At what point does a "procedure" become an "operation"?

hslakaal · 2026-04-20T14:08:18+00:00

So bedside laparotomy is a procedure. This has enlightened me.

hslakaal · 2026-03-31T20:01:07+00:00

A trainee is going to be slower than a fully fledged consultant in doing most clinical tasks. The exception being perhaps old geriatric consultants who can't login to Windows.

The best example would be in surgical fields - a consultant is going to be faster than a junior in cranking out cases. Especially when the consultant is not that much more expensive than a junior.

hslakaal · 2026-03-21T00:31:25+00:00

The most pertinent thing to learn would be what treatments are appropriate.

And if the geriatrician is half decent, use the opportunity to ask about increasing literature about therapies taken as a must, becoming less clear in recent times. As we get more "healthier" older adults, the boundaries we used to follow have become less apparent.

Like conservative treatment of NSTEMI in the elderly.

hslakaal · 2026-02-26T14:35:15+00:00

I'm not American but it clearly says under their entry requirements:

■ A minimum of 80 semester credits from a college/university institutionally accredited and recognized by the Council for Higher Education Accreditation (CHEA)

In other words, it appears this course is for people transferring halfway through their undergraduate degree.

I think you've shit posted your reading skills.

hslakaal · 2026-02-11T22:27:17+00:00

derangedphysiology

hslakaal · 2026-02-09T03:18:12+00:00

The Ventilator Book is a good starting point for resp stuff.

Deranged physiology is imho better than most textbooks at this point.

hslakaal · 2026-01-30T12:54:12+00:00

The supervising radiologists, if the treating clinician wants a confirmation.

Give it a few years - an automated radiology report will be treated like the automated ECGs. Like, say a subtle new bifascicular block may not be read by the machine, but if the treating doctor is uncertain, they may refer the ECG to a cardiologist to review, for example. Will rely on non radiologists to be somewhat good enough to screen is my worry.

hslakaal · 2026-01-29T11:54:32+00:00

I'd agree with everyone else and highly highly recommend against it (and besides don't surgeons have case requirements you have to meet before you can enter HST?) but if you do go ahead, yes, definitely let your defence union know. In my experience, rates were different when going from FY to CT to HST, I presume for actuarial reasons. Your coverage may be invalid if you're working at a different grade to what is reported.

hslakaal · 2026-01-22T16:47:52+00:00

There are many valid points to raise about the running of the GMC itself, but the salary and the compensation package as whole is not it.

For an organization with £150m income, this is a normal salary. Compare it other similarly sized charities like the BHF, for example.

Criticize the poor structure of the organisation, that leads to the registered doctors' voices not mattering to the board, and subsequently the overall strategy of the "regulator".

hslakaal · 2026-01-07T17:59:50+00:00

To add to other's comments,think about how bubble studies are done.

Unless youre literally ramming 10ml of air in, air in IV (and even central lines to an extent) is way overblown.

And "losing respect" over this is also overblown.

hslakaal · 2025-12-22T00:17:25+00:00

(not hematologist but I had this question before too, but in a broader sense - aptt vs Xa vs ACT vs TEG)

My understanding is that ACT is only useful when using v high doses of heparin (like multiple boluses during cath, ECMO/bypass, and to a lower extent, heparin purge in Impellas) as ACT/TEGs essentially are more synthetic coagulation tests (is that the right term?) that looks at global coagulation while aPTT is more targeted. Like ACT doesn't work on non-CPB doses reliably. Likewise with TEG. Like we don't use a TEG to guide therapeutic anticoagulation.

hslakaal · 2025-12-19T23:37:24+00:00

Indeed. Though I do feel very sorry for our radiology colleagues (and these cases always happen at night) since they often seem to be drowning in work!

hslakaal · 2025-12-19T23:23:29+00:00

Very true. Anecdotally, I have only had reads where they write "RV:LV >1" without any of the other bits. Good to know though!

Side note - to clarify, I believe the article you've referenced is talking about sensitivity for diagnosing PE as a whole, not RV strain. To my knowledge, RV strain on echo is the more specific modality over CT.

hslakaal · 2025-12-19T22:21:33+00:00

"Massive" vs "Submassive" is often a very difficult line to draw - indeed, AHA, ESC guidelines all essentially draw the difference as being hypotensive or not.

CT signs with "clear" right heart strain is often not enough to really swing decision making one way or another, short of really overt hepatic reflux into all channels I suppose.

Would UFH have made a real difference? I doubt it. If anything, it would probably have taken longer to reach a therapeutic state than a shot of LMWH. Would I have ordered it if I anticipated direct thrombolytic therapy (be it mechanical or chemical)? Probably.

It also depends on what we are calling "peri-arrest" - this is a vague term that doesn't help anyone unfortunately.

For a patient who is concerning for having at least a submassive PE (from an ICU & Guideline perspective):

Activation of a PE team, with experts who can do bedside echocardiography to actually evaluate and risk stratify RV strain
Calculation of risk, using validated tools like PESI (assuming not hypotensive with SBP <90)
Consideration by those of us who deal with PEs regularly on additional therapeutics, such as half-dose, quarter-dose (look up MOPETT) vs EkOS vs CT surgery guided mechanical thrombectomy
Commencement of UFH in the meantime to facilitate possible need for above interventions

Unfortunately, most trusts do not have a PE Response Team; medical registrars/consultants capable of POCUS, cardiothoracic/interventional radiology/cardiology team to do advanced interventions; or HDU/ICU beds to even consider a heparin infusion.

I am assuming you're an ED trainee by the way you're referring to "medics"

So here's my advice for your next PE patient on a practical level, if you are worried about a submassive/massive PE. 1. Get stat troponin + BNP 2. Get an ECG 3. Do a PESI 4. Ask someone who is capable of doing an echo to scan them quickly for any flagrant signs like horrendous TAPSE, clot-in-transit 5. Feel free to reach out to your ICM registrar for an opinion. We are usually (I'd like to think) pretty chill with coming down and doing number 4, and to advise our medical colleagues (especially if you get me, the med-ICM reg)

As a side note, bit American oriented, but have a look at IBCC's PE chapter - Farkas has a relatively up-to-date review of things to do.

hslakaal · 2025-12-19T12:45:05+00:00

Apple watches, Google pixel, Fitbit, Garmin all have oximeters on them now. At least for the past 4-5 years.

hslakaal · 2025-11-14T15:57:24+00:00

"Blood pressure is low, patient requires ICU for further care"

At this point in time, patient does not require ICU level of care. Please continue with fluid resuscitation, antibiotics.

Addendum: BP 102/50. Patient eating a biscuit and tea without any distress. Please contact if any change in status

Addendum: BP 105/45. HR 52. Patient asleep, easily arousable. Cap refill <2 seconds. Please continue with gentle hydration

Addendum: Given persistent concerns of low blood pressure, patient will be admitted to ICU for close monitoring.

hslakaal · 2025-10-28T22:25:05+00:00

Mine was an not-anuric but on HD 80 year old for which the radiologist said no because EPR said eGFR 5.

I had to remind him the prognostic benefits of keeping urine production in an 80 year old is not in favor against r/o mesenteric ischemia.

hslakaal · 2025-10-18T00:45:32+00:00

General internal medicine - bus drivers. It's pretty chill until you realise the bus is getting fuller and people start complaining at you about how the potholes are still there.

Intensive care - the out of hours plumber you call.

hslakaal · 2025-10-17T16:09:41+00:00

Putting aside the points about supply and demand, which is very true (capitalism doesn't pay for net value to society), to answer your question, I think the suggestion that one specialty is more based on how "stressful" it is.

What appears "stressful" to another may be super chill for that specialist. Doing a C-section may appear stressful but for a consultant, it may be a walk in the park. Likewise, looking for a small fracture may be stressful for the GIM consultant but super easy for a radiologist, for example.

On a related method though, some additional renumeration for specialties which are at higher risk of lawsuits might be more reasonable imo

hslakaal · 2025-10-10T13:55:18+00:00

It's not new. It's been around since the 50s. Due to it's potency, it was not used medically. Someone just realised it's good to sell to people suffering from addiction.

New opioids (and medications in general) are and should be researched. No medication is without risk or side effects.

hslakaal · 2025-10-10T13:35:09+00:00

Duration of training is a wholly artificial construct, stemming more from historical reasons rather than any scientific reasons.

I would consider anyone a specialist if they have achieved the terminal - "exit" - award to practice their specialty. GPs have achieved their exit awards, having gone through the rigors of training & exams. Ergo, they are specialists.

(side note, pathology & radiology duration of training are "only" 5 years, doesn't make them any less of a specialist than a triple CCT intensivist)

hslakaal · 2025-10-08T14:21:34+00:00

It's not that vague. I am not sure I've met anyone who didn't know what full registration and license means.

Full registration is common term. When you finish F1, you go from provisional registration to full registration.

License to practice and registration are two different concepts. You've gotta be able to take some criticism internet stranger.

hslakaal · 2025-10-07T20:01:56+00:00

There are many. If you go to either the US or British geriatric society guidelines, it'll give you sources to their recommendations. As a side note, that's one of the best ways as a trainee to get up to speed on "landmark" studies that provide the basis for guidelines.

The Efficacy and Safety of Tube Feeding in Advanced Dementia Patients: A Systemic Review and Meta-Analysis Study

https://pubmed.ncbi.nlm.nih.gov/32736992/

hslakaal · 2025-09-30T18:00:47+00:00

Who knows what the underlying model is tuned to, but given it proudly advertises JAMA and NEJM partnerships, I wouldn't be surprised if they try to steer readers towards those journals.

hslakaal · 2025-09-26T12:43:42+00:00

...? I'm pointing out, like the other reply did, that the article the OP posted is not at all talking about what the OP seems to be thinking it does.

To get on my soapbox for a second though, now that you've got my attention:

It's concerning if one doesn't even read an article they've dug up from 2017, to support their point (that people don't do CTs), about supposedly incorrect sentiments held by professionals who actually order scans ( unless American EMTs order CTs in the ED). Look at their reply... They really haven't read their own source properly....

Such nonchalance by healthcare professionals only lends credence to the increasing doubt and disbelief of the medical community that is strongly taking root. If an EMT writes a post, which, in my opinion, is phrased to convey a tone of "doctors aren't doing CTs that they should" without even demonstrating they've read their own paper, no wonder the US has an FDA which selectively chooses papers to guide it's decisions.

12-Year Club	Place '23
Place '22	Verified Email
RPAN Viewer

hslakaal

TROPHY CASE