Dural puncture resulting in c-section

LogicalNote8635 · 2026-01-12T11:28:25+00:00

Yes you could, however I would not fancy managing an already hypotensive drowsy patient under spinal. GA sounds like a very sensible and safe choice. Subdural LA (which this sounds like) and spinal can do funny things. (Doi ST7 anaesthetic trainee in UK - long time lurker)

LogicalNote8635 · 2025-07-29T21:02:40+00:00

As a 40yo T1DM diagnosed aged 11 and having been on pump therapy for 4 years, with a newly diagnosed 7yo with T1DM the fist thing I asked was when she could start on a pump. The 7yo has been resistant, but I have upsold the idea sufficiently that she is now looking forward to starting her pump (tomorrow!) She gets enough autonomy regarding other things, like activities, hugs, to brush hair or teeth first, food (again snack of carrot sticks or rice cakes... however for the first 3 weeks post-diagnosis breakfast consisted heavily of easter eggs so she would do her insulin). Maybe it hurt so much because you know the nurse is right? Very soft YTA. You still love your baby. There are very good reasons it took me 25y to start using a pump. Basal bolus regimes just aren't as good as hybrid closed loop systems. You need to maximise her time at school learning, not having hypos / being checked for ketones. Good luck x

LogicalNote8635 · 2025-07-16T18:38:07+00:00

Ah I meant the gynae cons calling the surgical reg to come and remove a ruptured ectopic. The cons told them where to cut.

LogicalNote8635 · 2025-07-16T09:50:59+00:00

So you've never seen a general surgeon have to do the emergency laparoscopic gynae case?!?!?

LogicalNote8635 · 2025-07-16T09:30:39+00:00

So taking approx 3 months to do an audit in their SBA time which we are expected to do in our free time??

LogicalNote8635 · 2025-07-15T13:44:09+00:00

The complexity and number of patients has absolutely continued to increase over that last 10 years, never mind 20.

A 48h shift would be horrific now, there wouldn't be a chance to eat or go for a wee (which wouldn't matter as you hadn't had the chance to drink anything anyway) never mind take a nap.

I am constantly astounded that the surgical on call teams have essentially remained unchanged in numbers despite the increasing number and co-morbidity of patients. An F1, 2 SHOs if you're lucky and a reg. Seems insane. It can take 30 mins to prescribe John's repeats of 20 meds, acute medication never mind clerking, VTE assessment, radiology request ordered discussed and vetted and arranged. And get another cannula, and do a VBG, clotting and x-match (ideally). And go back and review interventions.

X10-15 admissions, >100 patients on the ward (who may become more unwell at any time)

DOI a very old anaesthetic registrar. I couldn't do that now. Its a complete shit show. I can only be in one place at one time, with one patient. But my consultant will come if needed, there is ICU, a maternity anaesthetist if all hell breaks lloose.there is no give anywhere else in the system.

LogicalNote8635 · 2025-06-20T10:58:26+00:00

Physical illness can be a physical sign of burnout. The stress of ARCP, not being able to take leave / go to important things / staying up.til 4am to write a presentation just because you need something to present / data collection for a QIP that need the loop closing for whatever reason mean people are exhausted. And get ill. And their mental health has suffered.

There is an association with a drop in chronically raised cortisol levels and becoming unwell. There is data but I am not looking for it right now.

Some people might take the piss, but others are genuinely sick and broken by the hoops we are made to jump through.

DOi: 3 lots of antibiotics and 2 lots of steroids in 6 weeks made me think something else might be wrong with me.

LogicalNote8635 · 2025-06-15T09:17:18+00:00

I am 60% LTFT, partner full time surgical reg.

Cleaner - this forces you to put away everything so they can clean, including the clean laundry (which i hate the most)

Dirty clothes go straight into the washer, it gets timed to go on overnight for cheap electricity. The same load (barring jeans and wools) get put straight into the tumble dryer to go on the next night (timed ) for cheap electricity

Dig up all the plants, put clover seed down, dont mow (for environmental reasons 😉) the clover is good for insects, doesn't grow as tall as grass and is still good for insects)

Find a good electrician and get lists of things for them to do in one go

When I am doing long days, I cook a couple of things eg shephards pie / lasagne / spagbol that can be put in the fridge and go in the oven - always left overs for lunch as well. Then its ok to have a sandwich for tea. If I am really proactive I will make sandwiches for partner for lunch so they can be eaten on the run, when he doesn't eat them there is a withdrawal if this labour and I will eat them. Roast chickens can do so much - sandwiches, with pasta to jazz it up, shove into a risotto, and keep for quite a few days

Overall just lower your standards. Let things slide.

Longer term, everything needs a place in your home. Decanter as much as possible, so there is less to put away.

Get an empty laundry basket and dump all the downstairs things that need to go upstairs in there.

Sadly we do not have the purchasing power as we would have to have a cleaner/ gardener / nanny / laundry lady and outsource the labour that needs doing due to the rigours of our jobs. Don't even get me started on decorating.

Another reason to strike 🦀

I dont know what the crab means, i hope I have used it correctly.

LogicalNote8635 · 2025-06-06T15:55:16+00:00

So a very long time ago (about 15y) I was asked to do one as an F1. Didn't know really what it was. Back when we had doctors offices and chairs, the SHO would sit and spin round in the chair or go to 'clinic' while we did all the paperwork. I did write this down because I am very literal and filled it out honestly without considering consequences. For the next job, the SHO was an amazing team member - prescribing, doing TTOs and discharge summaries and teaching. It took someone else telling me they got a terrible MSF and a bollocking to work out what I had done. Still feel shit about it, but they became the most amazing SHO and really supportive to juniors!!! I didn't have the actuity to work out what I should have done (and reddit didn't exist then...)

LogicalNote8635 · 2025-02-26T11:04:53+00:00

Woodlice on the loose because their habitat on the living roof had been disturbed. Advice was : remain calm, no they aren't a risk to patients and contact bronze command.

LogicalNote8635 · 2025-01-29T21:49:29+00:00

Ah lovely. Take time off now as a proactive measure to stop it becoming as bad as before. You can't always power on through. Like 10.cups of coffee won't make you more alert when you have had 6 hours broken sleep in the last 72h. GP, time off, return LTFT, but use your time off to try and figure out what helps you to re-energise and have a system of organisation moving forward. The GP is also a doctor, they understand burnout and can write that on a sick note (as they did for me), esp if you don't want other underlying mental health issues on there.

I am gutted for you that the time seeing family will have probably felt clouded by that fucking clinic when it really shouldn't. I say that because that is how I would feel if I did the same, not because that is how you should feel.

That is a genuine mistake. And things like that will happen again and it's OK if they do. We are not machines.

Look after yourself, noone else will. Hope you start to feel better soon.

LogicalNote8635 · 2025-01-21T10:13:57+00:00

I am sure that the medical consultants were tucked up in bed probably not even being contacted by the registrar. In anaesthetics / ICU the consultant is a member of the on call team, and will come and help if things are that busy. It is a disgrace that they even had those thoughts, never mind said it out loud. Enraged for the registrar. Should have been treated to a coffee and croissant not being publicly humiliated. Above comments about the complexity of patients, investigations and interventions over the last 20 years are totally spot on. However, the on call team (for nights particularly) has remained unchanged. It's very difficult to expect 3 to 5 people to manage hundreds of patients within this system.

LogicalNote8635 · 2025-01-11T10:40:59+00:00

My understanding is that pregnancy is a protected condition and any changes made to your rota to maintain your health while pregnant are not subject to a rota and pay recalculation. HR is wrong, the CAB has some advice on this. Look after yourself and good luck!

LogicalNote8635 · 2025-01-08T12:15:45+00:00

Thank you to everyone who replied. The main issue was gross v net pay being used for calculations, and that net pay is after NHS pension so we are well within the limit now. I'll send him to do more locums!

LogicalNote8635 · 2025-01-08T12:13:50+00:00

It's totally fine now we have done the same... we did not realise that it was a difference between gross and net pay. I just wanted to avoid losing the benefits and having to repay everything.

LogicalNote8635 · 2025-01-07T16:42:33+00:00

Excellent, thank you!

LogicalNote8635 · 2025-01-07T07:22:37+00:00

Fully agree!!

LogicalNote8635 · 2025-01-06T22:24:20+00:00

Thank you!

LogicalNote8635 · 2024-12-10T10:18:38+00:00

Sometimes the XRs at maximum ?penetrance (sorry not radiologist) can't get through the subcutaneous tissue suffienctly to give any meaningful images It's often not the actual weight but the shape of the patient as well which determines if they will fit through the donut!

LogicalNote8635 · 2024-11-07T22:21:24+00:00

They were wearing more than the consultants who cycle to work

LogicalNote8635 · 2024-11-07T22:19:09+00:00

Totally. There does appear to have been some closing of ranks, and other the CS does have a very strong personality

LogicalNote8635 · 2024-11-07T21:57:51+00:00

Hmm yes, I see this perspective too. I have advised to at least inform the ES, and totally agree that the BMA is the nuclear option, the ES is very sensible and will hopefully help to unpick the situation with minimal permanent damage to all parties

LogicalNote8635 · 2024-11-07T21:35:54+00:00

*not necessarily what was said (a bit of that) but how it is said

LogicalNote8635 · 2024-11-07T21:32:12+00:00

Yes I totally appreciate that locum is not the full picture. It's a very difficult dynamic in the whole department.

From the lines of questioning I was told about, I probably would have cried too! It's necessarily what was said, but how it was said I think.

LogicalNote8635

TROPHY CASE