iiinova — where your digital self keeps evolving

Stu Marshall @hypoxicchicken.medsky.social · 03/08/2026

I will always be incredibly grateful for our Pharmaceutical Benefits Scheme (PBS). This drug that keeps my tumour load down so I can live an (almost) normal life and without having to worry where to find an extra $78k per year. #Auspol #Medsky

Medication packaging with label stating cost of $25 but full undiscounted price of $6530.27 for 30 days supply

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

Alistair McNarry highlights the central role of the airway assistant in the DAS 2025 unanticipated difficult intubation guidelines. #GAMC26

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

Then what…? Consider transport Assemble a team with the plans Have a strategy

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

Helen Harker talks about the paediatric difficult airway - how to identify. #GAMC26 #AnSky

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

TIVA-RSI Probably not unreasonable to do

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

Cricoid force. The facts. Can’t do an RCT would need 1.4M in each arm.

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

Inc incidence. Death from asphyxiation or ARDS

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

Components of RSI. Risks, evidence and logic

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

Next at #GAMC26 Tim Cook talks about RSI. First, coronial inquests have pointed to lack of guidelines in the age of TIVA etc. #AnSky

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

There is no retrospective data to show any increased risk

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

We know 1:8 patients have residual gastric contents. They don’t aspirate because of what we do to prevent it.

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

Pulmonary aspiration risk. Is this also increased? Needs to affect all of these factors.

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

If withheld, the risk doesn’t decrease within 12 days. Might be less there but still concerning volume. In endoscopy setting one small trial disputes this.

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

First the risk on inc gastric content is 6x those without

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Stu Marshall @hypoxicchicken.medsky.social · 18/06/2026

At #GAMC26 first up Kariem El-Boghdadly Is the Glp1 agonist response to pulmonary aspiration excessive?

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Stu Marshall @hypoxicchicken.medsky.social · 13/06/2026

Always leave one phrase from your lecture on a whiteboard for the next class.

Whiteboard with “Bus crash 8pm Saturday “ written in blue ink

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Stu Marshall @hypoxicchicken.medsky.social · 01/06/2026

I was under the impression this was just a regular school outing. However, the rapidity that the consent form escalates is making me wonder…!

Permission form for school camp:
We both give permission for this student to be administered Paracetamol / Tylenol (or equivalent) by school medical staff whilst attending the conference

We both give permission for the student named above to be administered
Ibuprofen by school medical staff whilst attending the conference

We both give permission for the student named above to be administered
Antihistamines by school medical staff whilst attending the conference

W both give consent this student to receive medication as instructed and any mergency dental, medical or surgical treatment, including anaesthetic.

In an emergency we both give consent for this student to receive a blood transfusion, if considered necessary by the medical authorities present.

We both give consent for this student to be resuscitated if required.

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Stu Marshall @hypoxicchicken.medsky.social · 05/05/2026

It’s not every day your one of your dearest friends becomes the president of a major medical specialty college. Congratulations Dr Tanya Selak aka @gonggasgirl.bsky.social President of the Australian and New Zealand College of Anaesthetists @anzca.bsky.social So proud of you #AnSky

Dr Tanya Selak being given the ANZCA presidents medal by outgoing president Professor David Story

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Stu Marshall @hypoxicchicken.medsky.social · 04/05/2026

Out today. A 10-year cohort analysis of coronial data of anaphylaxis deaths. What happens first, bronchospasm or cardiovascular collapse? Open access #MedSky onlinelibrary.wiley.com/doi/10.1111/...

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Stu Marshall @hypoxicchicken.medsky.social · 17/04/2026

A lovely thing about having an exchange student is the treats they bring. TIL that Colombians liked the corners of this one chocolate cake(?) so much they now just sell the corners - Esquinas in Spanish.

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Stu Marshall @hypoxicchicken.medsky.social · 14/04/2026

New anaesthesiologist: “I’ve been looking for theatre nine and three-quarters for hours, where is it” Surgeon: “Just walk past theatre 8 and then charge with one of the scrub trollies at the wall near the sign, Harry…” #Ansky #Medsky #Anaesthesia #HarryPotter

Operating theatre suite with numbers of the operating theatre above the door.

Operating theatre number decal on a wall “9 3/4” with a surgical trolley pushed up against it.

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Stu Marshall @hypoxicchicken.medsky.social · 18/03/2026

Anyone here coming to GAMC soon? Better get in quick! @gamclondon.bsky.social #Ansky t.co/wMz5RS0PzV

GAMC 2026
@GAMCLondon
Its been a quiet week but behind the scenes
#GAMC 2026 is coming together
/ Draft programme
Three parallel streams
/ Hybrid platform
Workshops nearly sold out
J Edutainment planned
Book now:
@bookcpd.com/course/GAMCJUN...
• • the space for program teasers next week!

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Stu Marshall @hypoxicchicken.medsky.social · 02/03/2026

Luckily for me I have one of the 3% of lung cancers that has an ALK-fusion mutation. This means targeted drugs called tyrosine kinase enzyme inhibitors prevent the cancer from growing. Newer ones cross into the brain and work there as well. This tumour is much smaller than at diagnosis.

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Stu Marshall @hypoxicchicken.medsky.social · 02/03/2026

I’d seen the CT. I was told it was sarcoidosis with widespread disease across both lungs. When I heard “carcinoma” as a doctor with that picture I knew exactly what it meant. Likely months, not much more.

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Stu Marshall @hypoxicchicken.medsky.social · 02/03/2026

Four months ago I was diagnosed with metastatic lung cancer. Early 50s a non smoker it was a huge shock. #medsky #anaesky

Health insurance claim form filled out by oncologist
“Advanced high volume disease considered terminal”

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Stu Marshall @hypoxicchicken.medsky.social · 09/02/2026

Always entertaining to find someone who’s never seen the arrow next to the fuel pump on their car and tell them what it means. Response is always 🤯

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Stu Marshall @hypoxicchicken.medsky.social · 19/01/2026

Finding way to confuse the removalists.

Box with “second best china, fragile” written on it

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Stu Marshall @hypoxicchicken.medsky.social · 28/12/2025

Looks amazing. This was mine from last year. Was delicious but a lot of work!

Vegan Wellington cut open showing veggies and mushrooms inside

Christmas table setting with vegan Wellington as centre piece

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Stu Marshall @hypoxicchicken.medsky.social · 18/12/2025

Structural gingerbread is not a thing. Kids insisted on a domed structure with curved walls -an observatory being hit by the Christmas comet it was observing. Just to be clear, baking curved biscuit structures in the oven is nigh on impossible.

A domed structure possibly a mosque, maybe an observatory made of gingerbread (badly) with a gingerbread shed next to it. There’s a dog out there front of it with chocolate chips for poos and decorated Christmas trees.
It’s just a mess really.

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Stu Marshall @hypoxicchicken.medsky.social · 07/12/2025

Currently wading through all the old family recipes, as I do at this time of year, working out which ones to honour. Messages like this of my Nana to my Mum fill my heart. They’re so precious and I can almost hear them busily passed on Christmas morning. #Tradition #Christmas

The back of an old stained postcard with tips for a turkey stuffing recipe to add Yorkshire pudding batter for consistency.

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Stu Marshall @hypoxicchicken.medsky.social · 24/11/2025

Some nice stratocumulus undulatus over the beach this morning. I think. Might just be pretty clouds 😊

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Stu Marshall @hypoxicchicken.medsky.social · 25/10/2025

I’m sorry but why aren’t there 100 million people in the streets in the US right now protesting the fact that one of their national assets has been completely defaced? Imagine if this was Buckingham palace, the Beehive or dare I say it… the Reichstag?

Satellite imagery showing the White House complex before, top, and after the demolition of the East Wing.
Satellite imagery showing the White House complex before, top, and after the demolition of the East Wing. Photograph: 2025 Planet Labs PBC/AFP/Getty Images

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Stu Marshall @hypoxicchicken.medsky.social · 18/10/2025

In my day Wagon wheels and Mars bars were way bigger and Thiopentone came in a larger, normal size dose vial. #shrinkflation #AnSky

Thiopentone sodium ampoule with 470mg rather than the standard 500mg dose

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Stu Marshall @hypoxicchicken.medsky.social · 04/10/2025

The unstoppable Liz Crowe. Anaesthesia as a profession by definition means to compromise your wellbeing for another human’s Purpose, mastery, and belonging is key and the generations expect different things

Liz presenting at the ASA NSC conference on wellbeing

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Stu Marshall @hypoxicchicken.medsky.social · 29/08/2025

At the AGES periop conference. Spellbound by Tracey Ezard talking about ferocious warmth. Leadership analogy with gin and tonic. Sometimes you need a little bit of gin and a lot of tonic. Sometimes you need all the gin but you still need some tonic. Traditional leadership is toxic ‘Gin shots’

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Stu Marshall @hypoxicchicken.medsky.social · 25/08/2025

Trying to rehearse a conference presentation. My co-worker not giving much detailed feedback but the purring is at least reassuring. #AcademicSky #EverydayIsCaturday

A black and white absolute unit of a cat missing half his ear sitting watching a screen of a talk.

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Stu Marshall @hypoxicchicken.medsky.social · 12/08/2025

Challenge: post your last photo taken in DC to show what a hellhole it is.

A cute albino squirrel seen on the National mall

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Stu Marshall @hypoxicchicken.medsky.social · 04/08/2025

Rasmussen’s dynamic safety model is one of those things that has had a massive effect on how I think about the workplace. The system and how we respond is an active process. Actions at a macro level can affect our work and how we perceive it based on cost, workload and safety boundaries.

Rasmussen’s dynamic safety model. Three curved lines representing economic failure, excessive workload and performance failure govern the acceptable space for safe work.
Gradients of cost containment, reduced workload and safety improvement determine where in the space we operate.

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Stu Marshall @hypoxicchicken.medsky.social · 30/07/2025

Came across this foreword in a book I contributed to today. Not seen it before and found it striking - mostly that we’ve forgotten so soon and allowed so many to rewrite the history of what happened just a few years ago.

This book is dedicated to the more than six million people who died of COVID-19 during the two years we spent preparing this edition.
We also dedicate this book to healthcare workers across the globe for their hard work and sacrifice caring for patients during this once-in-a-century pandemic, particularly those practitioners involved in airway management, who placed themselves at great personal risk.

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Stu Marshall @hypoxicchicken.medsky.social · 26/07/2025

Listening to the ABC #Hottest100 and reminded of the similarity between Jimmy Barnes in the Working class man video and his Scottish compatriot Rab C Nesbitt.

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Stu Marshall @hypoxicchicken.medsky.social · 26/07/2025

Go to the ANZCA library site. Click on journals then Anaesthesia journal. Go via the web version of Browsine rather than the app as there’s an issue at the moment. Click on articles in press and it should be there

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Stu Marshall @hypoxicchicken.medsky.social · 02/07/2025

Unsurprisingly @chrimesy.com has an opinion on this… 😂 The central point is if you consider it a ‘core skill’. Here’s our description of a core skill and why AFOI doesn’t meet that standard. #AnSky associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

Core technical skills would include those that are used frequently across a broad range of contexts, as well as those that may need to be implemented in an unpredictable and time-critical fashion where the opportunity to seek more specialised assistance cannot be relied upon. The core training must therefore include airway assessment, ability to establish an airway using a facemask, supraglottic airway and tracheal tube, basic extubation techniques and emergency airway management.

There are other techniques used in the context of difficult airway management, which, while satisfying these same criteria, have historically been considered as core skills that all anaesthetists should possess. These include awake fibreoptic intubation and inhalational induction with the intention of maintaining spontaneous ventilation. Many anaesthetists lack the opportunity to practice these techniques sufficiently frequently to profess mastery. That awake fibreoptic intubation is often overlooked as an option for difficult airway management may in part reflect the discomfort of many anaesthetists with this procedure

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Stu Marshall @hypoxicchicken.medsky.social · 14/06/2025

Agree. Have a standard set up coding for size position and colour. Use it every time. If working with others (eg trainees) have a method of reminding them what the set up is. I have a laminated strip on the work surface. Happy to share, just DM me. #AnSky

Anaesthetic drugs on a work surface with a standardised set up with a colour strip to prompt order and size of syringes. Muscle relaxants are in a box next to the other drugs to prevent inadvertent administration

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Stu Marshall @hypoxicchicken.medsky.social · 25/05/2025

All perioperative anaphylaxis should undergo testing at a specialist testing centre - avoidance of anaesthesia by patient and future safety being the reasons. There are scoring systems that indicate the likelihood it was anaphylaxis. #Ansky #MedSky Our paper here: pubmed.ncbi.nlm.nih.gov/31029409/

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Stu Marshall @hypoxicchicken.medsky.social · 18/05/2025

AI feedback focuses on a single moment. Not the trajectory and has no social context #ICSC10

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Stu Marshall @hypoxicchicken.medsky.social · 18/05/2025

How do we assess clinical skills using AI? An emerging problem and the next frontier #ICSC10

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