bob funnekotter
@bobfunn
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Anaesthetist/ Anesthesioloog ⚕️also 🐓📷🌌🪐🪴🌳 tweets in Dutch🇳🇱 & 🇿🇼English.
Zimbabwe-SA-UK-Netherlands
Joined March 2016
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Pinned Tweet
**This is my “thing”! 😃
I love attaining one-lung-ventilation (OLV) in my patient.
**great article 👌🏼✅
@BJAJournals
@ThoracicAGuys
@GSTTanaesthesia
#DoubleLumenTube
#EZBlocker
#DLT
#OneLungVentilation
#ThoracicAnesthesia
#bronchialblocker
#ThoracicAnaesthesia
🧵👇🏻
Can you describe the pros and cons of double-lumen tubes and bronchial blockers for lung isolation? Then take a look at this month’s
#BJAEd
article.
#anaesthesia
#lungisolation
#cardiothoracics
#airway
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@vanranstmarc
Hoi Marc,
Ik wilde even zeggen dat ik hoop dat jij een lang, gezond en gelukkig leven krijgt.
Dat zou ik heel fijn vinden.
En velen met mij.
Nog een fijne avond!
Groeten uit de regio Eindhoven. En vele andere regio’s.
Ik meen het echt: enorm respect en waardering voor je.
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I was today years old when I learnt what RAE stands for…
…I have been working in anaesthesia for 26 years 😳😳😳🙈!
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12yr old kid wants to be vaccinated so he can visit his terminal granny BUT Dad is antivaxx
Court case! 😳🤯
Kid wins 🏆💉🙏🏻
Hooray for kids rights
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@DGlaucomflecken
😂😂😂
but you got some essentials wrong!
1st rule of anaesthesia = no coffee no gassy.
2nd rule = keep everything as boring as possible.
And the drape? I always call it the blood brain barrier…
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@edkortekaas
@RdGziekenhuis
Keurig gehandeld door het ziekenhuis. Er zijn landelijke regels voor publieke ruimtes.
Trouwens, al moest ik in een narrenpak de horlepiep spelen... ik zou het doen om mijn zoon de noodzakelijke zorg te laten bieden.
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Idiot.
I vow never to work in the UK again.
You can stick my NHS George Cross up your arse.
Today in Parliament we have laid an order to ban overseas care workers from bringing dependants.
This is just one part of our plan to deliver the biggest-ever cut in migration 👇
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We need to get rid of the nonsense attitude that a Guedel is for the “incapable” or for “learners”
It is a very useful airway tool.
Using a Guedel can ensure a good/better airway and is therefore safer for the patient.
Safer.
Patient safety first.
@glauncel
@sydneyesbrown
I love a guedel but I’m afraid to use one. The side eye, the tuts, the comments.
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@DGlaucomflecken
Your mongering is excellent, keep at it. Hope Jonathan is scribing it all down for future reference.
Thank you eye sir.
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Als anesthesioloog ben ik ook bezorgd. Voorkom onnodige ziekte en overlijden en laat je kinderen vaccineren volgens het
#Rijksvaccinatieprogramma
. Het zijn geen onschuldige kinderziektes. Ik heb mijn kinderen daarom alle vaccinaties laten geven.
#ikvaccineer
Als ziekenhuisapotheker ben ik ook bezorgd. Voorkom onnodige ziekte en overlijden en laat je kinderen vaccineren volgens het
#Rijksvaccinatieprogramma
. Het zijn geen onschuldige kinderziektes. Ik heb mijn kinderen daarom alle vaccinaties laten geven.
#ikvaccineer
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@DGlaucomflecken
Oh I just do it the other way round; once I’ve induced the patient I call out “surgery! knife!” while looking Mister/Madam Surgeon in the eye.
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In a fickle moment of silliness I used a stethoscope for a phone conversation
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Final farewell to my father-in-law today. He passed away peacefully aged 90.
Physician, ethicist, a man of high standards and expectations, Japanese concentration-camp survivor, tough, uncompromising.
An avid gardener 💚so I took a few pics of his large, late autumn garden:
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THE MEUSE IS FLOODING.
Evacuation of a 500-bed hospital, my wife’s workplace. God help us.
Not only patients. Think radioactive isotopes, chemical supplies, oxygen, liquid helium MRI’s, millions of euros of equipment all to be stowed safely on upper floors.
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I have not read it yet….but my first reaction is: no, absolutely not.
A well-sited thoracic epidural is the bee’s knees. No way that i.v. lidocaine is going to achieve equivalent analgesia.
New randomised trial: In major abdominal surgery, IV lidocaine offers postoperative pain control comparable to thoracic epidural analgesia at 24h. Does IV lidocaine present a viable alternative to epidural analgesia
#Anaesthesia
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@DGlaucomflecken
It’s very challenging..
WE need to *random chore* = YOU do it
WE need to discuss/revise/set out/plan = I shall tell you
WE need to redecorate = YOU paint the walls in my chosen colour + I am going out to buy unnecessary adornments
WE need to chat = You hide!
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@DGlaucomflecken
I looove pushing the knockout cocktail in at just the right moment. We anaesthetists (yes, correct spelling) rock 💪🏼!
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@fuzzymittens
we call it paracetamol which has fewer letters so it takes up less space meaning we can give more 💪🏻
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I gave flumazenil once.
A young lad came tonEmergency dept in a coma, GCS = needs a tube, clear story of benzo’s OD.“jellies”as his friend said.
So, in with the flumazenil.
Next thing: generalised seizure - vomit - aspiration - intubation - ARDS - ICU ☹️- v slow recovery 😩
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@DGlaucomflecken
“anticipate my deceit”
A masterful phrase we all recognise.
What always flummoxed me (cause it’s just stupid) was: “The innominate artery has no name!“
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@AshleyGWinter
🐣paediatrics
🦕geriatrics
🦀oncology
🐬urology
🦉internal med
🦍general surgeon
🦔pain therapist
🐩plastics
🦨gastroenterologist
🦤pathologist
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Good morning everyone especially all the
@Ryanair
passengers who have ended up in random cities of Europe, wishing they had never boarded in the first place!
#StormIsha
Manchester to Stansted flight currently 39000ft over Germany right now 😂
#Ryanair
#StormIsha
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@DrBenLovell
Looks fine to me, but I’m a gasman.
Not really looking at the blue bit. Reckon I could get a Venflon in the side of foot easy, no US.
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Dad would have turned 90 this month.
I still miss him.
He could hold you just enough to let you feel both the struggle and his support.
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#RAUKISURA22
And: An impromptu private tutorial on ICBN intercostobrachial nerve block from the legendary
@LloydTurbitt
💙
What a gent!
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My youngest son turned 22 today.
My brother Paul never got any older than that.
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@rosie_hogg
showing us
@neumanmd
et al’s studie in the pro-con debate.
@EMARIANOMD
Importantly: NO DIFFERENCE IN DELIRIUM incidence
GA vs RA
Now we can - finally - stop the debate 😃
#WCA24
Singapore
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@chris__carey
@StGgas
Obligate mask breather and dangerous.
Monitoring: horrible breath sounds are audible at a distance. That’ll do.
Technique: Ketamine + Sux dart and cower somewhere safe till rasping stops…
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@shawnapandya
@jtrebach
😀 beat me to it!
Magnesium is the benevolent Queen 👑 of the electrolyte realm.
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Please do NOT go swimming/ surfing/ whatever in sea foam.
We 🇳🇱 had 5 able-bodied strong young surfers drown in sea-foam.
The thick choking foam has a low density making it impossible to swim on top of it. Sink you will, breathing in the foam that drowns you.
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@OrthopodReg
@DGlaucomflecken
“danger squiggles” 😄
I once had an ortho prof hand me an ECG and ask me “is it going up and down neatly enough”?
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Is there a standard frequency for 100% SaO2??
Listen to this👇🏻vid. Same hand, same 100% SaO2 but 5 semitone difference! Confusing🤔!
@doctimcook
@AirwayMxAcademy
@NicholasChrimes
@drtimmeek
@Masimo
@GEHealthCare
@DrGetafix
@Vapourologist
@dastrainees
@VirtueOfNothing
@jducanto
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very important point!
When doing an awake fiberoptic intubation: explain this part to your patient and get your assistant to gently apply jaw thrust.
HT
@DrEricLevi
Good morning.
Jaw thrust on. Jaw thrust off.
This is the most basic of all airway manoeuvres.
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@DGlaucomflecken
Thank you for all these, and specifically for growing your hair so that this moment could be
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I made an excellent decision to visit my nephew and his partner in Canberra.
Growing up in Zimbabwe we understood nothing of the “abomination” that was homosexuality.
Now I’ve stayed in a gay couple’s home, seen how well they do life. I am so very proud of these two.
Family 🥰
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@jeffgadsden
@ASRA_Society
@ESRA_Society
@AoraIndia
@LasraAnestesia
@ASA_Australia
@amit_pawa
@EMARIANOMD
@KalagaraHari
@James_Kim_MD
@dr_tgro
@MonicaHarbellMD
@AmandaKumarMD
@DrRobbieErskine
@ajrmacfarlane
everything has been said 😅! 👍🏻
My tip: To get the needle exactly in plane “newbies” can concentrate on their own proprioception by holding the probe between thumb and 2nd + middle fingers.
Then aim the needle towards a point below the middle finger.
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If you want to discuss a point with someone, YOU need to check that their “receiving antenna” is switched on, and the timing appropriate.
Otherwise it’s like a burp or fart:
You relieve your discomfort, but everyone else just thinks you stink.
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@AvrahamCooperMD
I am of the privileged few who have done this!
While in training, we had a complex Maxillo-Facial & Plastics oncology case which required face and jaw and neck to be “free of tubes”
My consultant let me do the intubation saying “you’ll never forget this”
He was right 🙏🏻
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The highest point of Africa this morning.
Kilimanjaro. Very little snow/ice.
Video taken by my son.
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We have had some terribly sick mothers in ICU.
Mum (and unborn baby!) induced in a coma, ventilated, caesarean section, baby to neonatal ICU.
No family/ maternity time for bonding.
Partner traumatised.
What a horrific way to start a family!
Preventable bij vaccination 👇🏼
“Sickest” mums: Inside COVID-19 maternity wards
“The experience should serve as a wake-up call for pregnant mothers who are hesitant about getting the jab”
If you’re pregnant 🤰🏽please get vaccinated, including getting a 3rd dose.
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As promised
@TheRealAlMay
a quick video of our anaesthetic-room-free theatre layout.
On a saturday night 🙃
Are anaesthetic rooms safer?
I won’t accept any opinion from anyone who hasn’t anaesthetised patients both in anaesthetic rooms and in the theatre itself ….
(Too easy to think the other thing is weird when you’ve never done it…)
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Anesth. Analg. Mar-Apr 1975; 54(2):273-4
I cannot even provide a link. It is probably written on papyrus in hieroglyphs 😑
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@DGlaucomflecken
Though I do think doctors (through their associations) could put a LOT more pressure on the system to instigate change.
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@DrBenLovell
@DrMarkLander
all those super-important waves and descents are visible!
I have to assume this is what internal medicine is like
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@anaecritmed
my colleague who had been working all night:
“come and help me, everything is 60!”
Me: what is?
Him: the BP, the age, the Sats, everything 😱😆
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One brave and insightful view of the situation in the Levant 👇🏼
It’s extremely complex.
I grew up in colonialist Rhodesia, experienced turmoil and war in the transition to Zimbabwe. I studied in apartheid and post-apartheid South Africa. Do not underestimate dehumanisation.
I grew up in a Zionist household, spent 12 years in a Zionist youth movement, lived 4 years in Israel, and have friends and family who served in the IDF.
When that is your world, it's hard to see apartheid when it's happening.
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#RAUK21
@ajrmacfarlane
“if you do not want a phrenic nerve block, don’t block above the clavicle”
@LloydTurbitt
“No matter what the BMI is, everyone has a skinny axilla” 😁
@DrEAlbrecht
“0,1-0,2 mg/kg dexamethasone i.v. works at least as well as (off-label!) perineural”
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@timricketts_
Taking blood does not cause lymphoedema 👇🏻
Dear
#BreastCancer
survivors who have had axillary procedures- it is SAFE to have blood taken, and blood pressure measurements done, on that arm. It does not increase lymphoedema and it makes me cranky to see pts scared unnecessarily into painful leg/foot procedures.
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Excellent 20min vid for anyone involved in care of pts with hip fracture. Thanks for sharing, Amit.
So I finally got around to recording my
#ASRASpring23
#ASRA100
Talk on European Guidelines for hip fracture !
Sadly- I have got a slight cold, so don’t quite sound myself! Hope it was close to what I delivered in person?!
YouTube Link👇🏼
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This 𝕏 place is no good without all the Amit Pawas.
@X
has suspended him AGAIN 🤬😤
#bringbackAmitPawa
meanwhile make sure you follow
@BlockIt_Hot_Pod
and his youtube channel
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Back in the Mother City for my reunion.
30years since I graduated 🙄
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In any case, if you do puncture the dura: insert a catheter l!
and THEN decide what to do.
Gives time to call a colleague, make a decision.
Such a pity if the tuohy is pulled out in panic.
🔓The effect of placement and management of intrathecal catheters following accidental dural puncture on the incidence of postdural puncture headache and severity: a retrospective real-world study.
@BinyaminYair
#FreeForAWeek
🔗
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Today was a good day for me on the bird app. Many positive and uplifting tweets. Good humour.
So cheers 🥃 to you all for the engagement, entertainment, education and earnestness!
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@fuzzymittens
Imagine that in the airline industry?
Compelling an understaffed aeroplane with an exhausted pilot and a sick co-pilot to TAKE OFF NOW..it’s vital to the economy.
•All hospitals/healthcare services will be fully staffed always. The doors will NOT open if any single member of staff is not present.
•This also means the staff have time to be fully dedicated to their specific task 👍🏻
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😱The answers are all like:
4 yrs BSc
3 yrs Clinical master
7 yrs Medical rotation to get MBBSCHBBM
3 yr Sabbatical completing my Law & engineering degrees
7 yr PhD in bioneurogenetical nanorobotic endocrinosurgical removal of the substantia nigra.
now 23rd yr junior doctor….
Doctors - how long & what qualifications have you earned that enables you to do your job?
Me -
3 yr BSc
1 yrs MSc
6 yrs med school MBChB
2 yrs (FTE) foundation doctor training
8 yrs training in anaesthesia
FRCA diploma, numerous professional courses
And lifelong learning/CPD
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@AcuteMedEd
@DGlaucomflecken
@LGlaucomflecken
I *would* donate to a protest bus full of medical professionals driven by
@DGlaucomflecken
himself to storm the US congress and paint it red with pig blood.
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@Shr_Nottingham
Yes, if filter off.
Not always.
@Chronotrope
’s video really helped me get orientated.
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Morning all!
No northern lights seen last night, nor the night before so here’s some morning glow instead 🧡
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The pudgy fingers and sluggish brain are slowly beginning to handle Händel
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FiO2 intraoperatively?
In otherwise healthy patient, say for lap. cholecystectomy.
What percentage O2 do you give?
>80%
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>50% <80%
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>30% <50%
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>21% <30%
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@drchadb
@maffygirl
I do not like the term opioid free.
“limited opioids” or somesuch would be better.
It makes it sound like a failure if opioids are used.
Sometimes, despite doing all the ESPTAPPVB blocks both forehand and backhand the patient just needs a tiny bit of opioid. Give it.
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