UK - Nurse Lucy Letby, murder of babies, 7 Guilty of murder verdicts; 8 Guilty of attempted murder; 2 Not Guilty of attempted; 5 hung re attempted #37

[mrjitty]

Thanks for all the great posts in here!

 

[Sweeper2000]

would like to express empathy for the people who have been utterly relentless in battling the misinformation on this thread and also acutely correct, which has been phenomenal from day one imo. quite the marvel to have stored such a vast amount of information, makes one wonder what they do irl but makes one sure they do it wonderfully anyways.
props to you and everyone contributing.

 

[magikarpmagikarp]

After all, Dr. Lee says that the reason baby K was not responding is because neopuff, delivering low-pressure airflow, would not be enough for the lungs that collapsed due to the airleak. Essentially, the consultant did not understand the mechanics of ventilation and how to use the neopuff.

I've written a really long detailed explanation three times only to have my phone eat it 3 times. Sigh. I will be less long winded.

The 2.0 tube, while smaller than ideal, was sufficient to resuscitate Baby K in the delivery room. This was just hours before, if I recall correctly. Therefore the tube should have been big enough to provide adequate PPV via neopuff. Usually with a too small tube, you will have a pattern of desaturation events requiring PPV. The PPV is usually successful and then an elective reintubation can be done when the benefits are judged to outweigh thr risks (of not being able to reinsert a tube, for one). Since PPV wasn't effective, it was reasonable for Dr. J to deduce it was dislodged.

Dr Jayaram did the competent thing which was remove and replace the ineffective breathing tube.

Additionally- when I read "3 attempts, 2.0 tube in a very small baby" what I think is: two attempts were made to place a 2.5. When this was not successful, the team prudently decided to try a 2.0 to avoid causing more airway trauma and to see if it would be big enough to proceed with resuscitation. We know that it was because the baby came back to the unit.

Dr. Jayaram 1) chose to try to insert a larger tube when he had the opportunity 2) was successfully able to pass a 2.5 tube. I think that demonstrates his competence.

Dr. Jayaram was there. Dr. Lee is Monday morning quarterbacking.

 

[magikarpmagikarp]

The neopuff is a pressure regulated device. It allows for precise delivery of pressure and variable amounts of volume. The neopuff manometer doesn't measure pressure in the lungs, but in the breathing tube (well technically at the adapter of the breathing tube). So in the end the true measure is not the number but the baby. Does the baby's chest move? Does the baby’s heart rate go up?

In general, you start with a setting of 20/5 (PIP over PEEP is how you read that) or the ventilator settings (if the baby needs 26/6 you start there), and you increase by 5cm of water pressure every 4-8 breaths until chest rise (which should lead to heart rate increase) or you have reached a threshold of pressure that is safe and reasonable to deliver and you have to presume the tube is dislodged/clogged or otherwise cooked. It is a systematic decision.

Remember that there was a successful resuscitation in the delivery room with the too small breathing tube.

It is possible to see that a breathing tube is dislodged by using an intubation blade to look into the throat. You need extra hands for that to be feasible.

Sometimes you can see that the tube is plainly dislodged with the naked eye. The tube depth is shallow, the tape is loose, there is no chest rise, the baby is purple, the data on the ventilator shows the air is not going in and out the way it should.

There are so many little details that form the picture and you are processing this information at incredibly high speed. Every decision is made in real time with the benefit of all the situational details. The opinion of the person who was there is so valuable because of these details.

 

[magikarpmagikarp]

Dr. Jayaram 1) chose to try to insert a larger tube when he had the opportunity 2) was successfully able to pass a 2.5 tube. I think that demonstrates his competence.

I need to correct myself here. Dr. Smith, not Dr. Jayaram, is who reintubated Baby K, according to the retrial.

 

[Ruthbullock]

NO, the consultants were constantly at the clinic, not just 2x a week. There was always at least one at all times.

Yes, nurse shortages are a problem so they get promoted faster. It's a problem.

But it was not the cause of the 7 deaths. IMO

Are you saying the consultants lied in the inquiry then? They testified themselves and I shared the inquiry documents a few days ago- there was not always a consultant on duty- they were short staffed and had gaps in the rotas where no one was on duty.

 

[Tortoise]

Are you saying the consultants lied in the inquiry then? They testified themselves and I shared the inquiry documents a few days ago- there was not always a consultant on duty- they were short staffed and had gaps in the rotas where no one was on duty.

was that your post here, no.897 on thread page 45? UK - Nurse Lucy Letby, murder of babies, 7 Guilty of murder verdicts; 8 Guilty of attempted murder; 2 Not Guilty of attempted; 5 hung re attempted #37

If so, that was the registrars.

 

[marynnu]

Lee’s thing is saying two central catheters in place with no infusion for up to 4 hours. Would that be common? Risky? They’re then saying the baby collapsed shortly after the infusion was switched on, likely a clot had formed at the end of the catheter. Also a clot in the liver on post mortem demonstrates a thrombotic event had occurred. Does this suggestion sound wacko to you?

This is above my pay grade! My only thought is that if there a blood clot the pressure in the line would be very high so a red flag.

 

[Charlot123]

The picture of the COCH maternity services..understaffed, poor levels of cover for Dr's and Nurses, poor standards of documentation, errors is only on view because of the enquiry...this could be a picture of any of thousands of wards and depts across the UK in various specialities...we just don't see it.
It's shocking if read in detail by people who are not aware...( most of the public)

Yes it's horrendous...yes it needs sorting ASAP...and yes sadly may lead to a very slight spike in deaths ....but absolutely not such a huge spike of unexpected deaths and collapses on such a small unit. Certainly not cases that cannot be resuscitated as expected

OK, the Vogue article mentioned absolutely identical rise in stillbirth on maternity unit in COCH in 2015. That wasn't Lucy's doing. It is not that we are talking about one unit in the middle of nowhere.

 

[Ruthbullock]

OK, the Vogue article mentioned absolutely identical rise in stillbirth on maternity unit in COCH in 2015. That wasn't Lucy's doing. It is not that we are talking about one unit in the middle of nowhere.

But yet another coincidence that hasn’t been really considered. We know the doctors and consultants covered all the wards, compared to the nurses based in a single ward- Dr J has acknowledged he was at the birth of child K, so we know for a fact they were involved in the births as well.

FOI 4568.docx

www.whatdotheyknow.com

 

[marynnu]

But yet another coincidence that hasn’t been really considered. We know the doctors and consultants covered all the wards, compared to the nurses based in a single ward- Dr J has acknowledged he was at the birth of child K, so we know for a fact they were involved in the births as well.

FOI 4568.docx

www.whatdotheyknow.com

So?

 

[Ruthbullock]

So?

There was also a dramatic sharp increase in still births at the COCH in the same period- as the previous poster and the one before that highlighted. Why was that also not investigated would be my first question, along with many more about how thinly spread everyone was and the knock on effect that had? You have no question or curiosity in that aspect- no need to participate in that part of the conversation.

 

[mrC]

i was concerned about a baby becouse the nurse dident call for help only she did call for help that evdence is miss leading to say the least

 

[magikarpmagikarp]

Doc felt 'very uncomfortable' amid baby collapses linked to Lucy Letby

Dr Ravi Jayaram said he found a premature baby collapsing when he checked on Letby

www.manchestereveningnews.co.uk

Doctor 'saw no evidence’ of Lucy Letby helping deteriorating baby

A senior doctor has told a jury he saw “no evidence” of nurse Lucy Letby having done anything to help a deteriorating baby girl before he…

www.chesterstandard.co.uk

These links are an account of Dr. Jayaram's testimony at the retrial. He explains the checks he did, how baby K's chest was moving, the sound of the air entry in her chest, and how he concluded the tube was displaced by testing and eliminating other factors. He mentions that the fact that Baby K picked up easily with mask ventilation after removing the tube was a sign that it wasn't a progression of her lung disease.

By the by, it takes real skill to mask ventilate well. And it's a skill you can only gain over time, through practice. You can't fake it. You can't lie about it.

 

[mrC]

he cared so much he only turned up twice a week

 

[Ruthbullock]

Doc felt 'very uncomfortable' amid baby collapses linked to Lucy Letby

Dr Ravi Jayaram said he found a premature baby collapsing when he checked on Letby

www.manchestereveningnews.co.uk

Doctor 'saw no evidence’ of Lucy Letby helping deteriorating baby

A senior doctor has told a jury he saw “no evidence” of nurse Lucy Letby having done anything to help a deteriorating baby girl before he…

www.chesterstandard.co.uk

These links are an account of Dr. Jayaram's testimony at the retrial. He explains the checks he did, how baby K's chest was moving, the sound of the air entry in her chest, and how he concluded the tube was displaced by testing and eliminating other factors. He mentions that the fact that Baby K picked up easily with mask ventilation after removing the tube was a sign that it wasn't a progression of her lung disease.

By the by, it takes real skill to mask ventilate well. And it's a skill you can only gain over time, through practice. You can't fake it. You can't lie about it.

Genuine question if this had been you and you had viewed this whole situation as a fly on the wall and had suspicions- when you had an interview with the CQC a few hours later (I will gift you a temporary promotion to clinical director of children’s services)- would you not have mentioned it?

 

[magikarpmagikarp]

Usually when there is a serious patient incident where staffing played a role, the staff involved know that and put it in the incident report!

 

[Ruthbullock]

Usually when there is a serious patient incident where staffing played a role, the staff involved know that and put it in the incident report!

You would think wouldn’t you- except they have numerous excuses for not doing so regardless of the reason- no DATIX, no SUDIC, no post mortems

 

[May72031]

But yet another coincidence that hasn’t been really considered. We know the doctors and consultants covered all the wards, compared to the nurses based in a single ward- Dr J has acknowledged he was at the birth of child K, so we know for a fact they were involved in the births as well.

Erm, can you elaborate what the "coincidence" is?

 

[JosieJo]

I don’t doubt that they cared- but to say it’s not a factor is a stretch. A parent stated there were sometimes 4 nurses on duty ( and we know the doctors and consultants were all over the place). The unit was usually at capacity or over capacity. The unit had 4 nurseries and the medicine was stored elsewhere. What do you do in the case of a serious incident- leave the room and the baby to summon help, or stay in the room and be accused of not calling for help? What if you need to grab something or have a comfort break- who is watching and helping then? Minutes matter in these situations and trying to magic staff from nowhere is absurd- when a baby had a crisis- who was watching any other babies in other rooms?

No matter how poor staffing.. crash teams are always prioritised...never left uncovered.

If you are alone during a collapse you would never have to leave the cot / bedside there are emergency buttons by each bed.

During emergencies specialist nurses are automatically bleeped alongside the Dr's which bolster numbers.

There are lots of factors that maintain safety alongside staffing.

During the trial staff numbers were discussed for each baby ..I honestly cannot remember any numbers I thought were dangerous...and I can't recall any mention of no one arriving (drs) or being really delayed