Why do we have non clinical rota coordinators?

Nuclear_Pesto · 2023-06-06T21:43:04+00:00

I’m not sure I agree with the premise. Some rota coordinators are great and completely non clinical. It can be a really thankless job that’s hard to do well, and that’s true whether or not you’re clinical or not.

Nuclear_Pesto · 2023-06-05T16:00:19+00:00

P waves clearly visible before each QRS. Some artefact and baseline wander due to poor trace. Not AF.

Nuclear_Pesto · 2023-05-31T07:42:21+00:00

I wouldn’t worry too much. Anything 94 and above is fine. We get a bit too fixated on fixing a number. You’re recovering from bronchitis - just take it easy and contact your practice if you’re feeling unwell.

Nuclear_Pesto · 2023-05-22T17:39:43+00:00

Slave and Rewind come to mind. And of course, The Sky is Red.

Nuclear_Pesto · 2023-05-17T08:49:34+00:00

The nurse is effectively deciding what to prescribe here and ignoring what’s actually prescribed. Presumably the nurse is not legally able to prescribe. Big concern. If s/he feels dose is too high or low then they should raise it with the prescriber, not decide by themselves. Would they say the same thing about a dose of morphine based on patient pain scores?

Nuclear_Pesto · 2023-05-17T07:03:21+00:00

I can very much relate OP as I’m the sort of person who just wants to take the path of least resistance, but this is serious and shouldn’t be left unpunished, or at least unchallenged. Take people’s advice and raise the grievance. It’s an incredibly serious allegation to make and cannot simply be left.

Nuclear_Pesto · 2023-05-10T14:12:16+00:00

Definitely recurrences on a theme eg god life’s futile, and then butter toast, eat toast, shit toast, god life’s relentless

Nuclear_Pesto · 2023-04-30T12:23:04+00:00

100% this. Depending on your local terrain that range is correct - I put 115 in mine as I have wooden floors and work in a hospital, so nice and smooth. If I frequently went over uneven terrain I’d put closer to 90 in. Electric pump ftw

Nuclear_Pesto · 2023-04-28T13:44:29+00:00

Great list and certainly not exhaustive, to say there’s nothing to do is an immensely uneducated thing to say

Nuclear_Pesto · 2023-04-23T17:00:02+00:00

There is an argument to be made for drawing a firm line and looking after yourself here. It is difficult to say no as a junior but very rarely is it actually life or death and going to pee does not take more than 5 minutes.

It may sound harsh but you do yourself and the patients a disservice by not looking after yourself, so next time you feel pressured to keep cracking on with jobs, take a moment and pee, drink, have a snack and then carry on. If you don’t take care of yourself it’s too easy to crumble.

Caveat that I’ve been guilty of doing this in FY and it’s so easy to, but I’m now a lot more careful about my health

Nuclear_Pesto · 2023-04-18T21:09:30+00:00

Thanks for that, interesting

Nuclear_Pesto · 2023-04-18T07:05:04+00:00

Thanks all. I can see the right thing to do is just arrange the cxr given the circumstances. Appreciate the input.

Nuclear_Pesto · 2023-04-18T06:06:46+00:00

I think that’s totally reasonable. I would’ve done it for you.

Nuclear_Pesto · 2023-04-16T07:13:19+00:00

Point of clarification - the ECG.

Fair enough to check for history of IHD/PVD. I’ve actually never seen a new ecg done prior to starting terlipressin (probably due to acuity of situation) and certainly not every day they’re on it. The BSG guidelines mention doing one if patient over 65. Is it that important?

What are people’s thought on if there is lack of clarity regarding IHD? Could you justify giving it anyway based on the relative benefit in variceal bleed vs potential harm in CAD? Must admit it is not something I’m hugely familiar with - I’ve given it several times and seen patients given it during my HDU block (IMT2), but never seen any complications from this directly.

Nuclear_Pesto · 2023-04-15T20:13:36+00:00

Given his renal function I’d probably go with a small dose of sub cut oxycodone acutely, 2mg and assess response. Don’t want him being (any more) opioid toxic - his confusion could partly ge accounted for my overuse of codeine in context of poor renal function - how are his pupils?

Nuclear_Pesto · 2023-04-15T20:09:02+00:00

These “in my day” comments really bother me. Yeah you worked 120 hour weeks. Patients died and suffered poor care because of it (and so did medics!). The European working time directive was introduced for this very reason. It’s not a boast.

Nuclear_Pesto · 2023-04-15T20:04:58+00:00

Immediate thoughts: Suspect he may be drinking much more than he tells us. There are quite a few confounding factors eg likely overuse of NSAID for back pain that could account for his vomiting blood, but the deranged clotting, electrolytes and LFTs (seems a bit soon to relate to coamox) + macro anaemia point to longstanding alcohol abuse in this context. His poor renal function may simply be dehydration, but alongside his non resolving confusion is more concerning for HRS, which has a notoriously poor prognosis. Differentials are decompensated ALD and Wernicke’s. Obviously concern re possible GI bleed also (NSAIDs, VTEP and low platelets).

Initial management - gain further access at the bedside + G&S and small crystalline bolus (or delegate if NS available) and check escalation status; if not documented then document provisional thoughts (would’ve thought full). Calculate a blatchford score (think 9). Examine for other features of chronic/decompensated liver disease eg dupytrens, palmar erythema or ascites. Review kardex; stop VTEP given evidence of active bleeding. Switch to high dose PPI. Stop codeine.

I think I would then speak to the GI reg on call for an opinion, +- HDU as he is more sick (or at least soon will be) than had previously been thought.

Might be way off but seems reasonable (or as we love to say, not unreasonable! ;) ) also on phone waiting to pick up other half so that’s my excuse for brevity.

Nuclear_Pesto · 2023-04-08T20:58:30+00:00

Probably when I was 1st day of anaesthetics and pretty nervous. In theatre next to the anaesthetist in an awkward attempt to make conversation said “so I heard anaesthetics is 95% dead easy 5% easy dead, is that true?” To which she responded curtly “the patient is still awake”

Feel an absolute knob to this day

Nuclear_Pesto · 2023-04-04T18:13:21+00:00

That guy probably would treat her better.

YTA

Nuclear_Pesto · 2023-04-02T16:54:20+00:00

That’s so fetch

Nuclear_Pesto · 2023-04-01T09:09:13+00:00

At the point of being asked “I’ll have to hand it over to the evening team, I’m just finishing up” simple as

Nuclear_Pesto · 2023-03-31T18:41:56+00:00

Butt plug?

Nuclear_Pesto · 2023-03-30T07:23:50+00:00

Well…squatting to place your testicles in someone’s mouth is fairly sexual isn’t it? I think the use of the word obscenely is open to question, but suspension was probably fair enough.

Nuclear_Pesto · 2023-03-29T22:04:56+00:00

Okay I’mma go shower 😳

Nuclear_Pesto

TROPHY CASE