UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #14

[May72031]

How though? Facebook memories is just things either posted by you, things you have been tagged in, or things posted on your wall on that date over the years. The random collages my Iphone makes are pics taken on or around that date too.
So whilst something could have popped up that triggered the memory of it being the anniversary, she still had to remember the full names/surnames of the babies/parents. Sometimes she had minimal interaction with these people and she's remembering their full names for a year? In my opinion, she was keeping them noted down somewhere.

MOO

That's what occurred to me. Unless LL has a really, really good memory for dates and anniversaries. MOO.

 

[magikarpmagikarp]

"Mr Myers says Child D recovered twice, which, in principle, is inconsistent with an air embolus.
Dr Bohin disagrees, saying it depends on the speed and volume of the air administered.
She said there is a treatment for air embolus."

Recap: Lucy Letby trial, Friday, November 11

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

I wish the reporter would have elaborated on that, as I'm sure she probably gave more details! The only thing I am aware of is that you are supposed to stop any ongoing air entry, and if the patient is not yet in cardiac arrest, you can position them on their left side if air entry was arterial, and on their left side with head down if it was venous. If they arrest, you obviously have to roll them back flat and do CPR. Hyperbaric chamber therapy is also possible, but again that's only going to be an option if they aren't in cardiac arrest. This is all only good when the air entry is accidental and identified quickly. In these cases, cardiac arrest was the first sign and at that point the only thing you can do is supportive care via resuscitation. Boy, I wish there was more detail in the article as I am fully willing to say that I only know what I know on this topic, and there may be a lot more I don't know that I don't know! I would love to know if there was something else they could have done. JMO.

 

[magikarpmagikarp]

OH! I think Dr. B is saying that recovery is not incompatible with it having been an air embolus.

 

[Imogenia]

I wish the reporter would have elaborated on that, as I'm sure she probably gave more details! The only thing I am aware of is that you are supposed to stop any ongoing air entry, and if the patient is not yet in cardiac arrest, you can position them on their left side if air entry was arterial, and on their left side with head down if it was venous. If they arrest, you obviously have to roll them back flat and do CPR. Hyperbaric chamber therapy is also possible, but again that's only going to be an option if they aren't in cardiac arrest. This is all only good when the air entry is accidental and identified quickly. In these cases, cardiac arrest was the first sign and at that point the only thing you can do is supportive care via resuscitation. Boy, I wish there was more detail in the article as I am fully willing to say that I only know what I know on this topic, and there may be a lot more I don't know that I don't know! I would love to know if there was something else they could have done. JMO.

Hyperbaric oxygen therapy is certainly good to know about, (I note the point you make regarding its usefulness prior to cardiac arrest).

This Polish article is quite interesting.

Hyperbaric Oxygenation in Pediatrics: Indications in The Light of Evidence –Based Medicine

Hyperbaric oxygen therapy (HBOT), which is a centuries-old treatment, has now increasingly often been used in the pediatrie population. The basie indications for HBOT are well-known disease entities, i.e. carbon monoxide poisoning or decompression sickness. ...

www.ncbi.nlm.nih.gov

 

[Tortoise]

I wish the reporter would have elaborated on that, as I'm sure she probably gave more details! The only thing I am aware of is that you are supposed to stop any ongoing air entry, and if the patient is not yet in cardiac arrest, you can position them on their left side if air entry was arterial, and on their left side with head down if it was venous. If they arrest, you obviously have to roll them back flat and do CPR. Hyperbaric chamber therapy is also possible, but again that's only going to be an option if they aren't in cardiac arrest. This is all only good when the air entry is accidental and identified quickly. In these cases, cardiac arrest was the first sign and at that point the only thing you can do is supportive care via resuscitation. Boy, I wish there was more detail in the article as I am fully willing to say that I only know what I know on this topic, and there may be a lot more I don't know that I don't know! I would love to know if there was something else they could have done. JMO.

Could it be treated similar to a blood clot and emergency surgery performed?

Actually not sure I'm ready for an answer on that, it'll probably go straight over my head.

 

[Imogenia]

Unfortunately, as far as I know, the treatment is only exactly what they did at Chester. CPR/NRP/ACLS until it either gets better and the patient revives, or it doesn't get better, and the patient is still dead, and they end the resuscitation. Happy to be corrected on this by anyone with more direct experience. JMO.

Could there be earlier clinical features suggesting AE, such as the fleeting strange rash, baby’s vital signs deteriorating rapidly?

 

[magikarpmagikarp]

Could it be treated similar to a blood clot and emergency surgery performed?

Actually not sure I'm ready for an answer on that, it'll probably go straight over my head.

No clue!

 

[magikarpmagikarp]

Could there be earlier clinical features suggesting AE, such as the fleeting strange rash, baby’s vital signs deteriorating rapidly?

Perhaps. But the thing about collapses is it doesn't really matter what causes the collapse because the treatment is the same (supportive care via positive pressure ventilation, chest compressions, resus medications, etc). The treatment pathway is based on what is most urgent and needful, and as things get deeper (as the things you do are successful or unsuccessful) this provides more information about what is going on. Really, to me there doesn't seem to have been anything different the staff at CoC could have done. It doesn't matter that they didn't identify the AE straight off the bat because they would have had to do everything the same regardless. That is my opinion.

 

[Sweeper2000]

According to what I have read there is an option to actually remove the bubble mechanically but I think that assumes you know what it is. Involves actually putting something in and drawing the gas bubble out of the vessel. Wouldn’t see why that wouldn’t work with a solid blockage.

 

[Imogenia]

No clue!

Is the patent foramen ovale the main danger, in that the air bubbles (emboli) can traverse from the venous circulation to the arterial in neonates where the hole between the atria in the heart has not yet closed?

This usually closes after birth.

Here’s an article about a man who went to the toilet against medical advice after a procedure, causing an air embolus to enter the venous then the arterial circulation. He still had a patent foramen ovale, (not everyone’s closes after birth).

So, opening one’s bowels immediately after having such a procedure increases the risk of AE, apparently.

He was diagnosed and successfully treated.

Air embolism as a cause of the systemic inflammatory response syndrome: a case report - PMC

We describe a case of systemic inflammatory response syndrome associated with air embolism following the removal of a central line catheter, coupled with a deep inspiratory maneuver. The presence of a patent foramen ovale allowed the passage of a ...

www.ncbi.nlm.nih.gov

 

[Imogenia]

Perhaps. But the thing about collapses is it doesn't really matter what causes the collapse because the treatment is the same (supportive care via positive pressure ventilation, chest compressions, resus medications, etc). The treatment pathway is based on what is most urgent and needful, and as things get deeper (as the things you do are successful or unsuccessful) this provides more information about what is going on. Really, to me there doesn't seem to have been anything different the staff at CoC could have done. It doesn't matter that they didn't identify the AE straight off the bat because they would have had to do everything the same regardless. That is my opinion.

I’m not criticising the CoC staff whatsoever.

I’m thinking about the future, now that we know what this fleeting rash never seen before or since by the doctors might indicate.

 

[Tortoise]

Perhaps. But the thing about collapses is it doesn't really matter what causes the collapse because the treatment is the same (supportive care via positive pressure ventilation, chest compressions, resus medications, etc). The treatment pathway is based on what is most urgent and needful, and as things get deeper (as the things you do are successful or unsuccessful) this provides more information about what is going on. Really, to me there doesn't seem to have been anything different the staff at CoC could have done. It doesn't matter that they didn't identify the AE straight off the bat because they would have had to do everything the same regardless. That is my opinion.

However, had they been able to identify air embolus it would no longer present itself to anyone with bad intentions as an undetectable method of attacking patients.

JMO

 

[Imogenia]

It would make people think more than twice about working there as well, IMO.

If people don’t want more cameras in hospitals they can campaign against this, or give feedback online (if any such Bill ever goes through Parliament). We live in a parliamentary democracy, so folk can have their say.

We already can have hidden cameras in hospitals if strong suspicion exists about a parent harming a child there.

If equally strong suspicion exists about a nurse murdering numerous babies in hospital it seems illogical not to have hidden cameras.

 

[magikarpmagikarp]

Here’s an article about a man who went to the toilet against medical advice after a procedure, causing an air embolus to enter the venous then the arterial circulation. He still had a patent foramen ovale, (not everyone’s closes after birth).

He was diagnosed and successfully treated.

Air embolism as a cause of the systemic inflammatory response syndrome: a case report - PMC

We describe a case of systemic inflammatory response syndrome associated with air embolism following the removal of a central line catheter, coupled with a deep inspiratory maneuver. The presence of a patent foramen ovale allowed the passage of a ...

www.ncbi.nlm.nih.gov

Haha, I actually typed out and then deleted an addendum to say that central line removal is a time when everyone knows there is high risk for accidental air entry, and those are cases where it makes sense to ask, "Could it be an air embolism?" if there is a sudden decompensation during or shortly after. There are other situations too, surgery, ECMO etc. Potentially if a sudden collapse occurs immediately after the start of an intravenous infusion. People already think of these things, because the "history" of the event matters. When did it start, what was happening?

Regarding the fleeting rash, the rash is not a definitive feature of AE, but it occurs in some cases (this is per the literature). A fleeting rash without any accompanying vital signs changes will rightly be regarded as interesting but unremarkable. No single sign or symptom or history is ever used to initiate treatment. It is the combination of information and evidence as well as the patient's own reaction

@Tortoise, I see your point, but IMO, AE's are not undetectable. The only the reason why CoC could not identify AE was because it was - allegedly - a malicious act done in secret. And once it became a pattern, then it was identified. This is the case with other health care criminals. They get caught because they do it over and over.

 

[Imogenia]

Haha, I actually typed out and then deleted an addendum to say that central line removal is a time when everyone knows there is high risk for accidental air entry, and those are cases where it makes sense to ask, "Could it be an air embolism?" if there is a sudden decompensation during or shortly after. There are other situations too, surgery, ECMO etc. Potentially if a sudden collapse occurs immediately after the start of an intravenous infusion. People already think of these things, because the "history" of the event matters. When did it start, what was happening?

Regarding the fleeting rash, the rash is not a definitive feature of AE, but it occurs in some cases (this is per the literature). A fleeting rash without any accompanying vital signs changes will rightly be regarded as interesting but unremarkable. No single sign or symptom or history is ever used to initiate treatment. It is the combination of information and evidence as well as the patient's own reaction

@Tortoise, I see your point, but IMO, AE's are not undetectable. The only the reason why CoC could not identify AE was because it was - allegedly - a malicious act done in secret. And once it became a pattern, then it was identified. This is the case with other health care criminals. They get caught because they do it over and over.

Thanks, this has really clarified things for me.

 

[JosieJo]

looks like the reporter's woken up
Mel Barham
@MelBarhamITV
·
5m

Jury shown a Facebook message from Lucy Letby to a dr colleague where she says “I might see if she (a student nurse) can work with someone else as don’t feel I’m in frame of mind to support her properly and paperwork to finish off”

Mel Barham
@MelBarhamITV
·
3m

Court hears Lucy Letby was the designated nurse for baby P, and was only looking after him that shift in nursery 2

Mel Barham
@MelBarhamITV
·
1m

Court heard baby P suffered a number of collapses through the day shift on 24th June 2016 needing resuscitation

Interesting that she was wanting the Student out of her way..

 

[esther43]

I think she is just admitting the baby was harmed, like she admitted the insulin poisoning couldn't have been done accidentally.

Clearly she believed police knew there was foul play, but I do wonder if she told them she suspected anyone.

I would think they would have asked her who she thought could be responsible since she insisted she didn't do anything wrong.

'they have no evidence' is a very strange thing to write, because (IMO) it speaks from a mind that has contemplated crime and evidence of crime. I'm not sure anyone would have said or implied anything to her about intention, the police investigation and medical investigation was to find out if crimes had been committed.

It's also worded in such a way as to imply knowledge of whether evidence was left behind or not.

IMO

I agree its a strange thing to write. Also 'what evidence do they have to support their comments' sounds detached and more 'investigative'

 

[esther43]

I've never worked in the public sector and certainly no where as sensitive as a medical environment but I don't see that there would be many reasonable objections if there was no way in which the video could be viewed unless under very specific circumstances which would be laid down in the Act.

I think the real stumbling block would be the cost; you'd potentially need cameras covering every bed, in every pharmacy, in every store room where medications or equipment could be fiddled with, in every operating theatre, over every ward door etc, etc, etc. The cost would be immense!

They would never do this in a NICU cot space where mother's express milk etc. I couldn't imagine having your most intimate moments like being able to hold your baby for the first time being videoed, even if noone would see them, I'd dislike it. In the corridors... Maybe!

 

[Tortoise]

Interesting that she was wanting the Student out of her way..

interesting indeed

They said in opening speech she sent the student with a baby going for an MRI at around 8.30am and the problems started for baby P.

 

[Sundial]

Interesting that she was wanting the Student out of her way..

I noticed this too.
Previously said student was “glued to her” (which I’ve actually heard others who mentor say similar things; one went on to elaborate one of her students even followed her to the loo!). A student needing reassurance or is unsure is not necessarily unusual.
That said, could it be possible even the student might have picked up something wasn’t right (as did the nursing colleague who said LL undermined her over moving one of the triplets)?

Then… LL is mentioning not having the student because she wasnt in the right frame of mind. Which is really odd because she didn’t want to take time off, and previously appears to point out she’s fine, doesn’t need counselling etc; really odd imo.