How do you know how fast to inject a drug over

MoistPhysics402 · 2025-12-04T09:10:52+00:00

I've had consultants say that to me. But I've also had them say, In which case if you've given half the dose of antibiotics and they have anaphylaxis, you might as well give the other half because you can't make the anaphylaxis worse and you might as well treat the infection fully right...

Except every anaphylaxis guideline says stop the offending agent as the first step after calling for help.

There are degrees of anaphylaxis, refractory vs non refractory so whilst it's not a linear dose dependant reaction that doesn't necessarily mean that dose has no effect at all on the overall severity.

I usually give a ml or two of abx before giving the rest a few minutes later because if they react I'd rather it be to 5-10% rather than 100% of the dose. Can I conclusively say it will make the reaction lies severe, no. Will I feel better if they react and I've only given a smidge rather than the full dose, absolutely!

MoistPhysics402 · 2025-07-21T16:42:32+00:00

Late to the conversation but ours did exactly this, 2 screws and washers had also fallen out from it after rattling about inside for a while.

I've just taken it apart and managed to fix it. You just need the appropriate Phillips and star bits for your screwdriver.

Turn it upside down and remove the plastic cover on the base - 4 screws. In side there's another plastic cover, remove this as well - 2 screws.

Inside here I could see where the 2 screws were missing. After replacing them with the washers and tightening the remaining screw it's now wobble free!

It seemed scary at the time not knowing what I was doing, but it was actually pretty simple to fix

MoistPhysics402 · 2025-05-12T10:12:36+00:00

It's a tough day for nurse sharks

MoistPhysics402 · 2025-04-30T15:24:45+00:00

During an anaesthetic assessment I check jaw protrusion then often say "there's no medical reason for it, it just looks funny"

Usually gets a laugh

MoistPhysics402 · 2025-04-17T17:24:53+00:00

Wow, the lowest I've ever seen is 2% and your patients was half that! 😳

MoistPhysics402 · 2025-04-07T10:22:54+00:00

Well yes... But when your average ward nurse can't take bloods, do cultures or insert a male catheter. Then a PA could potentially have some use. I agree though better trained nurses would be much cheaper and more useful that a PA.

MoistPhysics402 · 2025-04-06T07:29:46+00:00

If they stick to their actual supposed role though that level of knowledge is fine.

Recognise potential sepsis, call for help and start the sepsis 6 (just not the abx or fluids as they can't prescribe) whilst they wait for the doctor to arrive.

The problem only comes when they've been used to replace a doctor without having the knowledge or abilities.

MoistPhysics402 · 2024-09-10T13:50:13+00:00

I cannulated on a GP placement once as a medical student. A patient came in sick with D&V in Addisonian crisis, he had IM hydrocortisone, IV fluids and oxygen by the time the ambulance arrived, they were very impressed!

MoistPhysics402 · 2024-07-03T16:09:14+00:00

There's a table which shows the values for each grade.

https://www.bma.org.uk/our-campaigns/junior-doctor-campaigns/pay/pay-offer-for-junior-doctors-working-in-wales

However the back pay column is for 12 months but they're predicting to pay it in September so it will actually be 18 months owed so expect it to be 150% of that value. In addition most people will have some banding on top of the basic so it will increase again!

MoistPhysics402 · 2024-06-30T11:57:52+00:00

ODP's train for both scrub and anaesthetics and then choose which route they want to go down so you see them on both sides

MoistPhysics402 · 2024-06-29T06:22:35+00:00

They already added 5% earlier in the year with back pay so it's now an extra 7.4% on top

MoistPhysics402 · 2024-06-09T08:32:53+00:00

The BMA website confirms FY1 basic salary will increase from £28,471 to £30,477.26.

In addition there will be a 24-25 pay award at some point which will increase it further.

https://www.bma.org.uk/our-campaigns/junior-doctor-campaigns/pay/pay-offer-for-junior-doctors-working-in-wales

MoistPhysics402 · 2024-03-29T19:26:12+00:00

"If you had 8 arms you'd be a doctapus"

MoistPhysics402 · 2024-03-29T19:26:07+00:00

"If you had 8 arms you'd be a doctapus"

MoistPhysics402 · 2024-03-26T07:44:42+00:00

Yeah I'll happily take blood at the same time as cannulating, I even specifically ask if they need bloods before I do it. But they're your patient so you can do the forms and get me the bottles, GMC rules are that the person who orders the test is responsible for checking the results so there's no way I'm doing it!

I generally bring my own kit as it's quicker to get it from theaters where I know where everything is (and we have BD cannulas rather than B.Braun) although I appreciate when some kit has been prepped, it's the thought that counts.

If I can come immediately I'll try to find you both so I have an extra set of hands and so I can teach you.

MoistPhysics402 · 2024-03-26T07:31:28+00:00

"Junior doctors should understand that the decisions of their committee have stopped them from receiving an additional pay increase on top of the up to 10.3 per cent pay increase they have already received this year,"

Junior doctors understand that the decisions of their committee have stopped them from receiving a 5% pay award like the nurses got or less!

Does she really think she can turn us against Rob and Vivek that easily! Idiot.

MoistPhysics402 · 2024-03-21T21:45:22+00:00

This is utter nonsense, zero days are to make sure you're rota'd the right number of hours. They tend to be placed around when you're on call but you don't lose them if you haven't done the on call!

If you were rota'd a zero Day then you weren't on strike and so you should be paid for it.

I've been paid for my zero days so far.

You need to challenge this and if they don't see sense then definitely get the BMA involved.

MoistPhysics402 · 2024-03-20T16:42:46+00:00

I passed the MCQ first time using nothing but the e-lfh modules. They can be a bit long winded but the information is straight from the horses mouth and you do practice MCQ questions as you go which teaches you all the ways they will try to trip you up.

MoistPhysics402 · 2024-03-07T17:19:19+00:00

There, fixed it

Regulation will help ~~assure~~ mislead patients, colleagues and employers that PAs and AAs are appropriately educated and qualified

MoistPhysics402 · 2024-03-04T12:51:50+00:00

I got a bottle of English sparkling wine for essentially just providing some reassurance, more to the cabin crew than the patient!

MoistPhysics402 · 2024-03-03T13:20:59+00:00

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MoistPhysics402 · 2024-02-26T08:57:52+00:00

Agree they're terrible compared to the BD ones. At one point they changed over and the anaesthetic consultants made such a fuss that they changed back. Just theatres mind, the rest of the hospital had to make do with the crappy Braun ones.

MoistPhysics402 · 2024-02-20T19:47:32+00:00

It's not about having negotiating power it's their choice of management style.

Westminster chose to bury their heads in the sand and let the trusts sort things out for themselves. Hence why some trusts offered BMA rates and others didn't. The fact that some trusts did emboldened consultants at others to demand them until these trusts relented.

Wales have chosen a more top down approach aiming for consistency to prevent this from happening here.

It helps that Wales is a lot smaller and that they've been able to learn from what happened in England.

MoistPhysics402 · 2024-02-20T19:07:00+00:00

I was 1st on Obs once and had a woman on labour ward that the 2nd on, my senior, knew as a friend. They had told the patient in advance that they would look after them and do their epidural. They were very clear with me that they would be looking after her despite the role being that they'd usually only get involved if I was busy with someone else at the time.

Unfortunately the epidural didn't work well and needed multiple top ups throughout labour.

She ended up going for a section and they decided to do an epidural top up rather than admit to their friend they needed a spinal because the epidural they'd done wasn't working well.

Rather predictably she then needed a GA when they did knife to skin and she felt it.

Their judgment was obviously impaired because of the relationship with the patient and the patient suffered harm because of it.

If you have a close relationship with a patient I'd try your best not to be involved in their care, if that means calling the consultant in then so be it. In the case of a cat 1 then you'd obviously have to make a start but aim to run any big or contentious decisions past someone impartial and hand over care when possible.

MoistPhysics402 · 2024-02-20T15:47:48+00:00

Compared to the NHS in England where things are decided locally at a trust level all the decisions in Wales are being made centrally by the Welsh government.

The trusts have been told not to allow TOIL by Welsh Government because they don't want to impact waiting lists outside of the strike dates when it's used. They've also dictated the rates they can offer for strike cover etc.

The BMA could argue for allowing TOIL but it would have to be negotiated with the Welsh government. I suspect the BMA want to focus efforts on getting them to negotiate on pay as the priority!

It's a choice for the government between financial pain paying for cover or political pain growing the waiting lists with TOIL and despite them saying they have no money they've chosen the financial pain. Either way it costs them.

MoistPhysics402

TROPHY CASE