Silas 🫀
@GenerallyUnwell
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Critical Care Paramedic @SECAmb_CCP / HEMS Paramedic @airambulancekss
Folkestone, England
Joined November 2014
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Nothing makes my heart sink more than a C1 “confirmed cardiac arrest, 90 year old male, CPR instructions being given”.
Driving through the pouring rain and darkness towards another encounter with death and sadness is nothing short of pathetic fallacy.
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I’m not ageist, I’m sure some 90 year olds benefit from CPR, however I’ve been around long enough to know that most don’t.
The misappropriation of the term ‘cardiac arrest’ to people who have died peacefully is symptomatic of one of the biggest failures of modern medicine.
2/x
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Lying at home with a temp of 39° and a HR of 100 at rest, wondering why I haven’t heard anything about a vaccine for ambulance staff 🤔
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But for those whose body has become weak, have succumbed to illness, have naturally declined in their health and reached the point their heart and body can no longer continue, CPR is unfair, undignified, and unkind.
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Anyway, hope the
#morningmusings
of a new CCP aren’t too depressing an introduction to your Sunday!
I’m going to get a coffee 😅
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The myth of successful CPR is perpetuated daily by TV and fiction, yet it’s brutality and lack of dignity often remain untold.
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Warmth, comfort, pain and symptom relief, home, family, love. They are the appropriate interventions. Not CPR.
8/x
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Turns out
@SECAmb_CCP
do not give these out easily 😅
Very proud to be a part of such a prestigious programme!
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CPR is wholly appropriate for those with healthy bodies who have a sudden, reversible event causing their heart to dysfunction.
Here, aggressive clinical interventions can literally pull someone from the jaws of death, and being involved in that care is an amazing thing.
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@KWholesaler
I think it’s pretty misleading that most of them have arms and legs. Most doctors have arms and legs.
Coincidence? Don’t think so.
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It’s so pervasive that when a 90 year old dies peacefully in their sleep and their family call 999 as they don’t know what else to do, a whirlwind of blue lights and CPR instructions begins that takes some real effort to stop.
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We are so geared up with lifesaving drugs and equipment and algorithms and fears of the coroner that CPR is the norm. It is the easier option.
3/x
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If we keep making 999 call triage more and more risk averse, we won’t have any triage at all
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This guy is 💯 posting controversial tweets for engagement and followers.
It’s only a matter of time until he starts advertising something he sells.
🎣
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*Laughs in paramedic*
@Parody_RCGP
@iDrSunny
@DrGoblin3
Agree that GP isn't an emergency service.
Are you saying it's okay for a non-doctor to be independently responsible for making urgent-ish decisions about random patients in any practice?
My understanding of the duty doctor role is that it involves a lot of quick juggling.
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The ambulance service has come such a long way with end of life care in even the few years I have been a part of it, in no small part thanks to legends such as
@zurritojim
, but sometimes it feels we still have such a long way to go.
9/x
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Has this person been hit by a car? Don’t forget to rapidly conduct a CAR assessment:
- Consider airway problems
- Address breathing issues
- Review the circulation
Hey guys I think I’ve found the worst mnemonic in the NHS.
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“Non doctor RSI should be evidence based”
“It’s unsafe to conduct a trial of non-doctor RSI”
🥱
Plan by
@swasFT
to introduce pre-hospital anaesthesia air-ambulance teams without a doctor on board. Is this appropriate? We want to start this discussion now.
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Finally coming to the end of my three weekend nights with a new
#5minclinicalshiz
on pelvic binders 😎
Feat:
@FPHCEd
@Para_Practice
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Cardiac arrest is when the ❤️ stops
Death is when the 🧠 stops
Cardiac arrest ≠ death
So why does the guidance rely so much on the heart rhythm for recognising death?
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Phrases that should never be said in medicine:
– *Happy* to stop this resuscitation (alt. “In agreement w/ stopping”)
– Ceiling of *care* (alt. “treatment”)
– *Committed* suicide (alt. “attempted” / “completed”)
What else? 🤔
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Excited to say
@SECAmb_CCP
Team 5’s service evaluation has been published in
@BioMedCentral
Emergency Medicine today!
Shame it wasn’t a bit earlier and we might have featured on
@TheResusRoom
🤪
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@DrEilidhMaria
It tickles me that this is the attitude towards paramedics from a doctor interested in PHEM.
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This is such bollocks; students pay ~£9k a year to learn how to be a paramedic.
Corridor care is not the job of a paramedic, it is a symptom of a broken system.
Why not let students ‘ambulance surf’ and jump on with a crew clearing if their mentor is going to be stuck queuing?
Hot take: stop telling student paramedics that there’s learning opportunities in working/running the ED corridor. We know there is, but that’s not why we’re there. We’re often there as free labour provision when we could be out on the road with far greater learning opportunity.
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Why is there such contention around paramedic-led RSI?
Surely pertinent the questions are:
– is the system of delivery safe (regardless of "deliverer")?
– does the intervention improve patient outcome?
What has route of training and profession got to do with it?
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My 2022–23 inflation:
–
@ParamedicsUK
membership: ↑ 28%
– Haircut: ↑ 20%
–
@The_HCPC
fees: ↑ 17%
–
@netflix
: ↑ 13%
– Phone bill: ↑ 7%
5% increase in pay is not ‘constructive’, it is a joke.
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Every now and then I stumble across an article that is absolute gold dust.
This is one of them!
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Disagree. I’d argue a pre-alert is for patients who have immediate needs the ambulance crew cannot meet.
If the patient is symptomatically hypotensive and it’s a non-paramedic crew then a pre-alert is appropriate but a team isn’t required, no?
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If I hear another medically trained person say that a person ‘died’ and recovered when they had a cardiac arrest I think my head might explode 🤯
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Very nice explanation of the tailored resuscitation approach.
The ALS algorithm is a great but it is only ‘advanced’ when compared with BLS.
Those of us regularly involved in CA management should aim to bring more than just ALS.
Seeing the recent tweets about changes in approach to cardiac arrest.
Here is a 🧵on my point of view about current challenges of management of cardiac arrest.
and
My approach to CA
1/11
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It hurts so accurately
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Just doing my annual e-learning AKA ‘clicking all the boxes without reading the question because there is no negative marking’ 😀
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Sure, the Covid vaccine is great and all but have you tried a flimsy plastic apron?
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@Nat_O_Byrne
Call a third person.
Recognised and accepted occurrence in HEMS practice: if doctor and paramedic disagree - consultant call
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And the ‘holier than thou’ mob descends.
I appreciate there are issues with the expansion of PAs but attacking an individual by extrapolating from a cherry-picked, short, edited TV clip is just ridiculous.
🚨Stop & watch the future of the NHS‼️
My blood is boiling:
‘I’d not heard of physician associates until about 3 years ago’ (now in Resus alone)
‘We work exactly like doctors do just different training’
&
‘The medic is confident she’s addressed the most urgent of issues’
☠️
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Me when people say paramedic RSI is ‘scope creep’
ITU telling me to give more fluids to patient with VEXUS 3
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I was really pro this until I became more experienced in airway Mx - barely use these devices at all anymore.
The opposite of nuanced airway Mx.
That being said, the amount of people commenting who don’t seem to be able to place an NPA without causing bleeding is nuts 🤯
Your first intubation attempt failed. You have to bag the patient back up before you go to plan B.
This is what your patient should look like...
It's far easier to bag when you've double-barreled their nose and placed an OPA.
#emergency
#emergencymedicine
#foam
#foamed
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Back at the ol’
#5minclinicalshiz
board, this time on
#TBI
🤕
#FOAMed
#FOAMems
#CPD
#paramedic
#ambulance
#PHEM
@NWAmb_OOHCPD
@cpdme
@CpdForth
@geekymedics
@kssemfoam
@ParamedicsUK
@Para_Practice
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1/
Learnt a bit about blood pressure measurement last year. But if it’s not on twitter did it really happen?
Cue my second
#tweetorial
😎
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1/
Desperately procrastinating from doing any real work, so here is my first
#Tweetorial
- about ‘SVT’.
Feedback welcome, ideally nice feedback...
Enjoy!
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Back for weekend nights and a new
#5minclinicalshiz
about
#TLoC
Ref:
@escardio
,
@NICEComms
, and
@JRCALCguidance
#ECGchat
#MedChat
#FOAMed
#FOAMems
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Critical care:
Give the I-gel a wiggle
Pretend to know what that is on the ultrasound
Mumble something about the CO2 waveform
What is your speciality's go to moves
#medtwitter
?
As a geriatrician:
Fix the hearing aid
Start some different laxatives
Stop at least three other drugs.
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Sorry but these will provide essentially no protection to active CBRNE incidents or rollover RTCs.
As our summers get warmer some of our people have asked for shorts to be provided as part of our uniform. I’m pleased to say that
#TeamWAST
will soon be able to access shorts for use at work in the summer months to make working in the hot weather more comfortable.
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Another day, another
#5minclinicalshiz
Inspired by the introduction of high-strength IM Ketamine to the
@SECAmb_CCP
drug formulary.
Right care, right place, right time!
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Brilliant day at
@EastAngliAirAmb
for the
#SPEAR
course.
Huge thanks to
@EMDocJB
@DrPaulRees
@HaldenHB
and the rest of the amazing faculty.
Leaving feeling very inspired 💉🩸 🚁
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One week after listening to this my colleague and I recognised a serotonin syndrome due to accidental SSRI OD...
Wonder how many I missed before listening 😳
Excellent episode 👌🏽
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Nail on the head.
Non-specialist ambulance work is soul-destroying.
I don't know that I want to be a paramedic anymore...
Feels like we're driving around generating vast amounts of paperwork, attending calls that we're never really required at / are inappropriate.
Just wanna help people & make a difference & it doesn't feel like I'm doing that
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Yesterday my crewm8 + I watched a pt. arrest in front of us - ⚡️- pt. and I were joking about it by the time we got to 🏨 Amazing feeling!
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Hello I’m Silas and I work ON a helicopter, I’m NOT a helicopter
Physician Associate introduction should be clear when talking to a member of the public
"I work WITH doctors & part of the clinical team.
I am NOT a doctor"
The public should know clearly who they are seeing.
Trusts should stop drawing false equivalence
It's simple.
Cos it is
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@KHoulgate
Problem with only responding to C1/C2 is the triage system is so shit that there is barely any correlation between category of call and severity of problem.
Staff should be empowered (by trust policy) to say no, accepting a degree of corporate risk
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👋🏽
Welcome to Team KSS 🎉
Congratulations to our four new Paramedics Silas, Phil, Ash, and Adam and Doctors Chris and Andrew who all completed their extensive training!
Your work can help us save more lives🚁
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@dieworkwear
My engagement present from my fiancée - Hamilton Khaki Field in Mechanical Bronze 😍
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Unrecognised? Speak for yourself, this is ambulance service 101 😂
Defecation-induced cardiac arrest is an unrecognized cause of sudden cardiac death in patients with advanced cardiomyopathy. An increase in parasympathetic tone with sympathetic withdrawal is suggested. In contrast to atropine, epinephrine should be used
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Nothing shows a lack of willing to engage in discussion more than turning off replies 🥲
(1/2) We have undertaken a review of a qualification delivered outside the UK completed by a small number of paramedics who achieved HCPC registration via our international application route, after concerns were raised that the qualification...
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America is fucked, isn’t it?
Todd Drummond’s “Defender Safe Space Desk” is designed to allow children to hide away inside. The desk is 130lbs and made with ballistic material. Full story later today on
@WLOX
#safedesk
#preventschoolshootings
#parklandshooting
#deskinvention
#mississippi
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Early Halloween theme to this weeks
#5minclinicalshiz
🔪🎃
#CPD
#ambulance
#paramedic
#FOAMed
#FOAMems
#TXA
#CRASH2
#WOMAN
#CRASH3
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Yep, seems to be.
>90% of my friends* in the service are planning their escape.
* jokes about my small number of friends not welcome.
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Not just paramedics!
What medical person doesn’t look up the information they need?
More focus on test accuracy, risk management, cognitive biases, etc.
Paramedic tests should not be made to evaluate if students can memorize information. They should be made to evaluate if students know how to use the information, and where to find it if they need to look it up.
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@_JaceMullen
Weird flex when stroke and TIA are literally the same thing until symptoms self resolve
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@NJL_Blancq
Nope - if I thought I was going to be attacked with a knife I wouldn’t be going in.
And if I didn’t think I was going to be attacked with a knife I wouldn’t be putting a stab vest on 🤷🏽♂️
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Intubation is a ventilation (B) intervention, not an airway (A) one.
This is my hill 🤖
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@DonnchadhaD
I work on HEMS and solo as a CCP and in my experience the gap is narrowing, not widening.
It’s also not about doctors vs paras, it’s about experience and exposure, and a senior doctor (as is required for PHEM) simply has a lot more than almost any paramedic.
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A true 💡 moment for me.
I’ve seen this (CHB and high BP) so often in practice but never understood why.
Sometimes Twitter is awesome!
some tips- sometimes it can be hard to differentiate CHB and 2nd degree. hypertension is a suspicious sign for CHB.
in CHB theres prolonged filling time of the LV giving rise to big sys BPs. this is a function of their CHB- please do not try and control this
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This is some really poor advice. Not all cardiac arrests are the same. PPE decisions should be based on a dynamic risk assessment.
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Well this got a bit of interest, so here’s my position:
Cardiac arrest - heart stops (reversible)
Death - brains stops (irreversible)
By saying a patient is clinically dead but we’re trying to reverse it, we risk causing confusion and misrepresenting the finality of death
1/x
If I hear another medically trained person say that a person ‘died’ and recovered when they had a cardiac arrest I think my head might explode 🤯
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Probably a farmer
Simon Smith — on his way to pub in Reading — bus hits him, he picks himself up, walks into the pub and orders a drink. Respect.
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So the
@The_HCPC
literally breach a registrant’s human rights and all they have to do is publicly acknowledge it?
Their standards make suicidal ideation a FtP concern and yet their process is so prolonged it makes people suicidal.
Now they want more money.
Seriously?!
Fascinating new HCPTS determination - Registrant argued that HCPC had breached his right to a hearing within a reasonable time under Article 6(1) European Convention on Human Rights. Case against Registrant ongoing since July 2014. "Panel was wholly satisfied that the manner in
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Welcome to the new UK vs US medical debate: “MidaKet” vs “Ketolam”
New blog: MidaKet for procedural sedation in critical illness
⚖️ Midazolam & ketamine yield synergistic sedation while minimizing doses & side-effects from either agent alone (multimodal sedoanalgesia).
⚖️ Avoids suppressing respiration or Bp.
post:
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@AlloHermes
That accurately describes the role of a newly qualified paramedic in the ambulance service but that’s about it!
Plenty of paramedic roles which involve diagnosis, discharge, prescribing, anaesthesia, research, law, etc.
And there is no defined scope of practice
Nb. UK 🇬🇧
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Yes! While I’m on this soapbox:
Cardiac arrest ≠ death
🧠 death = death
No one has ever brought anyone back from death.
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@KHoulgate
By which I mean clinical staff calling back patients and telling them they don’t need an ambulance.
Yes, some would slip through the net but I guarantee the morbidity and mortality would be lower than the current model!
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There is so much dogma in paramedic / ambulance teaching its basically a kennelma 😀
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@simontutt88
@Dr_Done_
Funny thing is these opinions only seem to pop up on Twitter from anonymous keyboard warriors. In practice I’ve yet to meet a decent doctor that’s threatened by other clinicians 🤷🏽♂️
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@georgebellstarr
To be fair I find the whole anti-ACP thing on Twitter is not representative of reality.
Not to mention 140 characters or whatever it is makes it difficult to navigate the nuance of being an appropriately upset trainee without unintentionally insulting ACPs.
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@EmergMedDr
@SkyNews
@TheDA_UK
Multiple gvt petitions, multiple lawsuits, protests, lobbying. I imagine that all costs money? And even if she is taking a wage, so does the CEO of every charity?
I’m sure
@TheDA_UK
is great, but I’ve yet to see any evidence that justifies the hate Every Doctor gets on here 🤷🏽♂️
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