Miles Gandolfi

Emergency Medicine consultant. PHEM.

Know your priorities during resuscitation.
Airway, Breathing, Caffeination.

[Luke Mordecai @Shr_Nottingham]

If you half the number of hospital beds it doesn’t require a team of management consultants to work out why patients are stuck in corridors 🤷‍♂️

[Ben Zaranko @BenZaranko]

A short seven years (!) after I started writing the code, it’s great to see this paper published.

We use high-frequency NHS to data show that short-staffed, less experienced nursing teams deliver worse outcomes – with the largest mortality impacts for patients with sepsis.

[Margaret McCartney @mgtmccartney]

Dear @David_Cameron
I know you mean well, but unfortunately screening for early disease may sound logical and sensible but can also be ineffective and harmful. Recommending a bad test leads to false reassurance, and harms through unnecessary or ineffective treatment that only /

[C. Michael Gibson MD @CMichaelGibson]

DECAF trial: continued consumption of caffeinated coffee was associated with a 39% lower risk of AF/AFL recurrence at 6 months after cardioversion vs. abstinence from coffee. View the slides here: https://t.co/zHib2T5gL0

[Jon Barratt @EMDocJB]

“Physiology-Guided CPR” 🚨🚨🚨

The inclusion of “physiology-guided CPR” in the ERC resuscitation guidelines marks a significant milestone in progress.

So here are my reflections on the journey we have undertaken and thoughts on the future directions

#SPEAR

🧵

[Ian Higginson @RCEMpresident]

Work out the maths. Evidence from England shows that for every 72 people who stay 8-12 hours before admission, there is one excess death. Not tackling this is a deliberate policy choice.

[Neil Pettinger @kurtstat]

I think I might've found a metric that explains ED exit block a bit better than my previous attempts. The orange scatterplot compares - for each day in the year - ED length of stay (measured in minutes, on the vertical axis) with mean AMU 'movement-adjusted' fullness (arrivals into, and departures from, AMU).

[ehaatClinical @ehaatClinical]

Mannekin pictures of a cardiac arrest with the pathology as a dilated cardiomyopathy. What is the definitive treatment…? Where should refractory / recurrent VF in this context go for hospital interventions? What novel therapies are available on scene? 🤨

[Beds & Herts Emergency Critical Care Scheme @BHECCS]

Yesterday, we were joined by @EastEnglandAmb & @HFRS crews for a day of training.

The day was a great opportunity to sharpen our clinical skills, improve team dynamics & enhance patient care under pressure

Thanks to all that attended & to Zoll for their sponsorship of the day

[Beds & Herts Emergency Critical Care Scheme @BHECCS]

🚨 Meet the team: Dr Miles Gandolfi

“I get a great deal of satisfaction from volunteering as a doctor for BHECCS, where we provide advanced treatment for critically unwell patients. My favourite part of the job is the fantastic people I get to work with”

#VolunteersWeek

[Adam Boulton @AdamBoulton17]

Key output from my PhD fellowship has been published in Resuscitation

TLDR:
🚨 Prehospital critical care teams were less likely to attend cardiac arrest patients in more deprived neighbourhoods.
🚨 No association with neighbourhood ethnicity

🧵...

https://t.co/PZy1viA1lg

[Neil Pettinger @kurtstat]

We tend to assume that the reason why it takes so long to treat patients in A&E is to do with the number of A&E attendances.
1/12

[𒊓𒅂𒁓𒐗𒐕𒐗 Steve the skeptic @sib313]

are bigger NHS Trusts better than smaller ones? Do mergers improve performance?

Nope: https://t.co/ylrGbFaDKx

[Beds & Herts Emergency Critical Care Scheme @BHECCS]

Happy National Doctors’ Day!

Our pre-hospital doctors bring the A&E department to the roadside by providing advanced skills & expertise to the most critically ill and injured patients across the region. Thank you for everything that you do!

#NationalDoctorsDay #Beds #Herts

[Beds & Herts Emergency Critical Care Scheme @BHECCS]

We’re recruiting! 🚨

Check if you’re eligible to be a trustee here:
https://t.co/uscgBilzb1

Interested parties please send expressions of interest to [email protected]

#BHECCS #Charity #Trustee #Bedfordshire #Hertfordshire

[Lawrence Leroux @LawrenceELeroux]

✨The Tale of the Equitable Resuscitation✨
Once, there was a man who had a cardiac arrest. 🚑
Unfortunately, he lived 20 minutes from the hospital—just too far to be a candidate for ECPR.
The end.
Already heard it?
Let’s talk about ECPR & equity.

[James Yates @heli_med_james]

Anecdotally, I think this is a relatively common issue in cardiac arrest care.

Take time to perfect the essentials when managing an arrest. Don’t accept anything less. If you’re a team leader, or team member, take time to notice these little things that make the big difference

[Giacomo De Luca @jackdeliuc]

🎬

🧵... This is my third and final thread about sodium bicarbonate in critical care 🧂

☝🏻If you missed the first and second part about 8.4% and 1.3% bicarb, I strongly recommend you to read them before moving on 🏃🏻.

https://t.co/Ctw2dO59Hy

https://t.co/JMoXTIw4hH

[Giacomo De Luca @jackdeliuc]

🎬 2nd chapter

...🧵This a thread about 1.3% sodium bicarbonate🧂 (aka isotonic bicarb drip) in critical care.

☝🏻 If you missed the first part about 8.4% bicarb, I would strongly recommend you to read it before moving on 🏃🏻.
https://t.co/pInsTgPXjg

[Giacomo De Luca @jackdeliuc]

...🧵This is a thread about 8.4% sodium bicarbonate (aka bicarb amp) in critical care.

This the first part in a series of three about sodium bicarbonate 🧂in critical care:
🧐I will get in deep to complexities, benefits, risks and clinical implications of this (overused) drug.