Thank you - that’s a very thorough explanation as to how things work. Can I just check I am understanding though, if there are symptoms that present that don’t fit in with the ‘checklist’ of events that you note almost automatically, they more than likely don’t get noted? Ie because the rash wasn’t connected to what you would usually see for those conditions, it was left off? Have I understood that correctly?This baby was actively dead to the point they were asking the parents about stopping CPR. As soon as that happened, the rash went away. There was no time for pictures.
The notes for an arrest follow a specific structure - it has to be an automatic process in the scribe's head, just like everything in CPR that we try and make automatic.
You document how many rounds of CPR, when you're giving drugs (adrenaline), or shocking if appropriate. You document looking for your reversible causes - hypoxia, hypovolaemia, hypo or hyperkalaemia, hypothermia, thrombosis, cardiac tamponade, toxins, tension pneumothorax. This is why we get blood gases, a set of obs, and the heart and lungs are examined during compressions. These are recorded contemporaneously. You do expose the child, but you're looking for something BIG.
If there's none of these reversible causes present, and you don't have a pulse back, you start thinking about stopping. You have a discussion with family, or you ask the rest of the team do they have any objections to stopping. This is documented. Then you document when you stopped and why.
Issue is, the reason baby M arrested isn't one of those reversible causes. They were progressing down that specific structure from what we heard, then.... baby M suddenly got better for no apparent reason. The relevance of that rash was also only recognised once the consultants sat down in June - the art of note writing means down you're writing down relevant things only, I'm not going to write about my patient's 5 cats, or funny looking toe, or a bit of a rash when I don't think it's relevant. In an arrest situation, unless you think that rash is suggestive of anaphylaxis (gives hypoxia and hypovolaemia, which are reversible), or DIC (thrombus, which is reversible), or is due to a local reaction to a transdermal patch (toxins) or suggests surgical emphysema (tension pneumothorax) you're probably going to bypass it.
I seem to recall the parents' house was searched but nothing found.This is what puzzles me about the 'trophies' like, the house was searched in 2018, by this point she had been suspended hadn't she? Then put on admin duties, surely if guilty you'd know exactly what was going on and would lose the trophies, or even visit your parents with a bag of stuff and leave them there, they wouldn't think twice about them. Seems so odd to leave them in a bag under the bed knowing that an arrest and search is inevitable. Unless they're not trophies and she forgot she had them
I think they would have had to speak to Governance/Safeguarding/Medical Director/Director of Nursing prior to any police involvement. Probably a high level meeting would have taken place.Mundane detail but I’ll be fascinated to find out how they actually got the police in. Like there has to be an “oh fuck” moment where the bosses realise this is probably a deliberate thing and they have to tell the police.
What happens in that situation? Do you ring 999 and be like “someone might have killed babies a few months ago but not right now?” Do you ring 101 and risk it getting lost between the calls about lost cats and scruffy vans on posh streets?
Do they just call some top Inspector Morse type dude to come in and start looking?
I mean I shouldn't bite but no, I'm not trolling. I don't necessarily believe any of the possible explanations or situations I mention, they're just things that pop into my head as I interpret the evidence and I discuss them in here.. because its a discussion thread. I've never defended LL, I don't know her so how can I, I've just said whether I feel certain evidence is compelling or not. For me, the notes found aren't. Insulin however is very compelling, but for me there isn't a great deal to discuss with that one so I don't bother. Given that I've been a nurse for a while and worked in busy wards, I might see some evidence differently from some people.
Also we haven't even started the defence case and personally I'd like to hear at least some of their case before I come to my own conclusions. Some don't, that's fine.
I'm not quite sure what you feel you're contributing to the discussion
Just out of
Jk.. she's my sister I just want her to get out so she can give me back a dress she borrowed
This isn’t at all to be offensive or disagree, just an honest question. I get she could have easily taken certain paperwork home by accident, I’ve done it. But anything I shouldn’t have or I know shouldn’t have left the building gets destroyed straight away. There’s nothing malicious in it apart from absent mindedness and just being in a rush. But, the thing I struggle with here is this, why would you have them for as long as she’s had them and I guess it’s the nature of the paperwork that’s making think that’s just not right. Also in terms of ‘trophies’ I think the reason it’s suspicious is because you would keep it, hence why it’s called a trophy. Everyday people wouldn’t keep them, but by it being called a trophy and the very nature of what she’s accused of that’s what they are looking for. She wouldn’t get rid of it. I’m not disagreeing with you, I’m still very open, but it’s just these things that make me think. The police searched her house because they were looking for those things.I mean I shouldn't bite but no, I'm not trolling. I don't necessarily believe any of the possible explanations or situations I mention, they're just things that pop into my head as I interpret the evidence and I discuss them in here.. because its a discussion thread. I've never defended LL, I don't know her so how can I, I've just said whether I feel certain evidence is compelling or not. For me, the notes found aren't. Insulin however is very compelling, but for me there isn't a great deal to discuss with that one so I don't bother. Given that I've been a nurse for a while and worked in busy wards, I might see some evidence differently from some people.
Also we haven't even started the defence case and personally I'd like to hear at least some of their case before I come to my own conclusions. Some don't, that's fine.
I'm not quite sure what you feel you're contributing to the discussion
Jk.. she's my sister I just want her to get out so she can give me back a dress she borrowed
I guess if it's been taken home accidentally, it may have been in the same bag and therefore not noticed to return to the hospital? Or a bag for shredding. I'm not saying it isn't a trophy, just that it doesn't immediately strike me as suspicious. Maybe she's chosen them as trophies because it is less obvious than a belonging and could be explained away as being absent minded.This isn’t at all to be offensive or disagree, just an honest question. I get she could have easily taken certain paperwork home by accident, I’ve done it. But anything I shouldn’t have or I know shouldn’t have left the building gets destroyed straight away. There’s nothing malicious in it apart from absent mindedness and just being in a rush. But, the thing I struggle with here is this, why would you have them for as long as she’s had them and I guess it’s the nature of the paperwork that’s making think that’s just not right. Also in terms of ‘trophies’ I think the reason it’s suspicious is because you would keep it, hence why it’s called a trophy. Everyday people wouldn’t keep them, but by it being called a trophy and the very nature of what she’s accused of that’s what they are looking for. She wouldn’t get rid of it. I’m not disagreeing with you, I’m still very open, but it’s just these things that make me think. The police searched her house because they were looking for those things.
Agree with your points and also think another huge issue with it being an accident is that not only are these not regular handover notes but a very obvious record of the collapse that shouldn’t have gone anywhere except the bin, a blood gas record that is kept with proper medical notes and maybe more crucially - this is NOT her patient. She’s not carried these things round with her all day.This isn’t at all to be offensive or disagree, just an honest question. I get she could have easily taken certain paperwork home by accident, I’ve done it. But anything I shouldn’t have or I know shouldn’t have left the building gets destroyed straight away. There’s nothing malicious in it apart from absent mindedness and just being in a rush. But, the thing I struggle with here is this, why would you have them for as long as she’s had them and I guess it’s the nature of the paperwork that’s making think that’s just not right. Also in terms of ‘trophies’ I think the reason it’s suspicious is because you would keep it, hence why it’s called a trophy. Everyday people wouldn’t keep them, but by it being called a trophy and the very nature of what she’s accused of that’s what they are looking for. She wouldn’t get rid of it. I’m not disagreeing with you, I’m still very open, but it’s just these things that make me think. The police searched her house because they were looking for those things.
All of that is true, and yes I know somebody who moved recently and I can tell you he is a complete hoarder and probably took tons of junk with him because he couldn’t be bothered to sort it out. We simply don’t know what type of personality she is or how organised she is. However, isn’t the nature of said paperwork that’s the issue, the blood has report , now the police have raised this obviously as evidence, why would she have it. I suppose that the issue, yes of course handover notes etc, I suppose you could write that off as absentmindedness.I ventured onto the FB group just out of curiosity and someone did make an interesting point re the report under the bed …
‘Be interesting to know what type of person she is. If she is a type B personality, I wouldn’t find it unusual for her to have discarded notes in her house, under her bed etc. If she’s a type A and usually very tidy, then I would find the keeping of these notes interesting.’
Off topic but that makes me think of when everyone remembered Walkers Salt and vinegar crisps originally being in blue packets but apparently they were green all along! Sorry that’s prob not a relevant example but yeahWhat's that thing called where you 'remember' something that happened, but when lots of people also say they remember it, it begins to be remembered wrongly? I'm sure there's a word for it but I just can't think.
Wait - you’re telling me they weren’t in blue packets! That’s gotta be a lieOff topic but that makes me think of when everyone remembered Walkers Salt and vinegar crisps originally being in blue packets but apparently they were green all along! Sorry that’s prob not a relevant example but yeah
Yes, exactly. In an arrest situation it's really difficult, you might have 5, 6, 7 people in that room with you, and with a tiny premature baby you're going to struggle to see. Having a set list of what we look for helps lighten the cognitive load.Thank you - that’s a very thorough explanation as to how things work. Can I just check I am understanding though, if there are symptoms that present that don’t fit in with the ‘checklist’ of events that you note almost automatically, they more than likely don’t get noted? Ie because the rash wasn’t connected to what you would usually see for those conditions, it was left off? Have I understood that correctly?
Thank you, that’s really helpful.Yes, exactly. In an arrest situation it's really difficult, you might have 5, 6, 7 people in that room with you, and with a tiny premature baby you're going to struggle to see. Having a set list of what we look for helps lighten the cognitive load.
Additionally, you've got to remember that most doctors do not know what a rash looks like with air embolus. I can't even find an example of the rash easily on google (for obvious reasons) - I've had to go through a couple of different articles, find the latin name, then look that up because that's apparently what it looks a bit like in divers when they get a cerebral air embolus (which is different too!). The rash that an air embolus apparently 'looks like' occurs in 50% of newborns as well, the weird thing about it here is that it specifically disappeared when the baby got better...
For reference, this is the rash the articles say the cerebral air embolus in divers looks like, I've seen something similar in a lot of babies that is permanent, especially newborn ones. Remember that Baby M is only 2 days old at this point.
View attachment 1980221
So interesting. I looked up embolism rashes and saw fat embolism and pulmonary embolism rashes but not air for obvious reasons! Within those examples there was variation in how they looked and how I would describe each one, maybe more pink/purple/red. I think the descriptions are on the whole very consistent. Unusual, fleeting, different to normal mottling, between pinks reds and purples. I know pink secretions round the mouth was mentioned for a few babies too and somebody found a report about Bev A’s air embolism victim that survived, having been noted as having pink secretions round her mouth too. Would that possibly be significant?Yes, exactly. In an arrest situation it's really difficult, you might have 5, 6, 7 people in that room with you, and with a tiny premature baby you're going to struggle to see. Having a set list of what we look for helps lighten the cognitive load.
Additionally, you've got to remember that most doctors do not know what a rash looks like with air embolus. I can't even find an example of the rash easily on google (for obvious reasons) - I've had to go through a couple of different articles, find the latin name, then look that up because that's apparently what it looks a bit like in divers when they get a cerebral air embolus (which is different too!). The rash that an air embolus apparently 'looks like' occurs in 50% of newborns as well, the weird thing about it here is that it specifically disappeared when the baby got better...
For reference, this is the rash the articles say the cerebral air embolus in divers looks like, I've seen something similar in a lot of babies that is permanent, especially newborn ones. Remember that Baby M is only 2 days old at this point.
View attachment 1980221
there is actually a medical name for the fire/hot water bottle rash - ‘erythema ab igne’ - or affectionately known as ‘granny’s tartan’ (because of the pattern)Thank you, that’s really helpful.
Your picture made me think of what my granused to call ‘corn beef legs’- when you’d stood in front of the gas fire
not sure re this. Took the secretions previously to indicate a traumatic cause.So interesting. I looked up embolism rashes and saw fat embolism and pulmonary embolism rashes but not air for obvious reasons! Within those examples there was variation in how they looked and how I would describe each one, maybe more pink/purple/red. I think the descriptions are on the whole very consistent. Unusual, fleeting, different to normal mottling, between pinks reds and purples. I know pink secretions round the mouth was mentioned for a few babies too and somebody found a report about Bev A’s air embolism victim that survived, having been noted as having pink secretions round her mouth too. Would that possibly be significant?
Ah you are more than likely right and I’m thinking of the babies where there’s physical harm maybe.there is actually a medical name for the fire/hot water bottle rash - ‘erythema ab igne’ - or affectionately known as ‘granny’s tartan’ (because of the pattern)
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not sure re this. Took the secretions previously to indicate a traumatic cause.
Nothing to add to @F1Grid fantastic explanation. I’d only reiterate, strongly, that AE is extremely rare, so rare that the Drs didn’t realise the significance of what they were observing. Even though they noted LL was present foul play hadn’t occurred to them.@docmum @Haveyouanywool anything to add medically for the arrest baby M has? It’s so incredible to me that they, understandably, nearly gave up after almost 30 minutes and spoke to the parents about stopping efforts.. for baby to go on to be in air just hours later. Thank god they carried on. Important to remember how many babies have survived because of all their efforts too I think.
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