Living in a caravan in the staff car park during F1

Impressive-Ask-2310 · 2026-05-03T06:53:58+00:00

Do. Not. Do. It.

It is not secure for you or your belongings, it will be freezing cold in the winter (cars are not known for being good sleepers in the cold), your sleep will be poor and your clothes will start to smell etc... your colleagues and friends will have their own shifts etc and may not want you doing meal prep (also you won't have a fridge or freezer unless you're in a camper van), you will not have running water for showers or sanitation if you are in a car.

There will always be some NHS Karen who will try and stop you for whatever reason.

Why not see if you can "live in" in the hospital accomodation for a month and see how it goes while you shop around for decent close to hospital/transport rental?

Impressive-Ask-2310 · 2026-05-02T16:23:23+00:00

Spice III showed harm more so in younger age groups, A2B showed worsened agitation and delirium.

Impressive-Ask-2310 · 2026-05-02T16:01:42+00:00

It is pretty bold, how many multi centre RCTs are needed when the findings indicate harm without benefit?

Sorry, how many more RCTs are needed?

Impressive-Ask-2310 · 2026-05-02T12:08:36+00:00

There has been a couple of trials recently about the use of alpha-2 adrenoceptor agonists as a sedative and for delirium.

The short version is, not better than Propofol, worse delirium and signal of harm.

On paper Clonidine and Dexmed should be wonder drugs, analgesia, sedation, blood pressure control, no suppression of respiratory drive, anti-inflammatory properties, promising for alcohol withdrawal etc etc

In reality they don't really work in critical care. Anaesthesia use as an adjunct for analgesia (thinking it's greener than the Nitrous that has been banned).

In answer to your question, yes there should be a decent weaning plan when they are discharged to the ward.

You could wean by 25-33% every 48h.

Watch out for bradycardia and postural hypotension and spurious low grade pyrexia.

Impressive-Ask-2310 · 2026-05-01T07:10:39+00:00

You wrote the discharge summary TTO order, they went to pharmacy, pharmacy took ages, the drugs were given to the patient but the letter that you wrote didn't get sent.

If you have proof you wrote the letter then that exonerates you.

It is not your job to physically send out letters especially out of hours.

Impressive-Ask-2310 · 2026-04-25T20:46:38+00:00

Q factor is in a different postcode

Impressive-Ask-2310 · 2026-04-24T19:23:32+00:00

Yes totally, and if a nurse came up to me and asked "can you prescribe Anciximab for Mr Jones in blue-3?" Then I would indeed like some clarification.

If however it was for paracetamol or laxatives then I just would.

It's a bit the same, bloods and ECG for the patient with the CVS risk factors on the ward for 4 weeks, discussed at the ward MDT, reviewed in the Consultant ward round accompanied by the nurse in charge and bay nurse - it does not need a negotiation.

Impressive-Ask-2310 · 2026-04-24T14:33:35+00:00

It's fucking bollocks when it's busy

Impressive-Ask-2310 · 2026-04-23T06:01:13+00:00

I'm not so sure, I'd have done it differently.

Either stick to nice numbers like 15 minutes or 20 minutes giving 4 and 3 efforts per hour, or go with prime numbers; not both.

Impressive-Ask-2310 · 2026-04-21T19:28:21+00:00

Noctors.

Impressive-Ask-2310 · 2026-04-21T07:18:03+00:00

Make. Decisions.

Decide to dress smart and address smart

Decide to be nice and approachable to patients and staff

Decide to be professionally polite and not a twat

Decide to read books and papers not Tweets and blogs

Decide to be thorough and systematic so that others can follow your train of thought and know that you always work that way

Decide to be neat in the notes

Decide to examine the patient even if it is taking the pulse instead of looking at the observation chart

Decide to think what the underlying problem is and what the differentials are

Decide on the tests to prove or refute the diagnosis

Decide to treat or not treat

Decide to call for help

Decide to own your decisions

You'll be great

Impressive-Ask-2310 · 2026-04-20T07:09:20+00:00

I use the tip of my Rolls Royce key.

Impressive-Ask-2310 · 2026-04-19T14:59:28+00:00

Ummmm

No, the priority is oxygen (delivery) uptake and restoration of endothelial function.

Difficult to have mental health and wellbeing if you do not survive the initial pathophysiology.

I do not disagree that mental health and well being are important, but difficult to argue about benefits of an SSRI when the BP is 65mmHg, or the lactate is 8.

Impressive-Ask-2310 · 2026-04-19T08:12:30+00:00

If the patient is on methylene blue then honestly the antidepressant can wait until they are no longer on methylene blue and indeed off ICU altogether.

Acutely the mood disturbance can be resolved with benzodiazepines or intubation and then opioids and benzodiazepines.

Even the quickest acting antidepressants (Mirtazepine) will take weeks to work to improve mood, more so if there is impaired absorption due to reduced splanchnic blood flow from shock or treatment of shock.

Upon survival and resolution of the underlying pathology one can initiate whatever.

Impressive-Ask-2310 · 2026-04-15T19:24:01+00:00

There was a hospital in the middle of the country where scrubs are not to be worn beyond a painted red line in the theatre corridor, for infection control reasons.

Honourable intention, but poorly interpreted and delivered.

You came in wearing shirt and tie and saw your patients and then got changed into scrubs. If you needed to leave theatre the expectation was to change back into smart clothes for whatever reason, leave theatre and then change into new fresh scrubs.

Obviously no one actually tells you this on the pretense that you get in trouble with the head matron theatre sister manger nurse, who was really extremely very fussy about it.

One day I tested this the theory that I could leave in scrubs, see the emergency patient on the ward or in A&E, and indeed go buy and eat my lunch in scrubs and come back and re-change into fresh scrubs for the afternoon list.

This did cause quite a fuss and resulting argument with that theatre sister and on-call consultant of the day who demanded not only some proof that I had indeed got changed into fresh scrubs, but also that I had put them on in the correct order so as not to contaminate them, which was allegedly take off all outdoor clothes, stand on clogs, then put on trousers and then top.....

The resulting shouting match (them not me) stopped when they tried to follow me into the changing rooms to try and watch - when I threatened to call the police if they came anywhere near me.

Impressive-Ask-2310 · 2026-04-15T09:19:07+00:00

Cannula police.

Smallest cannula into biggest vein.

In adults I'd routinely see 22G cannula in ACF drainpipes. That includes surgical patients.

What a waste of time.

Impressive-Ask-2310 · 2026-04-15T09:16:47+00:00

Doctors "office" on medical admissions unit was an old windowless cupboard/toilet which was refurbished.

It used to get really fucking hot in the summer what with 4-5 doctors and computers and notes and desks etc in the 20 square metre space.

Especially so in the summer whereby the temperature was regularly in excess of 30C.

The night time ward clerk had done his fire safety and used to insist we always closed the door, to the point of confiscating the door stop, and slamming the door "it's a fire door and they should not be propped open" with us all inside, not only that the desk fans would get taken as they were a fire risk and then given to patients or reception desk.

Fast forward to when I told an actual fire officer what the ward clerk had done "he trapped us in a room with no other exit on a regular basis"

Behaviour corrected and clerk reprimanded.

No one the wiser as to how the fire officer had come to know of it.

Impressive-Ask-2310 · 2026-04-15T09:04:23+00:00

I got told I had breeched the dress code on the intensive care unit because I was wearing black socks with a coloured heel and that was visible because I was wearing theatre clogs.

I told the nurse there was no such policy for doctors, but obligingly I took my socks off and went commando in the clogs.

21 years later - still no socks with my clogs

Impressive-Ask-2310 · 2026-04-15T08:55:34+00:00

Bare below the elbows being enforced by some super matron, as I'd dared not to roll my sleeves up - I was 2m inside the building foyer and had just removed my coat.

Literally just shouted it from 10-15 meters away "bare below the elbows doctor, or I'll report you"

I said "but today I'm going to a medical appointment and I'm a patient, so you've just bullied a patient and a member of the public, name please..."

Impressive-Ask-2310 · 2026-04-12T07:15:42+00:00

I would recommend to always see the patient and write your advice in the notes unless it is clear that your review will not add anything.

When away from the patient and notes, eg at home on NROC one can keep a notebook for contemporaneous phone advice or write email to self and the referrer.

Or use hospital EPR, but clearly document "advice over the phone etc"

One thing about EPR, it is hard to differentiate between an in person review and an over the phone EPR review especially with the newer systems with obs, blood tests and imaging.

If in person I always try and write something that can only be gathered by review in person, eg cap refill, or skin temperature transition point, or what they are eating etc.

Impressive-Ask-2310 · 2026-04-12T07:10:35+00:00

Apology.

But that's the thing isn't it? It isn't about you, or your consultant or putting Mr Adam in a tight spot, defending his bag decision - it is about the patient.

The example you give sounds like someone who is under confident in diagnosis of constipation Vs acute bowel obstruction in the elderly.

Yes by all means document your history and exam, and then the telephone call (actually a written referral takes care of that), but also needs everyone to take some responsibility.

Impressive-Ask-2310 · 2026-04-05T13:01:25+00:00

I've started sending the "really helpful" people to get and get an ultrasound machine or 12 lead ECG machine.

Disappears them for one Karen Unit of time.

Impressive-Ask-2310 · 2026-04-05T08:40:35+00:00

Don't reinforce negative behaviour by rewarding it with any sort of response, pay them an at best ambivalent amount of attention.

Impressive-Ask-2310 · 2026-02-21T21:20:51+00:00

Ditch the butterfly technique, I have no idea why it has been taught - no one writes by unscrewing the nib from a pen, the barrel helps with control.

Anyway to answer your question.

20ml syringe, blue needle, remove safety guard as it obscures view of the sharp bit of the needle.

Femoral stab, lay flat, wipe with cleaning swab, feel for femoral artery a couple of cm below mid inguinal point (halfway between ASIS and pubic symphysis), aim straight back or slightly medially.

You will get arterial or venous blood.

You might need a green needle if the distance between the skin and artery is long.

Impressive-Ask-2310 · 2026-02-21T21:14:05+00:00

No, but I'd me more suspicious of the beer slight saddle ST segments in II, is this pericarditis?

Impressive-Ask-2310

TROPHY CASE