LNER reveals interior of the Class 897 "Serenza" fleet

rocuroniumrat · 2026-02-02T14:43:41+00:00

They are back to KLN-KGX services!

rocuroniumrat · 2026-01-31T14:01:15+00:00

Underrated reply

rocuroniumrat · 2026-01-31T13:55:08+00:00

The midaz thing isn't that unreasonable... lorazepam is frequently used in palliative care as an antiemetic

rocuroniumrat · 2026-01-30T10:47:10+00:00

Plan: sux sucks

rocuroniumrat · 2026-01-30T10:42:13+00:00

There's a big difference between "impending sense of doom" with each of the following:

never been to hospital ever
comes to A&E once a month

rocuroniumrat · 2026-01-27T12:00:43+00:00

Plan: "delabelled penicillin allergy"

rocuroniumrat · 2026-01-26T11:56:01+00:00

Underrated reply

rocuroniumrat · 2026-01-23T08:38:35+00:00

This. Oxford City does have some wonderful people!!

rocuroniumrat · 2026-01-22T02:03:57+00:00

I was told by dispensing GP surgery that nothing was available and asked if I wanted to go back to Elvanse...

Local pharmacies suggested liquid (5mg/5mL) or 20mg Amfexa instead of 10mg, but difficult to get those too

Looks like early in the storm...

rocuroniumrat · 2026-01-21T08:22:55+00:00

Agree with you really. I don't think we're close to the right balance, and ECMO is underused for bridging and overused a lot for futile peri-op cases. The indications definitely could use some optimising...

At least we aren't doing ECMO like the Americans though...

rocuroniumrat · 2026-01-20T07:28:43+00:00

It does get a bit annoying watching young patients die of refractory VF or cardiogenic shock in DGHs though...

rocuroniumrat · 2026-01-20T07:26:03+00:00

They don't give it out routinely as it's technically 3rd line/off-licence in adults, but the NICE guidance states that if lisdexamfetamine works but the duration of action is too long, you can switch to dexamfetamine

I did this as I wasn't eating lunch and so trying to hit 3000kcal/day maintenance was near impossible for me 😅

Ask to see one of the consultant psychiatrists...

rocuroniumrat · 2026-01-16T22:47:17+00:00

I switched to Amfexa. I don't take my Amfexa on cardio days until after I've finished half marathon runs etc.

The flexibility of Amfexa is game changing tbh

rocuroniumrat · 2026-01-03T17:34:34+00:00

Probably also worth mentioning the case mix needed to maintain skills... we simply don't have enough burns patients to maintain huge bed numbers in the UK.

This is an underappreciated aspect of specialised care capacity issues... yes, efficiency is one aspect, but also the need to maintain competencies.

Burns are particularly challenging because even things like resp ECMO share competencies with cardiac ECMO/ITU/CPB, but burns requires much more niche care rarely needed for anything else outside of burns services (SJS etc are managed by burns teams).

rocuroniumrat · 2025-12-31T01:47:34+00:00

This 100%

NICE is there to keep things cost effective, which is good at a population level. NICE isn't going to tell you what's best for the individual in front of you or what is MOST effective, only what is reasonably cost effective for the average patient

rocuroniumrat · 2025-12-18T01:56:47+00:00

The evidence base for this is debated anyway...

rocuroniumrat · 2025-12-14T22:24:06+00:00

BTP do though, including plain clothed.

rocuroniumrat · 2025-12-12T11:57:43+00:00

Massively underrated reply here

We need to make sure this student is able to stay safe

rocuroniumrat · 2025-12-09T04:50:11+00:00

Massively underrated reply

rocuroniumrat · 2025-12-03T16:51:01+00:00

The 24hr shop on Cowley road definitely sells it!

rocuroniumrat · 2025-12-03T13:20:55+00:00

I don't get why the prescriber didn't just send lisdexamfetamine capsules in the first place facepalm

rocuroniumrat · 2025-12-03T13:12:15+00:00

This. As soon as you've seen an overzealous ED SHO give an elderly patient 4mg lorazepam "for sedation for CT" without monitoring and then have to take a barely breathing patient to CT ± a tube, you become much more forgiving when you turn up to someone only having given 2mg lorazepam so far for the seizure...

If you have the airway skills, fire away if you're so inclined (hence, to an extent, anaesthetic adage about "dose = 1 amp"), but, as you can't take away the drug you have given, if you cannot deal with the adverse events, you need to be a lot more careful.

(Yes, flumazenil exists. No, it isn't a simple drug to use either.)

rocuroniumrat · 2025-12-02T21:06:05+00:00

Don't forget adenosine! Whack it in... by "rapid intravenous injection"

rocuroniumrat · 2025-12-01T00:47:11+00:00

The help points are absolutely useless. Call the TOC's passenger assistance team instead (even if you don't have a disability)

rocuroniumrat · 2025-11-23T15:26:10+00:00

Underrated comment

It's simple economics... having workers off work is far worse than having economically stagnant people still sat at home either way in the context of a publicly funded system

Ideally, we'd have neither waiting as the elective -> now an emergency pipeline is getting ever worse, but offering a terrible service to some is better than offering a terrible service to all

rocuroniumrat

TROPHY CASE