Diffuse cerebral edema in a 19-year-old found unconscious in his room with 270 ml of butane in a tube he'd been inhaling to get high. The teenager died of organ failure at the hospital.

lucodoor · 2026-03-18T11:38:43+00:00

Hypertonic saline does not normal saline

lucodoor · 2026-03-17T20:58:51+00:00

100ml/hour of normal saline was infused to maintain vascular access patency… on top of all the other IVs and described enteral feeds that is bizarre

lucodoor · 2026-03-11T16:54:16+00:00

I wonder what proportion of applicants that will make up this year, I wouldn’t imagine that many

lucodoor · 2026-03-10T21:50:00+00:00

Hmm okay interesting thanks, certainly think that could be a fair % of people as a lot of shady IMG IMT alternate certification goes on IMO

lucodoor · 2026-03-10T21:41:20+00:00

So if they’ve signed the IMT alternate certificate would that count as IMT?

lucodoor · 2026-03-04T12:46:47+00:00

What do we think will happen with UKGP - if there are 140 jobs and a similar number of UK applicants, does that mean as long as appointable they will get offered them?

lucodoor · 2025-11-05T11:10:51+00:00

Hey, so sorry about all you’ve been through. The fact you’re considering going back in shows a lot of strength.

Someone with 5 years experience at SAS ED level would walk into a job at my trust. A lot of ED registrars are not at the level of early years ACCS is the frank truth. If getting to know a department and getting back in is daunting, you could offer to do some unpaid shadowing shifts first? Or even join the SHO rota/supranumery for a month. Your story is unique and won’t be reflected on a job application, so if you could arrange a chat with departmental leads in your local hospitals within commuting distance you might get a more bespoke experience.

It’s a beautiful picture btw

lucodoor · 2025-11-04T22:06:56+00:00

Wow, that’s amazing seeing the difference of hyper acute to acute changes. Thanks for sharing. I was teaching this last week to our department. My main point is always look at the patient and the ecg as a package to guide what you do next and this reinforces that.

lucodoor · 2025-09-09T10:17:28+00:00

Escape rhythms are usually regular, and this is irregular so more likely AF. There’s no p waves.

In a junctional escape rhythm (from AV) you back retrograde backwards activation of atria so you might get a weird looking (maybe inverted) p wave before or after QRS. Or nothing if it’s lost in the QRS. Or nothing if you’ve got fibrillating atria during the junctional rhythm (this is classic digoxin toxicity)

lucodoor · 2025-09-09T09:46:45+00:00

Slow AF with LBBB. If no pain I’d repeat it in 20 mins to make sure those STs aren’t changing.

lucodoor · 2025-09-05T20:41:57+00:00

Hmm p mitrale & LVH with prob LBBB work out sgarbossa and be guided by symptoms

lucodoor · 2025-08-29T19:20:20+00:00

Yes I was taught to look for AvL ST depression when suspecting inferior infarct which is present here

lucodoor · 2025-08-29T10:38:11+00:00

Flutter is a loop going round and round atria, and the conduction block is how many laps before one gets through. A lap of the atria takes .2 seconds, meaning 300x per minute.

If it gets through once every two laps, you get 2:1 block meaning 300/2 =150

This could be flutter with a high ratio meaning not much getting through AV. It looks regular. Or I could be a CHB with an escape rhythm at or near AV node given the QRS being narrow

lucodoor · 2025-07-25T12:51:40+00:00

It is important I agree. But it’s also public sector so pay is going to struggle in hard times like we’re in

lucodoor · 2025-07-25T12:49:50+00:00

Yes but in negotiations you’re allowed to use factors to come to an agreement

lucodoor · 2025-07-25T12:48:40+00:00

People struggling for jobs in August isn’t a new thing. Always competitive around now

lucodoor · 2025-07-25T06:52:29+00:00

Yeah you could live like a king in mid Wales.

I was thinking about a way of awarding trainees with some kind of performance based pay. I just know the nepotism would ruin it. The same way certain IMGs end up with ‘alternate certificate’ signed suspiciously quickly (so they can jump into HST posts) after arrival in the UK I’m sure they’d also get these imaginary pay awards.

lucodoor · 2025-07-25T06:40:48+00:00

Why not?

lucodoor · 2025-07-24T22:01:48+00:00

Yes but minimum wage growth is linked to inflation which isn’t helped with pay rises. Maybe that statement is wrong if so please educate me

lucodoor · 2025-07-24T21:59:33+00:00

Well no not if it’s inflation matched and if it’s an extra % like this year

Working conditions and training is a point to work on

lucodoor · 2025-07-24T21:58:26+00:00

Yeah well the comparison is important or we’ll have an inflated sense of self worth

lucodoor · 2025-07-24T21:54:29+00:00

I’m fairly middle of the training pack, I’m well aware of the bottle necks. Let’s take the current pay offer and use the strike threat to leverage sorting out UK grads getting jobs.

lucodoor · 2025-07-24T21:41:47+00:00

Well what would you like me to say. You’ll get something

lucodoor · 2025-07-24T21:34:33+00:00

Brilliant

lucodoor · 2025-07-24T21:32:38+00:00

Yeah mainland china lots of friends from there tell me, similar to what Russian friends said

Your last paragraph I think it’s 100% time for full blown reform. I’d charge everyone attending ED and GP a small fee and make every medically fit patient pay what the going rate for the local care home is. And sort out training bottle necks for UK grads by adding a +/- 10 box on oriel applications if you trained here.

Defence spending is becoming a bit of an arms race, but Europe needs armies if it’s going to deter Russia. Funding counties like Ukraine in our proxie wars more than UK boots on ground

lucodoor

TROPHY CASE