Anthony Lewis

Impressive tweet from 5 years before he was born.
When twitter didn’t exist.

If able to, I try and give patients the option - bed or walk in.
Surprising number want to walk.

Going to throw in the ‘personal experience’ card here (not me but close).
It does change your life.
The anxiety associated with it is palpable and going into hospital for a procedure is fraught with a heightened level of ‘what if?’

Anyway, to completely derail you @chrimesy.com

….I’ve been spruiking your Narrative Description of Categorial Incidence.
Found that patients respond very positively to it.
….however I still include anaphylaxis as I believe it is a life changing event. 👀

But if you look at it from a best care for patients, I think the uk based (and I believe this is only applicable to uk and similar), is that even though all anaesthetists are trained in obs (and neonates, eyes, cabg), due to organisational circumstances it has become a subspeciality.

Maybe worth asking a few UK anaesthetists who haven’t done obstetrics for 15 years how they feel about that!

Agree. But many take up a consultant position in the uk which specifically has a general or an obstetric on call commitment.
Once you do general, you no longer do any obs at all - nothing. Not elective or emergency.

Hence why those doing general on call are more than happy for obs to be separate.

*in the UK

It can be on the UK and in most hospitals it is.
There are separate rosters for anaesthetists - as in some anaesthetists solely do obs on call and other anaesthetists only do general on call.
So in many ways it’s as separate as ICU and anaesthesia.
Different in Aus of course

Good points.
I do a Duty Anaesthetist day twice a month and the best part of the day is walking from theatre to theatre and having a chat with each anaesthetist.
So important for moral, wellbeing and sharing concerns or issues.
It’s definitely the yin to the rest of the DA duties yang!

…want to make it better. Whether that is making sure their acute or chronic health conditions are addressed to minimising the risk of anaesthesia and surgery.
And ensuring that the patients feel confident in how we are looking after them.

That’s it - we just want the best for patients.

Just been to a few days of #asm25cns
Workshops as ever were excellent.
But what was great was the chatting to colleagues I have known for either decades or sometimes minutes about being an anaesthetist.
It’s the same thing every time - we constantly worry about the patient experience and….

I’ve now moved past email management.
I’ve got over 25000 unread emails - but so what…I don’t care.
I find the new categories in Apple email - Primary, Updates, Transactions and Promotions works for me.
Anything important I Flag.
Oh and I removed the unread email number from the email app icon.

Thanks for that!

That’s good to know.
Once I’ve done the workshop, I guess the issue will be the supervision.
Not sure how I will be able to achieve that.

I’m going to do a Gastric US workshop at the next ANZCA conference in May.
Once I’ve done that, how many GUS do I need to do to become competent in making a reliable assessment?

True. But what to do in the meantime?
Guidance has changed - can’t stop the medications for weeks.

I guess because not everyone is trained in gastric US?

All change for GLP-1

Do not stop taking the medications

24 hours of clear fluids and a 6 hour fast pre procedure.

www.anzca.edu.au/getContentAs...

Well, you could have it earlier, but then the effect of the vaccine would wear off after about eight years. So the timing is gonna be interesting and I wonder if they’re gonna offer a booster at some point as well?

Seven breaths prevent death.

A few months ago I did a grade 1, POGO 100% intubation with a VL.
But on ventilation it didn’t feel right.
Inflated the cuff a bit more. Still not right.
Looked at ETCO2 trace, not right - low peaks.

Tube out, reintubated. All good.
7 breaths prevent death.

A natural experiment on the effect of herpes zoster vaccination on dementia - Nature Using a natural experiment that avoids common bias concerns, this study finds that the live-attenuated shingles vaccine reduced the probability of a new dementia diagnosis within a follow-up period of...

The study

www.nature.com/articles/s41...

Shingles vaccine study finds 'huge protective signal' against dementia The shingles vaccine could be an effective intervention for dementia, with a large "natural experiment" in Wales finding a substantial drop in dementia risk for those who received the vaccine.

www.abc.net.au/news/health/...

💯 % agree.
You don’t always need an A line for induction.
And if you don’t - asleep so much better

That’s a massive renal stone.

Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies* Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ....

The PUMA guidelines for prevention of oesophageal intubation are supported by

-RCOA
-AoA
-FICM
-ICS
-CODP
-DAS

This is true of no other airway guidance I am aware of & make them the de facto UK National guidance

associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

Quick video update from the ASA on the cluster of failures of laparoscopic insufflation equipment in Australia leading to potential patient harm.
#ansky
Reports can be submitted to Webairs at Webairs.com or directly to Safer Care Victoria at forms.office.com/Pages/Respon...

A very important video for all Australian anaesthetists
#AnSky #MedSky

❤️ Cardiac US - look at me! I’m so interesting and so many views, so many numbers.
Nah - too hard

🫁 Lung US - hey there, not as fancy as ❤️ but much more do-able.
Yeah, can do that maybe…

🍔 Gastric US - what about meeeee?!
Oh FFS

Just shows that it’s difficult to anticipate what the movement of ligaments and connective tissues will do in various positions in congenital conditions.
Flextension is for normal anatomy.