Chris Rigby @Chris_Riggers Twitter profile

Last Seen Profiles

@dul_turkporno

@rainbwprincess

@CoachSweeneyTBE

@lyly04945928681

@MannNicholaus

@Inkspirate_art

@QRy0HAX8yXToBeA

@likklemary

@dul_turkporno

@melansiamaluca

@AlrhalMany21428

@naisangry

@Latinvixen

@naisangry

@TavriD

@WestBowPress

@jared_ivey1595

@bigbird3420

@DommeDaily

@wojdzieg

@MaheshRamanand5

@Susan_Z03

@keri_ss1

@belaettiler

@_Rose_Graham

@Reyes64105927

@7moo__1211

@TravPorcaGianna

@januszek

@CoreyRowlandJR

@197SLEDGEHAMMER

@puruvjdev

@HalejoZ

@Doctors_Vote

@FilmsInFilms

@unknown_studio_

Chris Rigby

@Chris_Riggers

2 years

To anyone currently in two minds about having kids: I just spent the last few minutes sniffing the walls of my daughter's bedroom to work out which marks are pen (we've given this up as an unwinnable battle) and which are streaks of shit.

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Chris Rigby

@Chris_Riggers

1 year

Why oh why is kids' bedtime in this house a 2 hour extravaganza every night?! What age can I expect to be able to just send them to bed?!

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Chris Rigby

@Chris_Riggers

1 year

@ronansetron It's not *your* shift that is currently uncovered. It's the hospital's shift, you just happen to be the one who would ordinarily cover it. Seriously, medicine, get a grip - when the A/L request is granted, this is the organisation committing to have a means to cope without you.

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Chris Rigby

@Chris_Riggers

5 months

@IDdocAdi Try source control by removing the tonsil bone?

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Chris Rigby

@Chris_Riggers

3 years

Anyone else exhausted of arguing with patients that their cough / fever means they need to go through the isolate / test process

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Chris Rigby

@Chris_Riggers

2 years

Great, so now we also have to deal with "something just doesn't feel quite right, NHSuk said you should test me for cancer" @Parody_RCGP

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Chris Rigby

@Chris_Riggers

3 years

@DrNeenaJha @natprocyshyn Probably wouldn't have liked my "So, it sounds like you've had a bit of a crappy week" from earlier then!

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Chris Rigby

@Chris_Riggers

3 years

@docib @DrLindaDykes I mean the fact that over 50% even went to a school that *had* head boy / girl says a lot!

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Chris Rigby

@Chris_Riggers

2 years

Just seen another example of a paramedic talking about "GPs not seeing people F2F" Got me thinking about the importance of joined up messaging. In primary care, I feel like there are messages we need to get out there:

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Chris Rigby

@Chris_Riggers

1 year

@ronansetron If the organisation can't cope without you that day, then they shouldn't have let you have the day off! The only possible professionalism issue here is that the colleague hasn't shown up to work, and let's be honest the focus should be on welfare checking them!

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Chris Rigby

@Chris_Riggers

2 years

Anyone know Claire, respiratory reg @CUH_NHS ? Just asked her if she was the respiratory nurse, but I swear I misheard "reg", and wasn't making gendered assumptions! Please pass on my apologies if you know her - was really helpful

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Chris Rigby

@Chris_Riggers

2 years

@Jen_Taylor2 I love that this is SOP30, suggesting that there are only 29 things in a hospital more urgently deserving of an SOP

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Chris Rigby

@Chris_Riggers

3 years

Independent prescriber at last - now to make the computer accept this fact!

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Chris Rigby

@Chris_Riggers

4 months

Hang on I was halfway through the comments before I clocked that he is starting with 10x the dose I have seen solve the vast majority of opiate ODs I have ever seen. WTF?! UK ambulances don't even carry this much narcan!

armyemdoc

@armyemdoc

4 months

When it comes to naloxone opioid reversal, there are 2 schools of thought - give them just enough to increase their RR or totally reverse and wake them up. I'm in the latter. I rarely start with <4mg. There's a theoretical risk that their opioid could outlast the naloxone,…

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Chris Rigby

@Chris_Riggers

2 years

@mxmillsamillion @CrabithaStevens @vixnbox @RyanMarino They are called HERbs not HISbs

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Chris Rigby

@Chris_Riggers

2 years

@DrNeenaJha And by the end of the first 10 ducks there are now 30. And a few of them might be pigeons or parrots. And you keep getting asked your opinion about the birds other people have. Midway through, the chicken farmer calls to ask why you sent him a dodo yesterday.

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Chris Rigby

@Chris_Riggers

3 years

@MKIttlesonMD I take your point, but I don't think there's ever a place for running in healthcare. Running risks falling, breeds stress, and leads to error. Maybe "go straight there", but even if the arrest alarm is pulled, just walk quick

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Chris Rigby

@Chris_Riggers

1 year

@HealthRegLawyer When one of the times was paracetamol, you just know that this was someone just doing her best in a pressured system to push through being unwell to avoid "letting the team down". I hate the way that people are punished for trying to help

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Chris Rigby

@Chris_Riggers

2 years

Lots of discussion re in-flight emergencies on my timeline recently. Perhaps the call-out should be amended to "is there a paramedic or other healthcare professional on the flight"? @Aidan_Baron

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Chris Rigby

@Chris_Riggers

3 years

@DGlaucomflecken @RiderToast "Problems in this area" *gesticulates vaguely towards eyes* "are simple. Apply chloramphenicol, then pass to an opthalmologist"

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Chris Rigby

@Chris_Riggers

1 year

@Microbedoc2 To my mind it's not even family. If the pt came from an environment, and is deemed medically fit, why is that environment suddenly not fit for purpose simply because they spent a few hours in hospital.

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Chris Rigby

@Chris_Riggers

2 years

@zackferguson I'm glad you got the help and are doing OK Zack. I've seen some pretty awful postnatal depression in women I care about, and I wouldn't wish it on anyone. At least PND in women is a recognised thing with support groups etc - there is far too little awareness of PND in fathers...

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Chris Rigby

@Chris_Riggers

2 years

I had a really helpful rejection recently. "You referred hoping we could facilitate X test that you are no longer able to do in surgery. For future reference, you may not be aware that you can directly refer for this test. In the mean time, I have redirected" @Parody_RCGP

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Chris Rigby

@Chris_Riggers

5 months

@gmcuk May I suggest you avoid using the prefix "PA" to avoid confusion with paramedics who's HCPC number is prefixed with PA?

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Chris Rigby

@Chris_Riggers

2 years

@ollieburtonmed @Rachel_A_ @badsciencemonk @_NatashaDevon No, that's pavlova. A vulva is a small hollow case of puff pastry

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Chris Rigby

@Chris_Riggers

3 years

@clifford0584 Here in primary care we're largely going "probably isn't, you'll be 'reet"

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Chris Rigby

@Chris_Riggers

2 years

Intubation by ACPs in General Practice, a 🧵

Dr Linda Dykes @[email protected]

@DrLindaDykes

2 years

Could someone please start a thread about ketamine, who intubates in the ED, or sepsis, y’know, the kind of things where UK-EM-and-acute-Twitter can argue happily for days, like in the old days?

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Chris Rigby

@Chris_Riggers

1 year

@drgandalf52 I think I would struggle a little these days, and I *am* a paramedic. With the greatest of respect, I don't think that GPs would be capable of doing all of the role even if they had the resources to do so

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Chris Rigby

@Chris_Riggers

2 years

Colleagues elsewhere - please just be careful not to undermine these messages when talking to pts - I know it's easier in the moment to accept the narrative, but better understanding will have a long-term impact

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Chris Rigby

@Chris_Riggers

2 years

Stolen from elsewhere, but one for @DrSelvarajah When does a joke become a #dadjoke ? When it becomes apparent

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Chris Rigby

@Chris_Riggers

2 years

@833e0bedbd3b4d9 @CUH_NHS Thanks Clare. Appreciated your help regardless, have a great night!

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Chris Rigby

@Chris_Riggers

3 years

@pea88 "I'm not really asking your permission. I have a patient I am handing over to you. You can either have the benefit of my assessment, or you can start from scratch. Regardless, your patient now"

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Chris Rigby

@Chris_Riggers

2 years

Moral of the story - who cares how much water you drink, you'll feel knackered anyway

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Chris Rigby

@Chris_Riggers

2 years

@mevparekh The NHS solution would be to tape a chair upside down to the ceiling and jury-rig a harness

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Chris Rigby

@Chris_Riggers

1 year

@juniordrtruths Utter rubbish for a number of reasons. Managing is a very different skill to clinical work. Look at 🚑 services where most managers are paras to see why this isn't good. A massive issue is lack of clinicians. Pulling them away from patients to be managers compounds this shortage

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Chris Rigby

@Chris_Riggers

2 years

Just called 111 as daughter has a UTI. Pretty efficient service actually, but interestingly closing advice was "give paracetamol if needed, but no ibuprofen". Can't work out the logic for this advice, any thoughts? Can only think of AKI, but well child with good urine output.

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Chris Rigby

@Chris_Riggers

2 years

1) In diagnosis, the majority comes from the history. This guides what, if any, examination is required. 2) Most physical examination we used to do wasn't diagnostically helpful, and was done simply because it was expected.

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Chris Rigby

@Chris_Riggers

4 months

I know there are concerns re representation, but... Simply reading the tweet, it's not her fault - she was *welcomed* with this on her first day. This is not her fault, please don't pile on. For all we know, she introduces herself to patients as "Esther, one of the physios"

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Chris Rigby

@Chris_Riggers

2 years

@DrJSherrington My latest was from OT. "Patient has completely lost use of [a limb] and is therefore struggling to cope at home" "Referral rejected -you didn't say what they need" Isn't that your job?!

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Chris Rigby

@Chris_Riggers

1 year

@PaulNWilliamz @ElenaGGibson *stetho-scoped

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Chris Rigby

@Chris_Riggers

2 years

@LynnGreigMiller Count the QRS complexes on the page, divide by (number of T waves in V1 * height of R in lead II). Then simply add the square root of the total length of the baseline in aVR. Then chuck it all in the bin and look at the number at the top of the page

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Chris Rigby

@Chris_Riggers

1 year

@Alicee_wrightt They're not waiting 11 hours. They're waiting "just 5 more minutes" repeatedly

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Chris Rigby

@Chris_Riggers

1 year

@Microbedoc2 Even if it's imperfectly safe, as long as efforts are made to start the ball rolling for more support, what's the issue? Time in hospital is likely worse for majority of frail patients than sending them home to an environment they were coping with ahead of time.

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Chris Rigby

@Chris_Riggers

4 months

I have to confess tobwondering how a finger up the backside was supposed to help with COPD for a couple of seconds before I realised what Farhan was actually saying!

Farhan Amin

@MFAminGP

4 months

PR is the most cost effective treatment for people with COPD 1. It reduces Systems Cost of Managing COPD pts 2. Reduces winter hospital admissions 3. Free up hospital capacity for Elective Care 4. It improves pts QoL 5. It is quite simply the right thing to do!

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Chris Rigby

@Chris_Riggers

3 years

@rcpsych This is not a psychiatric diagnosis, but an EM diagnosis, and the only clinicians likely to have much exposure to it are ambulance, PHEM, and EM specialists

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Chris Rigby

@Chris_Riggers

2 years

@DrNeenaJha I won't be. Suspect it'll be Minecraft videos and Disney princesses most of the day knowing my kids!

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Chris Rigby

@Chris_Riggers

3 years

@rcpsych @rcpsych - you have this backwards. ABD is not used to "justify" death in custody / restraint, but to describe the physiology that leads to it (hyperthermia, acodosis...) so we move away from excess restraint & towards more humane treatment with a focus on normalising physiology

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Chris Rigby

@Chris_Riggers

3 years

Passed my non-medical prescribing course today. Chuffed with myself, but frustrating I now need to wait for the admin to be done before I can crack on!

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Chris Rigby

@Chris_Riggers

2 years

@DemetriAth @AshleyGWinter ... or the doses we use!

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Chris Rigby

@Chris_Riggers

2 years

@TessaRDavis Able to afford a housekeeper!

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Chris Rigby

@Chris_Riggers

2 years

@TheRealRead @rohan_gupta97 Never understood letting HART have the extra skills. They have less patient exposure, a higher average paramedic:patient ratio, and are designed to operate in environments where cardiac arrest pts aren't going to be prioritised

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Chris Rigby

@Chris_Riggers

3 years

#GP #TeamGP #PrimaryCare We have been mostly remote with invited F2F since pre-Covid. Our pts mostly like it, and have great access (same day consult, same day F2F if appropriate). More pts are unhappy with being asked to come in than with being managed remotely.

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Chris Rigby

@Chris_Riggers

2 years

@zackferguson Not sure what I'm aiming to achieve by sharing this in reply, but felt right to do so.

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Chris Rigby

@Chris_Riggers

2 years

@ErringtonAaron Has to be situation specific. If clearly unfit to see pts, then tell them and take off road. Home or not is harder, but by doing so what you *have* done is send a string signal saying "here is a manager who cares". Probably far more important than what decision is actually made

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Chris Rigby

@Chris_Riggers

3 years

@Aubrene_Fiore @DrLongissimus I like to think there's a radiology word wall!

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Chris Rigby

@Chris_Riggers

5 months

@andrewpunton With precisely 3 seconds of effort, I came up with "Doctor (DR), Doctor (DR), Patient (PT)" as a better mnemonic for this

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Chris Rigby

@Chris_Riggers

3 years

@PaulaMc007 @DrNeenaJha @natprocyshyn I'm a paramedic not doctor, but that's a lovely thing to say thank you! Always thought that one of the reasons that people tend to like paramedics is the straddling of the line between professional and "man on the street"

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Chris Rigby

@Chris_Riggers

2 years

A short 🧵on how drinking more water changed my life.

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Chris Rigby

@Chris_Riggers

3 years

@jbaaadgirl @AgnesRitchie8 I disagree. It's terrible that we think it will only happen if we "prescribe" it. Reductio ab abdsurdium, but what next, no-one speaks to the patient until a doctor prescribes "social interaction, route: verbal, dose: variable, frequency: PRN"

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Chris Rigby

@Chris_Riggers

3 years

I've been thinking about the conversations prompted by #SarahEverard case, and I now feel really uncomfortable with the whole topic. I'll tell you why: The numbers are too big. Too big that it can be "other men" that are the problem.

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Chris Rigby

@Chris_Riggers

10 months

Thinking a little further after today's hot take. Comments about how so many professionals defer responsibility by "discussed with doctor" or similar. Perhaps we'd garner more respect if we owned more of our decisions.

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Chris Rigby

@Chris_Riggers

3 years

@DrBenLovell Honestly this doctor needs a GMC referral. Not as a threat, nor as a punishment, but because they are clearly unable to fulfill the basic tenets of their role - treating colleagues with respect, keeping pts at the heart of decisions, working as part of the MDT...

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Chris Rigby

@Chris_Riggers

2 years

@Jen_Taylor2 Also, let's be honest, the SOP is clearly because someone has been making the custard too custardy or giving out portions deemed to be "too large"

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Chris Rigby

@Chris_Riggers

2 years

@reckydecky1989 Or replacing advice to "not move them" with "assist them up if possible" or similar

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Chris Rigby

@Chris_Riggers

2 years

3) We have got good at working out which examinations are necessary (and seeing these F2F) 4) There will be the odd patient where the diagnosis is wrong. This happens in pts seen F2F too, but will be slightly worse now.

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Chris Rigby

@Chris_Riggers

2 years

7) This is rare, and needs balancing against consult time. Some remote consults take 2-3 mins, but 10 by the time you call in the pt, they get comfy, we do the consult, they get dressed and leave. That's 3-5 pts in the same time as 1 pt - big difference in an overstretched system

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Chris Rigby

@Chris_Riggers

2 years

@BlondiieMama Hope you're OK Helen, and relaxing with a nice glass of something (and not doing admin!)

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Chris Rigby

@Chris_Riggers

3 years

@DrAseemMalhotra This is a little disingenuous Aseem. You are right, preventative public health measures will provide more "bang for your buck" than reactive healthcare, but you know as well as I do that medications have their place, and are far from useless.

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Chris Rigby

@Chris_Riggers

2 years

@doctornontrad I don't have a clue of the significanxe of any of these, but I suspect the solution is "give doxycycline"

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Chris Rigby

@Chris_Riggers

2 years

8) We're incredibly busy!! More workload than pre-pandemic, with more sickness, plus a vaccine programme to run, plus the overspill from secondary care delays (which obviously have their own reasons)

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Chris Rigby

@Chris_Riggers

2 years

@WhistlingDixie4 Should be EtOH really!

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Chris Rigby

@Chris_Riggers

3 years

@jtrebach Don't do an ECG Can't diagnose long QT

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Chris Rigby

@Chris_Riggers

3 years

@londyloo Nothing you offer them. And if you ask them what they want, they'll have a very specific demand until it arrives, then won't want it any more!

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Chris Rigby

@Chris_Riggers

2 years

@CalvinMoorley If your reporting chain hits the Director of Nursing at any point, you should be eligible to progress up that point. Could make DoN exclusive to nurses, but would then need to remove all other professions from reporting to the DoN

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Chris Rigby

@Chris_Riggers

2 years

This is a really helpful way of doing it - pt care not delayed, I learn for next time!

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Chris Rigby

@Chris_Riggers

2 years

@DrGoblin3 The short answer is: No. The longer answer is that the reasons for this are multifactorial and whilst fairly surmountable, require a massive shift in behaviours and organisational approaches to risk. 🧵

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Chris Rigby

@Chris_Riggers

2 years

@hayleymagill @harryclax At 4am the day team are preprerounding aren't they?

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Chris Rigby

@Chris_Riggers

2 years

@DrZeshanQureshi Why wouldn't they? And frankly what's it got to do with them anyway?!

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Chris Rigby

@Chris_Riggers

2 years

@clara_neuro @CatelinaBee Because ambos are increasingly inexperienced whilst increasingly pushed to avoid admission. Often seem to rely on "gut feeling that pt is vaguely OK" without the level of clinical reasoning / knowledge of what should happen next.

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Chris Rigby

@Chris_Riggers

3 years

@Caulimovirus Waiting for the first person who doesn't realise this is a piss-take

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Chris Rigby

@Chris_Riggers

3 years

Dear lord, who is everybody? @OmgItsTania appears now to be @Medic_Russell , who (along with the rest of #UKMedTwitter ) seems to now be @drphiliplee1 !

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Chris Rigby

@Chris_Riggers

2 years

@timricketts_ "Well, let me tell you a funny story about a *really* unorthodox neurosurgeon..."

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Chris Rigby

@Chris_Riggers

3 years

@abi_carey I agree and don't. People lead busy lives, often working some distance from their GP. I think, rather than going all the way back, we need to retain the ability for remote consulting, but also for F2F if preferred. Equally, pre-bookable is important for some, same day for others

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Chris Rigby

@Chris_Riggers

3 years

@DrMcWeb @theBSNR How long does a CT head take? Just trying to work out whether one will be enough at my GP surgery?

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Chris Rigby

@Chris_Riggers

5 months

Congratulations @PharmamedicDals , @helenbeau1 , @OcoRory and the rest of the @ParamedicsUK team. Culmination of a lot of hard work

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Chris Rigby

@Chris_Riggers

10 months

@DrLindaDykes You can tell it's bollocks from the moment the HCSW wrotes such a lengthy note *in the patient record* basically saying "doctor was rude, I'm reporting him".

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Chris Rigby

@Chris_Riggers

8 months

@BenAllenGP As I always say - *every* time a receptionist has grabbed me and said "I'm really worried about this patient, will you see them next", they've been right (well, with the exception of one rather excitable ex-colleague at least!)

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Chris Rigby

@Chris_Riggers

2 years

@DrRobgalloway My opinion - move 111 funding to social care & rely on self-triage. Suddenly you also create a pool of HCPs (mostly paramedics and nurses I suspect) who will fill some of the current vacancies. No point moving funding to ED - as I understand it, they need flow more than funds

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Chris Rigby

@Chris_Riggers

2 years

@donotcallmemike GP best placed to intubate and set up the vent. DNs twice weekly to monitor and bolus propofol. ICM via A&G within 5 working days if any issues

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Chris Rigby

@Chris_Riggers

2 years

What do we think would happen if this was tried in the ambulance service? Reckon said manager might leave injured

Simon Fleming 🛠

@OrthopodReg

2 years

A recent email posted on here reminds me of when a Trust *LOCKED* ALL THE JUNIOR DOCTORS IN A ROOM AND WOULDN’T LET THEM OUT TILL ALL ROTA GAPS WERE FILLED The people in there were DMing like “errr. Can I call 999 or something? This doesn’t feel ok” #MedTwitter #NHS

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Chris Rigby

@Chris_Riggers

7 months

@UKGastroDr Doctor I agree with (although arguably should therefore ban medical doctors from using "doctor" in an academic context). Can't ban them from using "Mr/Mrs/Ms" etc though, as this is the standard title for the majority of the population. Perhaps time for the surgeons to change?

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Chris Rigby

@Chris_Riggers

2 years

@davidmooremd @NishaTri04 @RachelBHope @daytheon Interesting. I'm a UK paramedic. Probably a pretty good choice to respond to an in flight emergency if I do say so myself. We don't even *get* printed evidence of our registration!

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Chris Rigby

@Chris_Riggers

10 months

@JohnGreenwoodMD @DrLindaDykes A much more British way of tweeting about this would have been "Minding my own business on the plane when some dickhead blacked out. Hadn't got pissed enough fast enough, so had to spend the rest of the flight holding a bag of fluids rather than knocking back the in flight booze"

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Chris Rigby

@Chris_Riggers

1 year

Fortunate that my family are currently healthy, but scared in case anyone needs truly urgent healthcare. What are fellow medical professionals doing to try to mitigate the risk to our loved ones and the moral injury to ourselves of not being able to help if anything happens?

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Chris Rigby

@Chris_Riggers

2 years

@zackferguson I didn't really have issues after the birth of my kids (although I also didn't get that immediate rush of love, and worried this was a sign of a problem). I do remember the arguement in which I admitted that I really couldn't give a shit about the upcoming birth of my second...

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Chris Rigby

@Chris_Riggers

1 year

Trying (and struggling) to find any literature on knowledge gaps for paramedics moving into primary care roles. Skills gaps have been done, but actually "need to learn about skin lesions / how the liver works" etc seems to be lacking. Anyone seen anything? @MallinsonT ?

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Chris Rigby

@Chris_Riggers

3 years

@Parody_RCGP He's talking rubbish. That said, for clarity, Thames Valley Ambulance Service are NOT an NHS service, but a private events and patient transport provider. I would take "Assistant Medical Director" with a pinch of salt - this is not someone with any national significance

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Chris Rigby

@Chris_Riggers

1 year

@Aidan_Baron @HelenBevan @PennyPereira1 @DrAmarShah @NHSConfed Easier to understand @Aidan_Baron 's version. Equally, it's not like there's anything innovative in this - the executive summary could be "don't be a dick, do what works, tell people"

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Chris Rigby

@Chris_Riggers

3 years

@mvercy @MKIttlesonMD Which bit aren't you happy with? It's essential to remain calm in an emergency. Part of that is ensuring that you are calm, collected, & controlled in yourself. Treating things as such an emergency that you need to run to it engenders a feeling of panic that runs counter to that.

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Chris Rigby

@Chris_Riggers

1 year

@VirtueOfNothing @DrJSherrington Non-visible haematuria - that well known surgery

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