2-yrs ago I donated bone marrow to my brother, Jack, with AML. He's now back working as an ED doctor in Sydney & has reflected in The Lancet Haematology He reminds us not to shy away from providing hope for our pts even when the odds are stacked against them 🔗bit.ly/2XQZ60I

A tragic death bbc.co.uk/news/articles/… Large volume LA infiltration (by a surgeon) now commonplace joint replacement, plastics & vascular surgery Falls between stools - who is the prescriber - who is responsible for preparation - who is responsible for complications Coroner's

Vadim Sizov There are numerous international reports in the mainstream press of deaths during mostly plastic surgery where an 'overdose of local anaesthetic' is postulated or concluded as the cause USA nbcnews.com/news/us-news/f… Aus smh.com.au/national/nsw/c… India hindustantimes.com/lifestyle/heal…

Brian Mc Kinney Yes agree As per my original post, there is an interesting multipartite process -Surgical team ask anaesthetist how much LA they can use -Anaesthetist calculates this -Circulating nurse listens and gives draws up what can be given -Scrub nurse draws this up -Surgeon administers

Tim Cook Thanks. That’s not the same as prescribing, the alert should have been sent to the RCS too I think. We do similar in the US, but the surgeons need to actually prescribe any LA they want to use and we liaise with them about blocks and dosing (in adults and paeds)

Definitely a national QI area

Not a time for silos... and that's not what my post is implying ....but it might be a time for us all to get together and get this done safer!

Richard Sloggett I’m not saying prevention is a bad thing. I’m just seeing some pretty sloppy thinking being bandied about.

Tim Cook Catrin Jones Resus Pieces Joe Pick Calling out the BS This!!! Error and harm are not the same thing at all. Equating the two has lead us down all manner of wrong paths.

Tim Cook Nose Coloured Glasses - Stavros Prineas Hi Tim I would anticipate samples in plasma to be fairly stable especially if kept in fridge until analysis. Ropivacaine is extensively metabolised by liver & highly protein bound Obviously clearance stopped though at point of arrest.

Alex Panton I would say this is pretty vocal with 80k views and many comments!

Sam Ghali, M.D. Anaesthesia, ICU, ED, PHEM CAPNOGRAPHY is THE only reliable way to confirm correct position of a tracheal tube. In life and in cardiac arrest. Clinical signs are of close to zero value. Look for sustained exhaled CO2: ie - goes up & down with ventilation - sustained - above 1

Tim Cook Could not agree with this more, Tim!!!

Tim Cook Association of Anaesthetists Agree with both points. Not sure I agree that a gown necessarily adds an actual layer of protection. In fact, poor gowning technique (e.g. fingers out of the cuffs and touching the gloves) may inadvertently worsen antisepsis. Not convinced there is a clear benefit.

Tim Cook Addy Sam Ghali, M.D. Strong agree with this. I'm sure many will've seen a tube where ultrasound would have confirmed it was in the trachea, but due to say, a mucus plug obstruction etc, that might not be obvious on US, but capnography gave a heads up before the situation was critical and tube pulled.

Tim Cook Addy Sam Ghali, M.D. All of the above. Plus, if you're not using it routinely in real time to watch the tube go in, just the delay for our US to 'boot up' (after having retrieved it) would be unacceptable for use as a 'valid alternative technique' when sustained exhaled CO2 is absent.

Regular reminder to all my colleagues to consider downsizing from your set mantra of ETT sizing to reduce (not increase) complications based on the data… …-publications.onlinelibrary.wiley.com/doi/full/10.11…

Congratulations to Royal College of Anaesthetists FPM & FICMNews members receiving their Fellowships in today’s Diplomates Ceremony @CentralHall. A very warm #TeamAnaesthesia welcome to all supporting family & friends! #RCoADips

4 fellows 1 report 4.5 yrs work 39 chapters 450+ pages 881 cardiac arrests & 1 pandemic 1 emigration 2 retirements 3 consultant jobs 1 new president 4 PMs 6 secretary’s of state for education 290 local coordinators 11000 anaesthetists 300+ sites 30+ panel members 4.5

Tim Cook Lovely photo - what a great bunch of people!!