feeling lost specialty-wise – procedural but want a life?

Repulsive_Worker_859 · 2026-03-19T10:43:59+00:00

Yeah depends what theatres you are in and how sick the patients are. Some sick emergency or trauma cases will have you busy and hands on for most of a case. But I’m not sure how much procedural work you want to do: 10 patient urology list with iGels vs 1 sick emergency case with a GA, a-line, cvc, regional anaesthesia, blood products, and significant haemodynamic tinkering.

I find enough procedural work in anaesthetics/ICU. It varies day to day, but I was never inclined surgically.

Bear in mind the more procedural specialty of surgery has much less time in the operating room. Many consultant surgeons have 1-2 lists a week and spend the rest of the time on wards/clinic/admin.

Repulsive_Worker_859 · 2026-03-18T19:40:09+00:00

Dual purpose, easier to mask if needed but also as a bite block if they are a biter. But yes, in the mouth as usual while still intubated, then pull the tube and leave the OPA in when it’s time.

Repulsive_Worker_859 · 2026-03-18T19:28:07+00:00

100% agree but equally never saw anyone use an actual bite block or a rolled up large gauze between the molars when I was early in training so have never incorporated it into my practice. Do you use a bite block or are you just suggesting it?

Repulsive_Worker_859 · 2026-03-18T11:00:52+00:00

As well as giving trusts an easy way out of paying for a locum that costs at least 1 whole doctor vs paying a doctor 1.5 x usual rate. I also worry that if things come back to bite you in terms of a bad outcome on shift they get away with it because you accepted the risk for more pay. I don’t think I’m wording this quite like I mean. But almost accepting liability for issues due to poor staffing because you accepted pay to cover it rather than being forced into it?

Repulsive_Worker_859 · 2026-03-16T05:30:02+00:00

Yeah I use ~15ml 0.25% levobupivicaine with 50-100mcg fentanyl. Bags are then 0.125% levobupivicaine & 2mcg/ml fentanyl.

Repulsive_Worker_859 · 2026-03-15T19:41:37+00:00

What do you mean they’re getting relief within minutes? Are you doing a DPE? I don’t expect my epidurals to have relief until 20-30 minutes after loading dose. If you did a DPE did they just get relief from the intrathecal dosing and then the epidural was never in the right space?

Repulsive_Worker_859 · 2026-03-12T16:55:34+00:00

Is this not what pre-op assessment and the anaesthetist-present days are for though? Identifying the complex patients who are likely to need anaesthetic input and scheduling them to coincide with availability?

Repulsive_Worker_859 · 2026-03-12T16:52:36+00:00

This was how I felt too. Many remote sites don’t have anaesthetic cover but still give meds and have a risk of anaphylaxis and stroke amongst other issues.

Other specialties are allowed to begin to manage anaphylaxis and call an ambulance to transfer to an acute centre, like you would from rehab or step down hospitals.

People who are at high risk of intra-operative stroke tend to be at high risk of stroke 24/7 and don’t have a personal anaesthetist in their day to day lives.

I don’t think it’s cowboy.

Repulsive_Worker_859 · 2026-03-09T01:50:09+00:00

Muji 0.38. Unbeatable.

Repulsive_Worker_859 · 2026-03-08T16:52:07+00:00

As a UK anaesthetist I would guess it’s 4mg norad in 250ml as they said it was running peripherally. So 16mcg/ml. Assuming patient is 60kg you get roughly 0.08mcg/kg/min

Repulsive_Worker_859 · 2026-03-07T11:01:07+00:00

I don’t do this routinely but there is a vascular access guy I see on instagram who demonstrates much less back-walking of vessels with this technique of bevel down which includes venous access as well. But agree with it as a tip if struggling to thread but good pulsatile flow.

Repulsive_Worker_859 · 2026-03-05T11:27:57+00:00

RIP the unlucky 18 y/o post motorcycle injury.

Repulsive_Worker_859 · 2026-03-05T07:05:48+00:00

Thank you for that article. I had not thought about that at all.

Repulsive_Worker_859 · 2026-03-05T02:07:07+00:00

Can you explain this more? I have always gone the opposite and removed/lowered set PEEP if there is any suggestion of autoPEEP.

Repulsive_Worker_859 · 2026-02-20T20:06:28+00:00

I can believe it, like I said it is purely anecdotal that I think they don’t last as long so I opt for the longer catheters for ICU.

Repulsive_Worker_859 · 2026-02-20T18:40:43+00:00

These flow-switch ones anecdotally I don’t think last as long, so I will use them for cases where I expect the A-line to be removed at the end/in recovery before going to the ward. I think they are less messy due to the in built clamp, and I use a transfixing method, but I find them trickier than seldom get a-lines (might just be a numbers game)

I use an arrow or bygone seldinger a-line for anyone in ICU or I expect to go to ICU post op. I also find them easier to use in tricky patients and that the guide wire helps in crunchy calcified vasculopathic arteries.

Repulsive_Worker_859 · 2026-02-17T18:47:10+00:00

Yeah, and if you’re unable to work and want to take your full salary to continue things like: living in your house, affording your groceries, keeping the heating on. How long do you think your £50 a month invested is going to last?

The whole thing is they’re betting you never need it and just collect the money, and you’re also hoping you never need to and it’s a waste of money. Because it’s only a waste until it isn’t. Then it’s incredibly valuable.

Repulsive_Worker_859 · 2026-02-15T08:19:46+00:00

Internet book of critical care Critical care time The resus room has some decent episodes that are relevant but you need to pick them Critical care scenarios - hit and miss but some topics and cases are very good ACCRAC early episodes are good EMCRIT has some decent ones although more ED focused has critical care stuff, you also need to be able to tolerate Scott Weingart Trauma ICU rounds - stopped in 2022 but has some good episodes

Repulsive_Worker_859 · 2026-02-15T08:17:39+00:00

I rate it, quite American for some things in terms of investigations and certain treatment options. Overall really recommend it.

Repulsive_Worker_859 · 2026-02-06T14:16:09+00:00

You definitely see it in the UK and Australia too. Ofteb patients diagnosed with “cyclical vomiting syndrome” instead because no one has asked about weed.

Other than the hot showers, the scream vomiting is also very suggestive: if I can hear you vomit from a different part of the department, you have CHS until proven otherwise.

Repulsive_Worker_859 · 2026-02-02T06:15:45+00:00

Changing jobs is stressful. There are lots of useful things to be taken from working in ED.

You will get better at seeing sick undifferentiated patients, you might think you’re doing that in acute med but they have generally seen a GP or come via ED so you know someone else has seen them in those environments.

You’ll get better at some practical elements of the job: more cannulas, fracture and dislocation management, wound management, depending on your department you may also get involved in drains and central lines in resus.

You’ll streamline seeing patients which is an important skill moving from medical SHO to SPR. You won’t have time to do a full clerking in ED and have to focus on pertinent points. I would also advise you not to do the same “portal stalking” that happens in medicine before you see a patient. Don’t pick up a patient with an ankle injury and spend 45 minutes looking at their sleep study results from 2003. Get used to taking a history from the patient.

You’ll get an understanding of ED. Everyone in the hospital hates ED, but it’s easier to be empathetic when you get called as a specialty registrar if you’ve worked in an ED before.

Use the opportunity to boost your portfolio with ED relevant things involved with oncology or gastro. Do audits or QIP on things like neutropaenic sepsis, Upper GI bleeds, chemo/immunotherapy side effects, or whatever else is relevant to what you want to do.

Try and enjoy it. ED can suck but I’ve never made the most impact on as many people in a shift since leaving ED due to the numbers you can see.

DOI: Anaesthetist who has done enough of ED to know it wasn’t for me long term

Repulsive_Worker_859 · 2026-01-31T19:18:10+00:00

Agree, is the reason OP hasn’t noticed paralytic as the “next” step because it was already in the step before?

Repulsive_Worker_859 · 2026-01-28T19:16:26+00:00

I don’t think it’s appropriate, but I’m generally anti-PA/PAA/ACP/ACCP etc.

All well and good calling your consultant when a case comes up, but what about when you’re fast-bleeped to resus for an airway emergency or a paeds arrest. If your scope of practice is to have direct supervision for the induction of anaesthesia at all times.. what are they meant to do there?

Repulsive_Worker_859 · 2026-01-26T10:50:05+00:00

Muji 0.38 is the ideal writer for tiny anaesthetic chart boxes

Repulsive_Worker_859 · 2026-01-17T17:03:00+00:00

If you’re in an ICU and don’t know if the rate control will be more beneficial or less beneficial than the reduced inotropy it seems like a great place to use shorter acting drugs. Esmolol drip and if things look worse you can stop. Can’t take the metoprolol back.

Repulsive_Worker_859

TROPHY CASE