
Manservant to Bella and Lachlan. 🏊♂️ 🚵♂️ 🏃♂️ Du&Triathlete. EM Consultant. Part of the @CEMBooks team ⭐️Finlay⭐️
Yorkshire
Joined January 2012
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Replying to @StuartNuttall1
“Focus on consistent habits & great cadence before marginal gains.”
Figure at some point you need a motto in life that you can stick to.
It’s not catchy but I think it’s true!
Always Open. Already Full: Why @grahamwalker is leaving emergency medicine in USA and is worried about its future
linkedin.com/pulse/always-op… @DrLKVaughan @sib313
Older trauma - is it a different disease?
Aetiology - different.
Physiology - different
Clinical presentation- different
Interventions required - different
Staff required - different
We should probably think of two linked trauma systems rather than one size fits all.
This study suggests that certain groups of older trauma patients treated at Level 3 centers may have equivalent survival to those treated at Level 1 trauma centers, while younger patients experience higher survival for nearly all injuries at Level 1 centers.
ovid.com/jnls/jtrauma/abstra…
Stuart Nuttall retweeted
This study suggests that certain groups of older trauma patients treated at Level 3 centers may have equivalent survival to those treated at Level 1 trauma centers, while younger patients experience higher survival for nearly all injuries at Level 1 centers.
ovid.com/jnls/jtrauma/abstra…
Also the added friction of working through endless upsell’s on these things is really annoying!!
🦔Fast food chains spent millions on digital kiosks and mobile order systems to replace counter staff. According to the Wall Street Journal, they've now gone back to human workers because customers want someone friendly to take their order. McDonald's has lost regulars to Chick-fil-A and Arby's over it.
My Take
I love this story because it's so simple. Companies spent millions to avoid paying a person $15 an hour to be friendly at a counter. Customers hated it and went to the restaurant next door where a human said hello and took their order. Now the kiosk companies want those same people back.
Chick-fil-A has had a person take your order at the drive-through for years and they're the busiest chain in the country. I don't think that's a coincidence. I'm guessing a lot of companies are about to find out the hard way that customers chose them for the experience, not the app.
Hedgie🤗
Stuart Nuttall retweeted
🛑Syncope-Stopper
#ESCCongress #HOTLINES #syncope
200 pts with unexplained syncope + high bradycardia risk (DROP ≥2), mean age ~80 (47% women 👏🏽🌟)→ upfront pacemaker 🆚 standard care
At 1 yr:
↓51% primary composite
↓53% recurrent syncope (11.1% vs 21.8%; HR 0.47, P=.037)
↓43% all-cause hospitalization
Upfront pacing may benefit selected high-risk pts
Stuart Nuttall retweeted
Congratulations to @mattreed73 and ASPIRED study team - presentation at #ESCCongress (and publication in @NEJM ). 14-day ECG monitor in pts with syncope did not reduce syncope burden - but did identify high risk patients and resulted in a 50% decrease in all cause mortality!
Stuart Nuttall retweeted
Among patients with syncope that remained unexplained after evaluation in the emergency department, the use of 14-day ambulatory ECG monitoring did not result in significantly fewer patient-reported syncope episodes at 1 year than standard care. nejm.org/doi/full/10.1056/NE…
Stuart Nuttall retweeted
The Lancet just released the REMAP-CAP manuscript pre-peer review. Oseltamivir (5 or 10 days) vs no antiviral in critically ill influenza. 🧵
papers.ssrn.com/sol3/papers.…
Stuart Nuttall retweeted
I think this is one of the most important dynamics we see in the UK right now. And the level of burning anger you're going to see across younger generations will reverberate across British life for decades to come.
In my opinion, it's a financialisation story. We produce some of the best-educated young workers in the rich world, and have done for a long time now, but we then hand the yield to whoever already owns the assets. So the trouble is, skill doesn't set your wage… the economy does. And when the asset value itself is what drives the incentive, building becomes the opposite of what the owners of capital want. Productive capital wants to build, because it profits from output, whereas rentier capital wants tight supply and a captive market whose yield it controls. We've spent two decades creating the most favourable conditions for rentier capital, whilst penalising the productive.
We've got one of the most highly educated populations in the rich world. So as a country, we've invested astronomical sums in educating our young people. We've been hoarding highly educated talent, whilst at the same time building nothing for it to do. We haven't provided the conditions for it to flourish.
As you'll know from a lot of what I've posted previously, we've built an economy that primarily looks to financially engineer new ways to extract yield from what we already have, rather than build new assets, new companies, new infrastructure.
As a result, the country has declined in almost every way. Our roads, public transport, housing, water and energy have all degraded, and the number of publicly listed companies is in freefall, down by roughly a third in a decade. Despite the decline, we pay record amounts to access it all, a large portion of which comes directly from its financialisation. At the same time, we've doubled down on higher education, churning out graduates and throwing them into an economy that has nothing to offer them. We then wonder why society continually feels like it's breaking down.
So the problem we have is this. We've built one of the most educationally advanced pools of human capital the world has ever seen, and an economy with nowhere to put it. The gap between what these young people were promised and what they've been handed… is where the burning anger lives.
And if you want to see this firsthand, speak to someone who left and took their skills elsewhere. I'm sure you'll be shocked at the lives they've been able to build for themselves in countries that still choose to build.
Stuart Nuttall retweeted
I needed my lawn mowed. I asked an American for the name of a company.
He said, "Get a kid."
A kid. Not a service. A child.
I asked which kid.
"Any of 'em."
I asked where one obtains a kid. There is no directory. There is no listing.
He said, "Ask around."
I asked around. Two days later a fourteen year old named Cody was standing on my porch.
He did not bring a mower. Nobody told me this part. The kid uses your mower and your gas. He brings arms.
I asked his rate.
He said, "Whatever."
Whatever. A negotiation had opened and the other party declined to attend.
A blade drawn against no opponent must be returned to the sheath in silence.
I put my wallet away.
So I conducted research. I asked four adults what the correct amount was.
Four numbers. Twenty. Forty. Twenty five. One man said he gave a kid fifty once and could not remember why.
There is no rate. There has never been a rate. An entire national labor market runs with no published price and every participant is somehow satisfied.
I looked up the state minimum wage. I timed the work. I arrived at a defensible figure and I paid it.
My neighbor watched this from his driveway.
Later he came over and told me, kindly, that I had underpaid.
I said the amount exceeded the legal minimum.
He said, "Yeah, but he's a kid."
THE PRICE IS NOT THE PRICE. THE PRICE IS THE PRICE PLUS SOMETHING NO MAN ON THIS STREET WILL SAY OUT LOUD.
So I corrected. I overcorrected. Sixty dollars for forty minutes.
The same neighbor came back over.
"Alright. Don't ruin him."
There is a floor and there is a ceiling. Neither is written anywhere. Both are enforced by men standing in driveways with their arms folded.
The samurai who cannot read the room dies in the room.
I have been dying in this room since June.
Cody was thirsty. I did not offer him water, because he had not asked, and a warrior does not name another warrior's weakness.
My wife told me he is fourteen and it is ninety one degrees. I now leave a bottle on the step where he can take it without being seen taking it.
I asked my neighbor why the whole street does this. Why grown men pay a boy more than the work is worth and then pretend not to have noticed.
He said, "You're not buying a lawn."
Then he went inside, because apparently that was a complete explanation.
Cody has cut my grass eleven times. He is saving for a truck. I know the exact figure because he told me, unprompted, in August, sweating, holding my own mower.
Last week a family moved in three houses down. The man came over and asked if I knew anybody who cuts grass.
I said, "I got a kid."
I heard what that sounded like. I did not correct it.
He is nine hundred dollars from the truck.
A mountain is not asked to be smaller. A mountain is walked around, at night, quietly, by a man with a truck payment he intends to make on someone else's behalf.
I have started mentioning him to people.
Others have clearly articulated how badly this will impact rotating docs and the likely workarounds.
Another example of IG getting in the way of work being doing so building a ridiculous reputation when actually it performs a vital function. Big parallels with IPC in my view.
Stuart Nuttall retweeted
An alien landing in most countries around the world would conclude that the role of a government is to take money from young people who work
and pass it to old people , in as many ways and as convoluted ways as possible
It’s utterly backwards. Somehow nobody gives a shit about people who are supposed to be the future. We drag them down.
And this is why it’s so important that he’s doing it!! Until you feel these issues yourself it’s someone else’s problem. Really support this No 10 in the north policy. Hopefully will lead to improved infrastructure up here.
Stuart Nuttall retweeted
Outside of London, Birmingham, Leeds, Liverpool and Sheffield are seeing heavy overcrowding on trains with little ability to resolve this thanks to retreating government ambition on electrification and network expansion.
Read the report here:
neweconomics.org/2026/07/cut…
Stuart Nuttall retweeted
Asked Kimi K3 what it would do as UK PM to return North England to being among the richest economies in the world. Best answer yet. From any model.
Stuart Nuttall retweeted
Your Sunday group ride is probably doing more for men’s mental health than most corporate wellness programmes & therapy combined.
Nobody calls it therapy.
That is why it works.
A group of men meet in a car park at 8am.
They insult & abuse each other’s equipment.
Argue about tyre pressure.
Pretend not to be cold.
Ride side by side for three hours.
And somewhere between the first climb and the coffee stop, actual life gets discussed.
The business that is struggling.
The parent who is sick.
The relationship that is falling apart.
The anxiety nobody mentioned in the office.
The fear of getting older.
There is no circle of chairs.
Nobody is asked to “share.”
No wellness consultant is taking notes.
They are just moving forward together.
A lot of men communicate better shoulder to shoulder than face to face.
Give them a difficult road, a shared destination and enough time, and the conversation eventually becomes honest.
Modern life has removed many of the places where this used to happen.
The factory floor.
The local club.
The pub where everyone knew your name.
The community organisation.
The football team you stopped playing for at 32.
Work replaced most of it.
Then remote work replaced the people at work.
Now a man can spend five days moving between a laptop, a car and a television without having one meaningful conversation.
We call this efficient.
It is also incredibly lonely!
Cycling accidentally solves part of the problem.
It creates routine.
Shared suffering.
Responsibility.
Belonging.
A reason to show up when you would rather stay in bed.
The group notices when you disappear.
They notice when you are unusually quiet.
They notice when you are riding badly.
They may not ask if you are okay in those exact words.
They might ask why “you’re glued to the road today”?
But the question is still there.
This is why local cycling clubs matter.
Not because the world needs more people chasing Strava segments.
Because adults need somewhere they are expected to appear.
Community is not a WhatsApp group.
It is someone noticing you were not there.
Protect your group ride.
Invite the rider who is drifting away.
Wait at the top of the climb.
The coffee stop might be doing more good than anyone realises.
Stuart Nuttall retweeted
I agree with @trentconsultant & @DrLKVaughan. As past Chair of @TheBMA Medical Ethics Committee & someone who has worked on confidentiality & privacy issues for decades, I regard these proposals as grossly inappropriate & unworkable. @NHSEngland must think again & consult experts
As so often I agree with Louella. @SwordsFrankie hard to imagine there has been consultation in this with working Drs, the examples are especially poor. Could @NHSEngland look again and consult please?
Stuart Nuttall retweeted
BBC 4 has officially ended its last Long Wave radio broadcast on 198 kHz at 0000 GMT tonight. They ended with an aviation and maritime weather report and one final sign off. The end of an era! 🇬🇧📻








































