@OmAndScop @DrBen_GT Jon Hilton 1. We are incapable of determining "volume status" clinically except in extreme circumstances. 2. The history matters quite a lot. 3. Saline is usually okay. 4. There is no such thing as colloid osmotic pressure. 5. Too much fluid is sometimes worse than too little.

@OmAndScop @DrBen_GT Jon Hilton 6. Lactate and base excess tell you almost nothing about how much fluid to give. 7. Most elevated lactate is not causes by insufficient oxygen delivery at a microvascular level. 8. Ask patients about thirst but not if they're also hypernatraemic. 9. Maintenance fluid at night? No

Opportunity to join the great multispecialty @qehbham and University Hospitals Birmingham consultant Acute Medicine team. Either as pure AIM or 50/50 with another GIM specialty jobs.nhs.uk/xi/vacancy/916…

This feels very relevant to my recent decision to step away from academia. Hard to find a work-life balance when you're regularly asked to do unrelated work in your own time.

#SAMBA2020 unit questionnaire is now open! Your chance to tell us more about how COVID has affected acute medicine services across the country Log in via data.casecapture.com or email us sambaSAM Online.org.uk @acutemedicine Dan Lasserson Tim Cooksley Chris Subbe @twh_knight

Prof Singhal thinks he is an acute physician, and that this gives him the right to take pot shots at the entire specialty. He exhibits a breathtaking lack of insight. A CTPA may be indicated... SAM Online

‘Brexit deal never made sense’ says man who negotiated it, signed it, prevented MPs from scrutinising it, campaigned for it and won a general election on the back of it:

Today’s the day! Looking forward to getting our acute medicine family together. Let’s do this! #SAMGlasgow

Massive congratulations to Dan Beckett and colleagues who have put together a great programme for #SAMGlasgow. Feels bittersweet watching it at home but so pleased that it's still on.

Today marks an important milestone in the fight against #COVID19. Interim data show the #OxfordVaccine is 70.4% effective, & tests on two dose regimens show that it could be 90%, moving us one step closer to supplying it at low cost around the world>> bit.ly/oxford-vaccine…

Manoj Wickramasinghe @manoj-w.bsky.social Resuscitation Council UK Ashley Miller Jonny Wilkinson Most people with sepsis have only modestly reduced total body water (sweating, tachypnoea). Vasodilation and extravasation as well as cardiac impairment are jointly the cause for hypotension. Which is why too much fluid is barmy. Adam Seccombe

Manoj Wickramasinghe @manoj-w.bsky.social Jacob de Wolff 🇳🇱🚲☕️ Resuscitation Council UK Jonny Wilkinson Adam Seccombe

Adam Seccombe Shai Sarb Clare MBE SAM Online @AcuteMedEd Dan Lasserson Ben Lovell @harryahmed01 Chris Subbe Matt Inada-Kim Recently I considered that we could actually produce pretty impressive prognostic databases. This in the context of the metformin lactate thread. x.com/jfdwolff/statu…

Jennifer Logue Thomas Shanahan (Dr.) MRCEM Dan Lasserson @TERNfellow West Midlands trainee group (WAMC) Adam Seccombe Joe Wheeler (when trainees) did some great work. Model works. rcpjournals.org/content/clinme…

I have had fantastic teachers and mentors over the years to help me start doing this Sarb Clare MBE Andrew Walden Nick Smallwood Adrian Wong Matthew Maw Adam Seccombe

Thank you! We’re very excited to start sharing updates about SAMBA (and our upcoming #SAMBA2021) with you all on Twitter, and hearing from acute medics about how we can make SAMBA work for you SAM Online Dan Lasserson Chris Subbe Cat Atkin Tim Cooksley @twh_knight