Richard Bauld
4.3K posts
@nickmmark I’ve never convincingly seen it outside of a patient who has begun the process of actively dying. Or, fulminant hepatic failure. I do stop RCA and move to heparin with multibic if severe acidosis doesn’t resolve or appears.
RCA induced metabolic alkalosis, not uncommon.
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I’m curious about people’s (aka nephrologists & intensivists) experience with regional citrate anticoagulation in liver disease.
How often you ever see anion gap metabolic acidosis due to impaired citrate clearance?
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@jabberwock951 I was once shouted out my a stroke consultant, over the phone because I could only tell them what the patient’s GCS was. He told me that he had no idea what “a GCS” even means.
The patient was intubated in a Neuro ICU having just been transferred in from another hospital.
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I once had a stroke referral rejected twice for "incomplete neuro exam" until I finally snapped and wrote 'neither myself or the SHO can think of anything else to add to the neuro exam, perhaps you could either be more specific or come and review the pt.'
Dr Hannah Lunch 🇮🇪🦀🇵🇸@DrHannahLunch
I referred a patient to the stroke nurse today and she said “oh by the way, the consultant read your notes and said you did and documented a perfect neuro examination. I think that’s the first compliment I’ve heard from Dr X” SORRY? A compliment from a STROKE physician????🤯
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How did I not know there are neo-noir crime books set in the Warhammer 40k universe?! @techpriest
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@AnahitaS @IBBI_2501 I’m a fan of curbsiders, though their intro is well known for being quite long. I enjoy it, but if I remember rightly they put the timestamp for when the intro stops in the show notes so it’s easier to skip to.
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@IBBI_2501 Clinical Problem Solvers & Curious Clinicians! Got some others on the radar too (Core IM, Curbsiders) but haven't started them yet. Lots of good UK based recs too :)
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@Dr_ErinLS A colleague of mine, many years ago, told me that she had the opportunity to do this. Never did. Regretted it for the rest of her career.
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There's a tiny voice telling me to consider using an "F3" year (or 2) to study music at one of the conservatoires. Maybe Birmingham or RCM. It would be crazy to even consider auditioning, right?
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In my semi retired state i decided to go watch a movie. TBH i couldn’t be bothered with coordinating with ppl to watch it so went on my own. Is it weird to watch a film solo?
Overall, really nice experience.
Beetlejuice Beetlejuice was mediocre though
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@EmergencyBod The “first blood” original book is an excellent, if difficult read. For this very reason.
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The original ending to First Blood had Rambo shot dead.
Stallone knew this was a terrible idea and threatened to walk away from the entire project because he knew the message of hopelessness would exacerbate the suicide epidemic amongst veterans.
#SuicidePreventionMonth
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@issypips Yeah, it’s pretty much disapproving nods for ever. Very occasionally it becomes more emotional:
GIF
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Do people ever forgive you when you don’t pick their specialty? Or is it disapproving nods across corridors forever? Asking for a mate
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Honoured to have been a collaborator for this worthwhile description of the use of echo in UK ICUs
Luke Flower@LukeFlower1
Very happy to share our first paper from NEAT-ECHO published in @yourICM. 🏥 178 ICUs & 1015 shocked patients 🫀 54% received an echo 💉 50% of echos altered management 📋 25% followed guidelines @TRICNetwork @ICS_updates @FICMNews @BSEcho @ICUDocAP link.springer.com/article/10.100…
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Amazing. Because my openathens account is linked to my NHS Scotland email account for login, every time I log in to download a pdf I’m forced to go through Edge. Which because it’s linked to my work account means I can’t download the pdf to my phone, only the OneDrive.
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@critconcepts @Thind888 Our V800’s need air and o2 source, otherwise can only deliver 1.0 o2. The oxylog transfer vents don’t need an air source.
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@Thind888 I’m pretty sure our Dragers don’t need an air source
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@LukeAmos__ When I worked only via adhoc locums I set up an excel spreadsheet that would calculate what I was expecting for each shift. Would be paid via several different health boards so each needed their own tax code, etc. Helped to make sure I wasn’t under or overpaid.
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If you prevent AKI but don't lower length of stay, mortality, use of dialysis, or prevent long term decreases in GFR have you actually done anything? #NephJC
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@TharushaGunawa4 @hasyourregtried It appears to have been a real thing
atlasobscura.com/articles/objec…
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