Michael Bright

@DrRJWebb @LeDyslexicMedic @Asiritrauma1 @YorksAmbulance A mix in reality…. certainly doing subclavian US CVCs gives you the tactile feel and memory for doing the skill. Then a mix of simulated, theatre and some on the unit also. But it certainly is a dying skill because on the unit you have time and US so hard to justify anatomical

@thepasteurpoint @LeDyslexicMedic @Asiritrauma1 @YorksAmbulance How did you get experience of this? Simulated practise or theatres etc?

Had a fantastic day simulating trauma line insertions in PHEM. The London Air Ambulance shows an 84%-88% success rate for subclavian line insertion via landmark technique. Read more here: (doi.org/10.1111/anae.1…) #fy #fyp #pov @YorksAmbulance #criticalcare #medicaleducation

@DrRJWebb @LeDyslexicMedic @Asiritrauma1 @YorksAmbulance But in PHEM land I use the landmark clavicle walking technique (due to speed and urgency - and I’d say I’m pretty good with an ultrasound) and can say I’ve not had a arterial placement (and we have a good feedback system in our service)

@LeDyslexicMedic @Asiritrauma1 @YorksAmbulance Looks great! May I ask, with landmark technique, what stops accidental subclavian artery insertion? Is it just location of artery vs vein vs insertion site/angle?

@DrRJWebb @LeDyslexicMedic @Asiritrauma1 @YorksAmbulance Broadly it’s normally technique and that we know the anatomy is “broadly” consistent. Walking the needle on the underside of the clavicle, following the trajectory of the notch. Now personally I do subclavians with US (if we’re being pedantic it enters the axillary) in hospital

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@LEGO_Group @KPComeHomeBaby Is this only in the US?

@KPComeHomeBaby Looks like you’ve found a clue, Trainer! To catch more details, head to LEGO.build/PokemonLineup. Good luck on your scavenger hunt! 🔎

@LEGO_Group I found this symbol on the Lego Pokemon About section for the scavenger hunt. Does this mean anything?

Vacancy: HEMS Specialist Paramedic - Lincolnshire & Nottinghamshire Air Ambulance Full info👉 collegeofparamedics.co.uk/COP/BecomeAPar…

@DrRJWebb @helenvecht Wes wants it to be free…. 🤣🤣🤣 if only you’d kept your NMC up lol…. Jokes aside is ridiculous and frustrates me

@helenvecht Plus the £850 I’ve just spent on my last exam, which of course you can’t claim anyway because it’s an exam.

Just gone to apply for a course. Two days. £100 for Nurses/ANNPs/Ultrasonographers. For doctors… £400. Absolutely not.

.@BSEcho have launched a new Level 1 library🚀- developed by Jen Gosling, @EchoFoundations, et al, which will support practitioners of emergency echo   The first 30 cases are FREE!   Find out more: bsecho.org/Public/News/Ar…

@Burnt2020 @TheSnoozeDoctor Would agree here, the McGrath has its own quirks. The C-MAC is excellent for DL whilst having VL 😊

@TheSnoozeDoctor Most Mac and Miller blades are the same design as traditional laryngoscope blades. The main difference is the handle, which you need to address when using a traditional pediatric handle, an obstetric handle, a McCoy, or a polio blade, for example

I can see a time coming when trainees become as deskilled in direct laryngoscopy as they already are with basic face mask technique. I make a point of ensuring they can manage a face mask properly for a straightforward 20 minute case.

@JAShuttleworth Not in OOHCA according to the imminently releasing REBOARREST trial….. PHEM trauma 🤷🏻‍♂️

I’m not sure the role for REBOA is in the ED - why keep a patient waiting for definitive control by a Surgeon? No info available on use of partial REBOA (spont vs intentional) Pre-hospital is a different matter?

@isitsleepytime Me frantically searching the article to see it with an “r”… Alas 🤣🤣🤣🤣🤣

Although a 3% difference in the mRS @ 30 days…..

Outcomes not a significant difference between the groups… ?due to the timing of getting REBOA in up and running from 112 -> REBOA (47 mins)

This afternoon hot off the press session, the REBOARREST trial…

This afternoons session around good quality post paediatric ROSC care from @BarneyUoB

@Pipes_n_pumps @EduardArgudo @ERC_resus @LDNairamb @EMDocJB 35mmHg is what I put in our guidelines 😉

Indeed! Though it’s very pleasing to see physiology-guided resuscitation finally make it into the guidelines for medical cardiac arrest - using intra-arterial DBP >30 mmHg and EtCO2 >3.3KPa where this is deployed Agree with my learned friend @EMDocJB that a DBP (as a surrogate for coronary perfusion) of >35 mmHg is a better target

🚨 New @ERC_resus 2025 guidelines on traumatic cardiac arrest have no major changes. They emphasise urgent, cause‐focused intervention: control major haemorrhage, tension pneumothorax & tamponade before or alongside chest compressions. And bye bye REBOA…🙄 #TCA #resus25

@Pipes_n_pumps @EduardArgudo @ERC_resus @LDNairamb That slide did make me chuckle…….. (purely for the bye Bye REBOA comment - which as you say Chris is a little more nuanced… and let’s not even start on ERICA and where that might take us) 🤣🤣🤣🤣

Perhaps ‘bye bye REBOA’ is an oversimplification. The guidelines do not allow for nuance; I am sure my collaborators at @LDNairamb will have some opposing views on this TCA is a broad church of pathology (as is indeed, medical cardiac arrest) - A Zone 1 REBOA in a peri-arrest traumatic subdiaphragmatic haemorrhage may be a useful bridge to prevent TCA), or if the balloon is deployed very close to the “time zero” it may be a useful tool to augment coronary perfusion and myocardial rescue when used with rapid volume resuscitation and ICM Never say never……

Locked on for three days of resus pearls and updates @ERC_resus congress in Rotterdam #RESUS25

Spending my day teaching on the @acutemedicine FAMUS course focusing on all things lungs, abdomen and vascular… alongside @RamMatsa #StokePOCUS

Out and about on the voluntary side today supporting Chester Marathon as mobile bike ALS provider #mysjaday @stjohnambulance