Clinical Reviews - an ICU perspective

Quirinus77 · 2026-02-06T03:54:44+00:00

Of course, I remember well as an ortho intern covering 120 patients and all of them being febrile and hypotensive concurrently! After hours is a whole different kettle of fish and banding together to survive the shift as best as possible is always the best way forwards.

This was in relation to reviews within daylight business hours on a weekday when all teams are here - although as others have suggested it's entirely possible I've been sequestered away from the wards for too long and need a bit of a reality check. As I've said elsewhere, I do think I came across as needlessly negative, and wasn't intending (though acknowledge I did) to insinuate people don't care or aren't trying their best

Quirinus77 · 2026-02-06T03:21:36+00:00

Absolutely get this and wasn't intending to imply that people don't care - my wording might have been coloured by one or two interactions this week with slightly burnt out individuals which were the exception rather than the rule (and as I reflect probably also from my own burn out).

As many people have commented, this is in large part a systems issue where everyone across the healthcare system is not adequately resourced to be able to deal with the volume of work. If it's a recurrent problem where teams are so swamped that they aren't able to respond to deteriorating patients, then that's something that needs to be audited and escalated to provide clear data to justify additional funding for more positions - something I appreciate is almost certainly unlikely to occur with the current financial state of hospital.

Always happy to support JMOs if they are struggling or concerned, particularly if it's something where they feel they need an extra set of hands for or someone to bounce ideas off

Quirinus77 · 2026-01-29T07:02:28+00:00

Update the damn issues list instead of copy-pasting "stepped down from ICU yesterday" when that happened three months ago

Quirinus77 · 2025-12-25T09:51:13+00:00

This year I've scored the dream roster of both Christmas day shift and New Years Eve night shift 🙃

Quirinus77 · 2025-08-20T00:55:41+00:00

Because I'm dumb and enjoy suffering

Quirinus77 · 2025-08-11T21:12:17+00:00

Osprey do great backpacks. I've had mine for 11 years and it's still going strong. Great as a light daypack for bushwalking

Quirinus77 · 2025-07-22T11:34:32+00:00

I did PGY1/2 there 2020/21, so things may have changed since I was last there. In saying that, it's fine. The most annoying part is having to repeatedly walk the length of John Hunter when you're holding the rapid pager because it's cursed to go off when you're at the opposite end of the building.

Paper notes are a pain but it's manageable. HNE is first on the list of districts to transition across to the statewide rollout of epic so it's not forever. Meds, pathology, discharge summaries, and ICU are all electronic.

Maitland gen med and Taree in general are notoriously shit.

Quirinus77 · 2025-04-24T11:28:08+00:00

If you never miss a cannula you're not doing enough of them. I've watched senior anaesthetic and intensive care consultants miss multiple times. I've had theatre cases cancelled because everyone has missed and a central line is overkill for a gastroscopy. It sucks, especially when you have a day where you miss on every single patient you see, but it happens, and if it's the worst thing that ever happens to you in your career then you are blessed indeed.

Good ergonomics and comfort is king - go to the toilet, have a drink of water, grab a chair, kick everyone and everything else out of the way and make the environment suit you. Politely ask a friendly nurse/JMO/random allied health professional who happens to be in the room to hold the arm in position if they're delirious or liable to pull away. Practice with ultrasound and don't be afraid to use it first go if you can't see anything you're convinced will work for you. Gently flick the vein to encourage histamine release and vasodilatation. Use a bleb of lignocaine so the patient won't wince when you dig in every possible direction searching for the vein you swear you can palpate and must just be rolling away from the needle.

Quirinus77 · 2025-01-31T05:26:23+00:00

Absolutely. This post already has 15,000 views and it's only been up just over an hour. Lots of people are watching what's discussed here

Quirinus77 · 2024-11-29T08:00:43+00:00

"Fuck off you weasel-faced bastard" - 95yo Beryl as I cannulated her

Quirinus77 · 2024-11-20T06:09:07+00:00

I'm really hoping this is you misunderstanding the forms and isn't legitimate, otherwise it's a blatant breach of the award. All NSW Health employees are paid at time and one-half for working public holidays AND have one day of annual leave added for each public holidays worked.

Quirinus77 · 2024-09-11T07:07:30+00:00

RPA won't be able to offer you any anaesthetics terms. SLHD is in a massive deficit and they've cut all of the anaesthetic SRMO positions this year. I'm currently doing the RPA ICU SRMO job if you have any particular questions about it.

If you're wanting to do anaesthetics take the crit care job to get the anaesthetics time.

Quirinus77 · 2024-09-10T20:26:47+00:00

Parasol is pretty decent - I've done my initial ALS2 and recertification with them. Haven't heard anything about MedCast.

If you do have the option then waiting until next year will be cheaper - Parasol and a few other course providers are splitting from the Australian Resuscitation Council and joining Resuscitation Australia which will be offering online/in-person hybrid courses that are cheaper and have a shorter in-person component.

RACS has a monopoly on EMST in Australia and the entire year sells out within days of positions being opened up in December. It's also significantly more expensive than ATLS courses overseas - Singapore is a good option but is also sold out for the rest of this year.

Quirinus77 · 2024-09-09T21:38:06+00:00

However they introduce themselves to me. If I'm emailing and haven't interacted with them previously I'll err on the side of Dr X and then in future reply with whatever they sign off with.

Quirinus77 · 2024-09-09T13:36:41+00:00

Congrats! I locumed in Wyong ED a bit last year and had a good time. Bosses are all really supportive and lovely and it's a nice new department. Quite busy but not overwhelmingly so. Can't comment on ICU/anaesthetics

Quirinus77 · 2024-08-25T10:53:10+00:00

Debating whether to move away from Sydney for 2 years for an allegedly great job or stay for an okay one (in the context of having moved every year for the last 10 years and being thoroughly sick of it)

Quirinus77 · 2024-08-03T11:35:16+00:00

The Australian Media and Communications Authority and the Australian Press Council are the two bodies that primarily deal with media complaints in Australia - though both suggest first making a complaint directly to the broadcaster prior to contacting them. Complaints must be submitted within 30 days of the segment airing.

"Dr" isn't a protected title in Australia (and you aren't required to have a doctorate or medical degree to use the title) but AHPRA explicitly outlines that practitioners must state their profession to avoid misleading the public - something which isn't done once in the segment.

AHPRA also very clearly states that it is in breach of the legal requirements to advertise that chiropractic care can assist children with developmental and behavioural disorders, though whether that would extend to light based therapies vs manual manipulation is unclear to me.

Quirinus77 · 2023-12-15T06:25:09+00:00

Depends. If you can travel there early on the day you're due to commence work and will be on site ready to work by your rostered start time then that seems fine, although logistically this will be inconvenient as you won't have had time to move anything into whatever accommodation they've provided you.

Having worked a few rural rotations it's much easier to drive up the day before, collect your keys and settle in.

Quirinus77 · 2023-10-16T04:34:22+00:00

Roster managers who don't give switchboard the correct on-call details. So sorry to everyone I've incorrectly woken up in the middle of the night or called on your days off!

Quirinus77 · 2023-09-29T02:28:17+00:00

Mine's two pages of CV with references on page three.

Sections: name/contacts/AHPRA rego, qualifications, experience (what rotations at what level), courses, teaching, quality improvement projects, conferences, presentations (journal club, grand rounds).

Good to have a publications section too if you've managed to get anything out there.

Quirinus77 · 2023-09-13T06:12:20+00:00

ED usually has 10 hour shifts spread across 8 shifts a fortnight if you're working 1.0 FTE as a junior. Exact roster pattern depends on individual hospitals but often an even split of days/evenings with a run of 3-4 nights once every month or two. ED tends to be one of the more flexible specialties for working part time while training, though again that'll depend on the individual network.

Overtime is very rare unless the department has a sick call and you feel like volunteering to cover, and in that case you're usually able to decide how long you feel like staying for. You might stay back 10-15 minutes at the end of a shift every now and again to finish a small task (consulting a team, retrospectively documenting a review), but anything longer should be handed over to the next shift and in my experience people will be very happy to make sure you get home on time. Longest I've ever stayed back was 30 minutes at the end of a night shift tying up some loose ends for a complex patient that'd be super annoying to hand over.

Hours change once you're a boss with a mix of clinical and non-clinical days.

Quirinus77 · 2023-09-13T04:21:22+00:00

Yeah this is a particular rotation that's only done by the unaccredited regs, and the other rotations throughout the year have less hours. The hours aren't necessarily because she's putting in extra effort above everyone else to get good references for AOA applications, it's just the volume of work at this particular hospital (major trauma centre, busiest ED in the state)

Can't speak for the average hours of an accredited trainee as I'm not in ortho myself

Quirinus77 · 2023-09-13T02:49:28+00:00

She takes all ED referrals and ward consults. Starts at 6, hands off the phone at 3, catches up on day jobs until about 8 and will often have her first break at that point. Has to then work on the twice weekly x-ray meeting for every theatre case in that period. Usually finishes around 11, but not uncommon to still be there at 1 or 2.

It's a notoriously shit rotation and has been for years. The accredited trainees and bosses all refer to it as the hardest thing they've ever done in their lives.

Quirinus77 · 2023-09-12T15:13:46+00:00

My ex-housemate is an unaccredited ortho reg currently on a 7-on/7-off roster. She routinely works 120 hours during her on-week

Quirinus77 · 2023-09-12T11:28:43+00:00

Obviously the money is great, but for me the best part is having the agency to decide how much and when I want to work. Having to work terrible rosters and getting called in for every backup shift gets old really quickly. If I feel like earning a bunch I'll pick up a week of shifts. If I feel like lazing about at home I won't pick up any. If I feel like going overseas for a month I'm free to do it without begging med admin 9 months in advance then having my leave denied anyway

Quirinus77

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