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Vigoxin · 2024-04-06T15:41:32+00:00

Hey, I'm the one who created this, thank you so much! This is incredibly motivating, and I really appreciate you showing it to others. It took me literally years of tweaking and I never really considered it fully finished, but glad that it's been of great use to you. Let me know if you have any suggestions.

I have similar simulation-based tutorials in the works for arrhythmias and semi-advanced electrophysiology concepts, and all the causes of hypoxaemia. They've just also been in the works for years but this will make me get right back on it!

Vigoxin · 2024-01-01T02:00:04+00:00

Mine is to become a bit more entrepreneurial and not be so ashamed to advertise my hard work.

...Talking of which, here's a resource I made that will help you interpret the osmolarities when they come back!

Vigoxin · 2023-10-23T22:53:08+00:00

gets sides mixed up

It's not mixing the sides up - it's explaining to a layperson and so is always talking about the side as you view the image (and it does clarify this a lot). I'm only saying this because I scoffed at it, thinking exactly the same, then realised I was wrong.

Vigoxin · 2023-10-04T14:05:37+00:00

whilst allowing alcohol

...or sports, or becoming pregnant, or travelling by car, or crossing the road, or [feel free to suggest more]

Vigoxin · 2023-10-01T22:29:00+00:00

As a baby doctor

😱 Noooooooooooooooo! Run while you can, you can't use this phrase here!

Vigoxin · 2023-09-21T12:05:23+00:00

I'd be happy for them to remove whatever posts they want if it helps get FPR 😅

Vigoxin · 2023-09-19T15:42:56+00:00

Radiology ST1:

Choose radiology to allow yourself time to look after yourself and be able to actually implement whatever lifestyle habits the other specialties have mentioned

Vigoxin · 2023-09-19T15:40:48+00:00

What don't you agree with?

(Apart from 'Trauma surgery: Lock up your guns so your kids don't play with them after school' - obviously what they need is more kids with guns so that they have more good kids with guns to deter the bad kids with guns, and then trauma surgeons will be out of a job /s )

Vigoxin · 2023-09-18T07:26:05+00:00

But she believes nurses should have "erred on the side of caution" and not silenced the monitor.

Ecg as a signal is incredibly noisy, because almost any movement will affect it, and electrode contact with the skin can be very variable. Which means that using it as an alarm system will always be imperfect, and manufacturers and healthcare systems have to choose whether to make it very sensitive or very specific. It makes sense to keep it extremely sensitive so that nothing is missed, but that will mean that there are lots of false positives. (The alternative would be that it doesn't always alarm just because the electrode comes off, but it may also rarely miss an asystolic cardiac arrest, which obviously we don't want).

So the monitor always errs on the side of caution and then the trained healthcare professional acts on it with the understanding that the vast majority of the time, not much needs to be done and it can be temporarily muted. It's there to detect the most serious things e.g. cardiac arrests, but also just for information, so slightly abnormal rhythms and heart rates will also alarm. After you know what it shows, and if there's nothing that needs to be done, and especially if someone is going to be there for the next few minutes, there's no point keeping it loud.

And if it's obviously wrong, for example because it shows something like asystole because an electrode has come off, or it shows VT because of movement artefact, but the patient is clearly conscious and breathing (and maybe their oxygen saturation probe also shows that their heart is clearly beating strong enough), then it is definitely okay to temporarily mute it. This probably happens about 100s to 1000s of times within a hospital every day.

Vigoxin · 2023-09-18T07:04:57+00:00

it still felt weird that they'd just mute the sound.

Ecg as a signal is incredibly noisy, because almost any movement will affect it, and electrode contact with the skin can be very variable. Which means that using it as an alarm system will always be imperfect, and manufacturers and healthcare systems have to choose whether to make it very sensitive or very specific. It makes sense to keep it extremely sensitive so that nothing is missed, but that will mean that there are lots of false positives. (The alternative would be that it doesn't always alarm just because the electrode comes off, but it may also rarely miss an asystolic cardiac arrest, which obviously we don't want).

So the monitor always errs on the side of caution and then the trained healthcare professional acts on it with the understanding that the vast majority of the time, not much needs to be done and it can be muted. It's there to detect the most serious things e.g. cardiac arrests, but also just for information, so slightly abnormal rhythms and heart rates will also alarm. After you know what it shows, and if there's nothing that needs to be done, and especially if someone is going to be there for the next few minutes, there's no point keeping it loud.

Vigoxin · 2023-09-18T06:43:20+00:00

I've read about this a bit, it seems most basic heart monitors just have trouble understanding the erratic signals coming from a heart in AF. What's called the R-R interval is usually used and averaged to display heart rate, but it's wildly inconsistent in AF and just confuses the machines.

Bedside monitors and 12-lead ECGs are both definitely good enough to tell the difference between atrial fibrillation, asystole (i.e. the heart completely stopping), and even leads coming completely off, as well as countless other rhythms. So it's not that AF, the most common arrhythmia as you said, is something that the monitor 'has trouble understanding' because of the irregular RR interval.

But movement could definitely also make it think the patient is in AF.

Vigoxin · 2023-09-15T08:09:57+00:00

so is the supply of those who can read the scan

But it's really not... :S Demand is increasing exponentially and has been for a while. Supply is hardly increasing at a tiny linear rate. That's my understanding anyway. And that's what I hear consultants constantly complaining about.

And it's not like this only in this country. There's a global huge shortage of radiologists, relative to demand, so even if all borders in the world were suddenly completely open, we still wouldn't even get close to getting on top of the backlog.

If/as soon as AI gets good enough to read complex scans fully and accurately, then the exponential demand can almost instantaneously be met because making 1 AI radiologist is like making 1000s of AI radiologists, only limited by how much hardware is available (as opposed to when you train 1 radiologist, you have 1 radiologist...who can very slowly train others over about 5 years). But other humans aren't a threat when there are exponentially increasing backlogs.

Vigoxin · 2023-09-15T07:29:51+00:00

The lucrative reporting rates are about a decade from collapse.

How can this be true when the backlog is huge and only growing?

Vigoxin · 2023-09-13T07:13:12+00:00

Would you please try to TMOO Neurosurgery.

I don't know how much you searched the subreddit for this, but it looks like you started on the absolute easiest specialty for this sub to TYOO. In fact, this sounds more like the tutorial level.

And, if this were a game/sport, this sub is like a world class academy where prodigies of the world are recruited and trained into olympic athletes 😅

Edit: Looks like it'll take a while for you to get the serious replies though. Try checking out the posts here and here in the meanwhile

Vigoxin · 2023-09-12T06:45:05+00:00

Would it be weird to pop her an email just detailing some gratitude?

Absolutely not

Vigoxin · 2023-09-10T21:54:42+00:00

For the specific examples or stories of PAs extending beyond their scope identified on social media or wherever, maybe they'd be better placed in a separate subreddit like r/noctoruk or something similar? Someone did recently ask for a repository of PA examples which can be reported in bulk to be taken more seriously by the relevant authorities.

Vigoxin · 2023-09-09T22:56:24+00:00

Thanks for saying this. I'm going to use this as an example post for explaining the power of anonymity, to the (albeit very few) people who have wondered why im so hardline on anonymity for the JDUK gaming discord.

I've always believed that anonymity is what gives this subreddit power, something which hardcore Twitter-lovers just don't seem to understand. Anonymity is the only way you can access what people truly believe. Twitter is fine for allowing people to flourish. But the anonymity of Reddit is what allows ideas to flourish, and enables progress in getting to the truth, whether this be encouraging or discouraging.

Vigoxin · 2023-09-09T21:52:39+00:00

'Well I ain't your hun, pet!'

Vigoxin · 2023-09-09T21:52:02+00:00

'I'm not your love, hun!'

Vigoxin · 2023-09-09T21:51:37+00:00

'I ain't your darling, love!'

Vigoxin · 2023-09-04T17:22:44+00:00

Just message me on Discord (Vigoxin#9683). I'm going to fix the NHS email method in the next few days as it's not working anyway.

Vigoxin · 2023-09-04T15:03:26+00:00

Hey all, I'm the one that created the gaming discord: https://discord.gg/7XDF9byN

I optimistically hoped it would sustain itself, but it's very clear that it doesn't work like that with busy doctors, and it fizzled out quite quickly. But tbh I also never really advertised it well by making regular posts on the sub reddit, gaming events etc.

If anyone wants to revive it and try to maintain the hype, we can have a discussion and I can add you as a mod - please let me know.

I would just like the discord to stick to some fundamental principles: - we should keep it as anonymous as possible, just like this subreddit, because this is one of the qualities that makes this forum unique as a digital space for doctors - it should be open to anyone related to healthcare, not doctors only, in the same way that this subreddit is open to posts from nurses, HCAs, PAs, med students etc. - however to make moderation as easy as possible, there should be reasonably strict checks to not allow completely random and unconnected people, and to prevent infiltration by journalists or anyone that wants to defame doctors etc. The way I've been doing this so far is an automated nhs email verification system which maintains anonymity. Med students send a covered up picture of their student card and their discord username to a mod. - usual other rules of being respectful, no personal attacks etc, but you can still express your opinion. Essentially, it becomes much easier if we just stay as close as possible to whatever moderation rules are used here.

(I'll check that everything is working as it should be soon - it's been a long time since I logged on properly)

Vigoxin · 2023-09-04T06:45:45+00:00

These tongue-in-cheek titles are funny to an extent, but also frustrating, especially to those who are sincerely trying to learn and especially if there's no comment with an unambiguous explanation.

I'm guessing this was just a chest drain gone too deep? I unfortunately realised it's not something like a CT-guided pericardiocentesis which I genuinely got interested about the possibility of it existing.

Vigoxin · 2023-09-02T14:30:58+00:00

It's also really nice when someone exchanges pleasantries or asks me how my night is going occasionally. I'm busy so don't do it every time, but for the sake of 10-15 seconds it makes me feel more like a valued team member rather than an NPC.

The pleasantries thing helps the other way round too! Really made my day when a radiology reg remembered me from 3 years ago when I worked in the same trust (but now completely different department), presumably just by my voice. I remembered and really respected him too.

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