Paul Alexander
@paul-alexander.bsky.social
Gasman who dislikes Gas, Intensivist trying to simplify the messy, developing human still looking for the ‘Grown-Ups’ but nearing acceptance we’re all just winging it in a crazy world…
You can perhaps explain ‘the anaesthetic’ better than you can ‘anaesthesia.’ 😉
November 3, 2025 at 1:22 PM
You can perhaps explain ‘the anaesthetic’ better than you can ‘anaesthesia.’ 😉
Jeekers! That is a big statement!
August 12, 2025 at 6:00 PM
Jeekers! That is a big statement!
Interesting - wonder about the median dose used as threshold (0.35mg/kg) seems v low. 16yr period and varied surgical population makes external validity hard to asess for own practice - for me 0.5-0.75 would be ‘low dose’ for post op analgesia, >1mg/kg for sick inductions.
July 7, 2025 at 12:47 PM
Interesting - wonder about the median dose used as threshold (0.35mg/kg) seems v low. 16yr period and varied surgical population makes external validity hard to asess for own practice - for me 0.5-0.75 would be ‘low dose’ for post op analgesia, >1mg/kg for sick inductions.
That was brill Kevin, 2 calm capable operators. Great stories and views from Cmdr Hadfield with positivity and cooperation from North America to the Soviet Union ‘Merry Creestmas’ 😉
June 26, 2025 at 3:47 PM
That was brill Kevin, 2 calm capable operators. Great stories and views from Cmdr Hadfield with positivity and cooperation from North America to the Soviet Union ‘Merry Creestmas’ 😉
Don’t you be flaming the McGrath! We love em round our place 🥰 Just don’t be stupid enough to put one in an autoclave….
April 19, 2025 at 8:16 AM
Don’t you be flaming the McGrath! We love em round our place 🥰 Just don’t be stupid enough to put one in an autoclave….
But but but….. its 100 times more potent than MORPHINE!!!!!!!!!!
March 18, 2025 at 10:19 PM
But but but….. its 100 times more potent than MORPHINE!!!!!!!!!!
Interesting, though quality low, magnitude effect of salbutamol bigger than insulin, both better, and dose of insulin makes little difference. Putting iv salb in ur insulin/dextrose then makes great sense. I’d though the insulin was main treatment & salbutamol an add on-guess not, another school day
March 18, 2025 at 6:35 PM
Interesting, though quality low, magnitude effect of salbutamol bigger than insulin, both better, and dose of insulin makes little difference. Putting iv salb in ur insulin/dextrose then makes great sense. I’d though the insulin was main treatment & salbutamol an add on-guess not, another school day
I’ve used and liked it in past for colorectal. RCOA statement and related editorial killed it for me. Still believed in it’s utility but that any complications v difficult to defend in that context so stopped for my own sake rather than being convinced of -ve risk/benefit argument for patients
February 25, 2025 at 6:27 AM
I’ve used and liked it in past for colorectal. RCOA statement and related editorial killed it for me. Still believed in it’s utility but that any complications v difficult to defend in that context so stopped for my own sake rather than being convinced of -ve risk/benefit argument for patients
For subclavian - yes i am 👍
February 21, 2025 at 6:11 PM
For subclavian - yes i am 👍
I appear to have missed the ‘ahem…discussion’ - interested though, this is a skill i have dabbled at but certainly nit confident with - signpost anyone??
February 21, 2025 at 6:09 PM
I appear to have missed the ‘ahem…discussion’ - interested though, this is a skill i have dabbled at but certainly nit confident with - signpost anyone??
Can i add close doors?
February 10, 2025 at 9:06 PM
Can i add close doors?
Only 20?? Lightweight!…..
February 8, 2025 at 6:16 PM
Only 20?? Lightweight!…..
Obvs if we can change the system to make it generally less shit that will make everyone working in it happer. We all have a responsibility to help-‘lead, follow or get out of the way’ ie don’t be a wingeing pain in ur bosses ass,identify problem & solutions and present together. Be a team player etc
January 17, 2025 at 2:01 PM
Obvs if we can change the system to make it generally less shit that will make everyone working in it happer. We all have a responsibility to help-‘lead, follow or get out of the way’ ie don’t be a wingeing pain in ur bosses ass,identify problem & solutions and present together. Be a team player etc
It is a real problem, personal experience, but having engaged medical leaders is also essential for the service and the profession - so how do we make being a medical leader better or more attractive?
January 17, 2025 at 1:58 PM
It is a real problem, personal experience, but having engaged medical leaders is also essential for the service and the profession - so how do we make being a medical leader better or more attractive?
If it wouldn’t be missed it’ll die without being ‘shut down.’ Shutting it down would be infinately more trouble. Massive money buys real power. Had modtlh shifted to this place but finally deleted the bird app few days back after his latest ‘shit urself in public’ rant
January 3, 2025 at 3:35 PM
If it wouldn’t be missed it’ll die without being ‘shut down.’ Shutting it down would be infinately more trouble. Massive money buys real power. Had modtlh shifted to this place but finally deleted the bird app few days back after his latest ‘shit urself in public’ rant
Once chewed & swallowed i’d suggest they could no longer be considered nachos…so no 😑
Perhaps too nerdy for most 11yr olds but maybe not for the progeny of Prof Roberts 😉
Perhaps too nerdy for most 11yr olds but maybe not for the progeny of Prof Roberts 😉
December 18, 2024 at 11:24 AM
Once chewed & swallowed i’d suggest they could no longer be considered nachos…so no 😑
Perhaps too nerdy for most 11yr olds but maybe not for the progeny of Prof Roberts 😉
Perhaps too nerdy for most 11yr olds but maybe not for the progeny of Prof Roberts 😉
And Keira Knightly…. 😮💨
December 18, 2024 at 9:15 AM
And Keira Knightly…. 😮💨
Just not a baby…..
Lactase persistence became a selected for human trait after domestication of cattle
Lactase persistence became a selected for human trait after domestication of cattle
November 26, 2024 at 8:05 PM
Just not a baby…..
Lactase persistence became a selected for human trait after domestication of cattle
Lactase persistence became a selected for human trait after domestication of cattle
Meh…. tbh 🤷♂️ I like prefilled for emergency drugs, not so motivated for ‘routine’ drugs like roc. If cost/co2 neutral maybe…. Re size depends on practise, i may draw up 10mls vs 5mls roughly 1:1, not infrequently a 20ml syringe required for 1-1.2mg/kg abw, multiple prefill sizes seems extra wasteful
November 25, 2024 at 4:32 AM
Meh…. tbh 🤷♂️ I like prefilled for emergency drugs, not so motivated for ‘routine’ drugs like roc. If cost/co2 neutral maybe…. Re size depends on practise, i may draw up 10mls vs 5mls roughly 1:1, not infrequently a 20ml syringe required for 1-1.2mg/kg abw, multiple prefill sizes seems extra wasteful
Transverse or oblique in-plane, if done pre-op i tunnel out further laterally using an 18G cannula to stay out of operators field. IMMB pump 30mls 4-6hrly (using y connector to deliver dose between 2catheters using 1 pump) Most often done post op in icu before waking pt up d1 post Emerg Laparotomy
November 19, 2024 at 12:36 AM
Transverse or oblique in-plane, if done pre-op i tunnel out further laterally using an 18G cannula to stay out of operators field. IMMB pump 30mls 4-6hrly (using y connector to deliver dose between 2catheters using 1 pump) Most often done post op in icu before waking pt up d1 post Emerg Laparotomy