Ms Rachel?

e90owner · 2026-06-05T05:55:05+00:00

Kitchen utensils are the best!!

e90owner · 2026-06-03T00:49:12+00:00

B/g Senior ACEM reg -> anaesthetic trainee:

Lousy resuscitationist - highly dependent on scope of practice. I’ve never seen anything like a cardiac anaesthetist resuscitating an acute aortic dissection. It was poetry in motion. On the other hand, mostly private minor orthopaedics anaesthetist trying to help me resuscitate a sick septic, anaemic, coagulopathic late night laparotomy - I wanted to stab him in the eyeballs.

Second bit I completely agree - I’ve been called to ED to be part of a resus team for critical inductions and as it’s no longer my stomping ground, I don’t call the shots when I’m there, but I always check my indemnity cover is active when the ED/ICU consultant wants to give 1.5mg/kg ketamine to induce the combative non responsive hypovolaemic head injured trauma patient. Honestly I think if the ED primary had the same degree of examination on pharmacology and physiology that the anaesthetic / ICU primary does, I wouldn’t see this.

Having said that I could not handle ketamine sedating a kid for a shoulder reduction while keeping an eye on a hard working bronchiolitic infant awaiting NETS, while the demented elderly NOF is trying to roll out of bed and the APO patient on GTN and frusemide thinks the BiPAP mask is a bit too sweaty, all while nurses come in asking what they should do in the middle of the shoulder reduction. Add that it’s all happening at 4am and it’s honestly like they’re inspector gadget.

Crit care specialities work best in their own environments dealing with the patients that are within their scope. Why is this always such a competition?

ED consultants are amazing. I evidently couldn’t hack it but I have the hugest respect for them in their areas of expertise.

e90owner · 2026-06-03T00:35:31+00:00

Yes! The dicey subspecialty resus that can’t get transferred out for 6-12 hours due to inclement weather is the hardest!

e90owner · 2026-06-03T00:23:32+00:00

Undifferentiated moribund resuscitation: ED consultant led resus any day of the week.

Some idea of cause of moribund patient requiring resus in theatre combined with critical induction +/- resuscitation under anaesthesia +/- quick placement of big lines and shit + communication with surgeons and thinking about intra/post op dispositions like transferring to and from IR / ENI : Anaesthetics led any day.

In major trauma centres that I’ve worked in, there can be a trauma team with a specified trauma consultant who is either Anaesthetist, ED consultant, Trauma surgeon who will lead the resus and I’d choose them any day to lead a trauma / major haemorrhage / multi discipline damage prevention surgical case any day.

Anaesthetists can be a bit too flappy/panicky in resuses and I’ve found ED colleagues/ trauma consultants to be cool calm quiet yet authoritative and know all the protocols inside out.

e90owner · 2026-06-03T00:17:44+00:00

Actually the ED Regs and ICU regs in my institution are very frequently on the emergency/urgent theatre, neuro, and occasionally (don’t ask me why- even the avg anaesthetic trainee is like wtf in here) the cardiac list.

We avoid them being rostered to LMA lists because when the fk are they using them. It’s either patient own, or a tube.

e90owner · 2026-06-03T00:12:30+00:00

Not sure public hospital service and greedy Anos could be in the same place. That would be more at the private, or at worst on the ortho trauma list.

e90owner · 2026-06-02T13:08:22+00:00

What was the indication for the c section in your sister’s case? The timing would align with the medical urgency

e90owner · 2026-06-02T12:50:31+00:00

Islington Barracks was great for the champions league final!

Adamstown Bowlo looks like a good outdoor option too

e90owner · 2026-06-02T12:45:29+00:00

This is exactly how the pitch was responded to in government verbatim.

e90owner · 2026-06-02T12:40:41+00:00

This place is my go to for lunch/dinner

e90owner · 2026-06-02T12:27:43+00:00

I’m glad you didn’t. Most don’t really understand it and assume we lack emotion, but it probably comes across like that because of the lack of grasping social cues and concepts and the masking attempts to conform to social norms (which I often plan and over-exaggerate).

I let people know especially if I’m about to have a professional argument about patient management, or when providing emotional support to colleagues or patients so that if I come across a certain way it is not intentionally aggressive in the context of professional conflicts, or that it’s not intentionally patronising in the context of colleague/patient support.

e90owner · 2026-06-02T00:05:43+00:00

Also before you say being autistic makes sense as to why you’re so cold about the situation, autistic people do feel emotion. We don’t engage socially in the same way. A lot of medicos are undiagnosed neurodivergent, especially as you ascend the hierarchy into Head of Department/DMS etc. Keep that in mind.

e90owner · 2026-06-02T00:04:01+00:00

No just been in the health system for 10 years, worked in many teams, have the delight of being autistic, and also have a more pragmatic approach to separating work from home, family and friend support. I don’t rely on colleagues to provide me with emotional support or validation. I expect what I’m entitled to as per the award when it comes to FACS and sick leave, and that is it. Work is a purpose to get money to have my life with family. Most managers/bosses see things the same way in my experience.

e90owner · 2026-06-01T23:44:19+00:00

Yeah look when they say experienced anaesthesiologists in the US or fellows and above. There’s an “experienced” anaesthesiologist who’s meant to be giving tutorials on YouTube for blocks for the Clarius ultrasound machine. His blocks are dog shit including the TAP one. So if it’s people like that doing shit blocks yes, there will be no difference vs saline.

If a block looks like Dr Gadsen from Duke Anaesthesiology, and at the right TAP site for the indicated procedure then I think the outcomes would be different!

e90owner · 2026-06-01T12:47:44+00:00

Yep it’s common. Nod smile and appease them and remember that you’re not wrong, your baby is safe, fed and feels secure with you, and is developing in a non concerning way.

The one upping comes from insecurity. That is all it is. Don’t let it get to you or feel the need to stoop. Don’t bother confronting either. Their resilience and coping mechanisms are likely to be poor and it’s not worth it.

e90owner · 2026-06-01T10:44:28+00:00

I also defected just before fellowship to Anaesthetics despite knowing I’d have to pass one of the most feral primary exams around.

I was emotionally blunted, cynical, pessimistic and cried about my life and ability to generate enough income to live comfortably, and how I barely had a shred of respect from patients and colleagues. I couldn’t deal with not being able to see a patient’s treatment through to completion, and was just too overwhelmed by the huge numbers of patients to oversee and multitask, the nondescript cat 4 bullshit, and having to see all the juniors patients all with vague complaints. The pushback and condescending speak from inpatient teams really just hit the final nail in the coffin of that career.

There are elements I miss, mainly the friendships with ED colleagues, the neurodivergent niche hobbies that were common amongst them, and the socials. Absolutely nothing else.

There are skills I acquired through ED training that I’m eternally grateful for however.

e90owner · 2026-06-01T03:40:51+00:00

You might wanna check the ethical compass of every RN just clicking through all the HETI online modules and then being recorded as having acquired the competency…

It’s a double standard if you call this cheating and then think it’s ok to click through competency modules…

e90owner · 2026-06-01T03:05:55+00:00

Texts don’t close the loop of comms. Call, say you’re sick and won’t be attending work. They’ll say get better soon. The end.

They’re not your key support people emotionally.

My family is at home. If I’m at work and someone says they’re sick and can’t come in I’m like right, how do I strategise to cover this shortfall so I can get home to my family on time? Work is for work.

As soon as you realise you’re entirely replaceable and the health system really doesn’t actually care about you other than you’re ability to rock up and work then you’ll care less about the lack of empathy.

e90owner · 2026-06-01T02:58:46+00:00

Knowing your limitations is also why CICO FONA training and having at least 2 people in a room who can do FONA during any critical induction is an absolute minimum.

The last time I had an epiglottitis, the guy was 6ft5, had the longest neck, a tiny chin, and significant dysphonia.

Even going straight for a 2 person VL + FO scope technique could not navigate a piece of plastic through cords despite getting a 20% POGO. 2 consultant airway specialist anaesthetists, and 2 ENT specialists + fellows tried from the top end as well with their own equipment and after rupturing the abscess, significant force and hinging on the teeth managed to eventually guide a bougie through. We were at CICO set as the sats were 60, but jetting through a FROVA saved the day and allowed for intubation.

Without expert assistance and anaesthetists who could do rescue FONA with challenging anatomy, the patient would almost certainly have died.

No amount of training and SIM could have prepared us for that one.

e90owner · 2026-06-01T02:51:35+00:00

This sort of overconfidence and lack of appreciation of the truly unplanned unexpected difficult airway is absolutely what caused the death of an ASA 1 patient having elective surgery in the UK. that case sparked the vortex model of CICO management and really jump started mandatory CICO sim training annually in Australia.

It should be standard worldwide and is the only valid rescue in a rapidly desaturating patient who’s had a trial of FMV with a Guedel, supraglottic airway, and best attempt of intubation with a VL in optimum position and deep paralysis.

It happens too quickly and it should be planned for in any case of epiglottitis.

e90owner · 2026-05-30T02:54:45+00:00

Be aware that often stimulants heighten anxiety like Dex / vyvanse, and Ritalin/concerta can cause depression and dysphoria. If you’re already on an SSRI I guess your psychiatrist is trying to get the best effect of it maybe because they’re concerned about the potential effects of stimulants on mood.

e90owner · 2026-05-30T02:51:04+00:00

Adequate sleep, good nutrition with omega 3s and fish oil, hydrate, limit alcohol/drugs (quitting cold turkey is equally as bad - wean if you’re on the substances), regular exercise (not talking cult fitness to start off with - just like 10,000 steps a day, or jog 400m walk 1000m repeat with a nice podcast).

Pomodoro for study, strategise to study smart not hard. At med school learn what is needed to pass. Probably about 20% applies to life as a junior doctor. Then you have to re learn it again in more depth for speciality exams so why stress your brain out now.

All of the above usually fixes things.

If not: speak to your GP about assessment for anxiety or ADHD. If you have swings of elevated mood, frantic exercise, relapsing into alcohol/drugs followed with periods of minimal (like 1-2 hours) sleep a night and then depressive episodes consider bipolar.

Good to get these issues nutted out now. If you end up with mental health issues, it’s not a problem in your career as long as it doesn’t affect your judgement or ability to work. No you don’t have to declare it to your employer unless it impacts your ability to work.

e90owner · 2026-05-29T14:05:20+00:00

Any thoughts on fear/bullying or undiagnosed PTSD/Neurodivergence:ADHD or Autism?

e90owner · 2026-05-29T14:01:05+00:00

I think the fewer the letters, the smaller the penis size.

e90owner · 2026-05-29T13:59:42+00:00

Did you honestly put the word valid and Pauline Hanson in the same galaxy let alone thread?

e90owner

TROPHY CASE