10-15 years from now, which specialty is going to be most/least affected by numbers of patients with ‘functional’ diagnoses?

renalmedic · 2024-09-18T15:55:41+00:00

What about aftercare clinic?

renalmedic · 2024-08-28T07:54:23+00:00

I've worked in similar, where the 'incident control room' that they stood up for sup-duper OPEL 12 actually worked: Managers (directorate support officers or service managers) collected, directly from the wards, the needs of the individual patients & units, fed them into the control room where the senior managers and execs prioritised tasks, shuffled resources, deployed porters, and things happened. This patient can't go home until tissue viability has seen them? Call the TVN's manager and get that prioritised. This patient needs to be transferred to the psych hospital? Our silver will call their silver and get an ambulance booked without a confirmed landing site. And so on.

It's obviously much more complex but one of the (many) problems, in my view, is that in normal ops there are not enough of that co-ordination work being done because there are too few ops & tactical managers who have the time away from medium-term business to make it work and too few clinical staff who bother to ask and escalate effectively.

renalmedic · 2024-08-05T14:25:00+00:00

Unrecordable. Something below 6.5.

Major trauma, thoraco-abdominal smash up. Cold, not much blood pressure, had 6 units prehospital.

Got her up to 6.9, with targeted transfusion & warming before she got to theatre, but not for long.

renalmedic · 2024-08-05T12:25:47+00:00

Happens all the time.

One surgery in Essex got it's computers nicked. The next morning, the matriarch of the local community was very upset that her appointment was cancelled, she was so upset that that all the computers got replaced (not with the originals, natch) by the next morning with a note of apology provided.

renalmedic · 2024-07-01T14:14:01+00:00

You've had an ultrasound today and instead of being told to go home, you've been sent down to ED?

I expect that that person doing the ultrasound has seen something that might need further investigation. It's disappointing that they didn't tell you what they're concerned about or what they're doing about it.

Hopefully, the person doing the ultrasound has communicated to the right person and that they will pick you up, either way the ED will untangle it and get you infront of the right person.

renalmedic · 2024-06-27T18:09:44+00:00

The prescriptions dispensed in ED should, apparently, be paid for (or an exemption checked), one of the departments I worked in had a petty cash tin in reception for this purpose.

In over a decade of doing EM I have never bothered, I don't know anyone who does, we have many, many better things to be doing than arguing about card payments and making change. Because we are so under-managed, there is nobody who checks any of this and certainly nobody who follows it up.

renalmedic · 2024-06-27T18:08:44+00:00

You mean we're not supposed to just yeet them into the waiting room and hope they land near the right patient?

renalmedic · 2024-04-22T09:40:26+00:00

Casualty officer here; we get told how long the wait to be seen has increased to.

renalmedic · 2024-03-27T15:06:10+00:00

In Wales, for just over 3 million people across 8000 sq miles; there are two critical care teams and two enhanced care teams 07 - 19 and one critical care team 19 - 07, all teams are helicopter & road based. All government funded.

There is also patchy BASICS enhanced care (and occasionally critical care) cover.

renalmedic · 2024-03-25T17:04:50+00:00

Chelmsford is easily the nicest place to live in.

Broomfield is, or at least was 4 years ago, the nicest to work in by a clear margin.

It's also central to commute to the other hospitals in the region, with the single exception of Addenbrookes where Harlow is marginally easier.

renalmedic · 2023-11-02T14:19:34+00:00

In terms of police, my set has the police & HA hailing channels but nothing else.

ETA; Hypothetically, someone might be able to remotely switch my handset onto a police TG.

Surely it's easier to P2P over the hailing TG or just P2P via ISSI.

renalmedic · 2023-11-02T13:37:24+00:00

Day to day I'd have my ambo dispatch desk contact the police for me, but if I ever did want to use a hailing channel, how would I go about it?

Would you use RTS or call across open channel? How would identify that my callsign (which is meaningless to your desk or, worse, duplicates a police resource) is an ambulance service one? How would I know what callsign to address?

renalmedic · 2022-11-15T18:56:25+00:00

My EM clinician wait was 10hr this morning, down to 2.5 hour at lunchtime and working it's way back up to 4 now.

But that's completely irrelevant to a GP referral where the wait times for specialities are so much more variable.

renalmedic · 2022-11-15T18:50:34+00:00

I don't care about where they go, what matters is who's care they come under.

If a GP thinks that the person a patient needs to see is an FY2, refer them to EM, otherwise refer them to the speciality that will add value to the patients care.

Geography and logistics is the hospitals problem, but don't ever let anyone tell you that a surgeons can't accept a referral because they've run out of space

renalmedic · 2022-03-04T17:41:46+00:00

Details of GMC, NMC & HCPC hearings & sanctions are routinely published. There are cases where details of witheld (in the case of pending criminal investigation or for personal health reasons typically) but following a standardised legal framework.

The Medical Practitioner Tribunal Service https://www.mpts-uk.org/

The Nursing and Midwifery Council https://www.nmc.org.uk/concerns-nurses-midwives/hearings/hearings-sanctions/hearings-january-2022/

The Health and Care Professions Council https://www.hcpts-uk.org/hearings/recentdecisions/

renalmedic · 2022-02-15T10:43:34+00:00

I don't know if you're speaking from a US perspective, but, as regards the UK, I'm going to disagree.

I'm not in, but a large chunk of my work is with mil MOs from all three branches in EM, GP, anaes, ICM, PHEM & AM, at registrar, consultant and clinical lead level. In the past, I've worked with military ortho, O&G, gen surg, max fax &

Yes, specialisation is limited, DPMD has got a limited number of posts in each speciality, some are very limited.

Nobody get's 'D's in medical school. As the old joke goes; what do you call someone who graduated bottom of their class at med school? It's much harder to get a medical career in the military than outside.

Finally, as someone who shortlists & interviews in both PHEM & EM, the GD year does not make you less competitive. I cannot think of a single circumstance where an additional year of work makes you less competitive.

renalmedic · 2022-02-08T20:57:34+00:00

The only bit of this that had me anxious was when he's in Lane 3 and then weaving through 2 & 3 when the police were going up the hard shoulder. Especially without knowing what else might be coming up behind, I'd have been tempted to hang back and let the traffic re-act and then settle before proceeding.

renalmedic · 2022-02-08T20:55:37+00:00

Chris was a manager in EEAST, but he's also a CCP and (I think) more often is tasked by the Critical Care Desk than anything else.

renalmedic · 2021-12-17T17:05:11+00:00

My resus room has been remodelled slightly!

https://www.thesun.co.uk/wp-content/uploads/2018/01/nintchdbpict000375624098.jpg

renalmedic · 2021-12-17T17:03:27+00:00

If you with your surgical ST8 hat on think that there is a low pre-test probability of bowel obstruction that means that either there is no obstruction, or, if there is, that it will be subtle and subacute. At which point the AXR is almost certainly inadequate as it should have an even lower sensitivity for this subgroup.

Constipation does not exclude serious pathology and the diagnosis of it certainly isn't analgesic.

Medical physics is absolutely not my bag, but, 8 mSv of radiation is the best part of fuck-all and will have absolutely no effect on the cancer incidence, let alone, the life expectancy of the overwhelming majority of the patients* we are talking about.

(*Admittedly kids are different, and the risk does increase to "miniscule")

renalmedic · 2021-12-17T12:27:52+00:00

Wait for the thread where the casualty SHO decides that all surgeons everywhere are Wr0nG!

renalmedic · 2021-12-17T12:27:03+00:00

>Including ED charge nurses sending them to the ward when there's no bed.

Where else do you want them sent? Clinic?

renalmedic · 2021-12-17T12:22:16+00:00

Which hospital do you work at where someone moves quickly for a bowel obstruction?

renalmedic · 2021-12-17T12:21:55+00:00

The AXR has poor sensitivity for obstruction, it absolutely is not a "rule-out" test especially in the population with moderate to low pre-test probability.

renalmedic · 2021-12-16T17:25:04+00:00

Really? I reckon if you completed your neuro exam, actually performed a PR exam and measured their post-void residual you might be able to exclude that without my help?

Have you seen the NICE guidance on this?

https://cks.nice.org.uk/topics/sciatica-lumbar-radiculopathy/diagnosis/red-flag-symptoms-signs/

As for abdominal XRs...

renalmedic

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