@pbw009 profile picture
Pete Williamson @pbw009

Anaesthetist, Geek, Londoner, Cyclist, Optimist, Jedi, Ravenclaw

Joined July 2011
  • Tweets 235
  • Following 72
  • Followers 244
Photos and videos
“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
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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
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"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
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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
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Lowest intra op BP which is sustained for >3min is what seems to predict cardiac risk #ANES18
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Published report - but I’m not a PowerPoint Paparazzi so I missed the reference...
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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
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"Standard ward care" (4-6hrly observations) misses 90% of significant desaturations and 70% of significant episodes of hypotension #ANES18
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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
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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
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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
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Post-op supply/demand myocardial injury behaves differently to plaque rupture & is often inappropriately explained away by "tropinitis" #ANES18
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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
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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
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Pete Williamson retweeted
Dr Helgi@doctorhelgi
13 Oct 2018
Safety isn’t just about checklists and speaking out. It’s also about organisations making staff feel valued and cared for. Dingy and horrible working conditions make staff indifferent to SOPs and policies. #anes18
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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
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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
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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
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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
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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
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