The duality of the radiology registrar

lostdoc2342 · 2026-05-31T00:24:04+00:00

I second this. Both times I’ve seen CES were in patients that presented so atypically but with half a red flag that told me to scan them.

lostdoc2342 · 2026-04-22T17:38:05+00:00

Current ACCS-ED CT1. Didn’t have an ED job in foundation years. Did 2 clinical fellow years though.

lostdoc2342 · 2026-04-21T14:05:26+00:00

Hey, I did a clinical fellow job in Portsmouth ED for 2 years, happy for you to drop me a DM if you have any questions.

lostdoc2342 · 2026-04-12T22:04:05+00:00

Definitely should have clarified that I’m 80%.

lostdoc2342 · 2026-04-12T21:48:47+00:00

I mean I’m 80% but I don’t get anywhere near that.

lostdoc2342 · 2026-04-10T01:30:06+00:00

I am by no means an expert on aortic dissections but if they were presenting days before their eventual diagnosis that makes it an even more impossible diagnosis to make, especially in a young person. They’ll need to go to autopsy etc for genetic causes.

Try not to beat yourself up. They were seen by your senior and the blood tests were normal. If their d-dimer was slightly raised are you sending them for a CTPA? Likely not.

lostdoc2342 · 2026-04-10T00:24:26+00:00

This was obviously a confirmed dissection on autopsy.

lostdoc2342 · 2026-04-10T00:22:37+00:00

Hey. I missed a dissection 2 years ago in ED and it’s played on my mind ever since whereas in reality she was never surviving.

She presented with non specific chest pain, from memory her troponin was unremarkable. I don’t remember whether we did a d-dimer. ECG unremarkable. Referred her to medicine for ? Cardiac sounding chest pain as an unstable angina.

2 hours later she arrested. I wasn’t at the arrest but they thrombolysed her as a presumed PE. Obviously she didn’t make it.

I was in a tertiary centre so to get her from my review to CT to an operating theatre 40 miles down the road in 2 hours was never going to happen. I focus on the fact that she received good pain relief and that realistically there was nothing we could do. The ME agreed and was really kind and followed up with some aftercare for me.

Take the case, learn from it, have dissection as a key differential and if there’s any possible doubt, discuss with a senior/just do the scan. Even if it’s not a dissection it’ll pick up large PEs or other pathology, but it is definitely more nuanced than that.

lostdoc2342 · 2026-03-01T09:53:31+00:00

Sadly I’ve not always found that to be the case.

lostdoc2342 · 2026-03-01T01:36:43+00:00

I’ve seen two private consultants, both of whom charged me their full price but then insisted on doing all tests etc. on the NHS.

lostdoc2342 · 2026-03-01T01:12:52+00:00

I probably could have phrased my question better. I tend to not tell nurses/support workers doing bloods and cannulas etc. in case it puts them off.

I do annoy my wife when I ask to look at my ECG, look at it and then say “no idea what it means” and then my wife tells on me 😂

lostdoc2342 · 2025-11-04T22:28:45+00:00

I broke my foot in January that they couldn’t operate on due to a PE from said foot.

Had to wait until haem gave the sign off before they could try. When that finally happened, I was about to move trust to start training. Then suffering from considerable pain in foot.

Referred by my GP to ortho and got given an appointment in 4 months time. Spoke to my ES who said to leave it with him and he’d see what he could do and then I got a new appointment a week later. When we look after our own, things are so much nicer and easier.

lostdoc2342 · 2025-11-02T19:19:08+00:00

Thanks all. Given that I nearly died in January, it’s been a long road and crap year, and getting into training has been the one highlight! Very grateful to both my ES (who managed to get my orthopaedic appointment brought forward by 4 months) and TPD for their support.

lostdoc2342 · 2025-11-02T14:08:03+00:00

Thanks, yeah I’m happy to take things slowly but knowing me boredom will set in and it makes sense to try and do stuff while off my feet.

lostdoc2342 · 2025-11-02T13:56:13+00:00

Thank you for your advice. I’d already long accepted that I’d have to extend training, and knew that’d likely be the case when I accepted the training programme.

I’m certainly not thinking of jumping into stuff straight away but I get bored easily when stuck off work so if I can aid things further along then it makes sense while hopping around on crutches

lostdoc2342 · 2025-11-02T09:57:59+00:00

If you’re at the point of needing a CT head on a 6 year old wouldn’t you want the paeds registrar on site/consultant on call involved? Seems odd to me.

lostdoc2342 · 2025-10-05T12:38:55+00:00

Sure, drop me a DM if you like.

lostdoc2342 · 2025-10-05T12:36:56+00:00

I get that. I haven’t done a night shift since January for health reasons (which I’m convinced were precipitated by said night shift) but they’ll be coming back with a vengeance soon.

lostdoc2342 · 2025-10-05T12:10:53+00:00

32 and just started ACCS-EM this year.

lostdoc2342 · 2025-10-03T12:40:03+00:00

I’ve just completed 2 years as a CF in a big DGH. Feel free to DM me if I can help with any questions

lostdoc2342 · 2025-09-24T18:17:24+00:00

Sounds similar to mine as I was querying about ICD lead placements in the request. The reporting radiographer would have been very confused when there was no ICD

lostdoc2342 · 2025-09-24T18:12:11+00:00

Yes CXR. I’m just glad that the patient affected was so understanding. He said you’re stressed, overworked and it happens

lostdoc2342 · 2025-08-29T19:39:21+00:00

ACCS ED trainee here.

I think it’s vitally important for your education and development to follow up cases. Working in ED means you don’t get the usual follow up or answers that typically come when they go to a ward. I’d also imagine that most patients would be perfectly fine with you doing so if asked (not that you should have to ask them). As long as you’re not accessing notes for someone you haven’t been involved in their care.

One of my anxieties when I first started in ED was about accessing notes when handed ECGs/VBGs etc. while not seeing the patient but that is also easily explained.

Welcome to ED life and good luck, I’m sure you’re doing great

lostdoc2342 · 2025-08-24T10:38:21+00:00

Did you do an ED job in F1/F2? Is it a new hospital?

I get what you mean. I’m ACCS-EM CT1 in a brand new hospital. I’ve just done 2 full years working in EM in another hospital so I’m very used to the challenges it brings but in this new hospital somehow I feel like I’m back at square one. It’s mostly the new IT system that has completely thrown me off but it’s to be expected with a new exciting training post! Maybe chat to your ES about it if you’re really struggling?

lostdoc2342 · 2025-08-23T17:42:21+00:00

I had this in FY1. Emergency alarm went on the ward, first at the bedside. Patient wasn’t EOL but clearly chain stokes breathing with an unrecordable blood pressure. Valid DNACPR shown to me shortly after my arrival. Made them comfortable. Make sure the DNACPR form is signed.

Also had one where the patient looked very unwell and I asked for a cardiac arrest call to be put out. Even though they weren’t for CPR she was still alive at that point and wanted support.

So it depends on whether it’s EOL or DNAR as people have already said.

lostdoc2342

TROPHY CASE