARE19
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Thank you to everyone who supported my first
#SMACC
talk. Now it’s time for therapy dog cuddles and gin to celebrate! 🇦🇺
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20 minutes of cold running water saves skin! Please ‘stay and wash away’ if within 3 hours of injury!
🔥 😌🚿
Hot off the Press: Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children via
@brongriffin
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40% sudden cardiac deaths in athletes are aged <18 years. Teach CPR in PE at school!
#FPHC18
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The message is to localise the bleeding point, put a gloved finger on it and press hard. The smaller the area, the more force you will be able to apply. So only use a small gauze swab, not a giant dressing. Thank you to
@Malcolm_999
who taught me this many years ago!
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As I’m seeing lots of very male dominant line-ups for forthcoming PHEM conferences & symposiums, I’m just going to leave this here….
🚁 🚑 👩
Watch “FEMinPHEM” on
#Vimeo
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All the doctors (like me) who are rubbish at opening glass vials have literally bathed in this stuff without any side effects. 🙄
It's a drug 50 times more potent than heroin, and doctors say just touching it can send you to the emergency room. The synthetic opioid, fentanyl, its not only dangerous, but it contributes to a frightening spike in deaths in LA County.
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After seeing another case of obturator artery injury, thought it would be useful to share this. Can present late after injury post-admission ⚠️
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Air ambulances and hospitals do not use commercial burns dressings. Cling film is the dressing of choice. Hydrogel dressings can keep heat in!
#TRAUMACARE18
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My vision feels weird. I’m going to put my whole family in the car and drive half an hour in a random direction to check it’s ok to drive a longer journey home. Said no sensible person ever......
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New quality standards out from NICE for major trauma
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Following motor vehicle collision all patients should be encouraged to self-extricate asap. If not possible, need to create minimum safe space for self/rescuer extrication w/o delay
#FPHC2023
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@EMManchester
We need to get away from the concept that ‘PHEM’ is just about 🚁 , orange suits & sub-specialty training! Every EM clinician receives patients looked after by PH services. Understanding the guidelines, capabilities & limitations is key to providing seamless care to our ED pts
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Why do patients drown following
cold water immersion?
💧 Gasp reflex & inhaling water causing hypoxia
💧 Arrhythmias eg diving response + sympathetic stress (autonomic conflict)
💧 cooling of muscles leading to swim failure
💧hypothermia
@ProfMikeTipton
@drpaddymorgan
@FPHCEd
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If two vehicles have a head-on collision & each are travelling at 50mph, please do not describe this as a ‘100mph crash’. The vehicle/pt went from 50mph to 0mph. 💥 🚗
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Me when a patient who was walking at scene is brought into the ED on a long spinal board.......
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Glad I don’t see the latter in the local supermarket 🤣
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99.3% of patients do NOT have an unstable spinal injury following RTC.
@robfenwick
#TRAUMACARE17
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New guidelines out for the in-hospital management of Devastating Brain Injury. If you work in ED or ICM please read
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New open access paper out on UK prehospital blood product use & calcium replacement
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Recently I had to attend my own ED as a patient. I was looked after brilliantly. Yesterday one of the nurses revealed that the code-word for my arrival (to maintain confidentiality) was ‘THE RABBIT IS IN THE HUTCH’! 😂This is going to be a tricky quote to live down! 🐰
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We are recruiting full-time doctors at
@Helimed53
&
@Helimed54
🚁 Come and work with the fantastic team at
@WNDLRAirAmb
More details at
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⭐️ New RCEM guidelines on Acute Behavioural Disturbance in ED’s ⭐️
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Concerned to see a UK air ambo is offering a Cons HEMS job for EM Cons with no prior PH experience. PHEM is a specialty, not a hobby.
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2. Every day we see people in severe pain, extreme suffering, in distress or dying. The raw& immersive PH environment contains more triggers than the sterile hospital. It is naiive to think these accumulating cases won’t have an impact on our emotional or psychological wellbeing
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Lots of great UK on-line prehospital study days coming up:
🏥 🚁
@RCEMevents
PHEM study day 9th Sept
🚒🚓Fire & Police
@TraumaCareUK
20th Sept
🚑 🚁 PHEM
@TraumaCareUK
21st Sept
🏥🚑
@RCEMevents
PHEM pre-conference workshop 4th Oct
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Dual sequential defibrillation for refractory VF. Charles Deakin says NO! Publication bias of cases. ⬆️ electricity may damage myocardium. 💥 Can damage your 2nd defib! ⚠️
#TBS19
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Colleagues and friends….thank you, you’ve been amazing this year. Better times are coming. Let’s go do 2022 ✊🏻
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Have been asked to give a talk to paramedics about head injury with normal GCS: which pts can be discharged at scene & which need conveyance to ED. Can you let me know...what are the common dilemma’s for paramedics? 🤯
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Some tough stats presented by
@ericaley66
#LTC2022
Advanced paramedics
🚑 Ambulance service role is changing
🚑Multiple different titles & paramedic roles: What is Advanced Para or Specialist Para or CCP?
🚑 ‘Weekend courses’ resulting in an advanced title undermine specialty
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🧡this graph. Orange is HEMS clinical team & blue is HEMS pilot levels of stress on a job. Now consider where you would put the land crew line? Dave Kelly
#TBS19
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Are you recognising any of these symptoms right now? Might be that you really feel nothing at all. 🤷🏻♀️ These are all usual and normal reactions.
@EM_HealthPsych
@TraumaCareUK
webinar
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Prehospital Arterial line introduction
@airambulancekss
presented by
@GreenhalghRob
High success rate, mainly radial, mostly Flowswitch type, mainly without ultrasound.
#FPHC2023
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GAME CHANGER ALERT 🚨
Do you need to prescribe antibiotics for this bite? New NICE guidelines
HT
@DrLindaDykes
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In UK air ambulances only 1 in 5 doctors and 1 in 4 paramedics are female. But if you are interested in a PHEM career please don't let that put you off! We work as one fantastic team.
#FEMinPHEM
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To date, evidence suggests that pre-hospital blood products ⬇️ pre-hospital mortality but not overall mortality eg moves the time/location of death. I wonder how our trauma systems can get quicker at definitive haemorrhage control to change this? 🤔
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⚠️ Today’s learning of a diagnosis not to miss! Incomplete SCI after a minor fall.
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7. Identifying the factors that made THIS case emotionally & psychologically more challenging can help make sense of your reaction. The model below can be useful to highlight when your team might need more support, or in a debrief to help identify why the case was difficult.
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PH Charity X in the media:
“We’ve got pre-hospital blood, ultrasound, video laryngoscopy, top of the range stab vests, and......we’ve got funding for REBOA to start next week!”
Me: “But you are only operational for your region for 10 hours/day, on a good day...?”
#priorities
💰
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Day 1 of annual leave. Took son to school then out for a countryside walk to catch some ☀️ and pretend I’m on a ski holiday 🤣. The cheeky mulled wine before the black run will have to wait!
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Today I am talking about “The Cases That Haunt us” at
#WEM19
recognising the significant psychological challenges of working in civilian pre-hospital care.
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Recent learning point: if (alert normal vital signs) patient has a limb tourniquet in situ, this will distract them from ANY other injury on examination. Grade 5 splenic injury with no abdominal tenderness!!! 🙈
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Worth being aware of the new UK Concussion Guidelines for Grassroots Sport as may present to ED 🏉 😵💫🥊⚽️
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A 🧵 about OHCA & defibrillation 🚑
For starters:
Which defibrillator mode do you use when treating an out of hospital cardiac arrest?
Automated (AED)
1188
Manual
1388
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Hypocalcaemia in trauma is bad, but so is hypercalcaemia on arrival to ED.
Early empiric calcium replacement may not be appropriate for all patients.
Article free to read at
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Me: it’s really important for my ED staff to have healthy snacks on a night shift. I’ve read all the evidence
Also me:
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Common theme. As pre-hospital responders it’s really important that we have ‘pre-hospital friends’ we can talk to about difficult cases. Our families & hospital colleagues may not understand.
#TRAUMACARE18
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Next week our adverts open for full-time HEMS doctor posts (2019-2020 start dates) based at Coventry & East Midlands Airports. If you are interested in joining the team, watch this space!
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If we are going to provide war torn countries with medical equipment, we also need to support the training to use it safely & effectively ( 📷 from The Guardian Weekly 17 June 22)
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Today’s
@ParamedicsUK
talk included the following learning nuggets!
1. The presence of a radial pulse does not correlate with a SBP >80. BP may be MUCH lower. From
@charlesdeakin
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