Tim Norfolk

27 ffs, it’s absolutely bonkers isn’t it. Totally agree with your reflections, I liked rotating but think each placement should be a minimum of 6 months, 4 different hospitals in a year is patently insane.

But anyway, congrats 🥂, and enjoy setting down some roots!

I was lucky enough to visit my god-daughter last week in Toronto, 🇨🇦. She goes to an excellent nursery for $22/d (≈£12) under their CWELCC program. Both parents happily back to work full time. Will doubtless pay for itself (& then some) through higher lifelong maternal earnings/tax revenue.

Used as go to push-dose vasopressor in our region of 🇬🇧

Correct. Trying to protect children from harmful content and from receiving DMs from predatory adults is so clearly worth the trade off. Additionally most of the people complaining already have a photo of themselves on their profile 🤷‍♂️

Those same pts have a RASS of -4/5 though right? I’m sceptical about using EEG in ICU to target sedation when the desired endpoint is clinical (i .e. RASS) not electroencephalogical (real word?).

Suspect we’d get more bang for our buck getting the basics right without more gadgetry

I just don’t get the anger about this. Features that mean children can’t be sent direct messages from predatory adults is surely a good thing. Why the big upset? I personally applaud any govt/company adopting such measures

How has this only got 1 like?! Criminal. Honestly this is the closest I’ve been to rejoining Twitter

A platform taking steps to protect children from SoMe should surely be congratulated, especially in a climate where all their competitors take no such measures

I like that stylets shape are pre-formed to the angle of the HAVL and don’t deform over time unlike (most) bougies, but whatever works for you!

Yeah this seems like a no brainer now, & it’s interesting as I don’t think I’ve ever seen or heard it of doing that, which gets back to your point about the defect in training on the nuances of HAVL technique

Interesting. I have the stylet fully withdrawn & have removed the blade prior to cuff inflation, although now I’m questioning why 😂

Yes, to the annoyance of the amazing nurses I work with!

A low Scvo2 is an important 🚩 about the inadequacy of DO2 & is worth paying attention to. Far more useful than the daily CRP/procalcitonin we’ve become accustomed too (with far less scrutiny!)

bsky.app/profile/icmt...

a penguin is jumping in the air with the words come at me bro below it ALT: a penguin is jumping in the air with the words come at me bro below it

Disclosure: Intensive care doctor (non-anaesthetist)

🔹 CVP is a very useful & underutilised tool as part of a multi-modal haemodynamic monitoring strategy.

🔹 It has been inappropriately maligned by prior generations who hoped for an easy answer to ‘is this patient fluid responsive?’

When the AI PanEcho overlords take over, I guarantee the stethoscope will be the first thing to go!

AIM must be top of the tree when it comes to volume of tickets completed eh? 🫡

I’ve used it too when on the fence about initiating RRT, but in truth I’m not sure if I should have. In the FST trial 1 in 4 people who were FST non-responders didn’t need RRT. That’s not an insignificant number,& even those who do go on to need it may not benefit from an accelerated initiation

Oh ffs, I should have invested my time learning Reiki instead. Even ChatGPT can’t realign Chakras (yet…)

I personally think it’s great George will get to manage a £500m budget in his gap year. His UCAS application will dazzle

a man in a suit and tie is looking at the camera . ALT: a man in a suit and tie is looking at the camera .

Don’t let perfect be the enemy of good! A universal PEEP of 5 has always been bonkers, especially when justified as a way to replicate ‘physiological PEEP’

Adjustment of positive end-expiratory pressure based on body mass index during general anaesthesia: a randomised controlled trial

#AnSky

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Permissive azotemia during acute kidney injury enables more rapid renal recovery and less renal fibrosis: a hypothesis and clinical development plan - Critical Care Preclinical models of acute kidney injury (AKI) consistently demonstrate that a uremic milieu enhances renal recovery and decreases kidney fibrosis. Similarly, significant decreases in monocyte/macrop...

It didn’t in the FST trial… & if not, it’s only adding prognostic, not therapeutic value.

Indeed it’s plausible that reversing the uraemic milieu by using RRT impairs the kidneys innate ability to repair & recover, actually worsening renal outcome 🫘

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Spontaneous diuresis in combination with furosemide stress test (SD-FST) as predictor for successful liberation from kidney replacement therapy: a prospective observational study - Critical Care Background The optimal time for initiating kidney replacement therapy (KRT) in acute kidney injury (AKI) has been extensively studied in recent years. In contrast, there are currently insufficient dat...

The fact the furosemide stress test does well at predicting who will need to commence/continue RRT is great (& unsurprising) but it doesn’t help us at the bedside.

The real question is does earlier initiation/re-continuation of RRT help this cohort?

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😱

As a non-American I honestly cannot understand how your countrymen are standing aside and watching this happen. Roaming armed bands of vigilantes, covering their faces, not showing IDs and snatching people off the street. I mean WTAF. Leaders of the free world… 🤯