Great video, as a third year medical student the university has taught us from day 1 that we have a duty to help in these situations (even in first year with little experience) - we've been taught all about the Good Samaritan act and the implications and ways to approach situations like this.
I had a similar situation in the UK in London city centre! As a sports physiotherapist we do get pre hospital care trauma training st undergraduate level which helped massively.
Hi Ollie, great video, always interesting to here other doctors experiences of this. I’m an F2 in the NE and since qualifying this has happened to me on 3 occasions (twice on a plane and once on train)! Plane cases were chest pain (most likely anxiety related) and ?seizure/vasovagal. Both pts were okay. Train case is most interesting/stressful- attended a case of reduce consciousness! (GCS 9/10 on arrival). Fortunately I was with my partner (also F2) for this one as pt more critical! We quickly decided one of us would do A-E assessment and the other would try obtain hx. Pt making incomprehensible words so unable to get hx. Pt was with (understandably distressed) young teenage son who could only provide limited hx - just that pt had been unwell earlier in day, vomiting. Son unsure about PMH but said pt had medication in their bag. Quick look in - insulin pen found. ? Hypoglycaemia at this point. Luckily we were able to identify that the pt had a libre device on their arm and the son had access to pts phone to access the app to check the BMs. BM 2.8…. The trains medical kit contained Only bandages and plasters, so asked train staff for sugary drink/call out to see if any other passengers were diabetic and had glucose/hypo kit. Only coke available.. By the time we got the coke, pt was now gcs 8/9, unable to swallow safely (risk of aspiration), had started to snore and needing head tilt and jaw thrust to keep airways open (so thankful there was two of us). This was made more difficult by the fact the pt had a large body habitus and we were unable to lay them down the narrow central isle, so Manoeuvers were done in chair. During all of his I had asked a member of train staff to phone for ambulance and train would have to stop for this. Rest of the story is: train stops at station, await paramedics, paramedics arrive, quick handover, iv access, iv glucose + IM Glucagon (bms had dropped to 2.5), gcs improves and pts able to maintain own airway, pt taken to hospital, train departs and we arrive at our destination 2hrs later. I think good learning points from this case are train first aid kits are very limited, to be resourceful, don’t be afraid to ask people for help (people can still help make phone calls, get you things)
I had a similar situation, with hypoglycaemic seizure in a cafe. Administering juice buccally helped to quickly resolve the symptoms, and the pt regained consciousness enough to start drinking and holding the juice in their mouth. If there are no IV/IM interventions nearby, this could help? Coke (cola), for example, could be coated on a finger and run along the inside of the cheek, provided you aren’t at risk of losing said finger.
I am always terrified of having to face this as a medical student! We were trained with basic life support skills from year 1, but really never had to use them. But when I was a 1st-year medical student taxi I have been on hit a pedestrian, I was the first person on the scene a long driver and all I did was just call the ambulance and just kept apologising to the person till paramedics arrived! thankfully it was a minor injury and the dispatch person guided me through the assessment!
In the pre-hospital setting like this, I think a Paramedic is the most relevantly appropriate clincian to take the lead. Acute illness, seizures, the unconscious patient, strokes, peri-arrest, ALS and moving fast are literally our bread and butter. We're also reeeeeeally good at spotting bullsh*t since we go to so much of it. I'd have called 999 and cancelled the ambulance.
100% agree I think a para would be most acutely useful. Sadly none on this particular train! You guys are very cool though, thanks for all that you do.
In my 23 year career as a pediatric oncologist (consultant), I have had over 12 incidents. As an American doctor living in the UK. I AM allowed to triage and treatment in emergency situations without a GMC license. Surprisingly twice in elephant and castle. One a seizure and one an MI. The incidents have inspired me so much. I took my Plab ( currently Studying for plab 2). As a licensed physician with California, DC and Sweden I can legally make recommendations here in the UK - but only in emergency situations. Btw, as a doctor, you are obligated to help. Ethically and morally you must tend to people in need. BTW the nurse is licensed and has priority over you in terms of leading. In fact the MI in elephant a GP arrived and I still lead as I was a specialist and more senior as a 23 year veteran.
@@khalidqidwai1867 you need to.go.through the General Medical Council for licensing. Once you have submitted documentation confirming medical and postgraduate and specialty training, you take a two part exam called the PLAB. First is theoretical and the second clinical. It's relatively easy. Once that is done you can then get a licence to practice. The process takes around 1-2 years depending on when you take the PLAB. I'm American so the GMC can find all my training through my states medical board via the American Medical Association. Easy peasy
Thanks Ollie for posting this video. I, sometime wonder how do doctors feel giving medical attention in theses scenario ….one of my boys ( fully pledged senior doctor) have been in these situations a few times….however refuses to talk about his own feelings…..and somewhat come across a bit awkward when the patient or the people of the facility thank him after the episode. Why? I would have thought one should feel proud or perhaps good that they have done a good deed. Perhaps you can explain. You have done good deed , and certainly should feel proud of your initiative
It's interesting to see how English medical education and where I am from in Europe differ. Thank you for sharing your experience. I am a last-year medical student just finishing up my practical rotations and at this point, I have had to take part in 2 cardiac arrests, multiple traumas from minor cuts (don't cut avocados against your hand people) to a broken wrist once, burns etc. My family pretty much laughs and says I am a patient magnet. But I have to say most of the people I patch up are part of my family at this point. Like the burn someone's kid close to me went after the tea kettle that had just finished boiling. Needless to say he took a trip to the ER but I was there and had to perform the first assessment and help as much as I could. Luckily what I did minimised most of the burn to just grade I. It's terrifying when it's a person you don't know but it's even more terrifying when it's someone you know. After that, I remember that I just went for a really long walk, like 10km just to get my mind out of that scene.
Heyy, just came across your video. Very honest, even I had no clue what to do during the emergencies in my beginner phase. Only now , when I work as a Notarzt (Emergency Doctor in Prehospital setting) in Germany, i realise there are just 20-25 cases which have to me mastered. Every med student should learn them, i feel. Obviously lack of instruments and medicines cannot be compensated, but still one will know more about the situation you are getting in.
We had something similar on the beach in Mallorca last month. A person was taken out of the water in cardiac arrest - by the time we realised what was going on and got back to the beach (we were in the water just having a paddle) the lifeguards were 150% on it - what looked like a well led cardiac arrest response was in progress. We are 2 middle grade doctors (ST1 Paediatrics and IMT2 with a couple extra years after FY2) and actually it felt very obvious that the better thing to do on this occasion was not to intervene. I speak some Spanish but not enough for that kind of communication and my partner speaks none. It felt very weird to remain where we were (the instinct they rightly drill in our heads is always to run towards the cardiac arrest) but it would have done harm for us to go and interrupt and try to explain who we were and what our roles could be in Spanish. Although, of course, if the lifeguards hadn't been there we would have intervened immediately. I suppose the point I want to make is to think about what you can offer and the kind of communication you are capable of in the specific situation. Nothing to do at all with what happened in your case, just an experience
Just a suggestion you might want to carry a small medical bag with just some basic stuff in it so that way you have little time in case something happens again
One of things I definitely am afraid of happening eventually, so thank you for sharing your experience and reflection! Definitely going to try and go to more sims and wilderness sessions next year to prepare since a performing a good A-E/reasonable acute community care is certainly something I need to know like back of my hand 😤
Great video, as a third year medical student the university has taught us from day 1 that we have a duty to help in these situations (even in first year with little experience) - we've been taught all about the Good Samaritan act and the implications and ways to approach situations like this.
I had a similar situation in the UK in London city centre! As a sports physiotherapist we do get pre hospital care trauma training st undergraduate level which helped massively.
Hi Ollie, great video, always interesting to here other doctors experiences of this.
I’m an F2 in the NE and since qualifying this has happened to me on 3 occasions (twice on a plane and once on train)!
Plane cases were chest pain (most likely anxiety related) and ?seizure/vasovagal. Both pts were okay.
Train case is most interesting/stressful- attended a case of reduce consciousness! (GCS 9/10 on arrival). Fortunately I was with my partner (also F2) for this one as pt more critical! We quickly decided one of us would do A-E assessment and the other would try obtain hx.
Pt making incomprehensible words so unable to get hx. Pt was with (understandably distressed) young teenage son who could only provide limited hx - just that pt had been unwell earlier in day, vomiting. Son unsure about PMH but said pt had medication in their bag. Quick look in - insulin pen found. ? Hypoglycaemia at this point.
Luckily we were able to identify that the pt had a libre device on their arm and the son had access to pts phone to access the app to check the BMs. BM 2.8…. The trains medical kit contained Only bandages and plasters, so asked train staff for sugary drink/call out to see if any other passengers were diabetic and had glucose/hypo kit. Only coke available..
By the time we got the coke, pt was now gcs 8/9, unable to swallow safely (risk of aspiration), had started to snore and needing head tilt and jaw thrust to keep airways open (so thankful there was two of us). This was made more difficult by the fact the pt had a large body habitus and we were unable to lay them down the narrow central isle, so Manoeuvers were done in chair.
During all of his I had asked a member of train staff to phone for ambulance and train would have to stop for this.
Rest of the story is: train stops at station, await paramedics, paramedics arrive, quick handover, iv access, iv glucose + IM Glucagon (bms had dropped to 2.5), gcs improves and pts able to maintain own airway, pt taken to hospital, train departs and we arrive at our destination 2hrs later.
I think good learning points from this case are train first aid kits are very limited, to be resourceful, don’t be afraid to ask people for help (people can still help make phone calls, get you things)
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Great story thanks for sharing
I had a similar situation, with hypoglycaemic seizure in a cafe. Administering juice buccally helped to quickly resolve the symptoms, and the pt regained consciousness enough to start drinking and holding the juice in their mouth. If there are no IV/IM interventions nearby, this could help? Coke (cola), for example, could be coated on a finger and run along the inside of the cheek, provided you aren’t at risk of losing said finger.
I am always terrified of having to face this as a medical student! We were trained with basic life support skills from year 1, but really never had to use them. But when I was a 1st-year medical student taxi I have been on hit a pedestrian, I was the first person on the scene a long driver and all I did was just call the ambulance and just kept apologising to the person till paramedics arrived! thankfully it was a minor injury and the dispatch person guided me through the assessment!
Thank you for posting this story! Your reflections on this situation are so helpful to hear, especially as a medical student - massive props to you!
Well done Ollie, sounds like you smashed it!
In the pre-hospital setting like this, I think a Paramedic is the most relevantly appropriate clincian to take the lead. Acute illness, seizures, the unconscious patient, strokes, peri-arrest, ALS and moving fast are literally our bread and butter. We're also reeeeeeally good at spotting bullsh*t since we go to so much of it. I'd have called 999 and cancelled the ambulance.
100% agree I think a para would be most acutely useful. Sadly none on this particular train! You guys are very cool though, thanks for all that you do.
In my 23 year career as a pediatric oncologist (consultant), I have had over 12 incidents. As an American doctor living in the UK. I AM allowed to triage and treatment in emergency situations without a GMC license. Surprisingly twice in elephant and castle. One a seizure and one an MI. The incidents have inspired me so much. I took my Plab ( currently Studying for plab 2). As a licensed physician with California, DC and Sweden I can legally make recommendations here in the UK - but only in emergency situations. Btw, as a doctor, you are obligated to help. Ethically and morally you must tend to people in need. BTW the nurse is licensed and has priority over you in terms of leading. In fact the MI in elephant a GP arrived and I still lead as I was a specialist and more senior as a 23 year veteran.
What process American doctor has to go through to practice in UK
@@khalidqidwai1867 you need to.go.through the General Medical Council for licensing. Once you have submitted documentation confirming medical and postgraduate and specialty training, you take a two part exam called the PLAB. First is theoretical and the second clinical. It's relatively easy. Once that is done you can then get a licence to practice. The process takes around 1-2 years depending on when you take the PLAB. I'm American so the GMC can find all my training through my states medical board via the American Medical Association. Easy peasy
Thanks Ollie for posting this video. I, sometime wonder how do doctors feel giving medical attention in theses scenario ….one of my boys ( fully pledged senior doctor) have been in these situations a few times….however refuses to talk about his own feelings…..and somewhat come across a bit awkward when the patient or the people of the facility thank him after the episode. Why? I would have thought one should feel proud or perhaps good that they have done a good deed. Perhaps you can explain. You have done good deed , and certainly should feel proud of your initiative
It's interesting to see how English medical education and where I am from in Europe differ. Thank you for sharing your experience. I am a last-year medical student just finishing up my practical rotations and at this point, I have had to take part in 2 cardiac arrests, multiple traumas from minor cuts (don't cut avocados against your hand people) to a broken wrist once, burns etc. My family pretty much laughs and says I am a patient magnet.
But I have to say most of the people I patch up are part of my family at this point. Like the burn someone's kid close to me went after the tea kettle that had just finished boiling. Needless to say he took a trip to the ER but I was there and had to perform the first assessment and help as much as I could. Luckily what I did minimised most of the burn to just grade I. It's terrifying when it's a person you don't know but it's even more terrifying when it's someone you know. After that, I remember that I just went for a really long walk, like 10km just to get my mind out of that scene.
Great video, as a PA student about to graduate loved the little PA shoutout at the end ☺️
All capable of contributing in these situations!
Heyy, just came across your video. Very honest, even I had no clue what to do during the emergencies in my beginner phase. Only now , when I work as a Notarzt (Emergency Doctor in Prehospital setting) in Germany, i realise there are just 20-25 cases which have to me mastered. Every med student should learn them, i feel. Obviously lack of instruments and medicines cannot be compensated, but still one will know more about the situation you are getting in.
what types of situations r these??
There are 20-25... begin with Anaphylaxis.. hope you dont expect me to write the list.
Thanks for your insight, it is greatly appreciated.
Thanks for sharing your experience
you can't take a blood pressure but you can get some info about SBP from the different pulses
We had something similar on the beach in Mallorca last month. A person was taken out of the water in cardiac arrest - by the time we realised what was going on and got back to the beach (we were in the water just having a paddle) the lifeguards were 150% on it - what looked like a well led cardiac arrest response was in progress. We are 2 middle grade doctors (ST1 Paediatrics and IMT2 with a couple extra years after FY2) and actually it felt very obvious that the better thing to do on this occasion was not to intervene. I speak some Spanish but not enough for that kind of communication and my partner speaks none. It felt very weird to remain where we were (the instinct they rightly drill in our heads is always to run towards the cardiac arrest) but it would have done harm for us to go and interrupt and try to explain who we were and what our roles could be in Spanish. Although, of course, if the lifeguards hadn't been there we would have intervened immediately. I suppose the point I want to make is to think about what you can offer and the kind of communication you are capable of in the specific situation. Nothing to do at all with what happened in your case, just an experience
Just a suggestion you might want to carry a small medical bag with just some basic stuff in it so that way you have little time in case something happens again
America has a good samaritan law as well
Ollie what do you think of the field immunology
One of things I definitely am afraid of happening eventually, so thank you for sharing your experience and reflection!
Definitely going to try and go to more sims and wilderness sessions next year to prepare since a performing a good A-E/reasonable acute community care is certainly something I need to know like back of my hand 😤
Safe in your ✋ hands
promosm 💘
It sounds like a slightly exaggerated version or a 'better version' of the story
That's disturbing given that it's not a very interesting story to start with
@@OllieBurtonMed I meant better as in making yourself a sound better, “I gave an sbar handover to the other doctor”
@@gagglesas if you think sbar is sexy you smashed it in life
Oldie such a great 👍 video
Bet your more self assured for next situation of this kind 📚👀😇🤣🥼