JWP

Registered Paramedic 》Special interest in palliative and end of life care 》Chronic realist, exacerbations of pessimism.

[Dr Linda Dykes has moved to Bluesky @DrLindaDykes]

Want to improve your ReSPECT discussions & create more useful ReSPECT forms? Try this structure, devised by Geris trainees @twiggmartha1 & @GSC_DeSilva.

Full-res PDF (to print off) at https://t.co/UAdWi9o6JI and it's #FOAMed - please do share by whatever means you like!

[JWP @WardleParker]

@guy_per @NHSEastEngland @EastEnglandAmb

[Kathryn Mannix @drkathrynmannix]

@MikeStone2_EoL @BakerIdris @ProfMarkTaubert @rcgp @doctor_oxford @TheBMA @ClareGerada @k *Wouldn't it make sense to have a local EoL care backup team? 24/7 phone line with flying squad able to despatch a prescriber to assess & help manage breakthrough symptoms like pain, agitation, breathlessness? Even to attend immediately after death if companions need support?
4/

[BBKA @britishbee]

Abbé Émile Warré was born on this day in 1867
(Some sources suggest May 9th)

A French abbot, he devised a simple, economical, 'bee-friendly' hive known as the 'People (Warré) Hive.'

The hive consists small 300mm x 210mm square boxes. It doesn't use frames, just eight top bars

[JWP @WardleParker]

Today was the first time utilising the recently implemented end of life PGD suite.

It allowed myself and my colleagues to initiate rapid symptom relief and meet the patient's priorities of care safely and effectively whilst establishing an onward chain of care.

Empowering.

[Dr Ben Bowers @Ben_Bowers__]

The financial costs of anticipatory prescribing: Median prescription cost £43.17 & used drug cost £2.16

Our new paper in @PalliativeMedJ @lloydamorgan17 @PELi_Cam

Pls share widely ⬇️ ⬇️

@WeCommNurses @RCNDNForum @hospiceuk @LearnPEOLC @HomesQi @TheQNI

https://t.co/pzSYqOQ3G8

[Paul Howard @Paul_Howard_IoW]

@WardleParker @OFFICIALIOWAS Other key theme was the PGD was predominantly used in those overlooked by "traditional models" of palliative care eg those with dementia, chronic illnesses with unpredictable acute exacerbations etc. The paramedics gave immediate symptom relief then flagged to us to pick up

[JWP @WardleParker]

@Paul_Howard_IoW @OFFICIALIOWAS That's really illuminating and certainly adds significant weight to the argument for urgent and emergency community services to have rapid access/carry them - thank you!

[JWP @WardleParker]

@Ben_Bowers__ @bmj_latest @Paul_Howard_IoW @TheQNI @QNI_Scotland @RCNPainPall @RCNDNForum @WeCommNurses @hospiceuk @drpoco @rcgp Myself and colleagues in the @EEAST_UrgCare with the @EastEnglandAmb have recently had the green light to carry Midazolam, Hyoscine, Haloperidol, Glycopyrronium and Levomepromazine under PGD for rapid accessibility to those unanticipated, dying patients.

[JWP @WardleParker]

@EEAST_OpSupport @EastEnglandAmb @HeyTomAbell Thanks for the reply - I look forward to seeing how the new catches fare when operational.

[Kathryn Mannix @drkathrynmannix]

Planning a gathering over the festive season?
Why not include a #WhatMattersToMe conversation? 🧵
It's a joyful topic, & it can be the very thing that helps you understand each other better, or represent each other's views if that's ever needed in the future.
Some resources:
1/

[Stephen W. Smith @smithECGBlog]

Introducing the OMI Pocket Guide.

Smith ECG Blog Posts organized into an amazingly educational collection, with examples of each type of subtle OMI and of mimics.

Also on the banner at the top for easy access any time

https://t.co/80q2sBdCAA

[Stephen W. Smith @smithECGBlog]

A man in his 70s with acute chest pain and paced rhythm. See what happened. @PendellM

https://t.co/R5fG79Gfwm

[Sam Ghali, M.D. @EM_RESUS]

Never forget that anxiety by itself is a diagnosis of exclusion

[Becky Platt @BeckyPlatt3]

Unpopular opinion:

You can learn more about a child’s clinical condition by spending a few moments looking at them than you can by attaching any monitor.

[Frontline Communication 💙 @FLComs]

💡 ⌚ 🔇👂💙 #FrontlineCommunication #toptips #MedTwitter

[Kathryn Mannix @drkathrynmannix]

@DrLindaDykes
Times to #HaveTheConversation
1. Make it a routine part of initial assessment: "Any PoA, ADRT etc I should make a note of? No? Well, .... let me tell you about how those could help you...'
2. "Any allergies? Any treatments you wouldn't want?"
3. ➡️

[JWP @WardleParker]

🗣️🗣️🗣️

'Dont ask a patient "What do you want us to do if your heart stops?" unless they would be a candidate for CPR.'

🗣️🗣️🗣️

#MakeDyingBetter