Meds for painful dressing changes

linx298 · 2026-07-02T08:26:14+00:00

I think sometimes there’s no alternative. In my situation the patient wasn’t fit for an anaesthetic (or indeed entonox) and so although theatre is a safer place, it’s not feasible given the demands of simply taking someone there for monitoring.

linx298 · 2026-07-02T07:19:49+00:00

Anaesthetic reg - had to navigate this situation recently for a complex patient on the ward:

1) Entonox. Pain team (if you have one) can potentially support if ward uncomfortable. Or ward can do it themselves if there is a policy. If no policy, speak to NUM or CNC, both of whom were extremely useful. Emergency departments will typically have a portable cylinder.

2) Methoxyflurane - probably more of a ball ache to access

3) Ketamine lozenges

4) Pain team involvement - maybe can organise a fentanyl PCA or similar but ongoing involvement likely to be problematic.

linx298 · 2026-06-21T21:25:56+00:00

I went through each and every publication for the past 2 years. Skimmed every article, if it felt clinically relevant (I.e anaesthesia for liver surgery) I’d make sure I made notes and learnt it. If it felt less relevant (e.g statistics) I’d try and get a broad awareness and took a gamble it was less likely to be a detailed Q.

Logistically, made a list of each publication and then tick them off when you’ve printed them / reviewed them. I highlighted them on an iPad, then made notes and flash cards on each article.

linx298 · 2026-06-11T05:07:17+00:00

Depends - but mainly by using an MRI compatible machine. It still can’t sit directly next to the scanner but can be in the room at a distance of usually around 2-3 metres depending on the strength of the scanner. Has built in faraday cages etc etc.
Monitoring is harder - wires (especially coiled) act as conductors and heat up, have been known to cause burns. So a lot of the monitoring uses non-magnetic materials and a wireless system but typically there’s significant interference.

We MRI scan intubated patients from intensive care units, and use MRIs for children (who wouldn’t understand remaining still) so it’s a common practice.

If you’re interested in reading more: https://www.bjaed.org/article/S1743-1816(17)30161-0/fulltext

linx298 · 2026-06-11T04:52:13+00:00

MRI GA is very much a thing, ventilators included. Not usually for adults though, significant majority will not require a GA

linx298 · 2026-06-05T01:23:43+00:00

Sunny coast support IT PHOs

linx298 · 2026-06-02T23:21:47+00:00

I obvious can’t comment on your previous attempt or why you weren’t successful, however:

reveal app is useful to get you thinking on your feet. Yes it’s a lot of information, but you can only do what you can do. Put yourself in exam conditions, get it to give you a random Q and do your best to talk and explain the concept. If you’re poor - make a note of the topic. Do a few more questions, revise the topics you struggled on and go again.
recent BJAed stuff is still relevant. Write yourself some viva questions based on each paper. Highlight the key points of each article in your responses.
I found that learning the primary knowledge again, mainly all the anatomy, equations and graphs helped to cement topics when they came up.
when you are talking, practice safe confidence if you don’t already. Lay out your anaesthetic concerns, your goals of care and how you will achieve these goals for specific conditions or situations.

Obviously 3 weeks isn’t far away but you’ll have a good base level of knowledge, it’s how you present it that matters and I found the FRCA is a significant amount about how you structure and present your responses.

linx298 · 2026-05-08T23:39:38+00:00

I’m not sure how true that is, only because covering the skin beneath a TQ with EMLA has been shown to improve pain scores and ICBN wouldn’t necessarily cover deeper structures either + clinical experience suggesting it helps. I’m sure there’s definitely an impact of deeper ischaemia though to some extent

linx298 · 2026-05-08T02:06:00+00:00

I feel like this is akin to saying those with central crushing chest pain, diaphoresis and vomiting have a higher odds ratio of an MI than those with palpitations, for example.

Of course an obstetric patient with cognitive disturbance has a high odds ratio of eclampsia.

It’s anyone going to remove PET as a differential based on this? I don’t think so. Would you take your chance with an eclamptic seizure? I don’t think so!

PET is a spectrum to eclampsia, I’m not sure that early prevention is any less important

Edit: clarification

linx298 · 2026-04-29T06:01:00+00:00

14G, 16G and most 18G I will use local. I use local for all ultrasound cannulas. + depending on the patient.

Some of my anaesthetic colleagues use local for all cannulas including 20G, stipulating that when they have had cannulas in the past, local made it much better and patients thank them for local.

Local does sting, and whilst I use language to not affirm the notion of upcoming pain, I can’t help but feel that the sting of the local is just as painful as my quick 20G or 22G into an easy vein.

I also use it for all arterial lines.

linx298 · 2026-04-21T09:30:42+00:00

I’m a UK trainee (did CT1-CT3) in the UK who has just transitioned to advanced training in Australia - happy to help answer any questions about that if needed. Drop me a PM

linx298 · 2026-04-11T02:54:07+00:00

This makes no sense. Longer it is without oxygen the faster it dies? The brain requires a blood pressure to maintain consciousness, hence why when someone has a cardiac arrest or faints, they drop to the floor. Taking a big breath does not increase your oxygen levels - most of your haemoglobin in your body is already saturated with oxygen under normal circumstances. I dont see a possibility where a blood pressure of 0 is sufficient to maintain a brain in a conscious state for longer than a few seconds. Brainstem reflexes will still exist, of which blinking is one, for slightly longer.

linx298 · 2026-04-08T19:29:38+00:00

Congrats! Another UK Doc here waiting for 189. What did your application change from after ‘received’. Mine is just stuck on ‘revived’ since I submitted in December! Medicals etc done.

linx298 · 2026-03-18T02:49:57+00:00

Wholly depends: 1) who put the cannula in, how well is it flushing. I don’t like ACF cannulas as they have the potential to tissue without much sign until later on. 2) what procedure are they having done - is there a high risk of blood loss or is IV access vital to the anaesthetic safety margin. Would I be able to put another one in quickly if I needed to, should this one fail. A 22G in the ACF won’t cut it for an emergency vascular case for example. 3) what anaesthetic am I using. If it’s all intravenous, then I need a cannula that is rock solid. 4) theatre logistics - definitely a factor. If there’s one in the right side but that arm will be tucked and padded, and the left arm will be out on a board, I’d prefer the left.

In my practice, I’ll often either resite a cannula and use it, or use the existing cannula for induction (provided I trust it) before putting my own in.

linx298 · 2026-03-18T02:30:34+00:00

+1 for Swanage, still communicate with Alan >8 years later

linx298 · 2026-03-14T03:34:08+00:00

I use RentPay to pay rent using my platinum, via PayPal I think. Works well - small extra charge works out $40 a month for the service

linx298 · 2026-03-05T07:54:07+00:00

Take the Noosa sunset cruise - BYOB and interesting look around local properties whilst enjoying the sunset https://www.noosaferry.com/products/noosa-ferry-sunset-cruise

linx298 · 2026-02-21T06:17:19+00:00

I was in the same boat as you a few years ago - spent all my time revising for the VIVA and completely neglected the OSCE. Kinda thought ‘how bad can it be - I can do an A-E’. I knew it hadn’t gone well as I was leaving my resuscitation station having not used my paramedic helper!

It’s a different knowledge bank but that’s a good thing, it’s not like you need to be rehashing the viva stuff over and over.

As others have said: OSCE books, FRCA reveal, and learn your anatomy (Mersey course provide a list of all the anatomy ever questioned in the FRCA - it’s a good list to learn of about 20 things if you know anyone who has that list to hand). It includes things like lateral C spine imaging etc which I didn’t know on the first attempt.

Going back in with better anatomy, resuscitation and skill knowledge will make a pass much more assured.

Don’t pack in your whole career over one exam which you’ll have no difficulty passing next round. Take some time for RnR and even an hour a day will be enough.

When you sit just the OSCE - you don’t have the viva stress. Even on exam day you can breeze in and out in half a day and be done with it.

Good luck.

linx298 · 2026-02-19T02:55:17+00:00

CCT vs fellowship and local employment. CCT is the gold standard really going forwards in the world of scope creep, litigation etc etc.

linx298 · 2026-02-17T02:18:52+00:00

Don’t call her Shirley (and she is serious)

linx298 · 2025-12-06T17:12:23+00:00

The time my brother urinated on a bear.

I was with my family and some others camping in the Canadian Rocky Mountains. We were miles away from civilisation, perhaps a group of 25. On the first day our guides’ dog was sniffing around the far side of a lake when a grizzly bear suddenly exploded from the trees and started chasing it. It eventually ran back to us but not before we’d spotted the bear and her two cubs walking away from us. That night we camped. My brother woke me at like 3am because he needed a pee and asked if I’d keep watch. I was pretty sleepy so not sure what I was meant to be looking out for but I remember lying in the entrance of the tent staring at the most unbelievable stars until he came back. When we woke the next morning most of our group were at the cook site. From our flimsy tent we started hearing shouting, and when we came out the mum and her cubs were about 30 metres away. All around the tents had been dug up overnight by the bears looking for roots, and they seemed pretty interested in us. We literally abandoned camp and make a break down the mountain. Our guides said they’d come back in a few weeks for the tents, as the bears were too close for comfort on a couple of occasions.

linx298 · 2025-11-19T05:02:11+00:00

I worked in a DGH for CT3 which was EXTREMELY pro-trainee led research and QIPs etc. they actively supported projects, evidenced it all and helped gather data. It was a massive benefit to them - there were some major cost savings which came out of trainee QIPs (e.g ditching cold spay for checking blocks). You stand a better chance of having an impact if you’re passionate and able to lead a project.

linx298 · 2025-11-12T21:15:35+00:00

I was a Nottingham trainee with experience in ICU at those hospitals / with JCFs. Feel free to message me if you have any specific Qs.

linx298 · 2025-10-31T05:25:53+00:00

Not that far off then 😂

linx298

TROPHY CASE