Simon Carley
@EMManchester
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EM, Major Trauma & HEMS Consultant, Dean @RCollEM . Associate Dean. #FOAMed @StEmlyns @PHCCC @NWAirAmbulance PGY32: Prof at #MAHSC @officialUoM & @ManMetUni
Manchester
Joined February 2009
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If you're in the North West, please think about supporting our
@nwpccc
charity night in November and even better subscribe to our lottery. 🙏
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@DGlaucomflecken
Also ‘Septic AF’ is
Atrial Fibrillation secondary to sepsis
and NOT
really bad sepsis
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So proud of team
@MRI_ED
last night & always.
Thanks for everyone’s thoughts and kind words at a very difficult time.
#GreaterManchester
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WOW, just WOW. I’ve just come off a call with
@rob_cosentini
from Bergamo in Italy about his experience in dealing with the Covid19
So much learning and a message of hope.
I’ll get this out on the podcast and blog tomorrow.
Thanks so much for this and all you’ve done.
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Delighted to pick up my PhD from
@ManMetUni
today.
Sad that my supervisor was not there. Janet Marsden was an inspiration and guide for many years but died a few weeks before my viva. She is missed by so many of us, and I wish she had been there today.
@MRI_ED
@ManchesterREH
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Delighted to be joining
@NWAmbulance
as MERIT doc
Honoured to starting at this time when so much going on.
Ping
@NWAmb_OOHCPD
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Look at what they make you give
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Delighted to be appointed as Major Trauma research lead for
@MFTnhs
Exciting times for trauma research here and in collaboration :-)
PING
@SRFTMajorTrauma
and
@AintreeMTC
@MajorTraumaRPH
@NWAirAmbulance
@StellaSmithSurg
@MFT_Research
@richardbody
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The whole of UK Emergency Medicine is saddened following the death of a truly inspirational man
@DrCJM
Ex president of
@RCollEM
and a real gentleman who inspired so many and led the speciality in hard times.
He will be greatly missed
#RIP
(Photo from
@EuropSocEM
2014)
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Lots of people asking about the
#COVID19
#Simulations
we have been doing. Here’s a thread of thoughts and advice
1. We already have an established process for low acuity patients. We’ve not done simulation with walk ins.
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Please visit
@stemlyns
to read about Max and the reasons why we need the AMAX4 algorithm in anaphylaxis/asthma. I promise you'll learn from this tragic story. Thank you Ben and Tamara.
Joining
@DFTBubbles
@LITFLblog
to get the learning out there.
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Delighted and honoured to pass final 'sign off’ to solo respond on behalf of
@CSIBASICS
in support of
@NWAmbulance
A long journey for me, with tons learned from
@BASICS_HQ
colleagues (and more to learn still).
A career ambition to contribute towards
#PHEM
now within reach :-)
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The relationship between confidence and competence is complex and dynamic. You can be both or either.
Confidence does not equal competence. We need to know our abilities and train for the blind spots.
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Opening the new Major Trauma Ward at
@MFTnhs
@stemlyns
@StellaSmithSurg
@MRI_ED
@Reynard_EM
New ward, new job, new team 😀
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Areas where you can miss a penetrating injury
Axilla
Back
Buttocks
Groin
And BEARDS!
Beware beards
#trauma
#penetrating
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Podcast now live here
Roberto has some essential messages here. Please listen and share widely.
#FOAMed
WOW, just WOW. I’ve just come off a call with
@rob_cosentini
from Bergamo in Italy about his experience in dealing with the Covid19
So much learning and a message of hope.
I’ll get this out on the podcast and blog tomorrow.
Thanks so much for this and all you’ve done.
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At Yorkshire anaesthetic conference - they have these amazing label sheets for Emergency RSI
Amazing patient safety solution from trainees
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Interesting kit. Bluetooth linked BVM which is weight adjustable. Links to direct feedback on BVM technique 😮
#DFTB19
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What the hell is this bougie for?
Is there a giraffe in resus?
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1. It mimics pretty much everything
2. It coexists with everything
You will see pts you think are covid and you will be wrong
You will see pts who you don’t think have covid who do
Basically you’ll be wrong a lot
#Medtwitter
: those of you who've met
#COVID19
in anger, can you transfer your newly acquired experience to those of us still waiting for it to hit? 1) what you have found COVID19 mimicking, and 2) what non-COVID presentations do you feel/know are going to get missed?
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We are really excited to publish our third e-book today
‘The Resuscitationist’s Guide to Health & Wellbeing’
Available on iTunes and as a ePub please share and comment widely.
#FOAMed
#wellbeing
#healthyclinicians
#Virchester
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One year ago today I was on bypass for major cardiac valve surgery at
@LHCHFT
with Mr Modi and team.
Lots to reflect on. Started some new jobs with
@NWAirAmbulance
&
@RCollEM
Moved on from others
Thanks to everyone especially
@FCarleyOphth
for getting me back on my feet.
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Just accepted a paper for
@EmergencyMedBMJ
on patient harm that is really going to cause some controversy.
No spoilers, but watch this space.
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This week’s tagline….
We know that crowding kills patients
Crowding + COVID will kill patients and staff
We can’t have crowding during the pandemic.
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#Covid19
Podcast from Bergamo, Italy with
@rob_cosentini
Rob is an EP at the heart of the outbreak and has lots to teach us all. THIS IS A MUST LISTEN
#FOAMed
podcast.
#coronavirus
#Italy
#emergencymedicine
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I can’t decide if this is genius or not 😆🤔
Suspect genius 👍
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Happy Birthday to the much missed and ever remembered
#DocJohn
An inspiration to us all
#Delta7
@docjohnmum
@stemlyns
@SmaccForce
@emcrit
@ashleyliebig
@ATACCFaculty
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Just checked in with
@FCarleyOphth
and apparently it’s NOT a good idea to test your eyesight by driving to Barnard Castle.
#ophthalmology
#advice
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Probably my favourite quote to live by and to end my session today on EBM at the time of COVID
Maya Angelou described evidence based agility long before I did
#codazero
@codachange
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CT not FAST
You’re going to do a CT if the fast is +ve OR if it’s -ve so it’s not a decision making tool.
TBH FAST is nowhere near as useful in adults or kids as some make out (in my system where I can be in CT within minutes)
7 yr old handlebar injury to abdomen. Worsening pain but stable observations. TXA? FAST scan? CT?
#EDCases
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JC: Tranexamic Acid (TXA) in Head Injury. The CRASH-3 results. St Emlyn’s
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Once again reminded of this from Richard Branson.
We do some great training here, but T&Cs which are outside my control force people away.
Very sad 😞
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LATE BREAKING ADDITION!!!!
Dexamethasone NNT of 8 for ventilated patients in the RECOVERY trial.
First drug to show real benefit
PING
@PeterHorby
@stemlyns
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RIP
#delta7
Still missed by us all
@DocJohnsMum
@DocJohnHinds
@ATACCFaculty
@codachange
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Not sure many hospital clinicians realise just how many people are not conveyed to hospital by NHS ambulance service (roughly 50%)
It’s a huge amount of expertise, skill and efficiency that helps support the whole emergency care system.
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Incredibly useful and educational shift with Cons Para Luke with
@NWAmbulance
as
#MERIT
doc. Learned loads. Huge respect to NWAS teams from EOC to the road and more
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Delighted that we are now the first and only MTC in Manchester with a helipad on site 😀🚁🚑😀
Looking forward to welcoming
@NWAirAmbulance
to resus very soon.
@MRI_ED
@RMCH_PED
@MajorTraumaMRI
@StellaSmithSurg
@mftchiefnurse
@MFTPgrad
@MFT_CSS
@MFT_MRI
🗞️NEWS: The first elevated Helipad of its kind in the North West has officially opened to patients today at Manchester University NHS Foundation Trust on Oxford Road 🚁🏥🙌
Read more on our website:
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Also smaller chest tubes work really well for haemothorax
Remember that a 24F is rhe same diameter as the average intercostal space. Bigger than that is unnecessary and painful.
Data says you can use a pigtail (even smaller)
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How can we expect the public to adhere to new COVID19 regulations whilst
#dominiccummings
has still not faced censure for breaking the previous ones?
#BarnardCastle
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Science backs this up. Dunning-Kruger effect shows confidence does not equal competence.
#smaccUS
http://t.co/NGlwjhiEgR
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What is the name for the bit of apron that sticks to the back of your neck after doffing - surely there must be a word in the English language for it (or maybe in German) 🤔🤔🤔
Things we never thought about before the pandemic 🙄
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Top 10 Trauma Papers for Trauma UK conference. 2020-2021.
No doubt COVID affected the number of clinical trials published this year, but some interesting studies here to consider.
@stemlyns
@TraumaCareUK
#trauma
#EBM
#FOAMed
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RIP Dr Cliff Mann OBE
Dr Cliff Mann OBE (22 June 1962 – 20 February 2021)
May your legacy live on, and may you rest in peace. 💙
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@expensivecare
I have had cards printed Ty at I can hand out to paramedics who bring trauma cases to our MTC. They can then contact me in 12-24 hours to find out what happened/discuss case.
Seems to be popular with all so far.
Ping
@NWAmb_OOHCPD
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One thing I love about this trial is SCIENCE
We had real problems at times persuading clinicians to accept randomisation, or to not to break blinding, as they ‘believed’ that TXA worked and wanted to give it.
That’s why we need large pragmatic RCTs like
#haltit
BREAKING: HALT-IT Trial (TXA in GI bleed) published
Death from bleeding @ 5d: No stat sig diff
Death from any cause @ 28d: No stat sig diff
No diff in any secondary outcomes
VTE higher in TXA group 0.8% vs 0.4%
TXA should NOT be given for GI bleeding
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A strong message here is that we should not be normalising bad care.
It's the wrong question to ask how we improve care on corridors or ambulances, we should just stop doing it. It's bad care and leads to death and increased morbidity.
#rcemCPD
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Amazing to see that the RECOVERY RCT (SOC, azithromycin, dex, kalletra, HCQ) has now randomised OVER 6000 patients in the UK.
That must be unprecedented in an intervention trial
We are going to SCIENCE this in record time.
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Think about it slightly differently.
The issue is brain injury not skull injury.
I’m much less interested about the box as opposed to the contents.
Anything that reduces acceleration/deceleration/shear forces to the squishy brain inside is good.
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Lessons from the ED:
The likelihood of the patient’s phone number being correct on the hospital is inversely proportional to the importance of contacting them by phone.
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I don’t think you’ve been treated well on Twitter. Without understanding the context I feel many comments have been very harsh and without an opportunity for you to explain.
Please don’t take all the comments personally.
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Delighted to be taking over from
@RCEM_CPD
as CPD director for
@RCollEM
Big shoes to fill! Carole has always been a tough act to follow.
Already met amazing
@RCEMevents
team and
@EmilyBeet1
who will keep me in the straight and narrow 😆
Exciting times ahead
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Can honestly say that having an ED pharmacist makes a huge difference to patient safety.
Importantly - they are clinicians and directly influence patient care. Eg invaluable in toxicology cases.
@RCollEM
Great to see pharmacists being recognised as valued members of the ED MDT, including 7 day & extended hours working. Whilst our roles & potential input in to patient care haven’t been fully alluded to here, it’s certainly a step in the right direction.
#pharmacistsatthefrontdoor
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What a final day at the big sick conference
#tbs24
Great lectures this morning followed by an awesome and inspiring trip to
@airzermatt
base with
@ATACCFaculty
Hugely inspired by the amazing professionalism and systems of their helirescue team
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Just had a fantastic holiday in
#Peru
for nearly 3/52.
Not really been on twitter, not looked at email, travelled ++.
Have I missed anything important?
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The PATCH trial is a great design to look at
#TXA
in
#majortrauma
No difference in 6/12 functional outcomes, but more survivors. NNT 23
Find out why we think we should keep giving it here.
@karimbrohi
@stemlyns
@DogICUma
@CTU_LSHTM
@HaleemaShakur
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HALO procedures are time critical, information light, high acuity, low occurrence events. That makes them tricky to train for. T
his week we outline a strategy for acquisition and maintenance of these skills and introduce the learning triumvirate
#FOAMed
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On the day when we elected a new
@RCollEM
president
@KatherineRCEM
My sincere thanks to Taj Hassan as outgoing
@RCEMpresident
He has been a kind, morally just, and politically skilled president who has guided us with style, panache &wisdom in difficult times.
🙏🙏
#Topwork
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I know people on twitter complain when we refer to colleagues as ‘legends’ but this is Prof Josep Brugada at
#EUSEM2023
and he is pretty awesome
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Is that probe cover what I think it is?
#POCUSfortriage
with
#POCUSforCOVID
at
#Lewisham
#butterflyIQ
This system has been in place since early April. Pocket sized scanners have been instrumental in making it possible . A training process has been put in place to train US novices in POCUS specifically for this process
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Weirdly just been asked to stop using a laptop to take notes at
#EuSEM18
Some strange people here!
Still using laptop…..
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New guidelines from
@RCollEM
and
@RCRadiologists
finally agree that contrast CT should not be delayed for creatinine levels in the critically ill and injured.
Yay!
@stemlyns
#FOAMed
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Kicking off the course with the memory of
@DocJohnHinds
whom the course is dedicated to.
The embodiment of
@resuscitology
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For anyone considering a management post in EM…. It’s worth reading the excellent (and anonymous) piece from
@stemlyns
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Crowding kills.
We’ve said this for years. Evidence from around the world and now from UK.
Underfunding is killing our patients across UK emergency departments
This is a national scandal
#crowdingkills
@ShaunLintern
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Very excited to say that
@stemlyns
have had a preview and will be co-releasing a blog & podcast immediately after trial released.
#foamed
facilitated knowledge translation.
@TheSGEM
@bad__EM
@srrezaie
@emcrit
@cliffreid
@LeechCaroline
all on board too
#Knowledgetranslation
👍
Very exciting week next week as we can finally share with you all the
#CRASH3trial
results (13k pts with isolated head injury)!! On Tuesday 15th October 2019...
#watchthisspace
#5daystogo
#TXA
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First day as
@RCollEM
dean completed ✔️
Taking over from the fantastic
@RCEMvp_Jason
who has moved into the VP position.
I’ll be doing dean stuff on
@RCEMdean
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Superb
@carrings
: Photo Captures the pace of a trauma & 1 person to maintain overall situational awareness HT
@emcrit
http://t.co/pja3bgck8p
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Lots of Qs at work about this!
Covid 19: A primer on ICU care for the non-intensivist. For those who may be redeployed to support critical care services during the pandemic
@jplomas
@traumagasdoc
@andyneill
@stemlyns
#FOAMed
…
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They can’t even manage a PowerPoint presentation ross. Slides wrong size for screen. Can’t see the data.
What hope do we have if they are so incompetent that they can’t even do this. 😞
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The Dunning Kruger effect.
Confidence DOES NOT EQUAL competence.
#rcem15
@rcem15
http://t.co/rYS4AfiLIU
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Just finished a weekend on call in Virchester and
#covid19
is here.
We must set up systems now in order to cope with what is coming.
EM will have to split into resp/non-resp asap, but defo requires a whole system response. This will change everything.
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There is a real difference between people who think this is an important question and those that don’t.
Spoiler: I much prefer those that don’t think it’s important. Judge people on their abilities and not their prior privileges.
Is there a difference in a doctor from Oxbridge vs from UCL/Imperial? (asking for a friend)
In my opinion, they're all fab unis and all produce top class doctors?
#medtwitter
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Top 10 (well interesting) trauma papers for the
@TraumaCareUK
conference
#TBI
#FOAMed
@stemlyns
#trauma
You won’t agree with my choices…. ;-)
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Very personal and emotive blog from
@LizCrowe2
on the impact of our jobs on our self and psyche.
A must read IMHO in two parts.
#FOAMed
#stemlyns
#stress
#compassion
#love
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