Richard Bauld

“Reduce the norad”. They’re to treat hypovolaemia and improve perfusion, not to spare norad.

2. The 2 inodilator trials I have used in septic shock without cardiac dysfunction have gone spectacularly badly. But thankfully, reversible badly.

Using echo early and repeatedly, and occasionally using higher MAP targets if I have a pre-test probability of success. And, eventually accepting I can’t improve the micro circulatory dysfunction regardless of what I do.

2 additional points:
1. I really wish we’d stop giving fluids to try and

With my predetermined bias, don’t think this will change my practice.

That is: identifying source and/or achieving source control, using CRT as ONE marker of perfusion, only giving fluid if I have evidence perfusion improves with it, not minding how much norad the patient is on if perfusion is good

@techpriest.bsky.social

Scotland’s residents are about to be balloted for potential action as well after recent breakdown in the relationship with the Scottish Government. So hopefully, the communications on that will be more succesful

I was talking to a trainee about this in September. For whatever reason, communications on the current dispute is not getting through very well. Disclaimer: I live and work in Scotland, but I felt well informed about the previous disputes regardless.

Birmingham, like many other cities, has significant problems.Rooted in social deprivation, the shadow of austerity and systemic effects of capitalism on urban inequity.It is also vibrant, welcoming and fun. I had the time of my life when I lived there.This was made more rich by its multiculturalism.

💯

Though bad implementation and transformation can be just as bad with a public product, I’d be absolutely behind this.

Reminded of the terrifying moment in “Green Room” where there’s a slow pan over the red laces…

Oh, why am I not surprised that Oracle are involved

“Seamless pick up”… yes, absolutely. Because that always works

@techpriest.bsky.social

I remember being desperate to get a 3dfx voodoo when I was 13, never did of course. Definitely had some GeForces along the way.

It’s bonkers that a 30-ish year old technology is what’s propping up one of the largest economic bubbles in history.

I asked ChatGPT how long until the AI bubble burst.

3 months if heavy GPU backed debt continues
24 months conservatively

lol

Grifters gonna grift

Sub-prime cars: are car loans driving us towards the next financial crash? Analysts fear the boom in personal contract plans are mirroring the sub-prime mortgage scandal and are fuelling a colossal build-up of debt in UK and US

Warning circa 2017…

www.theguardian.com/money/2017/f...

“That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes the politically inevitable.”

@techpriest.bsky.social

And has been used with devastating effect over the last decade or so via wall to wall coverage in newspapers of “immigration crises” and the dangers of the EU, etc. Now amplified by the siloing of social media.

But, in the end it all comes down to Milton Friedman’s well documented plan:

Politics is almost always framed as “how can we win the next election?”, which naturally makes it reactive to the whims of the voter.

What certain organisations have worked out, is that they can move the needle of the voter, and be lying in wait with a policy. This is the neoliberal playbook /

“Nothing can possibli go wrong”

Are close to being off, I’d be trying a beta blocker.

There is a trend in these patients to starting/restarting a DOAC early here and I’m not a fan. Prefer LMWH until a day or so from discharging from ICU. Been caught out by haemorrhage/procedures too many times.

Rate and I’m much more likely to do something about it early.

Amiodarone if they’re sick (I would include moderate doses of vasoactives here. Digoxin if I’m less concerned.

If they’re still like this after a few days and everything else is better, then I’d start something anyway. If the pressors

Mostly if consistently less than 140, then I do nothing, initially at least (with the caveats you’ve already included). I tend to ask the team “would we slow the heart rate down if this was sinus tachy?”.

But, if the a line has lots of missed beats, then that’s a heart that can’t cope with that

That is really goddamn impressive.

I’m reminded that my father was born, in London, in December 1952, during the Great Smog. There was an estimated 12000 excess deaths between during the Smog and the months after it.

I once looked after a patient post-anaphylaxis induced arrest, on scary high doses of adrenaline with an awful BP. Every part of his assessment said he was over-vasconstricted. Put a brachial line in and his BP was 240/160. Adrenaline off, perfusion improved.

Map of the D Day Normandy beach landings, illustrating the combine Allied approach to fascist regime.

Antifa circa June 1944 (not exhaustive)

Don’t tend to have this with tv, but games, yeah, big time. Never finished cyberpunk or rdr2 for this exact reason

Do I like this paper because it’s good, or do I like this paper because it reinforces my bias?!

Thank you Segun, I wasn’t sure about the picture outside of Scotland.