Nicholas Chrimes

Hilariously awful.

That doesn’t reflect my experience at all. Using 100mcg IT morphine for LSCS I’d say incidence of itch is <5% & has 100% response rate to 40mcg IV naloxone that outlasts its duration of action wout impacting analgesia. I haven’t used propofol (my 2nd line) to treat IT morphine itch for >20yrs.

The looming Trumpcession Orange man bad (for the economy).

"The president usually has limited control over the economy, with downturns being caused by events beyond their control. In this case, however, Trump’s policies are directly responsible for job losses, rising prices, wavering confidence, and a speedrun toward what looks like stagflation."

“There is moderate evidence that intrathecal morphine does not increase rates of sedation or hypoxaemia after non-obstetric surgery. There is very low-quality evidence that intrathecal morphine might increase the rate of respiratory depression”

Intra-operative ketamine and delirium

• Low-dose ketamine was associated with a LOWER risk of postoperative delirium.

• High doses did not influence the risk.

#AnSky #ketamine #FreeForAWeek #MedSky #PainSky

doi.org/10.1111/anae...

“We acknowledge that economic & logistical factors may limit the universal implementation of VL in all settings. However, as pt safety is paramount, our findings suggest that investment in this technology may be justified, partic when considering the potential costs of failed tracheal intubation”

This planet is run by crazy people. Remember what they have to do to get where they are. Their perspective is so narrow, so...brief. A few years. In the best of them a few decades. They care only about the time they are in power.

- Carl Sagan, Contact

NEW: Incredible scenes in Sydney, Australia today as tens of thousands march for Gaza, demanding an end to the genocide.

#MarchForHumanity

(🎥 Ema Franklin)

‘They roll right over’: Many Democrats call their party weak and ineffective, AP-NORC poll finds A poll from The Associated Press-NORC Center for Public Affairs Research finds that many Democrats see their political party as “weak” or “ineffective.”

This shouldn’t be surprising. The only way to fight back is to… actually fight back.

If Democrats want to improve their approval rating (or far more importantly, make actual change), we need real leadership to put up real resistance to authoritarianism.
apnews.com/article/ap-p...

MSM be like - it wasn't THAT many people that it could represent a groundswell of public opinion but also it was such a dangerously large number of people for public safety

I just need one member of the media to ask Trump how much a $500 drug would cost after a 1500% discount.

Editorial: Understanding the role of medical futility in determining non-beneficial treatment at the end of life

#AnSky #ICUSky #MedSky #futility #FreeForAWeek

doi.org/10.1111/anae...

Montgomery also says "anything the clinician is or should reasonably be aware that a particular person would consider significant". So if you are aware or even suspect that a specific patient might have a particular (though objectively unreasonable) concern about, that's a material risk.

Even without pain awareness could be extremely distressing. Firstly there's much more unpleasantness than pain: you're paralysed, have a tube in your throat and maybe your CO2 is uncomfortably high. Secondly you don't know that you're not about to experience pain. Terrifying.

Not that I'm pretending it's reasonable that individuals should have to take that type of stress on.

As a 1st year trainee I went on a one man strike over a weekend roster I thought was unreasonable & unsafe. I simply refused to work it. It broke me though. I ended up in tears in the Director of Anaesthesia's office. I never worked that shift again though (& eventually it got changed).

Oh I get it but those cliches "Be the change you want to see...", "The standard you walk past...", "The people who are crazy enough to think they can change the world..." are all true. It's fucking hard work though.

I'm far too young to remember that. 😉

(actually I loved the Rockford Files speaking of James Garner)

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

What about varicose veins? Choosing to have a regional rather than a general? Volatile rather than TIVA? Use of a BIS monitor?

There's lots of ways identifying that a patient is extremely concerned about awareness might impact the conduct of an anaesthetic.

Plus they don't have to be reasonable.

Awareness can be viewed as both a harmful outcome and a mechanism for harm. It's an unpleasant experience in its own right and a potential precipitant for psychological injury.

Anaphylaxis, aspiration, haemorrhage, hypoxia, oesophageal intubation and even cardiac arrest can all have consequences that range from nothing to death. This occurs whenever you look at a mechanism of harm rather than a harmful consequence.

I think that's an oversimplification of what anaesthesia is. It's not just surgery without recall, it's surgery without harm. Awareness is just one form of harm.

But how does any of that influence consent? Especially the common decision to omit it from consent. The issues you raise seem to make it more important that it is explicitly consented for.

Does that mean patients can’t withdraw, query, qualify or modify their consent on the day of surgery? It makes no sense.

That’s a common approach but anyone can have awareness & it’s entirely reasonable for a patient to say “if I’d known that was a risk, I wouldn’t have had this done” (or would have asked if you could have done things differently to reduce the likelihood) about any rare catastrophic risk.

Cutting corners to get a system you say is crazy to function sends a message to administrators that the system does work, and sends it at the patient’s expense.

Sometimes you’ve got to let the plane crash.

Why the desire to avoid it being reported to the theatre coordinator? Isn’t that what you want? If clinicians absorb these issues to keep a compromised system running, administration can legitimately say they didn’t know about them. Incur the delay & say it was necessary for safe/effective care.

Other than potentially being more severe, why is awareness different from any other adverse experience like nausea, pain or sore throat?

One of the most baffling aspects of interacting regularly with "normal" suburban people who voted for Donald Trump is that they genuinely seem to be unaware of his explicit racism, and if challenged, either refuse to believe it or fall back into exactly what Mulvaney does here.