Ischaemic pain has very different cytokine profile from inflammatory. I had a similar experience with microperforation after stone stuck in neck. I worry that necrotic appx can also present like this.

Well, you have to learn to chat as you scan so that you don't lose time. And you use your words to comfort the patient (no matter what you see) and your movements measured and,soothing never abrupt....Every interaction should be therapeutic. "Ah I can see that his heart has served you well"....

PoCUS does not so much change my plan as create it in the beginning- It is my examination on almost every patient. I think it is vital to avoid early closure. When I have time I like to glance and most systems and ask 'where is redundancy' and 'where have we reached capacity'?

Have only just read Prof Argulian's book so pretty shaky on this but would like to try....uncertain without ECG, maybe reversed S wave and very slow rising D suggesting poor/slow relaxation of RV?

PS All scans, even training ones, get a short report in relevent patient chart, including location(ie which machine) indication, quality, findings, patient consent re education, and next action recommended.

Yes most certainly, but I have to be very careful re confidentiality. I note UR/date/indication (but no other identifiers) in notebook, and then download clinically important scans (anonymised) AND then rung them through CLIP DeIdentifier App from Ben Smith. CORE USS.

I can't afford a proper system. I download to personally purchased hard drive every 3 months, and only put the occasional important scanset onto hospital radiology system. Would love to have Viewer (GE) or synchronicity (Sonosite) but no money.

Are you meaning recording images themselves, or the patient details?

What's a stethoscope?

I have always liked IV Magnesium as a rescue analgesic adjunct, particularly when there are chronic pain signals.

And there should never be more systematic reviews than original RCTs

What do you use it for specifically Josh?

Go Segs. Nice to see your face. I just listened to your Bipap talk from H&R...excellent primer and now going to listen again with speed reduced!

Sorry but they are a couple of years out of date now...

First ref is an expensive but complete reference that includes a lot of European experience. Second is free I think.

Sorry Gav, I don't post much on Bluesky, I just stalk. Since the Europeans are so far ahead of us, papers may not be in English. The best references I found were in Matthis' big expensive book. Gorg stated that you could not pick atelectasis from PNA just on colour...

Did you get my references? Wasn't sure whether to post to you or Segs.