{"id":21048,"date":"2021-12-30T05:19:00","date_gmt":"2021-12-29T21:19:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=21048"},"modified":"2021-12-30T05:50:56","modified_gmt":"2021-12-29T21:50:56","slug":"bmj%e5%9c%a3%e8%af%9e%e4%b8%93%e5%88%8a%ef%bc%9aicu%e4%b8%ad%e4%bd%bf%e7%94%a8%e7%9a%84%e4%bf%9a%e8%af%ad","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=21048","title":{"rendered":"[BMJ\u5723\u8bde\u4e13\u520a]\uff1aICU\u4e2d\u4f7f\u7528\u7684\u4fda\u8bed"},"content":{"rendered":"\n

Feature<\/strong> Christmas 2021: What a Wonderful World<\/p>\n\n\n\n

Just a smidge, or a bridge too far? Slang use in the ICU<\/h1>\n\n\n\n

James M Hodgetts, Ayat Mohamed,\u00a0Stephen Lewis<\/h3>\n\n\n\n

BMJ<\/em>\u00a02021;\u00a0375\u00a0doi:\u00a0https:\/\/doi.org\/10.1136\/bmj-2021-067900<\/a>\u00a0(Published 16 December 2021)Cite this as:\u00a0BMJ<\/em>\u00a02021;375:e067900<\/h3>\n\n\n\n

A shared lingo can create cohesion in \u201cthe unit,\u201d but James M Hodgetts and colleagues<\/strong>ask whether this is exclusionary and puts patient safety at risk<\/p>\n\n\n\n

Towards the end of the second covid surge, the intensive care unit (ICU) at Frimley Park Hospital enjoyed a brief period when patient numbers were falling but enhanced staffing remained. During a relatively relaxed evening ward the authors got talking about medical language and slang used on our ICU. What was its role? How much of it did we use? Was it a hindrance or help to communication? To what extent might it include or exclude the people using and hearing it?<\/p>\n\n\n\n

Thinking about slang<\/h2>\n\n\n\n

Slang can add colour, humour, and nuance to professional interactions and may reinforce group cohesion. It may sometimes seem dark or even callous to the external observer, but it can form part of the armour that doctors develop to protect them from continual exposure to human suffering.<\/p>\n\n\n\n

However, where one party doesn\u2019t understand its meaning, slang may create a sense of exclusion. From a patient safety perspective, it\u2019s difficult to support the use of terminology that\u2019s never been formally taught or codified when communicating potentially crucial clinical information. This situation would be unimaginable in the airline industry, whose safety culture anaesthesia and intensive care often attempt to emulate. But our colleagues, including those newer to our department, wish on the whole for it to remain, having worked hard to learn this unwritten code.<\/p>\n\n\n\n

Creating a dictionary<\/h2>\n\n\n\n

We collected the slang terms used by others and ourselves in the ICU over six months and collated these terms and expressions (those that can be committed to print) in a mini-dictionary of ICU slang, and some are used in UK medicine more broadly. We were surprised by how often we communicated crucial information using speech that could not have been learnt in a classroom or from a textbook.<\/p>\n\n\n\n

There was medical slang, British slang, and military slang (Frimley Park Hospital has a strong military connection). There was the British tendency to understatement (\u201cThe ICU is a little bit<\/em> busy at the moment\u201d). Some speech was related to medical superstition, such as referring to the Tangle Fairy or never daring to describe a shift as quiet. Perhaps the least accessible was phraseology with a subtext, such as a referral beginning, \u201cJust to let you know . . .\u201d<\/p>\n\n\n\n

We hope that our dictionary may be of use and possibly a source of amusement\u2014and that it causes ICU staff and other healthcare workers to reflect on the suitability and inclusivity of the language they use with colleagues.<\/p>\n\n\n\n

a bridge too far<\/strong>euph<\/em> Escalating the level of organ support to a point where the burden on the patient outweighs the benefit. From the title of the 1974 book by Cornelius Ryan describing the events of Operation Market Garden in the second world war.<\/p>\n\n\n\n

a little bit<\/strong>n<\/em>1<\/strong> A small amount: \u201cHe\u2019s on a little bit<\/em> of noradrenaline\u201d (see smidge<\/em>). 2<\/strong> An understated large amount: \u201cIt\u2019s been a little bit<\/em> busy on the unit<\/em> overnight.\u201d Meaning: \u201cI was run off my feet<\/em> last night.\u201d<\/p>\n\n\n\n

albatross<\/strong>n<\/em> The on-call bleep. Named after the sea bird metaphor for a psychological burden that feels like a curse. Originates from The Rime of the Ancient Mariner<\/em> (1798) by Samuel Taylor Coleridge.<\/p>\n\n\n\n

anaemia of investigation<\/strong>n<\/em> A fall in the patient\u2019s haemoglobin caused by repeatedly testing for it.<\/p>\n\n\n\n

bag squeezer<\/strong>n<\/em> Derogatory term for an anaesthetist.<\/p>\n\n\n\n

bed and breakfast<\/strong>euph<\/em> When a surgical patient is admitted to the unit<\/em> for observation in the postoperative period. They should aim to leave the unit<\/em> the next morning unless they wobble<\/em>.<\/p>\n\n\n\n

believe nothing, trust no one, give oxygen<\/strong>phr<\/em> Three golden rules for practising intensive care medicine. Occasionally, the third rule is incorrect.<\/p>\n\n\n\n

boggy<\/strong>adj<\/em> Wet, often when describing pulmonary oedema.<\/p>\n\n\n\n

career laugh<\/strong>n<\/em> The polite chuckle from juniors that follows a lame joke by the boss.<\/p>\n\n\n\n

chip away<\/strong>euph<\/em> Gradually reduce the patient\u2019s need for support. Commonly used regarding oxygen or vasoactive drugs.<\/p>\n\n\n\n

closest crocodile to the canoe<\/strong>euph<\/em> The most urgent clinical problem. ICU patients frequently have multiple pathologies with conflicting treatments, such as gastrointestinal bleeding while anticoagulated for pulmonary embolism, in which case the only option is to whack the closest crocodile to the canoe<\/em>.<\/p>\n\n\n\n

crack on<\/strong>v<\/em> To commence work, or an instruction to do so.<\/p>\n\n\n\n

crispy<\/strong>adj<\/em> Dehydrated. May also be a treatment target: \u201cRun them crispy<\/em>, we don\u2019t want them developing pulmonary oedema again.\u201d<\/p>\n\n\n\n

Domestos<\/strong>n<\/em> A cocktail of potent antibiotics, usually second or third line, named after the popular bleach. (Other brands are available).<\/p>\n\n\n\n

don\u2019t hesitate to cope<\/strong>phr<\/em> A parting plea from the on-call ICU consultant to the duty doctor before the former retires to bed. Meant to discourage frequent and unnecessary sleep disturbance. An outdated, unsupportive, and potentially unsafe request, now used only (semi) ironically with a wink and a smile.<\/p>\n\n\n\n

ED<\/strong>abbrev<\/em> Emergency department. Pronounced \u201cee-dee\u201d and now so integrated into medical language that some people have been known to refer to the \u201cemergency ED<\/em> department\u201d when attempting to use the full title.<\/p>\n\n\n\n

end-of-the-bed-ogram<\/strong>n<\/em> A hypothetical qualitative measurement of health that occurs in the brain of a doctor when eyeballing<\/em> a patient. \u201cThe patient\u2019s numbers are much worse than their end-of-the-bed-ogram<\/em>.\u201d<\/p>\n\n\n\n

eyeball<\/strong>v<\/em> To briefly assess a patient. \u201cI\u2019ll quickly eyeball<\/em> the patient before we transfer them out of the<\/em>unit<\/em>.\u201d<\/p>\n\n\n\n

faffing<\/strong>v<\/em> To waste time performing a useless task. \u201cStop faffing<\/em> around trying to place an arterial line\u2014his blood pressure is in his boots<\/em> and we need to move him to the operating theatre!\u201d<\/p>\n\n\n\n

finger dislocator<\/strong>n<\/em> Pulse oximeter. Named for its propensity to be left attached to the patient\u2019s finger during slides and turns.<\/p>\n\n\n\n

fell in a heap\/fell off their perch<\/strong>euph<\/em> The patient\u2019s condition has suddenly deteriorated.<\/p>\n\n\n\n

flapping<\/strong>v<\/em> Panicking. \u201cWhen I got to resus, the ED<\/em> registrar was flapping<\/em> like a pigeon in a wheely bin.\u201d<\/p>\n\n\n\n

gas man<\/strong>n<\/em> An anaesthetist who identifies as male.<\/p>\n\n\n\n

gas girl<\/strong>n<\/em> An anaesthetist who identifies as female. (\u201cGas woman<\/em>\u201d may be preferable, but the alliteration sounds better.)<\/p>\n\n\n\n

gas god<\/strong>n<\/em> An anaesthetist who is the subject of hero worship, usually by a more junior anaesthetist.<\/em><\/p>\n\n\n\n

going to my office to do some admin<\/strong>phr<\/em> From the ICU consultant to the juniors before allowing them to get on with the work of the unit<\/em>. Meaning: \u201cI\u2019m going to my office to drink coffee, gossip, and google my own name.\u201d<\/p>\n\n\n\n

have you had your Weetabix?<\/strong>phr<\/em> Are you feeling strong? Usually asked before performing a manual handling manoeuvre on a particularly heavy patient. Derived from a 1990s advertising campaign for the popular breakfast cereal.<\/p>\n\n\n\n

in their boots<\/strong>euph<\/em> Very low. \u201cTheir blood pressure was in their boots<\/em>.\u201d<\/p>\n\n\n\n

iPhone positive<\/strong>adj<\/em> The patient\u2019s health is good enough to allow them to continue to send text messages and update their Facebook status. (Other models of mobile phone are available.)<\/p>\n\n\n\n

just to let you know<\/strong>phr<\/em> The first words spoken by another specialty doctor when making a pseudo-referral to the intensive care team. An underhand attempt to passively transfer responsibility for a clinical outcome, guaranteed to raise the ire of the intensivist. The other specialist hopes to record \u201cICU aware\u201d in the medical notes without doing the work associated with a proper referral. \u201cJust to let you know<\/em> that I\u2019m in resus seeing an acidotic, hypotensive, bedbound nursing home resident who has severe dementia.\u201d<\/p>\n\n\n\n

knob twiddler<\/strong>n<\/em> Derogatory term for an intensivist.<\/p>\n\n\n\n

line monkey<\/strong>n<\/em> The only ICU junior on duty who can competently insert central lines. Usually a bag squeezer.<\/em> See transfer monkey.<\/em><\/p>\n\n\n\n

masterful inactivity and cat-like attention to detail<\/strong>phr<\/em> Carefully monitoring the patient and intervening only when there\u2019s a compelling reason to do so. A philosophy of intensive care that probably yields the best results. Extension of the Hippocratic entreaty to \u201cdo no harm.\u201d<\/p>\n\n\n\n

metal inotrope<\/strong>n<\/em> The Macintosh laryngoscope. Instrumentation of a patient\u2019s airway with this device is extremely stimulating and may produce a brief inotropic effect.<\/p>\n\n\n\n

micro-round<\/strong>n<\/em> A discussion of each patient with a microbiologist to agree on their antibiotic management. The arrival of the microbiologist usually coincides with the first mouthful of sandwich taken by the intensivist after finishing their own rounds. Not to be confused with a very short ward round.<\/p>\n\n\n\n

missed the boat<\/strong>euph<\/em> When a clinical deterioration has advanced beyond the point of rescue. \u201cYou can give him antibiotics, but unfortunately I think we\u2019ve missed the boat<\/em>.\u201d<\/p>\n\n\n\n

Movibomb<\/strong>n<\/em> A large dose of the macrogol based laxative Movicol (up to 8 sachets), used by some intensivists to treat constipation in ventilated patients. (Other laxative brands are available.)<\/p>\n\n\n\n

No heroics<\/strong>phr<\/em> An instruction not to escalate organ support inappropriately. See a bridge too far<\/em>.<\/p>\n\n\n\n

off-piste<\/strong>adj<\/em> Description of treatment that has deviated from clinical guidelines. Does not necessarily imply poor clinical judgment. Stems from a skiing term, when one skis off the mapped runs. \u201cThe management of DKA in bed 7 has been a little bit off-piste<\/em> . . .\u201d<\/p>\n\n\n\n

O sign<\/strong>n<\/em> A clinical feature, elicited when eyeballing<\/em> a patient, where they are seen to be unconscious with their mouth open. See Q sign<\/em>.<\/p>\n\n\n\n

Prolene deficiency<\/strong>euph<\/em> Inadequate surgical haemostasis causing postoperative bleeding. Prolene is a synthetic non-absorbable suture. \u201cI can give them more FFP and tranexamic acid, but I think the problem here is Prolene deficiency<\/em>.\u201d<\/p>\n\n\n\n

put the unit to bed<\/strong>v<\/em> To conduct the final ward round of the day, with the intention of dealing with any issues before night time. Creates the false impression that the intensivist will be tucking each patient in and reading them a story.<\/p>\n\n\n\n

Q sign<\/strong>n<\/em> Same as the O sign<\/em>, except that the patient\u2019s tongue is now protruding from their mouth, and therefore an even more ominous feature.<\/p>\n\n\n\n

quiescent<\/strong>adj<\/em> In a state of inactivity or dormancy. \u201cThe chest drain has been quiescent<\/em>.\u201d An example of an unnecessarily obscure word being used to describe a simple situation, usually by a doctor trying to sound clever.<\/p>\n\n\n\n

quiet<\/strong>adj<\/em> Superstition dictates that this word should never be spoken aloud, even if the shift has been blissful. Its use ensures that the rest of the shift will be excruciatingly busy. Sometimes used maliciously at handover to jinx the incoming team.<\/p>\n\n\n\n

red herring<\/strong>n<\/em> Something that draws attention away from the main issue. \u201cI think the fact that he had his first covid jab last week is a red herring<\/em>.\u201d<\/p>\n\n\n\n

retrospectoscope<\/strong>n<\/em> An imaginary device that allows the past to be altered, with the advantage of knowing how events will unfold.<\/p>\n\n\n\n

rinse and spin<\/strong>v<\/em> To simultaneously give intravenous fluid (often albumin) while administering a diuretic. To some, a valid method of driving renal function; to others, a contradictory approach. Derived from a washing machine mode.<\/p>\n\n\n\n

Royal College of Bag Squeezers<\/strong>n<\/em> Derogatory term for the Royal College of Anaesthetists.<\/p>\n\n\n\n

seminar room<\/strong>n<\/em> Commonly mispronounced as \u201ccoffee room,\u201d this is the social place where ICU doctors hand over patients, discuss management plans, drink coffee, and generally hide. It is rare for an actual seminar to occur here.<\/p>\n\n\n\n

SEP<\/strong>abbrev<\/em>1<\/strong> Somatosensory evoked potentials. 2<\/strong> Someone else\u2019s problem.<\/p>\n\n\n\n

smash and grab extubation<\/strong>euph<\/em> Where the sedation is turned off and the endotracheal tube is removed as the patient wakes\u2014usually a confused patient who is not expected to be compliant at any point in the process.<\/p>\n\n\n\n

smidge<\/strong>n<\/em> A small amount, commonly used to describe how much medication the patient is taking. \u201cHe\u2019s on a smidge<\/em> of noradrenaline for blood pressure.\u201d Shortened form of smidgen<\/em>.<\/p>\n\n\n\n

snake\u2019s wedding<\/strong>n<\/em> The chaotic mass of wires and lines that seem to tie themselves around each other immediately on transferring an intensive care patient outside the unit<\/em>. Usually blamed on the Tangle Fairy<\/em>.<\/p>\n\n\n\n

SOD<\/strong>abbrev<\/em> Single organ doctor. A derogatory term for a doctor specialising in a one organ system only, such as a cardiologist.<\/p>\n\n\n\n

Tangle Fairy<\/strong>n<\/em> A mythical invisible creature believed by some to accompany every patient transfer in intensive care. It ties knots in monitoring wires and lines when the staff are not looking, creating a snake\u2019s wedding.<\/em><\/p>\n\n\n\n

the expensive care unit<\/strong>n<\/em> Colloquial term for the intensive care unit, acknowledging that it costs around \u00a33000 per day per patient.<\/p>\n\n\n\n

the intensive scare unit<\/strong>n<\/em> Colloquial term for the intensive care unit, acknowledging that it can be a frightening place for all concerned.<\/p>\n\n\n\n

the unit<\/strong>n<\/em> Endearing term for the intensive care unit. Any hospital has several clinical \u201cunits,\u201d but in the same way that the SAS is known as \u201cthe regiment,\u201d only one is known as \u201cthe unit<\/em>.\u201d<\/p>\n\n\n\n

transfer monkey<\/strong>n<\/em> The only ICU junior on duty who can competently move intubated patients outside the unit<\/em>. Usually a bag squeezer.<\/em> See line monkey.<\/em><\/p>\n\n\n\n

trial separation<\/strong>n<\/em> A careful attempt to move the bed of a ventilated patient away from its usual spot, before commencing an out-of-unit transfer. Usually reveals that the mattress is still plugged in.<\/p>\n\n\n\n

TWOC<\/strong>abbrev, v<\/em>1<\/strong> Trial without catheter. 2<\/strong> To remove a patient\u2019s urinary catheter to see if it is still needed. Pronounced \u201ctwock.\u201d<\/p>\n\n\n\n

vein of shame<\/strong>n<\/em> A tiny, delicate, but reliably visible vein on the anterior aspect of the wrist. \u201cThe patient needed a cannula so that we could discharge him to the ward. He was so puffy<\/em> I had to put a 24 gauge in the vein of shame<\/em>.\u201d<\/p>\n\n\n\n

warm, wake, and wean<\/strong>v<\/em> Rewarm the patient, reduce their sedation, and slowly remove vasoactive drug support. An abbreviated handover of an intubated postoperative patient, from the anaesthetic team to the ICU team. Most commonly heard in cardiothoracic centres.<\/p>\n\n\n\n

wobble<\/strong>v<\/em> To become clinically unstable. \u201cThe patient in bed 3 had a wobble<\/em> overnight.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Feature Christmas 2021: What a Wonderful World Jus […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21048"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=21048"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21048\/revisions"}],"predecessor-version":[{"id":21049,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21048\/revisions\/21049"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=21048"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=21048"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=21048"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}