Luke Evans
@LukeEvans_EGS
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FEBS Emergency Surgery DGM Abdominal Wall Reconstruction
Norwich UK
Joined March 2017
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@DenzelWashngton
@Ahmedelhadi2010
Love the sentiment but for those working in the NHS it’s more like - If I died tonight my employer would... in around 3 months agree that a replacement was justified, then spend another 9 months writing job description, advert, interview and waiting for replacement to start..
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Very proud to have been appointed as a Guardian of Safe Working Hours for our fantastic juniors at the equally fantastic Norfolk and Norwich University Hospital. Big shoes to fill, hope I can come some way close to Anna Haestier’s excellent work.
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We are expanding! Just got the green light to advertise for a fifth emergency surgeon. We are one of the biggest EGS units in the country and can offer lots of whatever else you want to do as well. DM me for a chat if interested.
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Very excited to have appointed
@viseshsankaran
as our latest EGS consultant. Will bring a great depth of current trauma knowledge. Exciting times ahead! Well done Visesh.
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Time to start spreading the word - we will be in the market for an EGS consultant to join our ranks and take us to 6. We can offer lots of whatever you’re interested in doing! Please pass on to anyone that wants a fantastic quality of life in a wonderful city and department.
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First six months of a pilot with a NTN Registrar assigned to EGS
@NNUHTeamSurgery
- operating numbers up, papers and abstracts submitted. We’re so chuffed we’ve submitted a piece to
@estesonline
all about the experience. Thanks to
@ishaikh4
for making it happen.
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@RobertSmith
Even from what felt like 1/2 a mile away this was one of the best live performances I’ve seen. You all sounded amazing. Thank you.
#thecure
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Admission rate from a years worth of SDEC USS patients - 2.6% - Impressive but does worry me that we are seeing so little actual surgical pathology.
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Sad day to lose such a great colleague
@_JD27
.... but
@Ahmedelhadi2010
and I hope to welcome you back as soon as you are done with Edinburgh!
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Advert has gone live for our next appointment! Come and join us in one of the best places to live in the country. Happy to chat.
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So impressed with
@HughesDirect
within 12 hours of a hopeful enquiry by Anna from
@TeamEAUS_NNUH
they have delivered a TV, DVD player and radio to make a portable unit for our palliative care patients. Amazing!
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Our poster showing how you can go some way to CGA for surgical patients for free - although if you want to replicate you’ll need to clone James and Ellie.
#CPCongress
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Can we predict outcomes that actually matter to our patients pre-op? Yes we can.
@tcurlroper
holding an audience enthralled
@estesonline
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Not content with running
@TeamEAUS_NNUH
the all-powerful Heather is branching out from admin into acting - the happiest trauma victim ever.
#ATLS
NNUH.
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Always multi-tasking MihaiPaduraru signs participation certificates whilst the candidates try to find his kidney stones! Milton Keynes USS for EGS course - coming soon to NNUH.
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It’s that time again. NNUH ATLS treatment priorities in trauma. Can you spot our
#triplethom
? Although he does look a bit back to the future in the middle...
#trauma
#ATLS
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It comes to something when the nurses are so appalled by your hair that they pay for it to be sorted out. Thanks to
@RebF1987
for pushing me to get it done - in order that I stop disgracing
@TeamEAUS_NNUH
and thanks to Tommy
@Swaggerandjacks
for his efforts!
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Who knows what is going to happen with twitter but never mind - we’re launching our department twitter account
@TeamEAUS_NNUH
give us a follow!
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If anyone has a free hour tomorrow lunchtime and is interested in hearing how centres around the country are growing their emergency surgery services then tune in to this webinar.
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It’s that time of year again -
#ATLS
What do you call an orthopod with a stethoscope
@TeamEAUS_NNUH
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Thank Hilary for coping with us today 😉. It was a very rewarding day for all of us to help vaccinate our staff and patients
@NNUH
@NorwichCR
.
@RichardQWharton
thanks for your great efforts in making this happen
#covid
#PfizerVaccine
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Hey
@noelfielding11
and
@julian_barratt
you should feel very proud. First snowman of the year and my boys (9&12) first instinct is to make “look deep into the parka”
#eggofmantumbi
#tundraboys
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Most successful year for submissions to
@estesonline
- good work
@TeamEAUS_NNUH
and
@viseshsankaran
. We’re off to Lisbon baby!
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Who has the best student placement of the year? Us obviously (so we think). Well done today all.
@RebF1987
@NNUHTeamSurgery
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It is quite astounding to pull together and review everything we’ve done in the last year - 5 pages of concrete achievements. So proud -
@TeamEAUS_NNUH
@RebF1987
Chatham house rules - so can’t repeat what was said but great to spend a little time with some of the work family to celebrate all we’ve achieved in the last year and plan our “Vision 2023” for next. Thanks to
@JohnInnesCentre
for being a perfect host.
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And - you are under no obligation to ask a surgeon to see a patient before having the authority to request a CT for your patient as an ED doctor.
You are under no obligation to arrange an abdominal CT before referring to Surgery from ED - discuss…
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@MStott88
Agree - but even at one of the largest hospitals in the country, providing tertiary emergency care for >1 mil - some spec are not free from elec activity when oncall. - can’t believe I heard “well if I did it overnight I wouldn’t be safe to do my elective list tomorrow” in 2023
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Love it when a study reinforces your normal behaviour!
@RichardQWharton
@Ahmedelhadi2010
@ThomasBrowneACU
no more quips about my tailoring!
Just a reminder to my surgeon colleagues…data show patients prefer surgeons in scrubs as compared to other attire in both ambulatory & inpatient settings
So save your money on those fancy suits! 😁
#MedTwitter
#SoMe4Surgery
@SAGES_Updates
#surgery
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I’ve just discovered our Tanya has a special hot gallbladder hat!
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Here is the video we have produced as virtual work experience for our local schools who cannot come onto the unit at the moment
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Time for our priorities photo. Can you spot our double doubles.
#doublesara
#doubleash
#ATLS
@TeamEAUS_NNUH
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Great to be back. Our candidates displaying their order of priorities in trauma. Don’t they look so happy to be doing outdoor ATLS! No double Geoff but we did manage
#twoandahalfMegans
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Look at the lovely smiling faces with their sequence of care for trauma patients. No
#doublegeoff
this time but can you spot our double-double?
#outdoorATLS
#NorwichATLS
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Important piece of work. Am always amazed that US treats >65 as geriatric though. Our local geriatricians have a cut off of 80, would love to see the analysis using this as threshold.
Laparoscopic
#VHR
in the geriatric population: an assessment of long-term outcomes and
#QoL
.
#HerniaSurgery
#SoMe4Surgery
#IncisionalHernia
#UmbilicalHernia
#EpigastricHernia
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@mancunianmedic
Overnight it was bin-lids closing. Replaced them with “soft-close” and have had many fewer noise complaints.
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but how can we stop her? Being utterly unqualified and incompetent is clearly no barrier...
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@Orthopod_Errant
The greatest trick the devil ever played was not “convincing humanity he did not exist” but orthopods convincing all of medicine that they can’t read an ecg.
#usualsuspects
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Plus 3 hot gallbag lists, 2 major CAWR and >400 through SDEC! Glad I had this to recover …
@campat3rivers
Busy week
@LukeEvans_EGS
@EAUSNNUH
plus a visit from West Suffolk, TeamEAUS doing us proud 👌🏼
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Loads of work by our unit manager Rebecca, film maker Kieron Loane and student liaison Bethan Amblin
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Hurray! Well done
@ProsserSnelling
. Now just need to try and not buy a system that doesn’t work for clinicians!
‘Digital desert’ gets go-ahead for £155m records system
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@davidnnaumann
You can move towards this by just not admitting them... this is what AEC/SDEC does for us... we achieve >90% non-admission on days when we have a sonographer in our AEC.
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Free at last! Genuinely quicker to fly all the way to malaga than to leave gatwick airport. It’s like no-one had ever missed a flight before.
@easyJetholidays
and
@Gatwick_Airport
Please sort it out for future generations!
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@thefighter_sm
@traumaicurounds
@SWexner
@MISIRG1
@drdevirgilio
@Cirbosque
@DrThawaba
@ProfDemartines
@elliotthaut
@DissanaikeMD
@LiangRhea
@mj_pucci
@pferrada1
@PhillySurgeon
@estesonline
Totally agree but neither does cholecystostomy - if it allows your patient who might not breath that well post Kocher’s to be done lap in a couple of months. I’m sure we have all seen late “resp” deaths or disability post open chole.
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@MISIRG1
@SWexner
@Cirbosque
@drdevirgilio
@DrThawaba
@docmartin22
@kari_jerge
@traumaicurounds
@CelestinoGutirr
@pferrada1
@juliomayol
@salo75
Cholangiogram...
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@mancunianmedic
It’s not just patients. In emergency surgery we live with a higher degree of risk and uncertainty but I find it increasingly difficult to accept proposing treatment without a diagnosis when the only reason for not getting one is resources...
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Done! And agree important topic. Access to bariatric services seems to be much worse in Tory heartlands (no surprise) which means our population in the East is very badly served.
Surgical Colleagues
Please would you fill in and retweet, share on all available platforms.
Such an important question.
Many thanks
@susanmoug
@EmergentAcademy
@LukeEvans_EGS
@bengriffiths73
@SoniaLockwood79
@roux_group
@ASGBI_MA
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Yarp. Would classify as a normal Norfolk Lap Chole.
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@traumakhan
@docmartin22
If your 30-day fascial dehiscence rate is 13.5% I think there is a problem that has nothing to do with the absence of mesh? Patient selection / over/under resuscitated / technique etc. etc.
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Dr Valero
@estesonline
enjoying our poster on why patients with undiagnosed abdominal pain should go to ED not primary care.
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Very well deserved - and she is also our social / births / birthdays / marriages / events secretary.
The
@TeamEAUS_NNUH
Star of the month is Jo. Jo is one of our senior HCAs, she knows the unit like the back of her hand and is a true advocate for her patients. Her hard work and dedication shines through everyday. Truly deserved.
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Well done AMU! Promise not to have a rumble in the car park later. X
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Yes yes yes. But absolutely no appetite from the college or ASGBI. We have to do it ourselves by promoting the
#EBSQ
in Emerg Surg and by supporting Nikhil Misra in efforts to get NFAS recognised.
Has the time finally come to establish Emergency General Surgery/Acute Care Surgery as its own specialist entity in the UK? Interesting data about to be published regarding emergency laparotomy survival rates after implementation of a revamped EGS service - watch this space!
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@thefighter_sm
@SWexner
@MISIRG1
@drdevirgilio
@Cirbosque
@DrThawaba
@ProfDemartines
@elliotthaut
@DissanaikeMD
@LiangRhea
@mj_pucci
@pferrada1
@PhillySurgeon
@traumaicurounds
@estesonline
..this type of mantra promotes some less experienced to take on chole in unfavourable situation. If a borderline fit patient has had symptoms for 5 days before they can get an USS then waits another 7 days for a theatre slot then ch.cystostomy not wrong...
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Colette Thompson-Reil
@estesonline
presenting our work on appendicectomy. Message- Don’t undertake Lap Appendicectomy with the aim of preventing readmission in NSAP.
#ECTES2019
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@ELFStudy
@drkatbristol
@JKDhesi
@susanmoug
@Jen_L17
@CUGeriMSc
@lyndsay_pearce1
@drKathrynMcC
@KatParmar
@welshbarbers
@erincatmcilveen
Feeling a bit needy that we’ve not had a mention... hope you got our form last week? NNUH are keen to join!
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@edit_susan
@BigBiffyB
@MariaHaskins
And in the “original” Norfolk (UK) we have Wymondham (=wind am) Stiffkey (=stew key) and Happisburgh (=haze borough)
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Here are our candidates priorities for trauma - do you agree?
#ATLS
no
#doublegeoff
this time. Now it’s
#doubleemily
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@MStott88
In reality it’s lots of factors. We (GI surgery) work in an entirely different hospital (conceptually not physically) to them (thoracic, o&g, ent etc..) - those that don’t really have any volume of acute admissions don’t see the same problems.
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@mancunianmedic
Big doses of LMWH before CT for ?PE — leads to harm at least once every sox months in surgical patients....
“””clinical diagnosis””” of appendicitis = 25% negative appendicectomy rate vs CT use getting this down to around 5%....
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@BJSurgery
From
@tcurlroper
‘s last teaching session for
@TeamEAUS_NNUH
- at 75 years old AMI becomes a more likely diagnosis of new abdominal pain than appendicitis. Don’t think too hard, don’t measure lactate - just get the CT. P.S. don’t need the eGFR either…
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@AlkadhiO
@A03580132276
@veggieequallife
@RooDoherty
@markr1004
@PenfoldJohanna
Poorly thought through tweet… but Having known Omar as core trainee, registrar and now consultant can say he is (and has always been) extremely supportive of the trainees at all levels. He is very far from the person that replies to this tweet have portrayed him to be.
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That’s why (for surgery patients) I teach our juniors that the drug of choice for suspected PE is.....
IV contrast.
Bo Madsen on PE
@MayoClinicEM
How good are presenting signs and symptoms at predicting diagnosis of PE?
Not that great!
#MedEd
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@Godavarian193
Glad it’s generated a bit of discussion. My main point was don’t rely on lactate - the d-dimer will be up in anyone even vaguely unwell - get a CT
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Has anyone else had a big drop in NELA mortality? Ours has halved in the last year. I suspect more to do with heightened consideration of potentially futile cases (during peaks of the pandemic) than anything specific we’ve done.
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@paramedicjb
I am told I have operated on the only gunshot wound to have been sustained as a crime in a public place in the entire history of Norfolk. Suspect not uncommon in most of the UK.
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@clare_eliza
@dr_shai
We do get it but the risk has to be shared by ALL, not just IP ward medical teams. Need a realisation that an at-risk discharge (maybe without the gold-standard package of care pt is sat in a bed waiting for) is better than no discharge at all.
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On 28th June we (
@TeamEAUS_NNUH
@RebF1987
and I) have the privilege of taking part in our local GP’s CLASS (Clinical Learning and Sharing Seminar) evening. What do people in GP land want to know about emergency surgery?
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@MazinHamed12
@NNUH
@Ahmedelhadi2010
@ishaikh4
@RichardQWharton
@Bhaskar23859803
@mrami007
Thoroughly earned and no surprise at all. There’s a reason we gave you star of the month!
@RebF1987
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@HannahJavanmard
@susanmoug
@asgbi
@WSESurgery
@sarah_hare
@RCoANews
Not sure three days is a sensible measure of futile / non-futile? Was there any discussion with patients as to what they consider futile? A number of our patients might say failure to return to their homes / QoL counts as futile.
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hope I’ve done this right - should be the link to the job advert for our fifth EGS colleague. Come to beautiful Norfolk! Best weather in the country.
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If you can’t come and look round in person you can still meet some of the team here via
@YouTube
🚨🚨NEW VACANCY!!🚨🚨
Exciting opportunity for a Registered Nurse to join our incredible
@TeamEAUS_NNUH
To be part of the amazing Emergency Assessment Unit follow the link below!
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@tcurlroper
captivating an audience on how it is possible for EGS placements to offer great learning and operative exposure for senior trainees. It’s not just about being on call.
#ECTES
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@surg1979
@ProfDemartines
@SurgeryHPB
@liveRPancSurg
@paulo_sutt
@ProfW_edinsurg
@StefanoCrippa6
@salo75
@villesallinen
@doctor_felix
@polom_karol
@addeo_pietro
@LopezBenS
I did the course in Edinburgh with Olympus - brilliant but was about ten years ago!
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Anyone with experience of using Penthrox for ambulatory emergency procedures in the UK? We currently use Nitrous for abscesses but keen to switch if “greener”
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Closely followed by “clinical diagnosis” as an excuse for proceeding without reasonable investigation. 25% negative appendix rate in young women?
If I could ban a phrase from medicine it would be “?surgical abdomen”. What does that mean?! Undifferentiated abdominal pain? Pain that needs a CT? Peritonitis? A differential diagnosis which includes things where an operation may be indicated? It’s a ridiculous term.
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@ryancohenmd
@CelestinoGutirr
@SWexner
@SurgJournal
Any thoughts not just on timing but time of day? I’m uncomfortable with GGraf being given at night when patient may lie flat, not be as easily observed etc. NG tubes don’t really prevent vomiting and aspiration of gastrograffin is quite bad. I always wait until morning.
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@dr_shai
Almost all non-surgical / non-any pathology. A symptom of the “any abdominal pain should see a surgeon” mentality perhaps.
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@ELFStudy
@susanmoug
@lyndsay_pearce1
@nicolalreeves
@Jen_L17
@sue_chandler
@CUGeriMSc
That’s better! - I have a warm glow now. Looking forward to starting.
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