Pete Williamson

Anaesthetist, Geek, Londoner, Cyclist, Optimist, Jedi, Ravenclaw

[Pete Williamson @pbw009]

@traumagasdoc @ndavis120 @britishmuseum I have my uses!

[Pete Williamson @pbw009]

@Oesophagusuk @strachanjamie @amateursuman Not possible anymore. I CCT’d at 33 (18yr old +ICSM6 +FY2 +ST7) having gone straight through +1yr for intercalated BSc, so you could do it at 32.

[Pete Williamson @pbw009]

@traumagasdoc @loki1706

[Pete Williamson @pbw009]

@traumagasdoc @loki1706

[Pete Williamson @pbw009]

@traumagasdoc @loki1706 Two ratings only (because large number of consultants - impractical to do more domains)

[Pete Williamson @pbw009]

@paul_barlow @traumagasdoc Nope

[Pete Williamson @pbw009]

@paul_barlow @traumagasdoc Actually no - the server was immune to @traumagasdoc ‘s charms (much to his annoyance)

[Pete Williamson @pbw009]

@traumagasdoc @Davidmarkpye @ajwicko @ImperialNHS @Imperial_EM @SyedSadie @CSC16 @willtube4food Was replying to Wickham

[Pete Williamson @pbw009]

@traumagasdoc @Davidmarkpye @ajwicko @ImperialNHS @Imperial_EM @SyedSadie @CSC16 @willtube4food Definitely!

[Pete Williamson @pbw009]

@escoces71 Yes! Typo during a PowerPoint avalanche...

[Pete Williamson @pbw009]

“I only have one coronary stent doc”

1) you have the risk factors to need one
2) you have coronary endothelial damage
3) you are having surgery, which is pro-thrombotic
4) you are on anticoagulants

#ANES18

[Pete Williamson @pbw009]

Physiological reserve = biggest physiological insult the patient can survive minus baseline function

Frailty = loss of physiological reserve across multiple body systems (cannot be quantified by one test)

Elderly trauma patients have low reserve and high frailty

#ANES18

[Pete Williamson @pbw009]

"Words have power"
- Terry Pratchett

Perimortem section = sounds like you are killing the mother to save the baby, people think twice

Resuscitative hysterectomy = procedure necessary to save the mother and baby, people perform it

Same thing though

#ANES18

[Pete Williamson @pbw009]

Performing a blood patch on someone who turns out not to have a PDPH can precipitate seizures and delirium - something to think about if you’d asked to do one at 03:00 on the postnatal ward #ANES18

[Pete Williamson @pbw009]

Published report - but I’m not a PowerPoint Paparazzi so I missed the reference...

[Pete Williamson @pbw009]

Lowest intra op BP which is sustained for >3min is what seems to predict cardiac risk #ANES18

[Pete Williamson @pbw009]

There is no such thing as the "straightforward post-op surgical in-patient". If there were simple, they would be been a day case. The entire hospital population has been pre-selected as high risk #ANES18

[Pete Williamson @pbw009]

"Standard ward care" (4-6hrly observations) misses 90% of significant desaturations and 70% of significant episodes of hypotension #ANES18

[Pete Williamson @pbw009]

We all remember "that case" when the surgeon quietly cuts through the IVC without mentioning it, but in reality in 33% of cases the lowest sustained BP occurs before KTS - cycle NIBP frequently after induction #ANES18

[Pete Williamson @pbw009]

Risk prediction for cardiac events:
Scoring systems: everyone ends up as "intermediate risk"
Ex tolerance: patients lie
Stress echo: no evidence
CT coronaries: only useful if it’s clear, which rarely happens
BNP: probably the best
#ANES18