Thoughts on the A-F bundle

 I was always told to stay humble,

I was told let others speak about the things you do,

So I’ll talk about the A to F bundle,

It should be fundamental in every ICU,

If your not then that a major fumble,

Mobilising is good for patients research shows it’s true.

I’m tired of listening to all this squawking,

People who never been intubated telling us what is true?

Maybe you should all start listening and stop talking,

Delirium and acquired weakness are game changers,

Making your body feel like a dam stranger.

People who think sedating is humane,

What is going on in your dam brain,

Increases length of stay, delirium just to name some,

Disabilities, distress and insecurity what you’re imposing.

Let’s look at the bundle and what it does,

A- assess for pain and manage it appropriately,

B- breathing and awakening trials, 

Pausing sedation and making patient do more of the breathing work,

C- choice of sedative and analgesia, 

ensure your using the best ones,

D- Delirium assess, prevent and manage,

Stop the things that cause it and make the patient feel safe,

E- early exercise and mobilisation, 

Protect what’s there and reduce damage that will be done,

F- family it’s the worse time for them too,

Help them survive the stress their going through,

So they can help you too.

So let’s review all the things we do,

When you think of ICU ,

We all know what we should do,

Use the bundle that’s proven true,

To help more people survive the ICU.

Talk is cheap but here’s the cost

 

Why do I lay my trauma out for you to look?

I do it so you can stand and stare,

Wondering how we even got there,

Figuring out how I am still right here.

 

I tell my tale reworking it every time,

So that the impact gets better every time,

I relive the torture just so I can refine the talk every time,

When I’m done people question why I keep doing it every time.

 

It might stunt your recovery, might make worse,

You are not that important, your story doesn’t matter,

Thought banging round in my mind,

Trying to get any hook in it can find.

 

I might not be important but I am to some,

I’d still be happy if it was only one,

I have found friends in the worst of my trauma,

Ride or die friends I never thought I’d have,

But for each one I’m eternally glad.

 

I tell my story for those who can’t,

For those who pass or those who still suffer,

For those left defeated with no hope,

And for those who can give words to this rope.

 

The trauma like a noose squeezing out the life,

But we shan’t give in we will fight,

On the stage or the call I bare my trauma,

So there will be less mes tomorrow.

ICU Rehab Day 2023

                                                                    

We need to talk about the value of ICU rehab,

It is as important as drugs made in labs,

The battle we face after intubation,

The effort it takes, the shot heard across nations.

 

The A2F bundle formed to reduce the harm we cause,

But in a lot of ICU, the damage does even give pause,

Rehab in my home differs so much from the others,

We should all band together as sisters and brothers.

 

So heed this my call to join our movement,

Which is focused so fully on getting us moving,

Because never forget that not lost does not need to be regained,

That patient will not have to know the pain of muscle growing again.

 

So join us in voice, in spirit and in body,

Let’s do this properly for we can’t afford to be shoddy,

These people's lives we affect will impact so profoundly,

As for every person in a bed has people 100 deep,

The family and friends who witness the struggle,

Can be saved from the horror of seeing them suffer.

 

We all seek the solution which has eluded us all,

But we are not here to drop the ball,

We work hard each day to improve the world in tiny ways,

Because in weeks, months or even years,

Those tiny actions will reap us some gold.

 

 

Whether you stand at the bed, research or other,

The work that you do will be seen by fathers and mothers,

Your actions will be burned in that patient's brain,

Let’s not leave them with only a legacy of pain,

Working together we make rehab the focus,

We motivate, drive and support the goals that are chosen.

 

For in the end, we are all just supporting roles in the life of the patient,

We are stagehands, extras and even directors,

Managing the situations and bringing the important to focus,

We show the best that we have to evoke emotion,

Because of these plans, we are setting in motion,

They will impact people all across the oceans.

 

So I leave it here with these most feeble of words,

The patient in the bed wants to be heard,

We want to be seen and treated as a person,

We want to live life not simply surviving the crisis,

For when you look at the whole you will see too much more,

Learn about the person they were and who they’ll become.

 

 

Thank you for reading this I hope it evoked some emotion and I hope we can make ICU rehab a part of every icu patients journeys. But also make the time in ICU less traumatic and thus need less ICU rehab after.

A-F bundle lets get liberated

ABCDEF bundle

 

Assess for pain, analgesics so that they can engage,

Autonomy is key sedation's not a cure,

Alternate on and off intermittent is the key,

All together makes everything easier you’ll see.

 

Begin with SAT put a hold on sedation,

Before SBT to see if they are capable of breathing.

Back to the start for another day if their failing,

But a good start to think about extubation.

 

Choose carefully and aim for reduced agitation, not heavy sedation,

Choice of sedatives is very important Benzo’s should be avoided,

Could we use propofol in your thoughts in planning,

Can we use dexmedetomidine sure but only short term.

 

Delirium now that’s my enemy incarnate,

Do an assessment CAM-ICU the preference,

Different types, hyper or hypo active as well as mixed,

Dysfunction of the brain can affect behaviour.

 

Early movement prevention is better than cure,

Exercise protects the lungs and against weakness,

Every step taken helps to stay ahead of their illness,

Early is best when in the ICU as you can save before it's lost.

 

Family is so very important and helps to reorientate,

Fun how communicating effectively can leave an impression,

Feed them with confidence that they can help you,

Find ways to help them help your patient.

 

Get these points straight into your head,

Great to learn about what you should do,

Guidelines are important they support practice with facts,

Gathering understanding it’s a guidebook to success.

 

Hopefully, this helps you get to grips with the bundle,

How it works and why you use it,

Happy to help you with the words I am choosing,

Horrors lie ahead for patients whose care team don’t use it.

 

Confidence

 I always as myself if people are proud of me,

Have I had an impact do I matter,

When I am no longer here will I be remembered,

Will I be thought kindly and bring a smile,

Or will my name make people run a mile.

Everyday I look and reflect upon my failings,

Everyday worry that everyone’s time I’m draining,

I wonder all the time are my actions oppressive,

Or is this merely a reflection of poorly managed depression.

When I look upon what I’ve it brings lots of sadness,

As my health has took so much even most of my gladness,

I look at what I’ve done and think how much more I could’ve achieved,

If only my body did not hate me and kill me from inside,

December 28th 2015 the day I almost died,

Infection nearly made me face my maker.

If they looked upon my book what would he see?

Would it be very different from how I see me?

Would they welcome be into the fold a project complete,

Or will they shake their head in disappointment and defeat.

I know my many failings and it is more than one,

I know I’m too hard upon my self that’s failing number one,

I should treat myself with kindness that would be such fun,

But all I can ever do is reflect on ICU and make that gun is never a real one.

I’m turning corners now, I’m planning now you see,

With examples like Julie, Dorothy and Megan how great can I be,

I know see myself in futures never dared,

For in but just a moment it might not be there.

But after speaking with the greats,

I started to believe maybe I could dream and achieve,

Thank you goes to these council of three,

For giving my hope and faith I can believe.

Thank you to all who lift me up,

Thank you to everyone whose ever gave a fuck,

Thank you to those who brought a smile in dark days,

And finally thank you to those who support me everyday.

Doctors Strike

The government trying to paint em as evil,

Well hot dam can you believe em,

I listen as they say they are putting me in danger,

What a dam joke are you trying to offend me?

Are they out of their minds when they say Dr as harming,

Listen to me I'll be disarming or maybe even charming,

You can't abuse a system, underfund and supply it,

Then expect everyone inside to be happy about it,

 The gaslighting and abuse is what is dam harming,

You tried to break a system and met with resistance.

The Doctors are standing for what is right,

You are standing on wielding might,

Trying to undermine the public service that supports us,

Trying to villainize those who saved me,

When I was in ICU I know who was saving my life,

I know who did everything they could to bring me back,

You made sure I was here to write this.

I stand with the junior Doctors doing what is needed to make the NHS safe for all and be paid an amount that they can live life when they are not in the hospital. 

PINCH ME, a few of my favourite things

 

Pain should be managed and well-controlled,

Infection finding the source and treating quickly,

Nutrition are they getting all the sustenance that they need, 

Constipation are their bowels moving or blocked up inside,

Hydration are they dehydrated, let the fluids flow,

Medication look for deliriogenic medications you might be giving,

Electrolytes the ions out of balance can lead to real trouble.

These are a few of the Delirium things,

Remember night and day for sleep is essential,

Overstimulation is harmful like machine noises in ICU, 

Antipsychotics are a big no-no except in the rare time when it is needed,

Sedation, is it required or does it need to continue,

Moving while delirious is a bad idea,

Speaking calmly and creating safety is what needs to be done.

Delirium is a problem but is spoken about like Macbeth,

Can we please use the name, not using it won't kill you but it might cause harm,

Delirium causes patients and families a great amount of alarm,

Its a clinical diagnosis it is not a sentence of death,

Do we need more training and understanding to clear the air?

Delirium is everybody's problem, we all have to tackle it together otherwise we will never get on top of it. We need to understand that the hierarchy from inside the hospital does not transfer here, delirium is a peer problem we are all in this as one. The leaders we select for all that they have done, not what degree they have earned or job they have but the impact in the field that they've had. Delirium heroes come in all shapes and sizes but all have one thing the same, they don't want the patient to suffer again. Delirium undermines then very essence of you, it breaks down your thoughts and inhibits what you can do. The legacy it leaves is long and deeply effecting but we can battle it back by teamwork and not pretending. We can't go on using terms oblique to the problem, pleasantly confused a phrase I never want to rehear, it shows a lack of understanding after all of these years. So please friends join me in standing up to delirium by calling delirium delirium and treating it accordingly.