UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #11

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Becci said:
I know dr bohin ruled out pneumonia as causes of collapses/deaths can anyone remember the reason given pls?

Can pneumonia cause sudden death in infants?


Pneumonia can cause acute respiratory failure and is a relatively frequent cause of death in infants and pre-school age children, many of which are apparently “unexpected”, in that the child may not have seemed severely unwell prior to the collapse/death.
Click to expand...

Doctors checked for the presence of pneumonia by various methods, to rule it out or in.

Pneumonia is an infection of the lungs that can be caused by viruses, bacteria, fungi and parasites. Pneumonia is a secondary illness that develops because the viral or bacterial illness was there first.https://www.nhlbi.nih.gov/health/pneumonia/diagnosis

Pneumonia - Diagnosis | NHLBI, NIH​

What tests confirm pneumonia?

A chest X-ray is often used to diagnose pneumonia. Blood tests, such as a complete blood count (CBC) see whether your immune system is fighting an infection. Pulse oximetry measures how much oxygen is in your blood. Pneumonia can keep your lungs from getting enough oxygen into your blood.
 
Do we have confirmation that baby M's heart stopped before respiratory decompensation? Looking at the testimony, it seems that the decompensation happened the "normal" way - baby stops breathing, sats go down, HR then drops. That's very different than a cardiac arrest that is primary (and that almost never happens in the NICU, almost all of our cardiac arrests are due to respiratory causes, not cardiac.
 
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Oh yay! My verification came through!

So I'm a neonatal nurse practitioner at an academic Lvl IV hospital in the US (US system has 4 levels, UK has three) and much of the testimony from their medical experts seems sus as hell that they are working backwards from a conclusion, which leads to confirmation bias. And some of their "I've never seen anything like this" rings hollow - in that they just must not have seen very much to be able to say that.

Of these cases, the insulin ones are the biggest concerns, because of course, insulin should never be given if not ordered. I have a hard time tying it to LL because essentially they had uncontrolled insulin available on the unit and anyone could have accessed it and there's not a good trail from the insulin to LL.

No matter what, insulin on the unit is a systems issue that should be resolved in the UK - there is no need to ever keep insulin on a neonatal unit. Ever. If they need an insulin drip, it is not an emergency and they can get it from the pharmacy. It is poor practice and begging for accidents and intentional harm to happen.

I do want to say as well, I'm doing spring cleaning in my house and I have found all sorts of old report sheets that I then brought in for shredding - it's really easy to take papers home with you without realizing it. It would be more damning if she only had papers for babies who died or they were all collected together in a "special" place, but the presence of report sheets isn't that big of a deal to me overall.
 
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I haven’t followed this case very closely so forgive me for asking, but are there any witnesses or video footage of her doing these things? Is there proof or is it all circumstantial?

Have they said what the motive may be? Was she trying to be a hero by resuscitating a collapsed child? I.e. injure them and then save the day?

Did they do a psych evaluation? Was her case load too high and she wanted less pressure? Just trying to figure out an angle. Such a heartbreaking case; there’s nothing more helpless that a newborn baby.

<modsnip: sub judice>
 
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sapphireminds said:
Oh yay! My verification came through!

So I'm a neonatal nurse practitioner at an academic Lvl IV hospital in the US (US system has 4 levels, UK has three) and much of the testimony from their medical experts seems sus as hell that they are working backwards from a conclusion, which leads to confirmation bias. And some of their "I've never seen anything like this" rings hollow - in that they just must not have seen very much to be able to say that.

Of these cases, the insulin ones are the biggest concerns, because of course, insulin should never be given if not ordered. I have a hard time tying it to LL because essentially they had uncontrolled insulin available on the unit and anyone could have accessed it and there's not a good trail from the insulin to LL.

No matter what, insulin on the unit is a systems issue that should be resolved in the UK - there is no need to ever keep insulin on a neonatal unit. Ever. If they need an insulin drip, it is not an emergency and they can get it from the pharmacy. It is poor practice and begging for accidents and intentional harm to happen.

I do want to say as well, I'm doing spring cleaning in my house and I have found all sorts of old report sheets that I then brought in for shredding - it's really easy to take papers home with you without realizing it. It would be more damning if she only had papers for babies who died or they were all collected together in a "special" place, but the presence of report sheets isn't that big of a deal to me overall.
Click to expand...
As a UK (ex) nurse I do get a little tired of being told we shouldn't keep insulin on NNUs. It 's the system we have and nothing to do with anybody else.
 
marynnu said:
As a UK (ex) nurse I do get a little tired of being told we shouldn't keep insulin on NNUs. It 's the system we have and nothing to do with anybody else.
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Have you heard of the "swiss cheese" theory of medical mistakes? It's a hole in the swiss cheese, and good practice means filling as many of those holes in as possible. It's the same reason we don't keep adult dosages or concentrations on a neonatal unit.

edited to add: if insulin wasn't being held uncontrolled on the unit, it would have been far more difficult to use insulin against a baby and if they did, there would be more of a paper trail and physical evidence.
 
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sapphireminds said:
Oh yay! My verification came through!

So I'm a neonatal nurse practitioner at an academic Lvl IV hospital in the US (US system has 4 levels, UK has three) and much of the testimony from their medical experts seems sus as hell that they are working backwards from a conclusion, which leads to confirmation bias. And some of their "I've never seen anything like this" rings hollow - in that they just must not have seen very much to be able to say that.

Of these cases, the insulin ones are the biggest concerns, because of course, insulin should never be given if not ordered. I have a hard time tying it to LL because essentially they had uncontrolled insulin available on the unit and anyone could have accessed it and there's not a good trail from the insulin to LL.

No matter what, insulin on the unit is a systems issue that should be resolved in the UK - there is no need to ever keep insulin on a neonatal unit. Ever. If they need an insulin drip, it is not an emergency and they can get it from the pharmacy. It is poor practice and begging for accidents and intentional harm to happen.

I do want to say as well, I'm doing spring cleaning in my house and I have found all sorts of old report sheets that I then brought in for shredding - it's really easy to take papers home with you without realizing it. It would be more damning if she only had papers for babies who died or they were all collected together in a "special" place, but the presence of report sheets isn't that big of a deal to me overall.
Click to expand...
Sorry but how is it 'begging for accidents'? When UK nurses here have explained how it's literally not possible to accidentally administer Insulin to a neonate and the defendant herself admits it can't happen by mistake.
 
LadyEdgeworth said:
Sorry but how is it 'begging for accidents'? When UK nurses here have explained how it's literally not possible to accidentally administer Insulin to a neonate and the defendant herself admits it can't happen by mistake.
Click to expand...
Anything can happen by mistake. I don't think it was accidental in this situation necessarily, especially not with two children, but don't underestimate the ability of people to screw stuff up. Someone pulls up a syringe of it to mix, gets called away by an a/b/d, someone else picks it up. Or they see the vial, but don't register the contents and use it to dilute another medication instead of saline or dextrose. Why do you not keep battery acid right next to hand soap by a sink? Even if they are clearly labeled, someone can make a mistake if they are in a hurry.

It's not the cause of this situation, but it is low-hanging fruit to improve safety.
 
sapphireminds said:
Anything can happen by mistake. I don't think it was accidental in this situation necessarily, especially not with two children, but don't underestimate the ability of people to screw stuff up. Someone pulls up a syringe of it to mix, gets called away by an a/b/d, someone else picks it up. Or they see the vial, but don't register the contents and use it to dilute another medication instead of saline or dextrose. Why do you not keep battery acid right next to hand soap by a sink? Even if they are clearly labeled, someone can make a mistake if they are in a hurry.

It's not the cause of this situation, but it is low-hanging fruit to improve safety.
Click to expand...
Procedures are stringent re. drug checking on NNUs. There are ALWAYS 2 nurses checking every step. No matter how busy you are the same methodical steps are ingrained. The scenario you have imagined, while creative, would occur whether insulin was kept on the unit or not.
 
marynnu said:
Procedures are stringent re. drug checking on NNUs. There are ALWAYS 2 nurses checking every step. No matter how busy you are the same methodical steps are ingrained. The scenario you have imagined, while creative, would occur whether insulin was kept on the unit or not.
Click to expand...
It's stringent until it's not, until someone makes a mistake. No, it wouldn't, because the syringe would come up pre-labeled. So many things we do in medicine are "fine" until there is a catastrophic mistake.

What is the benefit of keeping insulin on a unit where it is unnecessary?
 
sapphireminds said:
Oh yay! My verification came through!

So I'm a neonatal nurse practitioner at an academic Lvl IV hospital in the US (US system has 4 levels, UK has three) and much of the testimony from their medical experts seems sus as hell that they are working backwards from a conclusion, which leads to confirmation bias. And some of their "I've never seen anything like this" rings hollow - in that they just must not have seen very much to be able to say that.
Click to expand...

I can recall them saying that they hadn't seen this fleeting rash before that seemed to move around and come and go before disappearing completely, and only in babies that had collapsed and were being resuscitated. Are you saying that you have seen that before?
 
www.chesterstandard.co.uk

Lucy Letby: Baby boy collapsed because of ‘slow injection of air’

A SLOW injection of air caused the sudden collapse of a baby boy allegedly harmed by nurse Lucy Letby, her trial has been told.
www.chesterstandard.co.uk www.chesterstandard.co.uk

"Letby, 33, is accused of trying to kill Child M on the afternoon of April 9, 2016 while he was being treated in nursery room one on the Countess of Chester Hospital’s neonatal unit.

The defendant co-signed for an antibiotic given via a port on the drip at 3.45pm – 15 minutes before Child M stopped breathing followed by a dip in his heart rate and oxygen levels.

Letby was near the doorway of room one, helping a colleague prepare medication for Child M’s twin brother, when the alarm sounded at 4pm, the court heard on Thursday.

Consultant paediatrician Dr Evans said using a syringe to inject air via a port would be slower than a direct injection into the bloodstream."


This ^^^ places LL in close contact with the victim, baby M, about 5 to 15 minutes before he collapsed.
 
Becci said:
I know dr bohin ruled out pneumonia as causes of collapses/deaths can anyone remember the reason given pls?

Can pneumonia cause sudden death in infants?


Pneumonia can cause acute respiratory failure and is a relatively frequent cause of death in infants and pre-school age children, many of which are apparently “unexpected”, in that the child may not have seemed severely unwell prior to the collapse/death.
Click to expand...
https://twitter.com/MrDanDonoghue

Dr Gibbs examined Child M on the morning of 10 April. He said he queried whether infection/sepsis was the cause of the boy's cardio/respiratory collapse the previous day - 'it transpired he didn’t have either of those, so there was no proper explanation', Dr Gibbs said

Dr Gibbs said subsequent X-rays and heart scans offered no explanation for the child's collapse

Dr Evans said he ruled out infection (like pneumonia) as the cause of Child M's collapse as he would not 'have made such a prompt respiratory recovery' in the hours after
 
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