Al May

@Steve_Coppens @WHarropG @BelgianBara @RegionalAnaesUK I use the example Right is correct and incorrect is wrong to open conversation about communication and standardised language

Can't stop laughing @WHarropG @BelgianBara @RegionalAnaesUK 🤣😂🤣😂😂🤣😂🤣

@coollyndz @VCIproject I agree CL grade is virtually useless when graded on video of VL- which is why I document VCI

@TheRealAlMay @VCIproject Didn’t say that. Not sure documenting grade is the most important thing tho as that is intubator dependent.

No.

@coollyndz @VCIproject That’s literally what VCI score is

@coollyndz @VCIproject It doesn’t matter what blade used, how much of the hole you saw and whether it was easy or difficult to put the tube in it?

@TheRealAlMay @VCIproject Because it doesn’t really matter?

@coollyndz Genuinely not getting why VCI isn’t used more widely @VCIproject

I should probably explain. Sure use the C&L grade and write it on the chart. Yeah whatever, everyone will get a slightly different view. What I want to know is: 1. Did you get the tube in? 2. How did you get the tube in? (And were you able to BVM?)

V interesting study out of Brisbane, revising previous estimates that suggested sugammadex hypersensitivity could be as high as 1 in 2,500. Crimmins et al. found in their data the incidence was 5-20 times less common (95% CI). → metajournal.com/articles/17640…

@coollyndz VCI score surely? Not CL

@NicholasChrimes @doctimcook @anaes_spr @BJAJournals Yes exactly. But work as done 2 person check is the reality. A 2 person check is 2 one person checks but in practice i don’t think that happens as often as it needs to be effective (in general).

@TheRealAlMay @doctimcook @anaes_spr @BJAJournals I don’t think the issue is as simple as whether 2-person checks improve safety. You have to examine how the 2-person checks are conducted. For example 2-person drug check of “Is this morphine?” is very different to “What is this?”.

TWO PERSON CHECKING TO LESSEN RISK OF OESOPHAGEAL INTUBATION is feasible & acceptable Great to see this paper in early access in @BJAJournals A simple feasibility study supported both 2-person checking of capnograph trace (sustained exhaled CO2) & 2-person checking of videolaryngoscopic view at intubation by intubators and assistants This is in line with #PUMA guidance @clokeetdagger @Fionafionakel @elboghdadly @dr_imranahmad @t_potter_1 @RUHBath @GSTTresearch bjanaesthesia.org/article/S0007-… 1/7

@JoannaCoates1 @Anaes_Journal @NAPs_RCoA @RCoANews @JerryPNolan @jas_soar @adk300 @IainMoppett @drrichstrong @emirakur @doctimcook In many cases suspending DNACPR just means you don’t do CPR based on clinical judgement, instead of based on DNACPR. To me the function of DNACPR is to avoid a harmful intervention when someone who can make that decision isn’t standing right next to you with all the information

@Anaes_Journal @NAPs_RCoA @RCoANews @JerryPNolan @jas_soar @adk300 @IainMoppett @drrichstrong @emirakur @doctimcook I discuss with each patient, but, in general, why would I reverse a DNACPR? What better way is there to die peacefully than under anaesthetic? We (anaesthetists) need to get comfortable with the concept of our patients dying. It is often what they want.

Peri-op decisions about CPR among adults @NAPs_RCoA @RCoANews 3% of patients had a ‘DNACPR’ recommendation pre-op, of which <30% were suspended. Do you routinely suspend DNACPRs prior to surgery? @JerryPNolan @jas_soar @adk300 @IainMoppett @drrichstrong @emirakur @doctimcook buff.ly/4ehvafr

@nosecglasses @Gasman_J @FearneHill @maureviv @AMPAdocs @jasumback @TschautscherMD @LawnerBen @laertezz GCS3 no raised ICP what is hypnotic adding?

@Gasman_J @FearneHill @maureviv @AMPAdocs @jasumback @TschautscherMD @LawnerBen @laertezz Neither of you are outliers. It certainly seems I am. Could it be possible we are both right?

The paralytic only intubation panel is underway!

@blikethecheese @AMPAdocs @jasumback @TschautscherMD @LawnerBen @laertezz Although NAP found all the problems as post intubation

@AirwayLegend @AMPAdocs @jasumback @TschautscherMD @LawnerBen @laertezz GCS 3 Benzodiazpine overdose GCS 3 Propofol overdose GCS 3 Ketamine overdose GCS 3 no raised ICP

@AMPAdocs @jasumback @TschautscherMD @LawnerBen @laertezz What’s the rationale for paralytic only? Are there specific patient scenarios?

@andymoz78 Presumably the premise for the original thing is a far more widespread omission of induction which clearly sounds a bit odd. I’m just saying it’s not a never (but it is a hardly ever). Obvious eg. Diazepam overdose GCS 3

@TheRealAlMay Ok, I grant you a totally unconscious patient with no concern about ICP. Ultimately I use far less anaesthesia for someone who is already obtunded than someone who is wide awake, but seldom feel that nothing is indicated at all.

Ok, another intubation hill I am willing to die on. If you can’t do drug-facilitated intubations without sedatives because you kill the patient you shouldn’t be doing drug-facilitated intubations. Full stop. This is cruel and unusual and physiologically harmful. Just stop it.

@t0uchgrasss @XelenX1 @JatinderHayre_ @ponteepon @CarolJFW @Dr_Done_ @Xeon4f145d96s1 @ExplosiveEnema2 @medicalmodelbri @TomStocks1982 @parthaskar @doctor_oxford @ItsnotrightUK @SocialistHealth @Britain_People It’s interesting but it’s a bit like Can u get a passport if you can sign your name: but u haven’t filled in all the stuff on the application first. But I can sign my name-can I have a passport?

@XelenX1 @JatinderHayre_ @ponteepon @CarolJFW @Dr_Done_ @Xeon4f145d96s1 @ExplosiveEnema2 @medicalmodelbri @TomStocks1982 @parthaskar @doctor_oxford @ItsnotrightUK @SocialistHealth @Britain_People I never suggested it did make a Dr, it’s astounding how many Drs have read this question and thread in-correctly. I was simply exploring the denial of opportunity to sit a specific exam and that not relating to competence

Psychiatrists! Your patients are the most socially and medically vulnerable, you’ve seen mass privatisation of in-patient care, extreme geographic inequity in service… the list goes on. ✅Your patients deserve better; they deserve You! ❌Reject PAs in Psychiatry for good

@andymoz78 @NickTriggle I’ll opt out please: where’s the form for that 😂😂😂😂😂😂😂😂😂💀

Remarkable-I must be hallucinating those weekends I work as part of my job. Perhaps I could just “opt out” 🤦‍♂️ No @NickTriggle this is absolutely incorrect. What is correct is that if consultants are asked to work above their contracted hours (most already do 48hrs) that will cost

@IJOA_Journal @Ropivacaine What’s the conclusion?

Does your hospital policy include the use of diamorphine, fentanyl or morphine for spinal anaesthesia? What about other adjuncts? @Ropivacaine (the person, not the drug) discusses the evidence at #OAA3dc24 regarding the addition of opiates for CS spinals. #Obanaes

@DrEilidhMaria They’re need to be trained with the driving model though

In its clinical practice guideline @Assoc_Anaes recommends that it is usually appropriate to suspend a DNACPR recommendation during the peri-op period. In contrast, only one-third of DNACPR recommendations are formally suspended pre-op. buff.ly/4ehvafr

@Anaes_Journal @NAPs_RCoA @RCoANews @JerryPNolan @jas_soar @adk300 @IainMoppett @drrichstrong @emirakur @doctimcook I generally suspend but that doesn’t mean CPR will occur