Tim Astles

ICM Consultant at Liverpool University Hospitals NHS FT. All views my own.

[Tim Astles @TimAstles]

@cliffreid Could be. Would be interesting to hear if does appear to be more successful.

[Will Angus @beercrit]

If you missed out on that ST anaesthetics job and need to fill 6-12 months, come and work with us on Aintree ICU: https://t.co/oUp5GoBcgZ

[Tim Astles @TimAstles]

@markpalexander @andymoz78 What is the advantage to consumers of this pricing structure? Who decides that it’s the mode we should use?

[Tim Astles @TimAstles]

@goldstone_tony @nhs_pensions Am I right to think the TRS doesn’t contain the figures you need to calculate your pension pot growth for Annual Allowance purposes?

[Tim Astles @TimAstles]

@docib @richardbody @smithECGBlog Genuine question… as testing becomes more sensitive/widespread, is there now over treatment? Are there groups which wouldn’t have been captured in previous studies? Is it right to extrapolate evidence for these patients?

[Will Angus @beercrit]

If you missed out on that precious anaesthesia ST job and are looking for a post to build your portfolio, come and work at the busiest ICU in the region in a big major trauma centre. Weekly teaching, research and QI opportunities, SPA time, and me.
https://t.co/CboltC39JT

[Tim Astles @TimAstles]

@armyemdoc Whilst you’re right that we should avoid nonsense mantras like this, it must be remembered that intubation is not a fix for asthma. They’re not an easy group to ventilate as it’s pathology where exhilation is the problem and intubation turns this into an entirely passive process.

[Tim Astles @TimAstles]

@jdrwilcox @BCIS_uk Looks like a very valuable audit with some really powerful data.
What are the inclusion criteria for being entered into the audit? Who gives the NSTEMI label - local team or PCI centre?

[Tim Astles @TimAstles]

@jdrwilcox @VirtueOfNothing @rbauld @mmamas1973 @BCIS_uk Our experience is it’s either immediate or delayed until patient is ward/outpatient level.
If relatively short ITU stay then that’s ok but if long stay then that 72 hours is distant memory!
Would be really interesting to know “delayed” timings for ITU NSTEMI patients nationally.

[Tim Astles @TimAstles]

@jdrwilcox @rbauld @VirtueOfNothing @mmamas1973 @BCIS_uk I am however now working out transfer times from Liverpool to Surrey for when we need 2nd opinions!!

[Tim Astles @TimAstles]

@jdrwilcox @rbauld @VirtueOfNothing @mmamas1973 @BCIS_uk Like much in medicine, it’s all psychology! Nobody comes to work seeking to do the wrong thing. These are complex decisions which trail data doesn’t nearly give us answers for.

[Tim Astles @TimAstles]

@jdrwilcox @rbauld @VirtueOfNothing @mmamas1973 @BCIS_uk Think this is where we often feel ITU patients miss out. I’ve no doubt they would be getting a cath if service available in our hospital without risks of transfer having to be considered.

[Tim Astles @TimAstles]

@jdrwilcox @rbauld @VirtueOfNothing @mmamas1973 @BCIS_uk Equal measures fascinating & frustrating most of the time!!

[Tim Astles @TimAstles]

@jdrwilcox @rbauld @VirtueOfNothing @mmamas1973 @BCIS_uk I take your point but a system where the patient only gets the treatment they need after multiple layers of referral/argument/pressure is by definition not a great system.
Human nature means we all make different decisions based on whether pt is in front of us or at end of phone.

[Tim Astles @TimAstles]

@jdrwilcox @rbauld @VirtueOfNothing @mmamas1973 @BCIS_uk Accept that the group I see in an ITU setting are a small minority of the workload of a Cardiology service and have additional logistic complexities which will factor into decision making.

[Tim Astles @TimAstles]

@jdrwilcox @rbauld @VirtueOfNothing @mmamas1973 @BCIS_uk Other area where there seems to be a big gulf between guidelines & reality is the delayed coronary intervention. Many studies will describe immediate vs 48/72 hour but our experience if often if patients don’t have immediate PCI then their intervention is delayed for weeks.

[Tim Astles @TimAstles]

@rbauld @jdrwilcox @VirtueOfNothing Interesting/depressing/reassuring to see that many regions in the UK have similar issues with emergent PCI access.
Out of interest, are many people thrombolysing this group of “persistent shock but too unstable to transfer” patients?

[Tim Astles @TimAstles]

@TeleFootball @Carra23 @HACKETTREF It does seem slightly odd that the infraction was offside. Seems to suggest that obstructing a defender would have been fine if done from an onside position.