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doctimcook.bsky.social

@doctimcook.bsky.social
545 followers 7 following 81 posts
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Anaesthesia @anaesjournal.bsky.social · 03/09/2025
Bougie or stylet: what to use when the chips are down? Is it truly possible to consistently and deliberately shape a bougie to fit a hyperangulated blade? @doctimcook.bsky.social @janhansel.bsky.social #AnSky #AirwaySky #MedSky doi.org/10.1111/anae...
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Reposted by @doctimcook.bsky.social
Anaesthesia @anaesjournal.bsky.social · 22/08/2025
Thinking of implementing default videolaryngoscopy in your department? Here are some common themes encountered & practical advice & strategies recommended by 5 UK hospitals that have made such a change! #AnSky @fionafionakel.bsky.social @doctimcook.bsky.social doi.org/10.1111/anae...
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doctimcook.bsky.social @doctimcook.bsky.social · 27/03/2025
Hello my name is…..needs rebooting with name, title & role : badges & introductions Without it -too much confusion -too much uncertainty -too much rom for obfuscation I like to think Dr Kate Grainger would agree www.bmj.com/content/388/...
bmj.com
“Hello, my name is” introductions and badges need updating to include full name, title, and role
Staff should introduce themselves with their title, name, and role and have badges clearly detailing this to avoid confusion and misdirection, writes Tim Cook The “Hello, my name is” campaign, set up...
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Nicholas Chrimes @chrimesy.com · 28/03/2025
5 years ago I complained that w HAVL “I can see but I can’t get the tube in”. @doctimcook.bsky.social pointed out “that’s a prob w the operator, not the device”. Having since learned HAVL I’ve used it routinely for 5 years w 100% FPS & never <G1 view.
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Difficult Airway Society (DAS) Residents @dasresidents.bsky.social · 28/03/2025
Time to retire ‘no trace, wrong place’ @doctimcook.bsky.social Many UOI do have ‘a trace’ It is all about sustained exhaled carbon dioxide @universalairway.org
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A Returning Doctor @returningdoctor.bsky.social · 28/03/2025
I agree Even as someone who had previously worked in the NHS, I found the new roles, titles and acronyms confusing at first which prompted me to get a #HelloMyNameIs badge! Roles should be a) clearly visible b) clearly stated
"Hello My Name Is" badge
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Dr Gavin Sullivan A.N.A.E.S.T.H.E.T.I.S.T 🇳🇿🇦🇺🇬🇧 @lotusgav.bsky.social · 28/03/2025
Absolutely agree with this. I have a standard patter. “Hello I’m Dr Sullivan I’m a consultant anaesthetist. What do I call you?” I think it speaks to credibility. Do you want to be anaesthetised by “ Gav” or “Dr Sullivan” ?
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Reposted by @doctimcook.bsky.social
Nicholas Chrimes @chrimesy.com · 24/01/2025
“No trace = wrong place” should be retired & replaced by the requirement to exclude oesophageal intubation if ‘sustained exhaled CO2’ is not detected. From @doctimcook.bsky.social, Andy Higgs & me. 🔑🔓Free full text in @bjajournals.bsky.social : kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...
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doctimcook.bsky.social @doctimcook.bsky.social · 27/03/2025
Hello my name is…..needs rebooting with name, title & role : badges & introductions Without it -too much confusion -too much uncertainty -too much rom for obfuscation I like to think Dr Kate Grainger would agree www.bmj.com/content/388/...
bmj.com
“Hello, my name is” introductions and badges need updating to include full name, title, and role
Staff should introduce themselves with their title, name, and role and have badges clearly detailing this to avoid confusion and misdirection, writes Tim Cook The “Hello, my name is” campaign, set up...
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Reposted by @doctimcook.bsky.social
doctimcook.bsky.social @doctimcook.bsky.social · 04/02/2025
AIRWAY RESEARCHERS!! We’re researching WHICH FACTORS SHOULD BE REPORTED IN ANAESTHETIC AIRWAY STUDIES (the core outcome set) A 15 min survey now & again in a month (Delphi) RESEARCHERS please complete Recruitment ends this week Link redcap03.gsttdms.co.uk/redcap/surve... Pass it on! Thanks
redcap03.gsttdms.co.uk
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Reposted by @doctimcook.bsky.social
doctimcook.bsky.social @doctimcook.bsky.social · 04/02/2025
EVER HAD AN ANAESTHETIC? What matters to PATIENTS? We’re researching WHICH FACTORS SHOULD BE REPORTED IN ANAESTHETIC AIRWAY STUDIES A 15 min survey now & again in a month Looking for PATIENTS Recruitment ends this week Link redcap03.gsttdms.co.uk/redcap/surve... Thanks. Pass it on!
redcap03.gsttdms.co.uk
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doctimcook.bsky.social @doctimcook.bsky.social · 04/02/2025
AIRWAY RESEARCHERS!! We’re researching WHICH FACTORS SHOULD BE REPORTED IN ANAESTHETIC AIRWAY STUDIES (the core outcome set) A 15 min survey now & again in a month (Delphi) RESEARCHERS please complete Recruitment ends this week Link redcap03.gsttdms.co.uk/redcap/surve... Pass it on! Thanks
redcap03.gsttdms.co.uk
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doctimcook.bsky.social @doctimcook.bsky.social · 04/02/2025
EVER HAD AN ANAESTHETIC? What matters to PATIENTS? We’re researching WHICH FACTORS SHOULD BE REPORTED IN ANAESTHETIC AIRWAY STUDIES A 15 min survey now & again in a month Looking for PATIENTS Recruitment ends this week Link redcap03.gsttdms.co.uk/redcap/surve... Thanks. Pass it on!
redcap03.gsttdms.co.uk
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doctimcook.bsky.social @doctimcook.bsky.social · 28/01/2025
PAEDIATRIC DEATHS DURING ANESTHESIA & SURGERY - LESSONS FROM NAP7 Great to see this published Link attached www.bjanaesthesia.org/article/S000...
bjanaesthesia.org
NAP7: high mortality risk in neonates and very low risk in children
Editor—We congratulate Lyne and colleagues1 on their initiative to explore and improve consent around perioperative mortality in children. Providing such data for families and clinicians is a key purp...
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Reposted by @doctimcook.bsky.social
Nicholas Chrimes @chrimesy.com · 24/01/2025
Frequency gambling vs severity gambling - from @doctimcook.bsky.social, Andy Higgs & me in @bjajournals.bsky.social kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...
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doctimcook.bsky.social @doctimcook.bsky.social · 24/01/2025
@AnaesUnited is challenging the expansion of & arguing for the need of a national scope of practice & regulation for Anaesthesia Associates This is how the legal cases is going. Big step take already. anaesthetistsunited.com/court-gives-...
anaesthetistsunited.com
Court gives us the go-ahead - Anaesthetists United
Court gives us the go-ahead
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doctimcook.bsky.social @doctimcook.bsky.social · 24/01/2025
The issue of the expansion, scope of practice & regulation of MAPs, & for anaesthetists AAs, remains front & centre of the agenda. @AnaesUnited continue to pursue a legal challenge This is worth reading anaesthetistsunited.com/our-legal-ca...
anaesthetistsunited.com
Our legal case - Anaesthetists United
We are less than four months away from the final hearing in our fight against the GMC’s failure to set proper standards for Physician Associates (PAs) and Anaesthesia Associates (AAs) to treat patient...
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doctimcook.bsky.social @doctimcook.bsky.social · 18/01/2025
Where it started, where it going A million of anything is….lots Very proud
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doctimcook.bsky.social @doctimcook.bsky.social · 09/01/2025
A new resource from @rcoanews.bsky.social Good get better rcoa.ac.uk/patients/pat...
rcoa.ac.uk
Risks associated with general anaesthesia
Everyone is different; it is impossible to know who will have a side effect or risk. These numbers are averages from research studies. The people in the studies usually had routine surgery, were a hea...
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doctimcook.bsky.social @doctimcook.bsky.social · 09/01/2025
It’s clearly described in the paper….
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doctimcook.bsky.social @doctimcook.bsky.social · 05/01/2025
The PUMA guidelines for prevention of oesophageal intubation are supported by -RCOA -AoA -FICM -ICS -CODP -DAS This is true of no other airway guidance I am aware of & make them the de facto UK National guidance associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
associationofanaesthetists-publications.onlinelibrary.wiley.com
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ....
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Glad that your only regret…..you’re a lucky man
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Reposted by @doctimcook.bsky.social
Nicholas Chrimes @chrimesy.com · 08/01/2025
Tube removal (+ FM/SGA ventilation) is the default action to exclude OI, not only if OI can't be excluded with FB. Tube removal + vent also necessary if desat occurs or sustained exhaled CO2 can't be restored (even if removing tube dangerous or OI apparently excluded w alternative technique).
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
I would alter “Assume no sustained exhaled CO2 = OI unless proven otherwise (by repeat VL/FOB/US/ODD)” to “Assume no sustained exhaled CO2 = OI. Remove tube inks unsafe. If unsafe exclude OI (by repeat VL/ & one of FOB/US/ODD)” Current wording misrepresents the guideline.
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
I would change “Assume no sustained exhaled CO2” to “Assume lack of sustained exhaled CO2” (or “failure to meet the criteria for….”) to avoid any possibly of conflating with “NO trace” (Gestalt notwithstanding!)
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Specific to RCoA FICM AoA This response to a coronial report is very clear & very explicit www.judiciary.uk/wp-content/u... In the case of the RCoA the guidelines were supported by council. FICM sits within RCoA (I assume!)
judiciary.uk
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Thanks Greg PUMA (which I’m not involved with) is an international collaboration It includes contributors from the 51st, 52nd & 53rd states of the USofEverywhere
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Greg Bryson @glbryson.bsky.social · 05/01/2025
For my Canadian colleagues, PUMA guidance was developed in collaboration with the Canadian Airway Focus Group.
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Jan is a clever bloke. Here the relevant papers wot he wrote associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/... associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
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Dr Mary-Ann Fox BMBS FANZCA GChPOM @maffygirl.medsky.social · 05/01/2025
If I hear chest rising, tube misting from trainees again, I might vaporise. I say sustained exhaled C02 is the only accurate indicator according to @doctimcook.bsky.social
media.tenor.com
a picture of an owl with the words say what written below it
ALT: a picture of an owl with the words say what written below it
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Summary 11/11
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
In 24/25 cases the type of hospital was reported. Interestingly all were in theatre or specialist hospitals. No deaths were reported from DGHs 10/n
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Clinical care was rated -before cardiac arrest good in 17 (68%) cases, poor in 2 (8%) -overall care rated good in 17 (68%), poor in none. Death was judged an inexorable process in 11 (44%) cases, partially in 5 (20%), not so in 6 (24%) with no judgement reached in 2 (8%).  9/n
bjanaesthesia.org
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Resuscitation attempts were often prolonged (72% >20 minutes, 12% > 1 hour) & generallywere longer than in adults. In 16 (64%) cases initial resuscitation was successful, with 9 (36%) deaths delayed. Contributory factors -patient in 23 (92%) cases -surgery in 11 (44%) -anaesthesia in 4 (16%). 8/n
bjanaesthesia.org
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
The commonest causes of death -haemorrhage (24%) -severe hypoxaemia (20%) -severe isolated hypotension (16%) All reported cardiac arrest rhythms were non-shockable (PEA 57% bradycardia/asystole 43%). 7/n
bjanaesthesia.org
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Ethnicity was reported for 22 cases: 9 (41%) were of Asian, black or ‘other’ ethnicity, compared to 15% in the anaesthetic activitysurvey: by age -3 of 10 neonates -2 of 3 infants -4 of 9 older children were in these ethnicity categories. 6/n
bjanaesthesia.org
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Patient characteristics associated with perioperative death -low age -male sex -high ASA (96% of deaths were ASA grade 4-5 vs 2%) of activity, 1 pt was ASA grade 3, none ASA grade 1-2) 5/n
bjanaesthesia.org
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Cardiac surgery & interventional cardiology accounted for 8 (32%) fatal cases, compared with 2% of paediatric anaesthetic activity Interventional radiology (3 of 15 cases) & emergency laparotomy (4 of 15 cases) prominent in neonatal & infant deaths & trauma in older children (4 of 10 cases). 4/n
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Nine (36%) interventions took place outside theatres including 5 (20%) in the cardiac catheter suite 4 (16%) in radiology. 3/n
bjanaesthesia.org
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
25 deaths in the cohort. 18 (72%) cardiac arrests that led to death occurred during anaesthesia, 7 (28%) after leaving recovery, all in a critical care unit. Out of hours & emergencies were risk factors. Ditto major surgery. 2/n
bjanaesthesia.org
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doctimcook.bsky.social @doctimcook.bsky.social · 08/01/2025
Responding to an article about consent for anaesthesia in children we analysed (all cause) PAEDIATRIC PERIOPERATIVE MORTALITY in NAP7 Really low for older children Low for infants High for neonates (80x) (Small numbers & wide CIs) www.bjanaesthesia.org/article/S000... 1/n
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doctimcook.bsky.social @doctimcook.bsky.social · 05/01/2025
Yes …..except time to embrace “sustained exhaled CO2” Time to move away from “no trace wrong place” as it is insufficient, cases may have poor but not ‘no trace’ & NTWP creates confusion
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doctimcook.bsky.social @doctimcook.bsky.social · 05/01/2025
The PUMA guidelines for prevention of oesophageal intubation are supported by -RCOA -AoA -FICM -ICS -CODP -DAS This is true of no other airway guidance I am aware of & make them the de facto UK National guidance associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
associationofanaesthetists-publications.onlinelibrary.wiley.com
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ....
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doctimcook.bsky.social @doctimcook.bsky.social · 02/01/2025
Sorry to disappoint ….not a typo I always use the “call me a pendant, if you wish…” line It’s my little joke I sort of toss the ball in the air to see if the ‘pendant’ will indeed pick me up on it & therefore ‘out’ themselves as a swinging pendant. Happy New Year. Stay outta the sun!
media.tenor.com
a ball of yarn with a string attached to it on a blue background
ALT: a ball of yarn with a string attached to it on a blue background
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doctimcook.bsky.social @doctimcook.bsky.social · 02/01/2025
Sorry to disappoint you all…. Not a typo I always use the “call me a pendant, if you wish…” line It’s my little joke I sort of toss the ball in the air to see if the ‘pendant’ will indeed pick me up on it & therefore ‘out’ themselves as a swinging pendant Gotcha! …but all in the spirit of fun
media.tenor.com
a ball of yarn with a string attached to it on a blue background
ALT: a ball of yarn with a string attached to it on a blue background
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Stu Marshall @hypoxicchicken.medsky.social · 28/12/2024
1/9 This is a really interesting observational study looking at VL and DL use. Comparison of success rates is flawed - the choice to use VL or DL was dependent on the complexity of the case - the populations aren't comparable But I think there are other lessons analogous to surgical technique #AnSky
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doctimcook.bsky.social @doctimcook.bsky.social · 21/12/2024
However the response by the @GMC is bordering on bizarre www.rcoa.ac.uk/sites/defaul... They state this should be based on ‘evidence’ …..the College has done a good job in trying to gain, assimilate & disseminate what evidence there is. There is not much! What has the GMC done? 2/2
rcoa.ac.uk
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doctimcook.bsky.social @doctimcook.bsky.social · 21/12/2024
The @rcoa is to be congratulated on navigating the treacherous path defining scope of practice for Anaesthesia Associates via -huge surveys of opinion -aiding #Nap7 analysing real life practice -Cochrane review -professional liaison/listening -pragmatic approach to patient safety & existing AAs 1/2
rcoa.ac.uk
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doctimcook.bsky.social @doctimcook.bsky.social · 17/12/2024
Isn’t the ratio surprisingly high….did only 15% of cases have LSCS. To this (dyed in the wool non-obstetric anaesthetist) that seems surprisingly low? Was there clinician opt out?
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Anaesthesia @anaesjournal.bsky.social · 12/12/2024
What are the disadvantages of 'total videoscopic tracheal intubation'? • ⬆️ stress response • ⬆️ risk of airway trauma • awkward ergonomics • prevents airway operator managing other aspects of induction @chrimesy.com @doctimcook.bsky.social #AnSky #MedSky #AirwaySky buff.ly/4gyjwy7
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