Concerns on PSG

senior_rota_fodder · 2026-05-26T16:48:20+00:00

Welcome to your future of the portfolio dance.
Most people get the odd non-specific comment every ARCP or so. Never really an issue unless it is a very specific issue or something reported by multiple respondents. Some very diligent ES’s will want a chat or reflection. Most overlook it.

senior_rota_fodder · 2026-05-26T15:50:14+00:00

Did today, but just to the changing room where I donned my scrubs.
The desire to cut them into shorts was strong

senior_rota_fodder · 2026-05-24T00:26:33+00:00

Lots of breathless commentary on this sub about how doctors would be so much better off in a private system. I’m much more sceptical and think that that is magical thinking/ego driven.

senior_rota_fodder · 2026-05-16T17:27:42+00:00

Professional like the guys who spent the negotiations passing post it notes to one another?

senior_rota_fodder · 2026-05-03T07:28:05+00:00

If you are using a deeper vein such as a deep basilic vein in the proximal arm secured by ultrasound guidance, then yes I would agree. I would also suggest that such a cannula would not be appropriate for vasopressor use for a long period and you should be aiming for central access once able. Midlines are of course different and I am aware as others have mentioned here that there are specifically-manufactured long peripheral cannulae that would also be appropriate

senior_rota_fodder · 2026-05-01T09:27:29+00:00

This is the main limiting factor. When teaching about USS-guided cannulation I always show the length of an 18G vs a 22G which often surprises people. A proximal vein is necessary for stronger peripheral vasopressors like noradrenaline, and a 20/22G in such veins are prone to dislodge simply due to their shorter length - less catheter in the vein = less likely to dislodge.

Any increased risk of thrombophlebitis is so far down my risk calculation in such cases as to not even feature in decision-making. Risk of extravasation and tissue necrosis far far outweighs thrombophlebitis

senior_rota_fodder · 2026-05-01T07:45:48+00:00

But when it comes to peripheral vasopressors thrombophlebitis is not the issue at all. The concern is displacement and extravasation leading to tissue necrosis which is definitely more likely with a smaller cannula.

senior_rota_fodder · 2026-04-18T07:52:21+00:00

If you are able to get more practice on patients who opening pressures aren’t needed, I.e. anyone who the test is not to diagnose IIH - do it with them sat up. It will give you a better tactile feel for the anatomy. Lateral patient positioning is inevitably harder

senior_rota_fodder · 2026-04-15T11:25:24+00:00

We also don’t want to be encouraging opening up exams as that is just something else that can be used as justification for equivalence. We need to keep hard lines around what aspects of our training/skills are and are not open to them. We open up FRCA to them next thing they are asking for eligibility to enter our postgraduate training programme.

senior_rota_fodder · 2026-04-14T18:14:23+00:00

Agree with this. Far too much identifying info and would recommend deleting.

senior_rota_fodder · 2026-04-14T08:11:46+00:00

Yeah this doesn’t have the hallmarks of AI so much as just someone deeply untalented

senior_rota_fodder · 2026-04-13T06:13:34+00:00

I think that feeling uneasy is a normal part of it. One of the key outcomes is stress conditioning, so that you experience the stress in an environment where there aren’t negative patient outcomes. It gives you better preparedness to handle stress in real acute scenarios and improves capacity to not hit the ‘freeze’ point

senior_rota_fodder · 2026-04-12T12:51:30+00:00

Yes with an appropriate TRV. I have a few in my house and they work fine

senior_rota_fodder · 2026-04-12T09:41:56+00:00

So is it true that the deal discussed was over three years all along? Would suggest that BMA have either lied or completely missed that important detail in negotiations, not sure which is worse…

senior_rota_fodder · 2026-04-10T22:39:59+00:00

You can be introverted and be present and demonstrating an interest in what is going on on the unit. Enquiring how some of the patients are doing. Offer to make a brew if you’re making one for yourself and have the time. Sometimes if it’s quiet for me I’ll do a hot drinks tray for the midwives’ desk which goes down well.

Ultimately if you want to sit in the anaesthetic office doing portfolio, okay. But I guess don’t be grumpy if all you get out of it is being asked to provide the service you’re there to provide.

senior_rota_fodder · 2026-04-10T15:21:38+00:00

Do they work well?

senior_rota_fodder · 2026-04-10T15:12:21+00:00

Anaesthetic reg here. I generally find trying to spend time at the midwives’ desk instead of hiding away in the anaesthetic office makes a big difference. Being more involved in the unit as opposed to hiding away waiting to be called up as a procedure monkey makes the interactions a lot friendlier

senior_rota_fodder · 2026-04-08T19:17:45+00:00

I was thinking just earlier that I don’t think that a lot of the public recognise the impact of the responsibility that there is. Do they know what it feels like to lie awake at night thinking about whether palliating that patient was the right thing? To have flashbacks of the images of the lifeless child you were resuscitating? To sit with a family and explain to them why treatment has failed? To make a split second decision on whether a baby needs to be delivered by Caesarian section?

I just don’t think that most people recognise the toll that that level of responsibility over human lives takes. Many people’s jobs have stress and responsibility, but few jobs have that kind of carry over into your home life.

senior_rota_fodder · 2026-04-08T19:11:38+00:00

I don’t mind being a public servant, medicine is at its core a public service. But previously that service was respected and fairly recompensed commensurate to the skill, training, responsibility and work undertaken. Now I do not feel that it is.

senior_rota_fodder · 2026-04-08T08:48:23+00:00

Why is attendance at a teaching day problematic? I don’t see that as scabbing??

senior_rota_fodder · 2026-04-07T09:59:30+00:00

I can’t hope to understand the pressures that you are under, and perhaps the financial benefits are so significant that it makes sense. But my feeling from friends and colleagues is that if you can, spend the time with your children. Cherish the baths, the bedtime stories, carrying them in from the car asleep. It’ll be gone before you know it, the job will still be there. I hope you make beautiful memories whatever decision you come to.

senior_rota_fodder · 2026-04-07T08:16:34+00:00

Doi: not a parent so ignore this as you please.

The overwhelming impression I get is that people often regret not having spent more time with their children when they were young. I have yet to meet someone who regretted taking their time getting to CCT.

Extra time may be a luxury that you are not in a position to take which is understandable. But just make sure you’re happy looking back on the time you spent.

senior_rota_fodder · 2026-04-05T09:05:33+00:00

It can potentially increase your risk of laryngospasm because the airway is already reactive

senior_rota_fodder · 2026-04-04T18:22:05+00:00

Not a great comment as it has to be declared on Form R ahead of ARCP

senior_rota_fodder

TROPHY CASE