Paul Alexander

Bougie or stylet: what to use when the chips are down?

Is it truly possible to consistently and deliberately shape a bougie to fit a hyperangulated blade?

@doctimcook.bsky.social @janhansel.bsky.social

#AnSky #AirwaySky #MedSky

doi.org/10.1111/anae...

Jeekers! That is a big statement!

Wonder if many of these were 20-30mg for positioning #nofs?

Interesting - wonder about the median dose used as threshold (0.35mg/kg) seems v low. 16yr period and varied surgical population makes external validity hard to asess for own practice - for me 0.5-0.75 would be ‘low dose’ for post op analgesia, >1mg/kg for sick inductions.

That was brill Kevin, 2 calm capable operators. Great stories and views from Cmdr Hadfield with positivity and cooperation from North America to the Soviet Union ‘Merry Creestmas’ 😉

Welcome Helgi 🤗

Don’t you be flaming the McGrath! We love em round our place 🥰 Just don’t be stupid enough to put one in an autoclave….

But but but….. its 100 times more potent than MORPHINE!!!!!!!!!!

Interesting, though quality low, magnitude effect of salbutamol bigger than insulin, both better, and dose of insulin makes little difference. Putting iv salb in ur insulin/dextrose then makes great sense. I’d though the insulin was main treatment & salbutamol an add on-guess not, another school day

I’ve used and liked it in past for colorectal. RCOA statement and related editorial killed it for me. Still believed in it’s utility but that any complications v difficult to defend in that context so stopped for my own sake rather than being convinced of -ve risk/benefit argument for patients

For subclavian - yes i am 👍

I appear to have missed the ‘ahem…discussion’ - interested though, this is a skill i have dabbled at but certainly nit confident with - signpost anyone??

Screenshot of petition to join EU as full member.

🔥 Well... this is now over 88,000 signatures!

Just one final push to get it over that magic 100,000 and get a parliamentary debate? Why not!

Link --> petition.parliament.uk/petitions/70...

Can i add close doors?

😉

Only 20?? Lightweight!…..

Obvs if we can change the system to make it generally less shit that will make everyone working in it happer. We all have a responsibility to help-‘lead, follow or get out of the way’ ie don’t be a wingeing pain in ur bosses ass,identify problem & solutions and present together. Be a team player etc

It is a real problem, personal experience, but having engaged medical leaders is also essential for the service and the profession - so how do we make being a medical leader better or more attractive?

If it wouldn’t be missed it’ll die without being ‘shut down.’ Shutting it down would be infinately more trouble. Massive money buys real power. Had modtlh shifted to this place but finally deleted the bird app few days back after his latest ‘shit urself in public’ rant

Once chewed & swallowed i’d suggest they could no longer be considered nachos…so no 😑

Perhaps too nerdy for most 11yr olds but maybe not for the progeny of Prof Roberts 😉

And Keira Knightly…. 😮‍💨

Just not a baby…..

Lactase persistence became a selected for human trait after domestication of cattle

Meh…. tbh 🤷‍♂️ I like prefilled for emergency drugs, not so motivated for ‘routine’ drugs like roc. If cost/co2 neutral maybe…. Re size depends on practise, i may draw up 10mls vs 5mls roughly 1:1, not infrequently a 20ml syringe required for 1-1.2mg/kg abw, multiple prefill sizes seems extra wasteful

Transverse or oblique in-plane, if done pre-op i tunnel out further laterally using an 18G cannula to stay out of operators field. IMMB pump 30mls 4-6hrly (using y connector to deliver dose between 2catheters using 1 pump) Most often done post op in icu before waking pt up d1 post Emerg Laparotomy