David Rees

ICM & Anaesthesia Consultant. TTE & TOE, Heart/Lung failure, ECMO & Transfer.

[David Rees @DavidRees1985]

@Hurricane15 @thepaulwilliams Sure no problem. Will do.

[David Rees @DavidRees1985]

@Hurricane15 @thepaulwilliams The ref was equally terrible reffing both sides. Was consistently awful.

[ACCESS London @ACCESS_London1]

Applications are now open for ACCESS Consultant posts. We’re hiring NHS Consultants in Critical Care or Anaesthesia to join the service. This is a flexible, fixed-term opportunity offering 1-4 PAs. Any interests or questions get in touch with the team. https://t.co/9G9qK1zRgd

[ACCESS London @ACCESS_London1]

Another milestone reached! 🎉 3000 completed transfers! 🚀 Huge thank you to everyone for making this happen! @NHSBartsHealth @imperialcollege @GSTT_ICU @GivingtoGeorges @Ldn_Ambulance @NHSEnglandLDN @drmamoun01 @LucyJ1982 @iancarbar @DoctorAmbroise @DrSanjChana @DavidRees1985

[David Rees @DavidRees1985]

Long time coming, but better late than never. @BSEcho #TOE #BSE

[ACCESS London @ACCESS_London1]

🚨 We're hiring! Seeking NHS Consultants in Critical Care Medicine or Anaesthesia for London's Adult Critical Care Emergency Service (ACCESS). Fixed-term, flexible 1-4 PAs. Make a difference in critical care & get in touch with the team. https://t.co/H1KKWHgZYj. #NHSJobs #ACCTs

[ACCESS London @ACCESS_London1]

🚀 3,000 Referrals in just 16 months post-launch! Thank you to everyone who made this possible. Special thanks to our Senior Leadership Team who continue to drive our mission. @drmamoun01 @LucyJ1982 @iancarbar @DoctorAmbroise @DrSanjChana @DavidRees1985 @Ldn_Ambulance

[David Rees @DavidRees1985]

@mattyheron Massive congrats 👏 🎉🎊🎈

[David Rees @DavidRees1985]

@doctimcook @ShaunLintern @NHSBartsHealth 2 very contrasting and sad cases. I think overwhelming majority would consider heavily tranquillizing a critically unwell patient would be incredibly risky and not sensible. The 2nd case would split opinion. The conclusions made from that case many would disagree with.

[David Rees @DavidRees1985]

@lzavorszky @armycritcare Pretty sure the norad and angio in a frail end stage dementia patient would also fall into the "not altering the ultimate outcome" bracket too.

[David Rees @DavidRees1985]

@PBSherren In potentially a "normal" or small LV cavity size like in that example would it push you towards / away from specific vent strategies? E.g Issue of suction events in that scenario with ECPELLA?

[ACCESS London @ACCESS_London1]

🎉Celebrating one year since the launch of ACCESS! 🚀 Huge thanks to our amazing staff, colleagues, stakeholders, and units across London for their incredible support and dedication. Here's to many more milestones !

[David Rees @DavidRees1985]

@drp297 @iceman_ex @jdrwilcox @VirtueOfNothing @AjEusuf @TRICNetwork @echonepean @chrisfduncan @jsemccm @GSTTnhs @UHWCriticalCare Many examples of exactly this around 🇬🇧. In fact some of the best POCUS / Echo clinicians in the UK, and FUSIC leads, aren't tertiary or cardiac based, delivering such models. 3/.

[David Rees @DavidRees1985]

@drp297 @iceman_ex @jdrwilcox @VirtueOfNothing @AjEusuf @TRICNetwork @echonepean @chrisfduncan @jsemccm @GSTTnhs @UHWCriticalCare Hence to justify the WTE you need the volume of requests. The secondary benefit to improved service delivery / governance is the education and everyone wins. In lower workload areas, part time input isn't a dedicated service. This then needs delivery from within. 2/.

[David Rees @DavidRees1985]

@drp297 @iceman_ex @jdrwilcox @VirtueOfNothing @AjEusuf @TRICNetwork @echonepean @chrisfduncan @jsemccm @GSTTnhs @UHWCriticalCare From experience in recruitment I would say the reality is the opposite. Physiologists in short supply with large workload already. For dedicated service you need 1 WTE at 8A (vs approx 4 DCC's) for consultant. Most consultants are delivering within job plan also. 1/2.

[David Rees @DavidRees1985]

@iceman_ex @jdrwilcox @drp297 @VirtueOfNothing @AjEusuf @TRICNetwork @echonepean @chrisfduncan @jsemccm @GSTTnhs @UHWCriticalCare But you have to have high volume scan requirement to justify the physiologist job plan and cost. Big centre esp cardiac, no problem. Smaller unit however much harder to finance and ultimately need critical mass of intensivists to deliver. 2/2.

[David Rees @DavidRees1985]

@iceman_ex @jdrwilcox @drp297 @VirtueOfNothing @AjEusuf @TRICNetwork @echonepean @chrisfduncan @jsemccm @GSTTnhs The 🐘 in the room is money. The ICU physiologist works well if fully integrated and learns the ACCE component and its use on ICU. @UHWCriticalCare has this and it works really well. Excellent governance, access to scans and education for everyone. 1/2.

[David Rees @DavidRees1985]

@Manoj_Wickram @iceman_ex @cianmcdermott @emma_bowcock @nat_echo @MaxRidley3 @SmallzAlex Yes. Used in pre vs post capillary Pulmonary HTN differentiation. Instigation of pulm vasodilating therapy Vs offloading and optimizing LV relaxation / flow. Paired with RV function and RV-PA coupling assessment.

[David Rees @DavidRees1985]

@Resuspiece Yes but with the caveat that as it's mandatory it should be fully funded and provided for all those on the resus teams.