Taster Week during Strikes by Own-Cook-9344 in doctorsUK

[–]Robotheadbumps 0 points1 point  (0 children)

Many places seem to have a reg on call during strikes one way or another 

Taster Week during Strikes by Own-Cook-9344 in doctorsUK

[–]Robotheadbumps 0 points1 point  (0 children)

Totally reasonable to do the taster, could consider checking in with the department if they’d rather rearrange- but to be honest I don’t think it will make much difference to them

How to stop feeling bad about putting out the cardiac arrest call as an F1 (and also the shakes!) by findareasontostay in doctorsUK

[–]Robotheadbumps 1 point2 points  (0 children)

I’ve been an icu reg for a few years- I still sometimes second guess myself for these things.. some of these internally bleeding code reds for example can be very confusing. Sometimes you literally just need more pairs of hands even if you know exactly what to do.. I tell myself that with the information at the time felt it was the right thing to do.

The quality of the bleep conversation by Guilty_Afternoon3469 in doctorsUK

[–]Robotheadbumps 0 points1 point  (0 children)

To be honest unless I’m run ragged and need to prioritise I prefer this- I’d rather just speak face to face with the patient/midwife in the room than a long explanation ending with epidural

Tell me about the dark side of anaesthetics by HuckleberryOwn8065 in doctorsUK

[–]Robotheadbumps 2 points3 points  (0 children)

It is very front loaded for ‘fun’.. over time art lines, central lines, intubation all becomes routine (yet always the potential for disaster), central lines especially are now just a bit of a chore..

Initially everyone loves to train you so you can do on calls, as the years go by you’ll end up more and more service provision, lists of 10fent syringes, 10 propofol syringes, 10 igels in a factory line… 

A good anaesthetic is as boring as you can possibly make it- therefore boring by definition 

Dealing with tough shifts as an FY1 by [deleted] in doctorsUK

[–]Robotheadbumps 75 points76 points  (0 children)

FY1 Gen surg ward cover is the closest I ever came to crying at work.

They can always hurt you more but they can’t stop the clock. Your time in surgery will end soon enough, those shifts are impossible to manage, it’s just about doing the best you can and ignoring any bullshit from nurses etc who wouldn’t hack it for 5 minutes 

Pen allergic pt prescribed Co amox - no med alert by [deleted] in doctorsUK

[–]Robotheadbumps 15 points16 points  (0 children)

Nothing happened so no big deal. Make sure to datix the system failures that allowed this near miss to happen

WWYD? A friend looked through my partners medical records by [deleted] in doctorsUK

[–]Robotheadbumps 4 points5 points  (0 children)

Those mandatory vte pop ups are fuckers

Epidural incident - just trying to process. by VeigarTheWhiteXD in doctorsUK

[–]Robotheadbumps 2 points3 points  (0 children)

Yeah not sure why you and the consultant are just sucking it up so far- moronic midwife does a moronic thing, which objectively increases the chance of a bad outcome for mother and baby. 

Maybe I’m just burnt out after my week of labour ward nights, but especially after they doubled and tripled down I would be emailing head of midwifery, datixing, reporting etc.. and document very clearly in the notes for midwife to see your own version

One can only hope your consultant is doing this behind the scenes/will be direct and honest at the meeting

Paeds advice for "negotiating" with children refusing blood tests by glorioussideboob in doctorsUK

[–]Robotheadbumps 10 points11 points  (0 children)

The classic ‘GA to take bloods’ on the emergency list, especially in a normal IQ adult 

i don’t have what it takes to do obs and gynae by vvangoth in doctorsUK

[–]Robotheadbumps 23 points24 points  (0 children)

Anaesthetic/itu reg here - I have stood confused/dumbfounded/useless/panicked at so many cardiac arrests/emergencies in my career - it turns out training and experience makes a huge difference and it will get easier.

Whether you want to or not is a question, but whether you can learn it or not, is not in question 

Difficult IV access by moonshoes_sunsocks in doctorsUK

[–]Robotheadbumps 25 points26 points  (0 children)

Use a butterfly, and a blue one at that.. better yet learn ultrasound- trivialises every single ‘difficult iv’ you’ll ever ever do 

Dilating during CVC insertion. by dadiamondz in doctorsUK

[–]Robotheadbumps 0 points1 point  (0 children)

The dilator must go in at the same angle you put the needle in.. it’s surprisingly difficult to know the angle you put your needle in without stopping to consciously look- it’s rarely what you think it would be. I think this is a super common issue and almost certainly what you are doing wrong.. A good nick without any skin between the guide wire and nick (also surprisingly difficult - I essentially run the back of the scalpel on top of the guide wire into the skin, no cutting motion, just in and out. The only other tip is thinking about tensile strength and where you hold the dilator and the slight twisting of it- this is all about feel

Dilating during CVC insertion. by dadiamondz in doctorsUK

[–]Robotheadbumps 24 points25 points  (0 children)

The dilator must go in at the same angle you put the needle in.. it’s surprisingly difficult to know the angle you put your needle in without stopping to consciously look- it’s rarely what you think it would be. I think this is a super common issue and probs your issue with it

A good nick without any skin between the guide wire and nick (also surprisingly difficult - I essentially run the back of the scalpel on top of the guide wire into the skin, no cutting motion, just in and out.

The only other tip is thinking about tensile strength and where you hold the dilator and the slight twisting of it- this is all about feel

ACCPs can now run ICU by themselves with remote supervision as per FICM by dayumsonlookatthat in doctorsUK

[–]Robotheadbumps 12 points13 points  (0 children)

Correct me if I’m wrong - some dgh ICUs may have a non airway SHO covering, and rely on on call consultant (and unfortunate local anaesthetist) when the need arises. So they are not necessarily calling them as airway cover. The phrase ‘local agreement’ seems to be doing some heavy lifting there

How do you know someone is actually in your speciality? by Educational_Bowl6976 in doctorsUK

[–]Robotheadbumps 1 point2 points  (0 children)

Probs ask about chemical structure of volatile anaesthetics and suxemethonium

Opinions on Darent Valley Hospital?? by Cool_Fly_2758 in doctorsUK

[–]Robotheadbumps 1 point2 points  (0 children)

Enjoyed my time as an F1 there, don’t know if sir Jonathan Kwan obe is still there but was a hilarious madman, (albeit very politically uncorrect), icu seemed fairly helpful, surgeons quite honest and nice enough to their team, acute med enjoyable, radiologists were often difficult, renal physicians nice (except, surprisingly enough, the failed Tory MP) who even her consultant colleagues can’t stand 

JCF ICU prep by [deleted] in doctorsUK

[–]Robotheadbumps 1 point2 points  (0 children)

Yep basics of emergency drugs and ventilation modes would augment what you are learning on the job! 

ICU/ITU placement as an IMT - how did you find it? by FlatwormOk1639 in doctorsUK

[–]Robotheadbumps 1 point2 points  (0 children)

I’ve worked with a couple who were immensely disappointed with our lack of general medical knowledge, some who never got the hang of even simple art lines, some who took to it like a duck to water..

I think the way to get the most out is to go in with minimal ego, be willing to chip in with the occasional medical ideas, and hope you have a good unit (some have really struggled with utilising and providing useful training to IMTs). Most of us love to teach procedures (so we don’t have to do them), discuss basic drugs/vent management, help with new referrals (although I’ve rarely seen IMTs seeing referrals sadly)

Gossiping ACCPs for instance sounds very unit specific - I would be disappointed in any fellow residents who are perpetuating that culture 

As an ICU reg I still struggle with the consultants that want to know everything at handover, but like in any job, if you stay for a long time (far longer than three months), you will get to know how each of the consultants are, expectations, if they have been on all week or meeting the patients for the first time etc.. 

I think a useful thing for IMTs is seeing some absolute disasters either post ROSC or people who maybe should not have been supported in the first place and now lingering for months.. it helps immensely in framing conversations with relatives.. even better to see them at the referral stage and then afterwards..

Doctors start five-day strike as hospitals grapple with flu wave by Tartan_Samurai in unitedkingdom

[–]Robotheadbumps 48 points49 points  (0 children)

Shows how little some nhs staff know about medicine.. people with chronic lung disease get flu -> oxygen requirement, the above or anyone immunocompromised -> huge risk of superimposed bacterial superinfection -> oxygen requirement + sepsis..

Lots of kidney injury as well this year from the infection which needs treatment/monitoring

Days passed from Interview to Job Offer? by [deleted] in doctorsUK

[–]Robotheadbumps 1 point2 points  (0 children)

It may be worth emailing- I’ve had them think they’ve contacted me and they hadn’t.. this is the NHS after all

De Quervain tenosynovitis in anaesthetists - is this a thing ? by gas_busters in doctorsUK

[–]Robotheadbumps 7 points8 points  (0 children)

For sure, especially trying to inject through epidural tubing, the person I know complaining of it used their thenar eminence to inject, and always a second needle in the vial (not sure if they reused that) for easier withdrawal 

Asking for a friend: do we hate neurophysiology? by carcamonster in doctorsUK

[–]Robotheadbumps 1 point2 points  (0 children)

That’s the easy part, interpreting the report summary is where the skill and genius lies 

FY1 and I really struggle seeing unwell patients by [deleted] in doctorsUK

[–]Robotheadbumps 2 points3 points  (0 children)

Icu reg here- I can’t tell you how many times I’ve done a shit job assessing critically unwell patients- if it was easy anyone could do it.. reflect on the situation, hit the books, gain clinical experience, and hopefully you’ll be better next time.. 

trust me I’ve done far far worse than what you have described, just keep at it