I’d like to see the BMAs stance on this. I wonder if there is any justification for a blanket “Our F1s need X weeks notice before starting a Job, any trust which gives notice late should expect F1s to start X weeks after that notice is given and not in August”
Unfortunately that would just end up disadvantaging the FY1s themselves as they wouldn't have enough time to complete FY1 and would therefore have to make up time with an extra run before going in to FY2, and cause they'd be starting FY2 later they'd be given the shittest jobs and have difficulty applying for training posts.
Can I ask why you'd jump straight to angiography after a CTC- rather than get an LP to check for xanthochromia? There's a relatively high incidental aneurysm finding on angiography (estimated at ~3.2% of the population in America and increasing with more scans being done) yet of only about 0.25% of those will ever rupture. I understand doing it that way if an LP is unsuccessful, or if the patient declines one, but going straight to angiography as the standard seems like it would lead to a lot of patients being unnecessarily stressed.
Ah apologies, I had no way of knowing you're referring to neurology OPC - most other posts in this thread seem to be referring to the acute presentations that would be coming to acute services rather than being seen weeks/months down the line. It seems baffling to me though that patients who develop a sudden onset excruciating/worst ever headache with sexual activity are being referred to an outpatient clinic without first being sent to an inpatient facility/ED for a proper work up (as I would expect to happen in the UK/Ire/Aus/NZ).
Medic. Cyclizine (PO/IV, agree wary of IV seekers), Ondansetron (issues with constipation noted), Metoclopramide (avoided in PD) in no particular order, though usually probably cyclizine first as few if any CIs.
IV prochlorperazine is given extremely commonly in NZ. It's just the IM stuff, you bung it in a bag of 1L IVF and run it over an hour. Works like a charm!
The problem with overdosing on paracetamol (called acetoaminophen in the US), is that death from liver failure occurs three weeks later when the person trying to commit suicide has usually changed their mind. Apart from stomach wash-outs and a liver transplant there's not much treatment.
If it's clearly msk pain then what workup is he waiting for? Why not just dc? Just curious bc in my country a guy with this presentation and no risk factors or history of IHD will be sent home as soon as the trops came back negative.
Honestly if someone can come up with a nice combination med of droperidol and mag sulf I'm fairly sure most emergency physicians would build a shrine to them.
If the UK wins in the near future I think it would almost have to go to Glasgow given they were runners up to Liverpool, and the BBC is trying to punt as many things out of London as they can. If not Glasgow I could see them having it in Cardiff - massive BBC production hub there and it's the capital of Wales.
Yes, which leads to an EDH. Due to it sitting just under the pterion which is an inherently weak part of the skull due to it being the fusion point of 4 bones, this making it more susceptible to breaks which then damage the underlying artery.
Yes, I assumed that. Most others reading the comments haven't however, and just commenting alone "middle meningeal artery tear" without any context makes it look like you're saying it's a separate thing to an EDH. TBH slightly strange to comment that alone...
It's why I said student. It's common to go straight from high school to medical or law school in many parts of the world that aren't America. In the UK there's a lot of 3rd year med students who start the year as 19 year olds.
This is the answer. Unfortunately, not all hospitals have paeds/A&E that deals with paeds on site and getting enough capillary blood for an adult tube would be soul-destroying...
You can get a sample in a paeds tube. It's slightly less accurate but the paeds hospital do microcollect bloods on 120kg 14 year olds where I am so it's not unreasonable to do it for 55kg 75 year old Doris.
2 mg of fentanyl will do that. A "strong" dose is 5 micrograms or 0.05 mg.
5mcg is not a strong dose of fentanyl, and that isn't 0.05mg either (it would be 0.005mg). 50mcg is a good loading dose and that would be 0.05mg.
The Golden Girls theme is surely the best one out there. It sets the tone of the show so well, and it's hella catchy to boot.
You'll be fine, they'll do their own form.
I’d like to see the BMAs stance on this. I wonder if there is any justification for a blanket “Our F1s need X weeks notice before starting a Job, any trust which gives notice late should expect F1s to start X weeks after that notice is given and not in August”
Unfortunately that would just end up disadvantaging the FY1s themselves as they wouldn't have enough time to complete FY1 and would therefore have to make up time with an extra run before going in to FY2, and cause they'd be starting FY2 later they'd be given the shittest jobs and have difficulty applying for training posts.
Patient needs NCCT + CTA / MRA first and foremost to rule out aneurysm +/- SAH.
Can I ask why you'd jump straight to angiography after a CTC- rather than get an LP to check for xanthochromia? There's a relatively high incidental aneurysm finding on angiography (estimated at ~3.2% of the population in America and increasing with more scans being done) yet of only about 0.25% of those will ever rupture. I understand doing it that way if an LP is unsuccessful, or if the patient declines one, but going straight to angiography as the standard seems like it would lead to a lot of patients being unnecessarily stressed.
Good question and LPis certainly appropriate acutely.
Ah apologies, I had no way of knowing you're referring to neurology OPC - most other posts in this thread seem to be referring to the acute presentations that would be coming to acute services rather than being seen weeks/months down the line. It seems baffling to me though that patients who develop a sudden onset excruciating/worst ever headache with sexual activity are being referred to an outpatient clinic without first being sent to an inpatient facility/ED for a proper work up (as I would expect to happen in the UK/Ire/Aus/NZ).
yeah, I just about NEVER use levo or cipro due to side effects......
It's only a slight risk of tendons and the aorta bursting, it's fine!
What are you talking about, they’ve got it in the bag this year
An Icelandic win? I feel it coming! wooh
Either oral ondansteron melts, or IV droperidol.
Medic. Cyclizine (PO/IV, agree wary of IV seekers), Ondansetron (issues with constipation noted), Metoclopramide (avoided in PD) in no particular order, though usually probably cyclizine first as few if any CIs.
IV prochlorperazine is given extremely commonly in NZ. It's just the IM stuff, you bung it in a bag of 1L IVF and run it over an hour. Works like a charm!
The problem with overdosing on paracetamol (called acetoaminophen in the US), is that death from liver failure occurs three weeks later when the person trying to commit suicide has usually changed their mind. Apart from stomach wash-outs and a liver transplant there's not much treatment.
Paracetamol (acetaminophen) poisoning is really nasty, but it's not quite like your post suggests.
If it's clearly msk pain then what workup is he waiting for? Why not just dc? Just curious bc in my country a guy with this presentation and no risk factors or history of IHD will be sent home as soon as the trops came back negative.
This sounds like the triage work-up that's been instituted by the triage team. They still need to be seen by a clinician.
Nothing 5mg droperidol can’t fix
Honestly if someone can come up with a nice combination med of droperidol and mag sulf I'm fairly sure most emergency physicians would build a shrine to them.
If the UK wins in the near future I think it would almost have to go to Glasgow given they were runners up to Liverpool, and the BBC is trying to punt as many things out of London as they can. If not Glasgow I could see them having it in Cardiff - massive BBC production hub there and it's the capital of Wales.
Middle meningeal artery tear.
Yes, which leads to an EDH. Due to it sitting just under the pterion which is an inherently weak part of the skull due to it being the fusion point of 4 bones, this making it more susceptible to breaks which then damage the underlying artery.
I also went to medical school.
Yes, I assumed that. Most others reading the comments haven't however, and just commenting alone "middle meningeal artery tear" without any context makes it look like you're saying it's a separate thing to an EDH. TBH slightly strange to comment that alone...
Probably not for their viral UTI
Oh you'd be surprised.
Holy shit.
Meemaw, uh, finds a way.
When they first showed the third set of players I genuinely almost blacked out from laughing so hard. Genuinely such a brilliant episode!
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She's 19. She is old enough to vote and join the military. She is an adult ffs. There are student doctors and lawyers her age, she is not a child!
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It's why I said student. It's common to go straight from high school to medical or law school in many parts of the world that aren't America. In the UK there's a lot of 3rd year med students who start the year as 19 year olds.
I think it's just Meredith, Bailey and Webber.
Remember in season 1 how Webber was talking about retiring?
This is the answer. Unfortunately, not all hospitals have paeds/A&E that deals with paeds on site and getting enough capillary blood for an adult tube would be soul-destroying...
You can get a sample in a paeds tube. It's slightly less accurate but the paeds hospital do microcollect bloods on 120kg 14 year olds where I am so it's not unreasonable to do it for 55kg 75 year old Doris.
Honestly? Sexual health.
The way Scarlet has done her makeup plus the lighting makes her look extremely pissed off
No babe, that's not the makeup. She is just extremely pissed off.
I had PLT of 1 that became 0 after I ordered a repeat lol. Woops.
It was used up healing the previous lab draw puncture.
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It's only a bus lane between 4-7pm on weekdays. Rest of the time it's free for any road user. Usually not free for someone going the wrong way.
Ophthalmology on the weekend
Literally everything is "pop an eye shield on and I'll see them in clinic in the morning".