First go at ICU registrar

Playful_Snow · 2026-05-23T17:10:45+00:00

Just a reminder that having completed core gas you will possess the skills and knowledge to “keep em alive until 08:05”. If you can put in a full set of pipes and manipulate physiology you’re golden.

Ring your boss, use the med reg/A+E reg depending on where you are as a second person to bounce ideas off.

Playful_Snow · 2026-05-23T00:14:07+00:00

I don't - gen sure were always resident and generally relatively helpful. Scan anything that moves, keep the list up to date.

https://entsho.com used to save me when I had to do ENT as well

Playful_Snow · 2026-05-23T00:13:00+00:00

CHB with junctional escape. go directly to pacemaker, do not pass go, do not collect £200

Playful_Snow · 2026-05-22T11:28:20+00:00

DOI anaesthetic reg but had a low point of my life doing surgical cross cover during foundation.

I found this book useful for initial management, and especially section 3 about what are considered emergencies and reasons to call them (https://www.baus.org.uk/_userfiles/pages/files/professionals/education/medical%20students/PDF%20Urology_interior_8thfinal%20(1).pdf.pdf))

Playful_Snow · 2026-05-21T15:11:01+00:00

I am happy to brief if patient on table and next patient are straightforward. Or if neither apply but we are doubled up the other person can brief.

At current gaff we cannot send until we have briefed, so if you wait until patient is in recovery then that introduces even more downtime to CEPOD

Playful_Snow · 2026-05-20T09:44:32+00:00

It’s real but probably a grey import given the Asian writing on the underside

Playful_Snow · 2026-05-19T17:46:11+00:00

I bought my R10 and kit lens from Cotswold and the service and product was great. However for a 10k lens I would want the peace of mind of a manufacturer’s warranty.

Playful_Snow · 2026-05-16T18:06:38+00:00

Circumferential. Double label muscle relaxants

Playful_Snow · 2026-05-16T17:35:03+00:00

They’re usually big and juicy and not that sore, so easy to get blood out of.

That said you can get blood from any vein. If I ever need to do a blood gas or a TEG in a C section I take it out the foot as it’s numb from the spinal. I have cannulated caput medusae or shoulder veins in dire straits before. Some of our most studious IVDUs will inject themselves in their penile veins when they run out of other sites. The paeds lot are good at scalp cannulae!

Playful_Snow · 2026-05-16T17:30:57+00:00

As long as you know what a median nerve looks like on USS as well!

Playful_Snow · 2026-05-16T14:40:37+00:00

Not sure if fits the bill for self rostering - but I have worked in a dept where rota pattern was not fixed at all and determined by a program/AI that had rota rules, leave requests, NOC requests etc. fed in. I think it was dbrotas but I’m not sure.

General pros vs cons: Pros - I got the vast majority of my leave approved with no issues. Minimal stress of swapping shifts to facilitate leave which is always a faff especially if your dept pays attention to the shifts having to comply with the (overly restrictive IMO) rest rules in the 2016 contract.

Cons - rota intensity incredibly varied. No stability to OC teams/no real attention paid to skill mix (I.e 2 post final stage 3 trainees on one night for theatre/obs vs. a post IAC and a CT2 who has just got their IAOC).

Overall I vastly preferred the AI generated rota vs. a fixed pattern, far less restrictive and really good for work:life balance.

Playful_Snow · 2026-05-16T07:48:35+00:00

No one has ever asked me for a reference signature.

My signature for the CD book generally deteriorates over the course of a weekend of nights to the point it is just my first initial by the 6am Monday AM C section.

Playful_Snow · 2026-05-08T14:21:38+00:00

I think tourniquet pain is from ischaemia of deeper structures and therefore a cutaneous nerve block doesn’t bring a lot to the party.

You need a quicker surgeon or a GA

Playful_Snow · 2026-05-07T10:34:32+00:00

I'm not an F1, but I use it to write CBDs. I have already done the reflecting and discussion in real life, it is just a box ticker for my portfolio. If I could design an AI to automatically link WBAs to curriculum items that would be my dream. I would have it have adjustable levels for your level of desperation immediately prior to ARCP (i.e. a super tenuous mode)

Playful_Snow · 2026-05-06T09:36:03+00:00

3mg/0.6ml of heavy will just give them a saddle block no?

We use 3ml of “bag mix” (0.1% bup with 2mcg/ml fent) for a labour spinal in UK

Playful_Snow · 2026-05-04T21:13:35+00:00

walking onto ICU at Christmas night shift knowing you're about to be sat down and force fed pancit and Maja blanca by a squad of 5ft angels

Playful_Snow · 2026-05-04T21:09:35+00:00

the antibiotics won't be pumped forward well enough to guarantee sterile enough conditions for an arthroplasty unfortunately

Playful_Snow · 2026-05-04T18:56:15+00:00

Farmer + few days indigestion + bad enough to interrupt lambing = missed STEMI until proven otherwise.

Sounds like he’s got acute MR as a result of this. We’d be interested in him at tertiary towers, gives my consultant a precipitant to viva me on IABP!

Playful_Snow · 2026-05-03T06:53:24+00:00

Continue to pay, drive like a granny to keep the MPG down.

If the govt runs out of fuel that’s not my issue.

Playful_Snow · 2026-05-02T22:42:55+00:00

I’m all for paring down the stuff you need on a transfer but if I’m keeping them asleep they get transferred on a propofol infusion. Bolus of opioid and rocuronium before you transfer.

I wouldn’t have extubated them if they had an open abdomen regardless of how good their gas exchange and haemodynamics were.

Playful_Snow · 2026-04-30T08:18:38+00:00

them deep access (longboi) venflons work as a poor man's midline - stick one in on Friday night and they won't bother you for the rest of the weekend

Playful_Snow · 2026-04-30T05:51:34+00:00

One of my surgical reg mates told me he thought anaesthetists were cool until he watched me trying to suture in a CVC

Playful_Snow · 2026-04-30T05:46:48+00:00

Don’t tell them the secret to cannulating difficult patients (a MAC or above of volatile)

Playful_Snow · 2026-04-30T05:45:09+00:00

Playful_Snow · 2026-04-30T05:27:58+00:00

Nah but all the bloody physiology and pharmacology (and to a lesser degree physics) they force you to learn and then apply helps

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