James Cuell

@gasbagheera @nickopotamus Is this a scene from the eternal ‘Greenwing’?

@DrEilidhMaria @trentconsultant @OBrucey From the proverbial otherside, MRCP, does not provide generalist paediatrics. What serves you well is only a retrospective diagnosis. I’m not trying to preach, just attempting to aid. But I appreciate I am likely to be not helping in any respect. 🎤🫳

@DrEilidhMaria @trentconsultant @OBrucey And once on the other side (training so to speak), you have insight into the limitations of the current system, to aid it for the coming generations of medic to come. I am incredibly grateful of my general medical knowledge in getting both patients and myself out of ‘trouble’.

@DrEilidhMaria @trentconsultant @OBrucey general practice is maybe the last great bastion of generalist medicine, so try and see the trivial and irritating process before you as hopefully providing the future you the ability to contribute some real good when least expected.

@DrEilidhMaria @trentconsultant @OBrucey as an anaesthetist. Just having that itchy feeling at the back of your head because, ‘it’s just not right’ is often earned rather than bought. The best diagnosis is made in the library, but you need to provide the patient time to get to the library, metaphorically speaking.

@Drjoelpittaway @pjsouthall 2000’s boy band reunion?! Merry Festiveness all.

@willtube4food @Davidmarkpye Also sounds quite similar to liver transplant pts on dissection phase. Does your group have significant collaterals? Is there an enlarged splanchnic circulation? In combination with the hypotension, do they become coagulopathic? I often find this a feature of glycocalyx failure.

@willtube4food @Davidmarkpye Hmmmm, definitely SVR loss? We have started to get quite concerned with the large chemo loads our HPB cohorts are getting and lack of CVS reserve to big insults. ?NTProBNP PreOp to risk stratify?

Does anyone have a good explanation as to why patients with high grade ovarian cancer completely fall apart when the peritoneum is opened? Feels like the air hitting the abdominal deposits sets off some sort of huge cytokine storm.

@Drfattyliver @NadirAbbas_X @uhbtrust @Bham_HPB_LTx @unibirmingham @BirminghamBRC @NeilRajJ1 @jfergus75 @CholestasisDoc Would have loved to have been able to be present for this, alas in theatre. Could I have copies of the slides?

⁦@NadirAbbas_X⁩ at grand round ⁦@uhbtrust⁩ ⁦@Bham_HPB_LTx⁩ ⁦@unibirmingham⁩ ⁦@BirminghamBRC⁩. Assessing surgical risk in #cirrhosis. Challenging, but increasing clarity ⁦@NeilRajJ1⁩ ⁦@jfergus75⁩ ⁦@CholestasisDoc⁩ #livertwitter

@danny_mercer The ‘normal’ saline that is ‘normally’ prescribed for ‘normal’ patients. All fluid is bad fluid.

Every time I prescribe fluids I hear a certain nephrologist over my shoulder whispering “theres nothing normal about normal saline” And, dear reader, my 🖊️ hovers.

@pjsouthall You saw and signed a contract?!

@liveRPancSurg @davinia_bennett @johnrisaac @UHB_HPB @NChatzizacha @DaveCBartlett There are a whole host of factors in Marc’s statement that we just don’t have, and are not solely at the feet of ‘theatres’.

Incision at 08:45h sharp. 😔 @JamesCuell @davinia_bennett @johnrisaac @UHB_HPB @NChatzizacha @DaveCBartlett

@drohanlon @JKDhesi @BrianwDolan @betterageing @DrPhilipBraude Chicken or the egg? Preoperative baseline of patients? Rather than the effort after the event does this put more weight on ‘prehabilitation’??

After #surgery, walk walk walk Every 4 minutes of mobilization per hour was associated with fewer postoperative complications and with shorter hospital length of stay @JKDhesi @BrianwDolan @betterageing @DrPhilipBraude jamanetwork.com/journals/jamas…

@Pete_Labib @ucl Mazeltov!

@siobhanmckay @e_rangelova Is there any information on outcomes (morbidity and mortality) with patient factors? Frailty, multimorbidity, sarcopenia, nutrition? Some significant ‘complication’ / morbidity numbers in there……….

Vascular resection in pancreatic surgery by @e_rangelova ✅if expect a vein resection do a Catell-brasch so not limited ✅shorter length of vein resection for DP to prevent tension ✅arterial rx 5yr survival 40% ✅ TP with arterial resection to avoid. POPF #RACS23

@aneelbhangu @Assoc_Anaes @RCoANews @BJSurgery @BJSAcademy @DrJamesGlasbey @ASiTofficial I can go on, but it’s likely the devil is in the detail. However, as we often find, the thoughts and ideas are stymied by our limits in implementing them. ERAS full stop really. So in answer to your question, we regress to the mean

@aneelbhangu @Assoc_Anaes @RCoANews @BJSurgery @BJSAcademy @DrJamesGlasbey @ASiTofficial Well, the question ends up posing a number of other questions: 1. What actually happens perioperatively for anyone? Do patients get the observations required, ?portable constant monitoring. 2. A proportion of PCA benefit is the reduction of health care staff workload,

Question 🙋🏽‍♂️ Do PCAs reallyyyyy need those nasal specs If there’s too much opiate, does 2L O2 do the trick Or is it just another thing thing patient down and drying out their airway

@aneelbhangu @Assoc_Anaes @RCoANews @BJSurgery @BJSAcademy @DrJamesGlasbey @ASiTofficial Which inadvertently reduces the assessment of patients. 3. How much oxygen is enough for anyone at any time? 4. What is in the PCA - morphine? Fentanyl? Opiate + opiate sparing agent? 5. What multimodal analgesia have they had already ?spinal diamorphine and how long ago?

@DeirdreGodfray @sas_sobauk I do so hope so. Fashion is for now, style is for ever, not only in the sartorial sense but also in ones actions and demeanour. I don’t have role models but if I did, this chap sounds like one to have. Thank you sir!

@JamesCuell @sas_sobauk Well spotted. It certainly looks that way.

Seen a lot of senior con making unsavoury jibes at JDs and their IA. Be more like Mr Niall Aston. Lifetime of service, still on the LNC campaigning for the rights of others and also surgical SHO today. #JuniorDoctorsStrikes