Tom Lawson
@Vapourologist
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Father. Husband. Anaesthesiologist. Intermittent Artist. Attempted writer. Other Adjectives and Nouns. 🖖🏴
South Wales
Joined March 2020
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I drew up half these drugs, the trainee the other. One of us isn’t leaving the anaesthetic room alive
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Just because ... Alan Rickman as the anaestheist: a thread.
Just how rapid are your rapid sequence inductions?
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Seasons Greetings! An old fashioned on an old fashioned anaesthetic machine a.k.a. The ‘Back Bar’
#Anaesthesia
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Registrar came back and handed over a strong contender for my top ten patient’s opening lines: -
“I do not have multiple co-morbidities, as that would be tautologous. I simply have co-morbidities”
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Hogwarts department of Anaesthesia:
Dr Potter CT1 - From the moment he picked up a laryngoscope, he’s been told “Yer a gasser Harry”
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What could go wrong?
Same size, same colourings …
Time for distinct and standardised size/colouring of paralytic agents?
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The Recycled Anaesthetic Machines of twitter. Thought I’d try and get them all in one place! Up first the one that started it all
@nrsaran
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Getting the most out of your monitor: a tweetorial thread. Inspired by a twitter question from
@mork66236485
and
@GongGasGirl
's chairing of the
@aagbi
's latest recommendations on monitoring. Lets start with a series of
#OnePagers
on aspects of the ECG
#FOAMed
#MedTwitter
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Unpopular opinion ... I love inserting an NG in intubated patients. The great
@SteveBree2
taught me the 'split tube' technique - I try to teach this to all trainees - it really is a game-changer ...
#MedTwitter
#Anaesthesia
#FOAMed
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So my project of turning an old anaesthetic machine into a drinks trolley; Phase 1 is complete. Had intended on painting it, but opted for the much harder route of stripping all the green paint off, back to metal. Think it looks pretty nice. Stay tuned for Phase two…
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Edmund Blackadder: Anaesthetist; a thread
When you make up something about The sodium-potassium pump to mess with the surgeon
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Homer Simpson: Anaesthetist
When anaesthesia is no longer needed at the trauma call …
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The Muppets Christmas NHS: a thread
#MuppetChristmasCarol
#MedTwitter
Brand new Surgical F1 being sent to the oncall radiology consultant to request a abdominal Xray for ?appendicitis
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Training in Anaesthesia is about learning how to do the same thing fifteen different ways.
Anaesthesia on twitter is about being angry / confused that people do that same thing, one of the other fourteen ways
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Today, 4836 days (or 13 years, 2 months, 25 days) after leaving Morriston Hospital after my first F1 rotation, I’m returning to Morriston Hospital
@SwanseabayNHS
as a consultant ... it’s going to be an interesting day
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Me: Hey Siri. Define ‘suboptimal’
Siri: “After 2 years of scrupulous rule following, test positive for COVID 24hrs before going on your 1st family holiday for 2 years to Disneyland Paris, that you’ve been excitedly discussing with your 4 year old daughter for weeks.”
Me: yep…
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An Indiana Jones / Anaesthesia Thread ... just because. Real footage of what happens after ROSC
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Is it too much to ask for a vascular surgery girl band called “Fem Pop”?
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@Vix_turnock
Side effect may include:-
Inability to operate heavy machinery
Inability to operate light machinery
Inability to operate own lungs
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Obi-Wan Kenobi: Anaesthesia Master
Emerging from behind the screen, when the blood pressure suddenly tanks …
#medtwitter
#kenobi
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The NHX-Men: a thread for
@TharushaGunawa4
and
@DrJSherrington
#MedTwitter
Wolverine: the oncall consultant surgeon; always grumpy and only ever wants to cut things
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Well this was a very pleasant surprise. Hope people find this updated version helpful!
@APAGBI
@sasakatwork
@LaurenceHulatt
@FashamJuleen
@PlymAnaesthesia
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It’s time to stop being romantic, we need to ditch stethoscopes. Risk of infection and transmission. Use ultrasound in theatres. Here’s a crash course for anaesthetists
#POCUSforCOVID
@RCoANews
@AAGBI
@ICS_updates
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It’s still rough out there people. So, because he’s awesome and we could all use a little of him in our lives, I give you, Tom Hanks; anaesthetist - a thread.
When you’ve done your first block and it works!
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I’m a US history buff & I have to say, stumbling on to
#Manhunt
was such a treat! Sumptuous production design, Well written & paced, superbly acted (Bravo
@TobiasMenzies
even if you don’t sport Stanton’s neck beard!), but overall compelling. If you’ve got Apple TV give it a go
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On the 20th anniversary of the film, I give you … The Fellowship of the Cricoid Ring: an emergency theatre thread
#medtwitter
#LordOfTheRings
Novice when they do their first list in emergency theatre
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Dr Hagrid SAS - the heart of the department. No FRCA, but knowledge and experience to boot. Occasionally let’s department gossip slip out when supervising novices
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The single greatest diagnosis of my career: methaemoglobinaemia secondary to metoclopramide administered for antiemetics after pacemaker insertion for complete heart block in … my wife
Feeling blue? 🥶
Methylene Blue for methemoglobinemia pharmacy education board 💊🏥
#MedTwitter
#twitterx
#meded
#twitterx
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Good luck to those sitting the primary FRCA today.
In medicine, we’re bad at talking about failures. I failed my 1st go by 0.6%, although the number stays with me, & failure is a good teacher, it didn’t define my worth as an anaesthetist.
You are more than a mark on a paper.
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Have found the perfect print to go along side the anaesthetic machine drinks trolley
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Real footage: surgeon starts talking about adding patients to an already overrunning list
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So remember a while back when someone posted a photo of an old anaesthetic machine they’d turned into a bar? Well guess who has a project ?
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Since some of you have asked me about my library, here’s a quick peak.
#TheLibrariesOfMedTwitter
I know
@DrBenLovell
has a top notch one, and I imagine
@bobfunn
has a lovely one too.
@Dr_BellaR
you think you have a book problem …
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It was literally … and I do mean literally … called ‘Abed’s Uncontrollable Christmas’ … words can’t describe what should happen to whoever at
@nbc
thought they should make these
@CommunityTV
Xmas ornaments but not include Abed (or Shirley)
@dannypudi
@YNB
@joelmchale
@kenjeong
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Envelope calculations… say an anaesthesia CT1 earns ~40-45k pre-tax/deductions. That equates to ~2.3-2.7k per month net.
@RCoANews
asks for ~25% of monthly take home pay for an exam, but can’t allow payment by installment? We can do better right?
@GaslingSarah
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It’s still rough out there. So I give you ... Die, Hardly ... an anaesthesia thread.
@amit_pawa
@admit_medics
@SecretRadiology
Feeling when you have to wear someone else’s theatre shoes
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Mostly the defining reason why doctors choose a specialty is not prestige, intelligence, dexterity, ability or earning potential. It’s interest. I’m interested in anaesthesia. Others are not. That’s good. We need the differences & should respect and celebrate them
#sincerity
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Dr Granger CT1 - passed her primary FRCA at the first opportunity, has 3 QI projects on the go, 6 abstracts under review and can spell ‘Amitriptyline’ without having to look it up
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Dr Snape - aka Dr Kryptonite, whenever he’s around you fail to intubate, cannula the, function at a basic level, and makes you feel he thinks you’re barely competent to breathe unaided, but for some reason is always there to help
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Comportment Syndrome
- condition in which female doctors are advised (most often by mediocre, white men) to act in a manner they consider to be more professional / empathetic / considerate / well-behaved (delete or insert a suitably condescending adjective as appropriate)
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Because I have some time on my hands now that
#JanuAirway
is over, I present ‘The Princess Bride/Anaesthetist’; a thread.
Colleagues response when you volunteer for a plastics list
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I often say anaesthesia is like cooking, so here’s the obligatory Chef Anaesthesia Thread with a guest appearance by Walter White
#MedTwitter
#AnaesthesiaTwitter
The Teicoplanin rebel
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It’s been a rough couple of days, so thought I’d do something to ‘stay classy’ - Panchorman: an Anaesthetic thread.
@amit_pawa
@admit_medics
@SecretRadiology
@morefluids
@WeekesLauren
@GongGasGirl
Mivacurium ... that’s the tweet
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The grudging admiration when someone else slips in the cannula/art line/epidural after you’ve struggled for 10mins
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When you’ve been in theatre the whole time and the surgeon storms in demanding to know where the anaesthetist is
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So the kind of day I’ve had can be summarised in 5 words:
Unplanned
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Page
Anaesthetic
Chart
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So to keep myself busy / distracted whilst Mrs L is having an op, ‘the project’ has begun. Converting an old anaesthetic machine into a drinks trolley for us. I might need an ODP to help put her back together (the trolley, not Mrs L)!
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Back of envelope calculations regarding
#RCoAEGM
mandate
2020 RCoA census says there were roughly 15,500 U.K. anaesthetists
Resolution 1 had 4942 votes cast, this represents approx 31.8% of U.K. anaesthetists.
~1/3rd of all anaesthetists voted - that’s pretty impressive
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Recommendation time:
#TheOutlaws
... I came for
@stephenmerchant
and Christopher Walken, I stayed for a fantastic West Country comedy crime drama. Definitely worth checking out.
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Trainee asked why I use epidural catheter to deliver LA via flexiscope, rather than spray with a syringe via the working channel. I’ve said you get better spread. Decided to do a blue Peter experiment with my daughter with toilet roll as the trachea. Left = spray, R = catheter
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When a trainee mentions how they did things in their last hospital
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Dr Dumbledore Clinical Lead - the elder statesman of the department, seen it all, and likely given it an anaesthetic. Unflappable. Knows exactly which rules to break and will always have a colleague’s back. You (not-so) secretly wish he was your dad.
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Dobby ODP - immensely skilled, often overlooked, you start out wondering if he’ll hurt you, but ultimately is there to protect you
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Dr Weasley CT2 - lives by the adage “never say no to a break”, wears second hand theatre shoes from the big bucket in the changing room
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Impossible not to be cheered up by these guys...The Muppet Theatre:
A thread
@amit_pawa
@admit_medics
@SecretRadiology
@morefluids
Feeling you get to work with your favourite ODP/scrub nurse
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Some clear and concise guidance from PHE and what Mask PPE should be used when
@RCoANews
@doctimcook
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ECG tip - a standard ballpoint pen (e.g. biro) is approx 30 large squares long (6 seconds).
If your ECG doesn’t have a rate on it, simply put the pen on the rhythm strip & count the number of QRS complexes along its length, then multiply by 10
#ECGhacks
#MedTwitter
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Real Skinner energy being put out by
@RCoANews
tonight
Our position on the supervision of anaesthesia associates is 2:1
We don't support 3:1
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Dr Malfoy CT1 (ACCS ED) - inexplicably not impressed by our ability to draw ketamine, or recite the blood:gas partition coefficients of various vapours. Jumps at any opportunity to go to a trauma call and get away from theatre
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Well it’s been an eventful evening, but it’s ultimately for the best, despite how bad many might feel. So to cheer you up here’s a Jurassic Park vs Anaesthesia Thread
@morefluids
@WeekesLauren
@admit_medics
: - anaesthetist regarding pretty much every case on the emergency list
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The Life Anaesthetic with Steve Zissou or the Grand Budapest Hospital: A Wes Anderson NHS Thread for
@VirtueOfNothing
#MedTwitter
Cast in order of Appearance:
Alec Baldwin as the trauma call team lead. Distant from the main events, narrating events in a soothing husky voice
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Internal feelings when the surgeon says ‘well that took a bit longer than expected’
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Anaesthesia when they arrive in ED to see ‘them’ managing the airway
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When 37 of your ministers have resigned. Shake it off, you have 5 more hours
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This should be standard procedure when you arrive at the trauma call
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Congratulations to all who’ve passed the FRCA today - savour the moment
For those that sadly didn’t, it feels crap, no way around it. But remember exams don’t define your worth or ability, they define whether you can answer arbitrary questions on a paper. You’re more than that.
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Today is a Fibonacci sequence date; 1/1/23. I love this sort of thing.
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Dr Trelawney - her mixing if anaesthesia with new-age feelgoodery gives you reason to question how she passed the FRCA
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The Rebel NHS:
#MayTheFourth
After 6 cups of coffee, the constant sound of running water and no breaks, Dr Skywalker is finally released from an interminable urology case
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#JanuAirway
Day 28 – Bariatric Airways. Increasingly common in general practice. Let’s dive in…Here's a
#OnePager
covering anatomy/physiology/key issues & management principles
@AirwayFirst
@dastrainees
@Dasairway
@OTJOnline
@AirwayMxAcademy
@gunjeet99
@SOBAuk
@ProfEllenO
1/5
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It’s here, the cover for our book,
#CPETmadeSimple
. I’m biased, but I think it looks great! Thanks to all at
@CambridgeUP
for their help. Due out 31st of March. If you’re interested in CPET / Peri-operative medicine / physiology /exercise/functional assessment maybe take a look
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Flourless pistachio cake with a chocolate ganache … as it appeared before its grisly demise
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In honour of the late great Akira Toriyama, I present Dr Agonball: an Anaesthesia thread
#MedTwitter
Young Goku: CT1 - full of promise and hidden strength, will have many master’s over the years but will be able to knock people out with his skill and strange powers
5
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Have been thinking about ways to teach laryngoscopic view optimisation (DL & VL), and inspired by PART for USS, came up with DART (LEFT) … thoughts?
@dastrainees
@AirwayMxAcademy
@amit_pawa
@doctimcook
@dr_imranahmad
@VirtueOfNothing
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When the medical student confidently says they know how to intubate
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To celebrate
@EmmaRaducanu
’s amazing achievement. Here’s a Tennis Theatres Thread
@drladeback
@amit_pawa
@aroradrn
@admit_medics
@SecretRadiology
@morefluids
@WeekesLauren
#medtwitter
#anaesthesia
#EmmaRaducanu
#Tennis
When you get the last recovery space/nurse ….
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Because
@amit_pawa
asked for it and
@dannyjnwong
inspired me. Toy Story: Anaesthesia.
New airway device on display in department
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Dr Lupin - another contender for ‘work dad’, hugely impressive intellectually and clinically. Oozes compassion, but with a tendency to disappear without warning … 🌕🐺
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Ms Umbridge Medical Director - no longer does clinical work. Constantly referencing how ‘the old days’ were much harder, and that the current generation are ‘snowflakes’. Loves infantilising trainees and getting rid of oncall rooms
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Professor Slughorn - Medical school. Drops in to the department twice a year to complete an AM session daycare gynae list to ‘keep his hand in’. Encyclopaedic knowledge of educational theory, but shouldn’t be let near a syringe of Propofol
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Dr McGonagall College Tutor - seemingly appears out of nowhere for a ‘quick catch up. Loves nothing more than a fully completed form R. A stickler, but a good egg.
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2 new Lawson’s Laws of anaesthesia
1) You’re fine as long as you have an airway & access
2) if a patient is going to give you trouble, you can bet they’re last on the list
I’ve had a fun evening in work 😬
#CanIBeOnTheNextMug
@amit_pawa
@CEgeler2
@nhoare
@Miko_Charleswor
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Dr Lockhart - constantly regaling the coffee room with stolen anecdotes from doctors he’s worked with in other hospitals, but never been seen giving an actual anaesthetic.
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