georgeclews.bsky.social
ACCS CT4 Anaesthesia Trainee. Interested in performing at the level expected for this stage of training.
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It can be emotionally challenging and the lows can be hard, but I still feel like a big of a magician when I place a well working labour epidural.
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Considering we are giving more and more carb-loading drinks, doesn’t follow that the rest of our patients are already in a state of catabolism before knife to skin!
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I think is key when people talk about there being no maximum dose of vasopressor.
It’s true, but if I am on 1mcg/kg/min of norad then maybe we need to consider that it’s not an SVR problem!
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3). Full agree with the waiting well principle and something we should be pushing more! Arguably this should be starting from the moment of referral but we should be stressing this at every patient encounter along the perioperative journey.
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2). If patients are going to get scan results on the same day, does that mean patients will have a scan in the morning, MDT at lunch and result discussed in the afternoon?
Could be amazing for patients though will take a lot of co-ordination from hospitals to pull it off!
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Does this mean patients can submit forms for tests themselves? Potentially good, although important to know how they are going to be followed up, especially if unusually findings are seen or a patient no longer fits the pathway.
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1). Patients being able to request scans/tests without seeing a consultant.
Do they mean GPs will have access to more tests? I think this is largely a good thing, especially for well-defined NICE pathways.
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Did the patient have any abnormalities on a pre-op ECG? How did you end up treating it?
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Vastly underrated/underused move. I feel with US you started off doing similar techniques to landmark and then you realise you can do so much more!
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Out of plane, but I will probably start trying more in plane. Good to have a skill mix and will hopefully help with my regional technique.
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Probably a difference in skill then, as I am terrible at getting tiny veins and arteries perfectly in long axis!
To get my direction of travel, I just move my probe cephalad and caudad, and if my target vessels stays in the middle of the screen, I know I am orientated in the correct direction.
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I’m also a fan of the saline flush under ultrasound guidance, but why switching to long axis? I find short axis works well, especially if you can see the saline going into tributaries away from the vein you’ve cannulated.
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If you have the opportunity to give yourself enough time to enjoy it, it becomes a lot easier. Doing little bits here and there over 6 months meant I could sometimes enjoy learning.
But also, sometimes you got to cut your loses and there is a lot in eLFH that is very low yield!
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I think it also depends on how you much social capital you have in the bank. If you foster a positive environment the majority of time, I’m sure it will affect your colleagues less when you have to be more direct in an emergency.
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Dexamethasone is rapidly becoming my favourite anaesthetic drug.
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And yet there is 40% chance I won’t get a job to complete my anaesthetic training!
Whilst these figures are frustrating for me personally, they are an example of terrible planning from the government.
There are missing out on 250 new consultant anaesthetists per year!
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I’ve completed 6 years medical school, 2 years foundation training, 2 years working outside of training and in my 4th year of anaesthetic training.
I’ve worked 48 hours per week, alongside time to teaching and service improvement and hundreds of hours to studying for the Primary FRCA.
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I’ve definitely seen people use APRV as a panacea for hypoxia without doing the usual ARDS Net regime (and sometimes used inappropriately in the wrong patient group). Culturally, people are more concerned about high PEEP than they are about APRV.
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This study seems quite exciting, in that my understanding of APRV is that it (supposedly) works best as a spontaneously breathing mode rather than for patients already sedated and paralysed.
Hopefully this will provide some data either way.
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Also, a lot of these patients are treated OOH by resident doctors.
Better to do a safe block which may reduce opioid requirements rather than attempting a ‘better’ block with more risks!
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(It is actually delicious, the courgette adds a sweetness)
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Next level adulting is putting vegetables in your overnight oats!
www.sneakyveg.com/courgette-zu...
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Really enjoyed doing my IC and meeting many candidates from different backgrounds.
Whilst I agree ALS is pretty basic with regards to resuscitation, it creates a common language and encourages people to do the basics well!
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Residual neuromuscular block? Severe hypotension?
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My experience of melatonin between night shifts is that I once slept for 12 hours and missed the start of my shift!
Between nights I use 5-HTP or magnesium which in my experience is a bit gentler (definitely anecdote and not data or science)
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If you have a lot of time on your hands ‘The Bee Sting’ by Paul Murray is a real family epic!
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Sounds like the kinda scenario they might ask in the ST4 interviews!
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This is probably the thing I am most nervous about. I’ve been trained to give an anaesthetic but this ‘soft’ stuff I’ve rarely had to think about before.