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Tim Norfolk @icmtim.bsky.social · 17/12/2025

I’m not big on conspiracy theories but this one rings true… #CritcalClosingCriticalSchmosing

Tim Norfolk @icmtim.bsky.social · 26/06/2025

I personally think it’s great George will get to manage a £500m budget in his gap year. His UCAS application will dazzle

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Tim Norfolk @icmtim.bsky.social · 05/06/2025

This was version 1 and then 2. I don’t know if anyone has any insight from the authors as to why it was changed mind?

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Tim Norfolk @icmtim.bsky.social · 08/05/2025

They do discuss this in the paper tbf. The non-septic group had to have no clinical evidence of sepsis documented in the EHR, & they suggest pts with culture -ve sepsis wouldn’t have been included in either group. I worry Pct may be worsening, not improving antimicrobial stewardship 🤷‍♂️

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Tim Norfolk @icmtim.bsky.social · 07/05/2025

A drop >25% predicted FR with a sensitivity of 93% and specificity of 92%❗️ It’s single centre, small pt no.s, specific inclusion/exclusion criteria & no invasive CO monitoring as the gold standard BUT… this is an exciting test to keep an eye on & could be a welcome addition to the toolkit 2/2

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Tim Norfolk @icmtim.bsky.social · 19/04/2025

Sometimes checking an ScvO2 feels pointless, but other times it’s 23% P.S. a CO2 gap of 2.3 (17mmHg) must take some beating?

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Tim Norfolk @icmtim.bsky.social · 17/04/2025

NB/ There has actually been a much larger cohort published (n = 4265) in 2023 And they found the exact same thing! “Even very fast correction rates were not associated with adverse neurological events” jamanetwork.com/journals/jam...

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Tim Norfolk @icmtim.bsky.social · 17/04/2025

In the largest published cohort (n = 449) rapid correction occurred in ≈ 30% In the 78 pts who corrected >12 mmol/L per day, 0 cases of cerebral oedema were identified In fact, there was a trend towards lower mortality in the group who corrected more rapidly 2/ pubmed.ncbi.nlm.nih.gov/30948456/

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Tim Norfolk @icmtim.bsky.social · 09/04/2025

The finger sweep test is in every article there is on necrotising fasciitis yet in my experience, I’ve never known a surgeon perform it. Indeed they look askance if I’ve suggested it 🫤 Is this a 🇬🇧 thing? Curious to hear other people’s experience… #EMIMCC academic.oup.com/bjs/article/...

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Tim Norfolk @icmtim.bsky.social · 29/03/2025

Clearer reviewer 2 got the short in early! 🤣

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Tim Norfolk @icmtim.bsky.social · 19/03/2025

A great opportunity to recite this 💎: 1L of 0.9% Saline contains as much salt as 23 packets of Walkers Cheese & Onion crisps That initial 3L resus = 69 bags worth‼️ It’s no wonder people get a bit puffy as their poor kidneys battle to pee out all that 🧂😵‍💫🧂

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Tim Norfolk @icmtim.bsky.social · 26/02/2025

Exactly & they were excluded from CAPE-COD, which was the RCT that really changed practice. We don’t know the right answer, & I’d guess there are sub-phenotypes who they benefit/harm, but we still need to make a decision with the evidence we have & that’s the side of the fence I’m on (for now)!

https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2395-8

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Tim Norfolk @icmtim.bsky.social · 20/02/2025

Some very challenging interactions with a new surgical colleague this morning #ILookLikeASurgeon 👩‍⚕️ 🥰 🦄

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Tim Norfolk @icmtim.bsky.social · 18/02/2025

In MINT the restrictive group achieved a median Hb of 8.8 vs 10.1 in the liberal group (where >10 was the target). So haven’t we effectively studied 10 vs just below 9 & 10 looked better?

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Tim Norfolk @icmtim.bsky.social · 12/02/2025

Very common in 🇬🇧 This is an exert from the BNF (our prescribing bible)

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Tim Norfolk @icmtim.bsky.social · 09/02/2025

Status myoclonus thus can accurately predict a poor outcome with a false +ve rate ≈ 0 BUT, whilst simple myoclonus is still an unfavourable sign, it does not rule out neurological recovery, with a range of false-positive predictive value ranging from 0-22% link.springer.com/article/10.1... 4/

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Tim Norfolk @icmtim.bsky.social · 09/02/2025

Post-anoxic status myoclonus is diagnosed in the case of continuous and generalised myoclonus persisting for >30mins & when occurring within 48 hrs has excellent specificity for predicting a poor neurological outcome. As such it forms part of the ERC multi-modal neuro-prognostication guidelines 3/

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Tim Norfolk @icmtim.bsky.social · 05/02/2025

Useful BNF reminder in 🇬🇧 context too. 500mg oral sodium bicarb ≈ 6mmol HCO3 1L of 1.26% sodium bicarb = 150mmol HCO3 Orders of magnitudes difference

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Tim Norfolk @icmtim.bsky.social · 28/01/2025

🇬🇧 Anaesthetist pals: Trying to educate myself on the role of CPET testing prior to major intra-abdominal surgery. Seems to be good evidence for its ability to predict mortality/morbidity/LOS, but any data to suggest routine HDU admission based on CPET scores actually improves patient outcomes?

A screaming patient on a exercise bike in the middle of an operating room surrounded by cheering surgeons

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Tim Norfolk @icmtim.bsky.social · 24/01/2025

Question for MedSky community: Has anyone seen obstructive shock physiology resulting from dynamic hyperinflation in a ̲𝚜̲̲𝚙̲̲𝚘̲̲𝚗̲̲𝚝̲̲𝚊̲̲𝚗̲̲𝚎̲̲𝚘̲̲𝚞̲̲𝚜̲̲𝚕̲̲𝚢̲ ̲𝚋̲̲𝚛̲̲𝚎̲̲𝚊̲̲𝚝̲̲𝚑̲̲𝚒̲̲𝚗̲̲𝚐̲ patient with a severe COPD/asthma exacerbation? #EMIMCC

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Tim Norfolk @icmtim.bsky.social · 22/01/2025

If a picture’s worth 1000 words then this cine loop’s a damn novella dedicated to the pathogenesis of hepatic hydrothorax 😍 #EMIMCC #pocus

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Tim Norfolk @icmtim.bsky.social · 17/12/2024

I don’t disagree, but sometimes perfect is the enemy of good. I take a little reassurance from the various Kaplan-Meier curves too. Most of the group separation occurs by day 4, which makes me think it’s the first few days that make the difference

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Tim Norfolk @icmtim.bsky.social · 06/12/2024

Another day, another dissection, another excuse for the Drake Meme #EMIMCC

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Tim Norfolk @icmtim.bsky.social · 16/11/2024

Radial arterial lines are the default in most 🇬🇧 ICUs but can be wildly inaccurate in cases of profound shock. These pics are taken seconds apart, after inserting a Femoral PiCCO line, systolic BP 121mmHg higher!!! I’ve seen big discrepancies before but nothing of this magnitude! 😲 1/

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