Cheery Littlebottom

As a GP, I am not allowed to receive a pen or post-it note pad from a pharmaceutical company rep

Govt banned them in case I was influenced to prescribe medications

This should also be banned

Influence being bought in Govt

Patients should influence not the healthy & wealthy

Screen cap of parodic version of William Blake's "The Tyger" that begins: Tyger! Tyger! Burning bright (Not sure if I spelled that right) What immortal hand or eye Could fashion such a stripy guy? What the hammer that hath hewn it Into such a chonky unit? Did who made the lamb make thee, Or an external franchisee?

In honor of National Poetry Day, the greatest parody rewrite of all time:

please enjoy Discworld Elysium, everyone

this was clearly written for me personally but I think a lot of you will also like it

I do a normal RSI then once intubated start my pump low at around Cet 2 and titrate up over the case to BIS.

The effect of the initial bolus on the model being inaccurate becomes decreasingly relevant as the case goes on

Do your patients get a bairhugger preop? If so that's amazing, I can barely get this done with the patients getting colorectal cancers preop.

The one which really interests me is the theory that it might reduce postoperative delirium being studied in WHITELIT

www.fundingawards.nihr.ac.uk/award/NIHR20...

I like it for propofol sting.

For analgesia I think it's low on my list of marginal gains of multimodal. Regional, ketamine and clonidine are higher up my list of adjuncts.

The data on reduced ileus means I sometimes do for open abdominal surgery.

This brilliant video by singer Chris Cron deserves its own applause (he’s on Instagram), but it also reminds us how astonishingly good Queen were as songwriters and musicians. The melody, harmony, and lyrical flair are all elite — and this isn’t even one of their Top 5 most downloaded songs!

And Lu-tze and the yeti hunters when he introduces them to Rule 1

My favourite one off is The Truth. Small Gods is pretty good too.

The first two of the Moist trilogy (Going Postal and Making Money) are fabulous.

Obviously I would recommend the Watch series (with Night Watch often being agreed as Pterry's finest), but the backstory makes it less accessible

GA and nerve block is my default

The main outcomes in #NOF improve with orthogeries input and timely ASAP surgery. Unnecessary delay is bad.

(I will confess I'm not great at lateral spinals and worry about positioning patients with #NOF with just a block and a bit of ketamine/fentanyl)

Enormous leap apart

The "robot" in your surgery was being controlled entirely by a human. The robot is used is that the joints can move in a way that a hand can't and get to difficult to reach angles better.

There's nothing really automated about your robot surgery.

And slightly more depressingly, I can't imagine any AI component willing to take on the huge liabilities involved with diagnosis and misdiagnosis

We're seeing similar issues with apportionment of blame in driverless semi-autonomous cars

Not just our procedural specialties either

I'm not convinced that an AI in any near years will be able to take a history from a patient who meanders off topic, throws in lots of irrelevant talents, and had key non verbal clues to what's actually going on. Never mind the skill of examination

Is this a comparison between bluesky now and peak twitter before enshittification though?

Peak twitter took years to build organically to grow a community that educated and interacted.

Bluesky had a relatively fast development following spacebaby's nazification so might not be as ready

Might try this video though because I'd only seen colleagues user a 25G needle with higher volumes so thought the pain didn't outweigh sting unless big cannula

Only for 16G and 14G.

I love the medial needle insertion approach to the IPACK block. Have you tried it?
I find it
Faster,
Easier to perform
Easier to see the needle

But you must take care not to puncture long saphenous.

#RegionalAnaesthesia #RegionalAnesthesia #RAsky

Full video here:

youtu.be/q-4TXakDoXA?...

What's the smallest gauge cannula that doesn't need local infiltration?

Four consecutive weeks off guaranteed over summer?

Nights and weekends double time back?

Is Sweden hiring anaesthetic consultants? Asking for a friend (and several thousand NHS consultants)?

(Admittedly language skills might be a challenge, time to hit Duolingo)

As long as parent is (relatively) calm, I find their presence can be helpful for routine IV or inhalational inductions in kids.

I normally have them out of the room for RSIs as I want them gone as soon as I'm pushing propofol and that doesn't already happen speedily otherwise

So 3 new videos released today!

1. Femoral Triangle & AFCN

youtu.be/3hIqmH3vTNo?...

2. Medial approach to IPACK

youtu.be/q-4TXakDoXA?...

3. Serratus Plane

youtu.be/jbLKyV--2d4?...

Please Enjoy, Like & Subscribe!

#RegionalAnaesthesia #RegionalAnesthesia #RAsky #AnSky

Common in decent size Chinese supermarkets, or if you can get cheap prawns and put them in a dehydrator till they're tiny and dry, they keep really well at room temperature or keep forever in the freezer

Shanghai Noodles with Dried Shrimp and Spring Onion Oil for Cook the Books April/May Selection: "Shark's Fin and Sichaun Pepper" by Fuchsia Dunlop Here it is almost June and here I am ducking in at the last minute with my Cook the Books dish for this round's selection, Shark's Fin and...

With practice, the Fuschia Dunlop recipe for noodles, spring onion and dried shrimp is fast and delicious. It's nutritionally not good though, it's mainly carb and oil. Maybe add some veggies and meat or something

kahakaikitchen.blogspot.com/2018/05/shan...

Brexit dividend: our swimming waters are MUCH more polluted than any EU country's because we no longer have to follow EU environmental law since Brexit so water companies can get away with just about anything.

(Just one of many pesky EU rules Brexiters hated.)
www.theguardian.com/environment/...

It's a pretty good SGA especially for people with low experience (arrests).

However it doesn't seat well in people with no teeth and can leak if the head needs to be turned.

My preferred one is an inflatable with a bend like a proseal/protector

IIRC the risk of dystocia was 9%, but to go on to cause the HIE that it did brought the overall risk to 1:10,000.

The hips and knees scenario was referring to if under GA, spinal +sedation very much the patient should be prepared to remember much of the case!

I don't routinely talk about AAGA but wonder if I should

But how about for elective surgery like hips and knees? The Montgomery case with shoulder dystocia causing HIE had an estimated overall risk of IIRC 1;10,000, not far off the rates of AAGA

Especially bearing in mind it's recently off patent.

What are the benefits of adamgammadex?