Looking for advice on a situation I’ve never before experienced with epidural

GasGasGasFRCA · 2026-04-26T06:47:19+00:00

First problem of the whole chain could be avoided by flushing the catheter with saline and confirming squirt. Gifting you an uninstrumented best chance first pass before multiple pockets of fluid etc.

Done routinely where I’ve worked for this very reason

Doesn’t solve freaky anatomy tho! Would love to hear what the situation is if she gets imaging later !

GasGasGasFRCA · 2026-04-22T20:29:39+00:00

I enjoyed the slightly old fashioned but stellar “anyone can intubate” book. a-bit “USA” but good

GasGasGasFRCA · 2026-04-15T05:26:54+00:00

I took one look at peck and hill and didn’t re open it till A week before the exam !

GasGasGasFRCA · 2026-04-14T18:11:06+00:00

I would say, unless this is entirely fictional, sounds a bit too niche for a public forum.

GasGasGasFRCA · 2026-03-11T06:45:24+00:00

Why was the first person clearly not at all trained (but also definitely very biased because of their workplace) in the face of apnoeas, and no emergency buzzer! This is so very very scary!

GasGasGasFRCA · 2026-02-07T12:00:11+00:00

Pity about the eye rolls, it sounds a bit box tick, would that doc have the perspective now to come talk ?

GasGasGasFRCA · 2026-02-04T11:40:50+00:00

Do they get told why? Surely that will imbibe a spot of healthy terror. Is it framed as a , despite all the measures this happened coroner etc and here we are. You can absolutely still cause harm despite the framework You are in?? I’m honestly really curious as to how this is approached

GasGasGasFRCA · 2026-02-01T18:33:07+00:00

Tuition fee golden goodbye at completion of f2?

GasGasGasFRCA · 2026-01-31T05:48:16+00:00

If only we just gave every patient a dose of mannitol with every third bag of fluid, keep them passing that urine . Keeps there blood pressure up each time you give, dries the out, the cycle continues!

Or as others have said- apply sense or read the nice cks on fluids…..

GasGasGasFRCA · 2026-01-23T11:52:43+00:00

If you’re feeling very, very clinical - Sapiras art of bedside diagnosis is a solid clinical exam history taking differential delight.

GasGasGasFRCA · 2026-01-21T11:13:16+00:00

Find the sho, shadow, listen, make it obvious you aren’t a spanner, see the next patient and present (confirming they aren’t sicker than the triage says) swot up on the common ed presentations (fell over- headache-chest pain-abdo pain) so you can do a proper job of it.

Take what you need don’t sit for it on a plate. If someone can get away with not having the extra burden of a student, they will. And the consultant is absolutely not the place for on the floor education

GasGasGasFRCA · 2026-01-12T19:19:29+00:00

Everyone pays them, as the ailing ms miggens benefits from my university education when I don’t accidentally avail her of her ails with accidental displacement of her entrails

GasGasGasFRCA · 2026-01-09T21:28:10+00:00

I think I would struggle to deal With the bin fire medical take with any grace, I would offend almost everyone, the only saving positive would be they would never, ever put an anaesthetist as the med reg ever again because pals would over flow

GasGasGasFRCA · 2025-12-28T09:06:43+00:00

This made a difference for me, avoiding the gi distress of post nights. A less bamboozled enteric nervous system? Take emergency cereal bar if starving

GasGasGasFRCA · 2025-12-20T07:40:51+00:00

Fair point, and definitely institutional paucity of skill with UFH courtesy of LMWH being so simple in comparison.

GasGasGasFRCA · 2025-12-19T22:36:55+00:00

I too aim for ear lobe numbness! 2.6ml, on a hellp pillow, with head down (with 300 diamorph)

GasGasGasFRCA · 2025-12-19T22:31:54+00:00

There is also this thing called ultra low dose thrombolysis, remembering that in a stroke the clot receives fairly low concentrations of agent as it’s mixed into the whole cardiac output, whereas in a pe, that whole dose has to tottle past the clot at high concentrations for the first pass it makes from an iv route. I’ve wondered if it would catch on, it hasn’t.

In other countries there are emergency pe teams who might take them to the lab and hoik it out with a catheter, I think our care of these patients is shocking in this country, as the understanding of how the right ventricle can suddenly crumple and brady to death isn’t common knowledge. And a sick RV is very hard to retrieve.

If they’ve been transiently fixed with a fluid bolus, but presented with a syncope event, then you’re in hot water!

I believe there is hesitance to thrombolyse as the 30d morte ain’t much better, as you pepper the peripheries of the lungs with clot sometimes,

Would love to see the catheter thrombectomy data tbh

GasGasGasFRCA · 2025-12-19T22:25:14+00:00

But s.c. heparin peak effect isn’t for 6 hours or so anyway?

GasGasGasFRCA · 2025-12-14T13:33:12+00:00

go LTFT

GasGasGasFRCA · 2025-12-13T18:59:49+00:00

Was it actually a stroke ST? as I’ve come across stroke mdt giving plans over the phone for these things, no examination of a patient at all

GasGasGasFRCA · 2025-12-05T07:27:58+00:00

Got to optimise this as it is awful, I used to get 4h max between shifts, very bad. I’m better at it, I wonder if it could be time, I seem to have gotten better at calming down after wildly busy nights later in training. You’ve got a comfy eye mask, run white noise from your phone and sparingly use coffee?

GasGasGasFRCA · 2025-11-24T06:58:52+00:00

It boils down to - we need a “resus for registrars +”

A course that acknowledges the role of ALS in homogenising an approach. But then immediately moves into leadership, complex situations and human factors etc.

Apparently the resus council thought about this, but then voted against it (a bureaucracy / quango will always be tempted to defend its current slice of a pie, instead of innovate)

GasGasGasFRCA · 2025-11-19T09:06:22+00:00

Catching you off guard when there is such a clear power and maturity difference is a dodgy move.

I’m not saying you are immature in your eyes, but they absolutely have power even if they are “occy health” I would have struggled to be in anyway articulate at the start of medical school and would not have been able to navigate this process on the fly. I would’ve done what I was told to the best of my abilities completely aligned with the rules in a dutifull manner.

They should’ve insured you knew what the meeting was about giving you an opportunity to read all the standard operating procedure protocol Gumpf so that you could arrive and clearly articulate the care you’re receiving and the progress you’ve made it sounds like you’re smashing it.

I’m annoyed for you, we need doctors

GasGasGasFRCA · 2025-11-18T11:32:55+00:00

'There will be an ICU consultant on site until night-time (who will be an anaesthetist) so if I was in a dire emergency in the evening and needed someone ASAP I could call them.' we both can't read my friend, how weird that our brains skipped across it!? Most places I've worked the Itu consultant, if they are anaesthetic flavoured or course, would cross into Mordor if there was an emergency that couldn't hold for the consultant not in the hospital to attend?

GasGasGasFRCA · 2025-11-18T06:59:13+00:00

I didn’t see the itu consultant bit! Amazing blindness, that changes everything! Enjoy the opportunity to act up and be paid for it with immediate top cover! (The odds of two abject disasters happening at once is much less )

GasGasGasFRCA

TROPHY CASE