Alex Smith
@doc_smithy
ICU SpR, England rugby fan and wishes he still lived in Melbourne.
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🧵/ Identifying patients with RV dysfunction that are higher risk of RV failure and death in the dynamic and time critical ICU environment is hard. Choosing the right treatment at the right time is also hard! (1/12)
When I started in ICU as a Consultant 24 years ago our caseload was mostly reversible illness in the relatively well. Sometimes, of course, we couldn’t help. It’s now mostly irreversible illness in the debilitated sadly, & in a lot of cases we feel a little helpless. #lockdown…
YOU SEE IT DOESN’T FUCKING MATTER HOW YOU LABEL SYRINGES
Risk-adjusted probability of death by individual surgeon vs individual anaesthetist. pubmed.ncbi.nlm.nih.gov/26511481/
On the topic of videolaryngoscopy and direct laryngoscopy skills, @derangedphys put it best … 🎯 derangedphysiology.com/main/required-…
Yesterday I posted a slide on the benefits of VL That was unfair so I've made one for DL too so they can be compared Have I missed anything?
Congratulations to our three new Honorary Fellows who were recognised for their contribution to echocardiography at Saturday's AGM: 💚@JudyHungMD, international speaker 💚@SSharmacardio, invited speaker 💚@EchoFoundations for services to education
The reason we've got such a terrible brain drain of British doctors abroad is because they're fucking good Well trained, capable, effective Other countries pay multiples of what we do to secure that talent What sort of fuckwit thinks the answer is to make our own doctors shit
🚨 | NEW: Rishi Sunak hopes to increase the NHS workforce by letting doctors take shorter degrees [@thetimes]
Third year medical students arriving for the weekly consultant round of 12-bedded hospital ward, September 2025
This is bang on & the only long-term solution to pressure facing GPs. We need this long-term thinking on workforce from Govt to avert slow decline in NHS standards. All eyes now on Budget to see if enough training places will be funded to meet big increases in demand facing NHS.
Results of the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial will be published soon. Better to harm patients with fluid restriction or with lots of vasopressors? No difference, of course! What about just enough fluids and enough vasopressors?
Echo is one of the more skilled ultrasound exams you can do. Having learnt it and now teaching it, I see the same mistakes being made over and over again. I have put together thread on beginner mistakes in echo. #tweetorial #POCUS #FUSIC #askpocus
theguardian.com/world/2020/nov… @AlisonPittard @SusanMastersRCN @MattHancock Disappointing that none of your statements acknowledge that this is worse for patient safety. You are making it legal to put even more workload on the ICU nurses who continue to be asked to do more for less.
This sums up most of my echo reports recently.
The first rule of transfer medicine...forget A-E...come back with treats! Trying to maintain the high standards taught by @FrimleyAnaes
Intensive Care Yoda: Refer, or do not refer; there is no “just to let you know…”
79% of what? Amongst whom? By what definition? No paper = No EBM = No change. We cannot conduct science through press release.
Royals as anaesthetists.
New toy at work! Not sure I'm going to be deemed senior enough to use it unsupervised...mainly as I can't afford to replace it! Great images though. Hey @ButterflyNetInc... Any chance of a trial probe for a keen intensive care trainee? #POCUS #ButterflyIQ #FUSIC
This is nerdy cool gizmodo.com/mit-engineers-…
Pearl of wisdom from my consultant this week...If the anaesthetist can name the artery/vein that the surgeon has damaged, the patient is in trouble!
Just so you know how anaesthetists think....it’s hard work being this suspicious. We are the curtain twitchers of medicine.
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