What do tactile fremitus and OR fires have in common? Why we keep doing things that don't make sense: radial art lines, NPO after midnight, Trendelenberg position, etc?
Checkout my new blog post about Ritual and Reason in Medicine.
open.substack.com/pub/nickma…
🚑 Can you deliver ICU care at 60mph?
ACCESS is recruiting Doctors – August 2026.
✔ Largest Critical Care Transfer Service in the UK
✔ Complex inter-hospital transfers
✔ QI, governance & research
Not routine ICU. ICU in motion.
#ICU#CriticalCare#RetrievalMedicine#MedJobs
.@BSEcho have launched a new Level 1 library🚀- developed by Jen Gosling, @EchoFoundations, et al, which will support practitioners of emergency echo
The first 30 cases are FREE!
Find out more: bsecho.org/Public/News/Artic…
Avoiding unrecognised oesophageal intubation
The @RCoA & @dasairway have agreed to drop ‘no trace wrong place’
The message now is that we need to exclude oesophageal intubation by identifying SUSTAINED EXHALED CO2
This requires 4 elements
-CO2 rises & falls with respiration
-sustained (non-fading, >7 cycles)
-amplitude >1 KPa
-clinically appropriate
It replaces ‘no trace wrong place’ which is insufficient & therefore inadequate
See these two updated webpages
Sustained exhaled CO2
rcoa.ac.uk/safety-standards-…
Prevention of future deaths
rcoa.ac.uk/safety-standards-…@AAGBI@AndyHiggsGAA@NicholasChrimes
(1/x) Intubating patients with shock in the ICU is by far the most dangerous bedside procedure we perform in ALL of medicine.
There is a 3.1% cardiac arrest rate during ICU intubations (JAMA 2021: PMID 33755076)
Here’s how you can make it as safe (as possible) 👇
Recruiting non-clinical volunteers!
Share with someone who you think might suit
@wmcareteam vacancies:
>HR manager
>Fleet manager
>Operational support staff
-Experience desired but not essential
-Likely 2 hours per week on average
More details/Apply:
wmcareteam.com/wmct/vacancy/…
Avoiding unrecognised oesophageal intubation
The @RCoA & @dasairway have agreed to drop ‘no trace wrong place’
The message now is that we need to exclude oesophageal intubation by identifying SUSTAINED EXHALED CO2
This requires 4 elements
-CO2 rises & falls with respiration
-sustained (non-fading, >7 cycles)
-amplitude >1 KPa
-clinically appropriate
It replaces ‘no trace wrong place’ which is insufficient & therefore inadequate
See these two updated webpages
Sustained exhaled CO2
rcoa.ac.uk/safety-standards-…
Prevention of future deaths
rcoa.ac.uk/safety-standards-…@AAGBI@AndyHiggsGAA@NicholasChrimes
🚨 Exciting news! 🚨
The CARE Team Junior Membership scheme is growing.
Since 2023 we’ve supported med students & junior docs — and this September we’re opening the doors to nurses & paramedics too.
Applications open soon… stay tuned ⚕️
It's that wonderful time of year when new residents are joining the ICU team!
Here are a few of my favorite @CritCareTime infographics to help you understand key concepts:
⚡️Undifferentiated shock
💉 Vasopressors
😮💨 The physiologically difficult airway &
🧪 Metabolic acidosis