I’ve always thought if you have enough of a concern that you feel the need to right something negative on an MSF/MTR then you should have broached this with the person prior to writing it. Impossible to reflect and respond to out of context comments. Should we ask for evidence to back up comments?!
Not normally one to self promote but I’m pretty proud of the question book I have written. 2 years in the making and now available!
Hopefully this will be a helpful resource for people having to tackle the FFICM exam!
gbr01.safelinks.protection.outlook.com?url=https%3A...
I think vascaths or swan introducers are useful if you can get them in for faster flow rates (not a central line). But would still use an ultrasound to insert it (as likely to be a little more technically difficult if they are significantly hypovolaemic).
Putting a central line in on ICU as an SHO on a level 2 patient, local had gone in and getting ready to start and the patient shouts ‘I am a snake’ and kind of wriggles off the bed like a snake. We were all so shocked no one stopped him! Luckily I’m short so the bed wasn’t that high 🫣
All based on my assessment of the patient. Theatre patients have pre-filled metaraminol/atropine if needed and run a pressor infusion for those who will definitely need it. ICU patients often have dilute adrenaline (10mg/ml) and metaraminol drawn up.
I work in a DGH that is the Maxfax centre for the region. About once a month I will have a patient on the emergency list with negligible mouth opening, AFOI only option. Imagine very few of us do 20 a year but we are competent at it, not enough people to have a separate rota.
Do your machines already have a hose with a Schrader valve at the wall end? If so can just get a portable cylinder with quick release Schrader valve. This is what we have done, much easier than trying to sort yokes. If they don’t then I’m sorry my solution is useless!
The analogy I use is: imagine drawing up 20mls of propofol into a syringe and squirting 19mls down the sink and only getting to use 1ml for the patient. That is the proportion of nitrous used for patient vs lost to the atmosphere. Portable cylinders massively reduce this loss.
As well as physical leaks and loss from machine testing, when a manifold alarms low pressure the cylinders are all changed and any residual nitrous in the cylinders vented into the atmosphere, sometimes this could be a significant volume of nitrous, which contributes to global warming and ozone loss
Cheeky Midweek #AnSkyMedSkyDebate from @bobfunn.bsky.social
We should remove all N2O pipelines from hospitals and replace with portable cylinders.
#AnSky #MedSky
Yes! No brainer! In my hospital there is a piped supply to so many areas that haven’t used it for years/decades. Decommission manifolds (a proportion of which just gets vented back to the atmosphere) and switch to using portable cylinders. This also reduces nitrous wastage from machine checks.
The hoses are pretty long, but yes using them is an excellent idea! Will see if I can get that adapter ordered!
Just dug out Wards and realised it is a NIST valve! So need a cylinder with a regulator with integral schrader valve, then a small length of pipe with a quick connect schrader probe on one end and a NIST on the other. Does anyone have this setup and if so can tell me where you got it please!! 😃
Thanks Garry, that is the plan- I’m just wondering what bit of kit people used for this, as it seems for our machines you would need a cylinder ->regulator ->short piece of piping with a screw valve on the end, the name of which I don’t know (have just been calling it a screw style schrader 😂)
Hoping #AnSky might be able to help!
In the process of decommissioning of our nitrous manifold and still have colleagues who use it. Looking for solutions to supply occasional use nitrous to a machine without a cylinder yolk please? If a mobile cylinder how did you connect to the machine? Thanks!
New safety checklists now published by the Society and FICM focusing on procedures commonly performed in ICUs.
Find them in the Journal of the Intensive Care Society or download editable PDFs below.
bit.ly/checklists25
“If you design a city for cars, it’s fails for everyone, including drivers. If you design a multi-modal city, it WORKS BETTER FOR EVERYONE INCLUDING DRIVERS.” — Brent Toderian
FACT: The more people choosing to walk, bike & take public transit to get around cities, the better cities work for EVERYONE, including DRIVERS.
Anyone claiming that less car dependency is a “war on cars” doesn’t understand how cities (or geometry) work.
It’s time we tell #TheTruthAboutTraffic.
Anaesthesia contributes ~40% #GHG emissions from operating rooms. #TIVA had lowest GHG emissions (0.4kgCO2e/hr) but most plastic pollution vs #TCIA (3.1kgCO2e/hr) vs manually optimised sevoflurane (3.8kgCO2/hr)
Poster showing that more walking and cycling leads to more safety and less congestion, pollution, and noise. Includes diverse people walking and cycling.
More walking & cycling mean
🛣️less traffic,
🍃cleaner air,
😌and quieter streets.
Walk & cycle your way toward safer, healthier & more liveable cities.
Learn more 🔗bit.ly/43eExcc #RoadSafety #BeActive
Happy International Nurses Day to all of the amazing nurses I currently work with and have worked with in the past. You guys are an invaluable and irreplaceable part of all hospital teams 🥰
For those doubting the importance of sustainability in healthcare - since our nitrous oxide consensus statement came out last year, we’ve used 9.8 million fewer litres of manifold nitrous, equivalent to nearly 6 million kg of CO2
(Or a trip to the moon and back 60 times, if you prefer…)
The Intensive Care Society reaffirms our commitment to inclusive and dignified care for all patients.
Read our full statement below👇
bit.ly/inclusivecareforall
I am pleased the ICS have come out with a much needed statement of support rather than yet another ‘helpful to have clarity’ which is neither helpful nor provides clarity.
I have a remarkable and it’s invaluable to me. Used it for FICM revision, now have access to all those notes at all time on my phone. Use it to make notes for conferences and as a way to read and notate papers. Also helpful to entertain the kids if you forget paper for drawing!
One week to go! Join us for a brilliant evening on prioritising plant-based meals in hospitals!
🗓️ Wednesday 23rd April
🕖 7pm
📍MS Teams - links will be here/Twitter nearer the time or sign up to our mailing list via our website GHASP.org.uk 💚🌱
Waste and cost assessment of total intravenous anaesthesia in the context of environmental sustainability
journals.lww.com/ejanaesthesi...
We recommend that trusts and health boards decommission their nitrous oxide manifolds, switching to point-of-use cylinders.
This new Nitrous Oxide toolkit from @england.nhs.uk and UCL Partners offers step-by-step guidance to reduce nitrous oxide waste safely and efficiently.
ow.ly/twNv50V5ZAL
@ics-updates.bsky.social @ficm.bsky.social
The Intensive Care Environmental Sustainability recipe book is here! Amazing resource and a brilliant way for those of us working in ICU to continue and expand our green work! Have a read and get involved in some projects 🌎
Thanks for all the hard work of those involved.
ics.ac.uk/static/d96de...
Looking for some practical recommendations you can implement to improve wellbeing and morale for resident anaesthetists?
Here are some local, regional and national solutions!
#AnSky #MedSky
https://doi.org/10.1111/anae.16575
