Matt Thomas

I'm not a clever artistic person, but I quite like this picture that I took this morning (obviously turned upside down).

Beautiful inversion in Snowdonia yesterday 🙂

My Mum has just sent me a message wishing us a quiet night.
Better dust off the major incident plan...

Oooh, this is interesting!

"Surgical start timing was an independent risk factor for increased short- and long-term postoperative mortality, morbidity and healthcare resource utilisation."

#AnSky

doi.org/10.1111/anae...

Good ride today 🙂

Last week, we launched our guidance “The Decision Making and Transfer of Critically Ill Adults to Their Preferred Place of Death” – providing a framework for healthcare teams navigating one of the most important decisions in end-of-life care.

The shape of a life by Shing-Tung Yau is great.

Key lessons seem to be:
1) Work on projects you are passionate about.
2) Work hard, dedication matters.
3) Work on multiple projects in parallel - when one project stalls work on a different project for a while.

Wonderful post-work swim 🙂

Different for consultants, but for us trainees I wonder whether we are trained to be too scared of a GA in obstetrics. Clearly we need to know the risks of an RSI in pregnancy, but I felt there was a lot (I don't know whether too much) of emphasis on a GA being a last resort.
(I don't do obs now.)

On-call shifts in medicine are so draining, not just because of the overwhelming workload during the shifts, but also because of the inability to rest for at least a week before due to the sense of dread at the thought of what is to come. I've never experienced this doing ICU, only in medicine.

"What is their exercise tolerance?"

I'm very sorry to hear that ☹️
I hope it improves soon.

Things that keep me awake at night:
1) Being post-nights.
2) Whether the pleural of GREATix is GREATices or GREATixes.

My self-management is escalating quickly. I have considered taking paracetamol. Presumably the next step is an adrenaline infusion.
(Unfortunately the paracetamol I have expired in 2016, reflecting the frequency with which I take them.)

My more senior form of Medical Student Syndrome means that whenever I am ill I immediately think of the person who I saw most recently whose illness started with the same symptoms and how they ended up on triple organ support and (nearly) died.

This is going to hurt and Bodies are both good.

CT BRAIN QUIZ: Pre + post-contrast: Postural headaches. Cerebellar signs. What is the most likely diagnosis?
A: Subdural collection
B: Subarachnoid haemorrhage
C: Intraventricular haemorrhage
D: Extradural haematoma
E: Posterior fossa meningioma
Start Quiz bit.ly/3F2dhB8

Sea to summit to sea duathlon to try to fix my circadian rhythm after nights 🙂

Interesting question: 'my best photo'. I think this would be mine.
www.bbc.co.uk/news/article...

ICU Hemodynamic Secrets – The role of ScvO2:

There is not such a thing as a “normal” cardiac output (CO). A CO of 3.5 l/min may be adequate for a 90 years’ old, 100 pounds sedated patient but inadequate for a 40 years’ old, 250 pounds patient with septic ARDS. Ideally,

The lonely death of Dr Jagdip Sidhu He was a rising star of the NHS. Could his work have contributed to his death?

"…doctors had been turned into "factory workers" in an effort to deliver ever-increasing productivity."

A NHS doctor dies by suicide every 3 weeks.

A nurse attempts suicide daily.

Who cares for the carers?

The lonely death of Dr
Jagdip Sidhu
www.the-londoner.co.uk/nhs-doctor-s...

From my cycle-walk-cycle today. In my opinion, one of the best three views in Snowdonia.

Not a good week, but some progress generating this phase space today, I was beginning to think it might not be possible to produce the properties I wanted.

thrombolytics cause angioedema by increasing *bradykinin* generation

this will *not* respond to epinephrine

yes. I know many references recommend steroids/epi.

they're wrong.

(knowledge translation on this topic is super slow)

(#2/3)

(more on angioedema physiology: emcrit.org/ibcc/angioed...)

I need your help! The airway checklist card initiative grew to 17,000 cards across the 🌍, supported by major bodies & heavily propelled by Twitter 🪦. Please help me re-spread the message with a repost!

Adult, paediatric & global (LMIC) versions. NFP.

checklistcard@outlook.com.

#patientsafety

I'm pretty happy with my DIY bouldering wall. Given it's freestanding, it is surprisingly stable 🙂

I like: Oxygen needs to go in, blood needs to go round and round, everything else is window dressing. (Glucose is an exception.)

The Rules of Anaesthesia are fantastic. Is there an equivalent for intensive care? If not, what would you include?

www.bmj.com/content/375/... would suggest: Believe nothing, trust no one, give oxygen.

A thread 🧵 on trials I think have changed or will change ICU practice (at least my own). #emimcc

I shall start right now!
The order shall be "randomly as they occur to me"