“I only have one coronary stent doc” 1) you have the risk factors to need one 2) you have coronary endothelial damage 3) you are having surgery, which is pro-thrombotic 4) you are on anticoagulants #ANES18

Physiological reserve = biggest physiological insult the patient can survive minus baseline function Frailty = loss of physiological reserve across multiple body systems (cannot be quantified by one test) Elderly trauma patients have low reserve and high frailty #ANES18

"Words have power" - Terry Pratchett Perimortem section = sounds like you are killing the mother to save the baby, people think twice Resuscitative hysterectomy = procedure necessary to save the mother and baby, people perform it Same thing though #ANES18

Performing a blood patch on someone who turns out not to have a PDPH can precipitate seizures and delirium - something to think about if you’d asked to do one at 03:00 on the postnatal ward #ANES18

There is no such thing as the "straightforward post-op surgical in-patient". If there were simple, they would be been a day case. The entire hospital population has been pre-selected as high risk #ANES18

"Standard ward care" (4-6hrly observations) misses 90% of significant desaturations and 70% of significant episodes of hypotension #ANES18

We all remember "that case" when the surgeon quietly cuts through the IVC without mentioning it, but in reality in 33% of cases the lowest sustained BP occurs before KTS - cycle NIBP frequently after induction #ANES18

Risk prediction for cardiac events: Scoring systems: everyone ends up as "intermediate risk" Ex tolerance: patients lie Stress echo: no evidence CT coronaries: only useful if it’s clear, which rarely happens BNP: probably the best #ANES18

Useful interpretation of troponin is challenging given the different assays available and local reference ranges for Trop T, Trop I, 4th generation, & high sensitivity assays #ANES18

Post-op supply/demand myocardial injury behaves differently to plaque rupture & is often inappropriately explained away by "tropinitis" #ANES18

My read on mass casualty situation: Surgeon = hothead X-Wing pilot, flies around blasting stuff in quick succession hitting multiple targets in a short time Anaesthetist = Jedi, prolonged 1:1 battle, helps keep X-Wings in the air, cool, calm & collected #ANES18

Roles for anaesthetists in major incidents Clinical (obvious): inserting ETT, lines, chest drains etc. Non-clinical (important, often forgotten): offering breaks / food / drinks to other anaesthetists, resupplying airway kit, helping theatre turnover, runners for blood #ANES18

Avoid quick safety fixes that don’t work: adding yet another mandatory Moodle module and chasing people to complete it is just a punishment in disguise, creating indifference and resentment. #ANES18

Roughly 50% of medical students think they’re at risk of burnout, only 30% of those sought help. 70% of that 30% talked to family. Should family members be given a ticket to your peer review/MSF? #ANES18

Spotting signs of burnout in a colleague is like hypotension in a bleeding patient: it is a late sign just before falling off the cliff, and people go to great lengths to “explain it away” with another diagnosis #ANES18

Supporting doctors is cost effective. Burnt out doctors give poorer & less efficient care, with poorer patient satisfaction, and also need shifts covering more often costing £££ #ANES18

Top ways for anaesthetists admit using to deal with stress 1) exercise 2) talk to friends 3) sleep, Least common way: prescriptions via their GP #ANES18