Dennis Reichert

anaesthesist, interested in FOAMed, regional anaesthesia, intensive care, views my own

[Dennis Reichert @Robowski2000]

@EM_VATA @AirwayMxAcademy @EM_RESUS @AirwayLegend What are your thoughts on nebulised adrenaline in addition to Abx and i.v. Dex in cases like this?

[Dennis Reichert @Robowski2000]

Just nodding with every tweet of this thread.

[Katie Wiskar @katiewiskar]

Suggested New Year's Resolution: more mindful prescribing of IV fluids 🫧

Far too often I see IV fluids thrown around with minimal consideration; meanwhile, we'll deliberate for hours about a dose of lasix 🤦‍♀️

Here are the 10 most common fluid prescription mistakes I see 🧵

[Dennis Reichert @Robowski2000]

@VirtueOfNothing @Anaes_Journal Yes that’s a good point.

[Resus Pieces @Resuspiece]

@AirwayMxAcademy @AntonBooth_SAS @doctimcook Therefore, I would use HA-VL in patients with predictors of difficulty

With a slightly lower threshold as I want to use it regularly to refine technique

[Tim Cook @doctimcook]

Decisions about suitability of ICU admission are not about “extubation”.

When there is doubt it’s usually about -whether the patient will benefit, long term, from the burden of treatment that ICU imposes
-whether exposing the patient to risk of complications from both their disease and invasive critical care treatment is in their interests
- whether this is also true taking into account the extraordinary deconditioning that occurs rapidly during critical illness
- whether their condition is reversible or is part of their secular physiological decline towards the dying process
- whether the worsened quality of life the patient may experience if they survive would be acceptable to them

Critical care is more than organ support.

Sadly, as we have so few beds compared to other high income country healthcare systems it’s also sometimes about whether there is space and how to best manage that.

Although this article is about whether to operate it captures much of the nature of making these important difficult decisions

https://t.co/tDp8ADwNyJ

[Mark Barley @Chronotrope]

Happy New Year all, here’s to accidentally writing “2024” in the notes until at least April.

[Dennis Reichert @Robowski2000]

@rejschaap @LowkoTV Very interesting. Thank you and a happy Christmas!

[Dennis Reichert @Robowski2000]

@rejschaap @LowkoTV Really? Nothing on the 24th or 25th?

[Tim Cook @doctimcook]

Great to see a national process for this - I think the same in Scotland. Is that right @altgm?

Funnily enough we’ve just got rid of ours……

We have all we need for emergencies on each airway trolley in theatre
-routine VL
-routine use of 2nd gen SGA
-box with scalpel/bougie/tube

So no clear need for a rescue cart

Our excellent airway leads have replaced with an awake intubation cart

@RUHAnaesthesia

[Will H-G @WHarropG]

@Robowski2000 @amit_pawa @RAPMOnline Call me old-fashioned if you will (and you will) but for painful lap surgery I tend to pop some diamorphine in the cerebrospinal fluid - it works terribly well.

[Dr Amit Pawa💉🎙️ @amit_pawa]

@Robowski2000 @RAPMOnline You are not alone in this thought process- and between you and I - I agree!

That’s kinda why I wanted to see an anterior QL arm as I wondered about visceral analgesia with that!

Don’t tell @jeffgadsden !

[Dennis Reichert @Robowski2000]

@Yashas777 @amit_pawa @RAPMOnline I definitely think though that some form of RA (either local infiltration, abdominal wall blocks or QL blocks) is helpful for post operative analgesia.

[Dennis Reichert @Robowski2000]

@Yashas777 @amit_pawa @RAPMOnline Personally I don’t usually see a significant enough stress response in our patient population to warrant an abdominal wall block.
But that’s also another question: do the abdominal wall block before or after the operation?

[Dennis Reichert @Robowski2000]

@amit_pawa @RAPMOnline @jeffgadsden Thank you. Will try to stick to Bluesky. 🙂

[SIVA Trainees @SIVATrainees]

pEEG and ketamine
If youve spent any time around TIVA and EEG
You'll know that ketamine can increase the BIS number - Perhaps you never use ketamine because every time you do your processed EEG keeps telling you the patient's 'awake'
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[Alistair Steel 🇺🇦🇮🇷 @alistairsteel]

@Anaes_Journal I’ll bite. That conclusion isn’t consistent with the data the paper presents.

👶🏼 HFNO isn’t used to keep oxygen levels high, it’s to stop oxygen levels getting low

👶🏼 the numbers are low - 60 patients in a study of uncommon events is inadequately powered.

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