Andrew J @EM_Dr_Jacklin Twitter profile

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Andrew J

6 months

The ABC of Emergency Medicine. A is for Aorta You should always think aorta. Aortic dissection can present atypically. It can present painlessly. It can present 6 months after you've seen the patient. Probably safer just to scan everyone.

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Andrew J

@EM_Dr_Jacklin

2 years

Rule of Emergency Medicine #267 : there will be one letter on the patient's electronic record which makes everything clear which, despite spending over an hour going through everything you will not find but which will be the first thing the consultant you discuss with clicks on.

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Andrew J

@EM_Dr_Jacklin

1 month

Asking the patient a question and then being quiet and actually listening for a bit.

Nico Gagelmann

@NicoGagelmann

1 month

What's your most favorite basic skill every medical trainee should learn? Mine is ultrasound.

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Andrew J

@EM_Dr_Jacklin

2 years

Rule of Emergency Medicine #114 : If you think now is a bad time to have a discussion about end of life decisions you won't believe how much worse it will be in about two hours.

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Andrew J

@EM_Dr_Jacklin

6 months

Your first cannulation attempt failed. This is what your patient should look like before you ring anaesthetics.

armyemdoc

@armyemdoc

6 months

Your first intubation attempt failed. You have to bag the patient back up before you go to plan B. This is what your patient should look like... It's far easier to bag when you've double-barreled their nose and placed an OPA. #emergency #emergencymedicine #foam #foamed …

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Andrew J

@EM_Dr_Jacklin

1 year

Rule of Emergency Medicine #135 : in the frail elderly patient if 'septic shock' is on your differential diagnosis list 'natural dying at the end of life' should also be on there.

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Andrew J

@EM_Dr_Jacklin

10 months

Interesting timing of this story from the Daily Mail, isn't it? All about the greedy, angry millionaire doctor. Except there's a little more to it then that... 1/6

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Andrew J

@EM_Dr_Jacklin

1 year

Rule of Emergency Medicine #71 : clinical seniority - the point when people say you are 'always calm' but you can't figure out if it's because you've reached an acceptable level of mastery or just run out of shits to give.

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Andrew J

@EM_Dr_Jacklin

6 months

Didn't find a good reference for this recently so had to make my own.

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Andrew J

@EM_Dr_Jacklin

2 years

Rule of Emergency Medicine #15 : if you write a clinical guideline that promises the services of a given speciality and fail to inform the said speciality of this you may precipitate a 'situation'.

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Andrew J

@EM_Dr_Jacklin

3 years

Slightly weary of people saying "can you come and teach on this - you're on a day off". Firstly, it's a day off. Secondly unless you want part of the lecture to be on "Octonauts: Which Gup is Best?" I'm not certain you'd want me and my three year old there.

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Andrew J

@EM_Dr_Jacklin

6 months

T is for The Sepsis. The Sepsis is a syndrome caused by a co-infection between a pathogen (usually bacterial) and a marketing campaign. It manifests as Systemic Inflammatory Response in the patient as Systemic Audit Response in the organisation.

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Andrew J

@EM_Dr_Jacklin

6 months

N is for nalaxone. The correct dose titration for naloxone is to produce a patient response where breathing is adequate but punching is weak or absent.

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Andrew J

@EM_Dr_Jacklin

1 year

...and this is why I just want to order the MRI myself. Suspected cauda equina pathway for referrals ED to ortho

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Andrew J

@EM_Dr_Jacklin

2 years

What's it's like doing Emergency Medicine: Imagine you are in an ALS station, and the patient arrests. You are oddly happy because you think: 'Oh, I know what to do with this'. However you don't get the patient back and then someone points out you discharged them yesterday.

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Andrew J

@EM_Dr_Jacklin

2 years

Medical advice please @DrSelvarajah - my four year old boy has started eating electrical supply cords. My wife thinks we should ground him but can you suggest another way to make him conduct himself better?

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Andrew J

@EM_Dr_Jacklin

2 years

Thoughts today on things we write on ReSPECT/DNACPR forms that are less useful than we think (but thank you so much for caring enough to write one!) - from the viewpoint of someone who tended to read them at about 1am. 1/n

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Andrew J

@EM_Dr_Jacklin

1 year

Careful guys with this whole "strike thing". Someone might find out that I'm better at Emergency Medicine than the new F2s.

Edwina Currie

@Edwina_Currie

1 year

Then campaign to improve the pay of the 11% of doctors on the starting salaries (though they're receiving training in these grades, & they'll soon move up and get much better paid). But don't strike. Because we might then discover that consultants are better at the job than you..

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Andrew J

@EM_Dr_Jacklin

6 months

L is for Lactate Lactate is an investigation which, if it's red, you need to give antibiotics and fluids. Lactate is created by The Sepsis.

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Andrew J

@EM_Dr_Jacklin

3 years

The Zen of ED: "other specialities think you are too incompetent to know where an unwell patient should be placed, but so competent that leaving the same patient under your care for an additional four hours is the best way to heal them"

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Andrew J

@EM_Dr_Jacklin

6 months

G is for General Practice. Everyone gets discharge letters to General Practice wrong. You need to both write 'GP to kindly' in front of what you want them to do AND tuck a couple of sweets from a Celebrations tub into the envelope. Sorted.

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Andrew J

@EM_Dr_Jacklin

2 years

I know for a fact I'm not the President of anything. But I'm just saying if I was RCGP President and had a social media presence I might want to be saying something about the GP contract stuff that is going on?

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Andrew J

@EM_Dr_Jacklin

3 months

"They can go to their local Accident and Emergency Ward to get help" @VictoriaAtkins - it's not a ward, I have no ability to treat the underlying cause of dental pain and if you paid any attention you'd know we prefer 'Emergency Department'. But never mind....

ITV News Politics

@ITVNewsPolitics

3 months

ITV News has spoken to a patient who was in so much pain she pulled out 12 of her own teeth with pliers because she couldn't get an NHS dentist. 'Somebody in that amount of pain must always remember that if they need to they can go to their local A&E,' the health secretary says

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Andrew J

@EM_Dr_Jacklin

6 months

@peteturton85 Meanwhile in ED the registrar gets ready to cannulate the c. diff positive active IVDU patient.

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Andrew J

@EM_Dr_Jacklin

2 years

Rule of Emergency Medicine #133 : every diagnosis is obvious in retrospect.

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Andrew J

@EM_Dr_Jacklin

1 year

So after giving the overnight reg a specific 'this is when to call me and feel free to call me' brief when he rang about a paediatric case I..... immediately hung the phone up on him because my sleep addled brain had decided I was snoozing my alarm clock.

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Andrew J

@EM_Dr_Jacklin

5 months

Used the new BMA modeller to precisely calculate what I'll get with the new Consultant contract on offer. Gotta say: couldn't have done the maths without it.

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Andrew J

@EM_Dr_Jacklin

6 months

B is for breathing. This is probably important. Refer to respiratory. They deal with breathing. Or you can refer to medicine.

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Andrew J

@EM_Dr_Jacklin

10 months

The thing is: all these facts are easily findable - but the Daily Mail has (without stating it explicitly) made it appear as if she's a rich medical doctor. So the journalist either can't do basic research, or is happy to frame things in this way. They even use "top doctor"! 4/6

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Andrew J

@EM_Dr_Jacklin

6 months

C is for CT scan. If you think the patient might need a CT, or another speciality thinks they might need a CT scan at some point in their hospital stay, or if you think that someone else might think they need one at some point to get it ordered and done as quickly as possibly.

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Andrew J

@EM_Dr_Jacklin

2 years

Final thought directed at @ResusCouncilUK - you currently recommend discussions regarding CPR don't need to be had unless patient approaching EOL or likely to suffer an arrest. I think a better standard would be discussions to be had whenever CPR likely to be futile. 7/n

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Andrew J

@EM_Dr_Jacklin

2 years

Since becoming a Consultant < 2 years ago I have now seen two conditions that have (according to literature searches) occurred 2x only in medical history. Which suggests either: 1. I'm very unlucky 2. Not enough case reports of rare conditions get done....

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Andrew J

@EM_Dr_Jacklin

6 months

H stands for Hs and Ts. Hs are: Hypoxia Harmander Harmeleon Harizard Ts are: Tension Throbbing Tickling and people can only remember 7 out of 8 at any point.

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Andrew J

@EM_Dr_Jacklin

1 year

*sigh*

Dr. Ron Daniels BEM

@SepsisUK

1 year

@when_cats_away I’ve worked in the NHS under a Labour government and guess what? It was absolutely no better…

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Andrew J

@EM_Dr_Jacklin

1 year

I see the ITU consultants are at it again... Always worth a read of this by a different ITU Consultant: Prof Mervyn Singer.

Sepsis hysteria: excess hype and unrealistic expectations

“Sepsis kills over 52 000 every year—each death a preventable tragedy”, tweeted Matt Hancock, UK Secretary of State for Health and Social Care, in March, 2019.1 Many other non-contextualised or...

www.thelancet.com

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Andrew J

@EM_Dr_Jacklin

1 year

I remember being an F1 and finding out that one of the surgical consultants had been having an affair. I look back on that now and wonder: "where did they find time?!"

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Andrew J

@EM_Dr_Jacklin

6 months

I is for lab Investigations Investigations are very important and come in three categories -the ones which you give antibiotics for if they are displayed in red -the ones which you give fluids for if they are in red -the ones you give a blood transfusion for if they are in red

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Andrew J

@EM_Dr_Jacklin

6 months

P is for Panic Attack. This is a great diagnosis because you can get it to explain any possible constellation of symptoms you like as well as stigmatising the patient. You may not need to refer to medicine.

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Andrew J

@EM_Dr_Jacklin

6 months

X is for X-ray. It is important when requesting an x-ray, or any imaging to put the smallest amount of info that will get it performed. Radiologists love this so much that they play a game at Christmas where they try and guess the clinical history from three slices of a CT.

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Andrew J

@EM_Dr_Jacklin

6 months

D is for disability. This is probably important. Refer to neurology. They deal with brains. Also do the GCS or something. Then ring anaesthetics if the number is less than 9. Or possibly equal to or less than 9. No one is sure. And refer to medicine.

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Andrew J

@EM_Dr_Jacklin

1 year

To my colleague from a surgical speciality that shall remain nameless: yes, the EM Consultant is still in the department at 1am. No there aren't any medical beds I can admit the patient to for analgesia. The fact you were genuinely surprised at these facts pacified me greatly..

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Andrew J

@EM_Dr_Jacklin

6 months

Y is for Yoga This cures all the burnout, stress and exhaustion so well it's amazing more people don't do it.

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Andrew J

@EM_Dr_Jacklin

6 months

E is for eFAST. Some people think this stands for 'extended focussed assessment using sonography in trauma'. It can't stand for this because FAST is clearly an acronym for 'Random Ultrasound Investigation That You Think Will Answer Your Question Done Really Quickly'.

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Andrew J

@EM_Dr_Jacklin

6 months

Positive medical stereotypes 🧵 Dermatology: if it's wet, dry it. If it's dry, wet it. If it doesn't respond to that deploy some mind bendingly complicated array of immune modulating drugs that no one else can spell.

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Andrew J

@EM_Dr_Jacklin

2 years

Thought of the day: why _do_ we get moved around so much in training? I could have completed all of my ACCS training in a single hospital and probably my ST4 year. Then switched to another hospital for ST5/ST6 and it would have been much the same. 1/2

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Andrew J

@EM_Dr_Jacklin

6 months

S is for ST elevation, sub arachnoid haemorrhage and stridor. Basically S is a bad letter.

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Andrew J

@EM_Dr_Jacklin

4 months

Here's something useful you can write on ReSPECT forms: "not for ABGs".

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Andrew J

@EM_Dr_Jacklin

6 months

R is for Refer Refer is a contraction which is short for 'refer to medicine'

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Andrew J

@EM_Dr_Jacklin

6 months

F is for Flow Flow is _very_ important. Refer to the first person who'll take the patient. They deal with flow. Or refer to medicine.

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Andrew J

@EM_Dr_Jacklin

6 months

M is for medicine (general internal) General Internal Medicine is a broad speciality which looks after a range of conditions which other specialities are bored of. Refer to medicine.

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Andrew J

@EM_Dr_Jacklin

2 years

A doctor asked me for a reference for a job at 16:10 on Friday when I was just starting out on the 15-2300 shift and e-mailed me at 09:10 on Monday morning to ask me if I'd done it yet. Incredibly, he's still alive.

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Andrew J

@EM_Dr_Jacklin

2 years

Loving the suggestion from some that the Nightingale Hospitals could be reopened to let ambulances drop off patients instead of waiting for offloading in ED. After offloading there they'll then later need transfer to an actual hospital with staff. Presumably via ambulance.

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Andrew J

@EM_Dr_Jacklin

2 years

Rule of Emergency Medicine #134 : the atrial fibrillation at 120 is probably not causing the hypotension, but the blood pressure at 90 _is_ probably causing the tachycardia. Also see: "when not to beta blockade"

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Andrew J

@EM_Dr_Jacklin

1 year

Me on the BMA Twitter feed finding out whether I'm going to have to learn how to be an SHO again next month.

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Andrew J

@EM_Dr_Jacklin

6 months

A "good department" in the morning where I currently work used to mean we'd switched off the lights in minors, paeds and resus; everyone had come together in majors and we'd even spent some time doing audit or coding. Our current crop of docs find this hard to believe.

Rob Galloway

@DrRobgalloway

6 months

I'm an A&E consultant and I'm tired after a weekend of nights. But this am, I've handed over what I described as a "good department". This was said genuinely and with no hint of irony. We provided great care and have very short waits to see an A&E doctor, but I'd forgotten how…

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Andrew J

@EM_Dr_Jacklin

1 year

That'll change some pathways.

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Andrew J

@EM_Dr_Jacklin

10 months

You do wonder: if a judge in court has actually found that you've been lied repeatedly are you going to end up in front of the GMC? The answer here - no. Because Dr Paes is a public health researcher and not a medical doctor. You can check the GMC register easily enough. 2/6

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Andrew J

@EM_Dr_Jacklin

2 years

Rule of Emergency Medicine #23 : it's not my fault that you disagree with your own Royal College that you should look after a certain condition.

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Andrew J

@EM_Dr_Jacklin

10 months

The other thing is: having previously complained about Daily Mail coverage which I thought was inaccurate they are usually careful enough not to publish something absolutely false. Just twisted enough to create the impression they want. 5/6

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Andrew J

@EM_Dr_Jacklin

6 months

W is for warfarin. WE DON'T LIKE WARFARIN.

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Andrew J

@EM_Dr_Jacklin

6 months

J is for Joint Care. This is where two specialities agree they both should look after a patient, just not on their ward. Sadly this form of joint care doesn't respond to cod liver oil and costochondroitin.

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Andrew J

@EM_Dr_Jacklin

15 days

The basic underlying problem with all NHS medical staffing is you need a lot of people to do all the work the consultants don't do, but you don't have the resources to let all those people go on to become consultants.

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Andrew J

@EM_Dr_Jacklin

6 months

U is for Uvula. We like the uvula in Emergency Medicine because it very rarely goes wrong. Not like the appendix, or the naughty aorta.

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Andrew J

@EM_Dr_Jacklin

2 years

As always with gratitude to Linda for her work on this which I'm just adding a few thoughts to. 8/n

Dr Linda Dykes @[email protected]

@DrLindaDykes

6 years

CPR is not a treatment for #ordinarydying . Every instance of futile CPR - which is what will happen if nobody has sorted out the protection of a DNACPR for someone whose life is coming to an end - is a tragedy. Please, doctors, nurses, patients, families - #havetheconversation .

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Andrew J

@EM_Dr_Jacklin

10 months

Or you can Google for her list of publications. Without wishing to assume too much the millionaire status is more likely to come from her "finance boss" husband (unless research has started paying much, much better then it used to - but maybe she is unusually successful!) 3/6

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Andrew J

@EM_Dr_Jacklin

5 months

Ooh it's mini changeover time isn't. Have a mini tip for new EM doctors: If your patient cannot eat, walk or survive without supplemental oxygen and they normally do these things you're probably not going to be discharging them.

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Andrew J

@EM_Dr_Jacklin

6 months

Q is for Q Fever If you write 'Q Fever' in your differential diagnosis everytime you see a patient with a fever on the one occasion you are right you will look like a genius. See also: Takotsubo Cardiomyopathy, Lupus

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Andrew J

@EM_Dr_Jacklin

2 years

Rule of Emergency Medicine #201 : every time you write 'rule out' in an plain film imaging request a fairy dies.

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Andrew J

@EM_Dr_Jacklin

3 years

Dear doctors in my own speciality, I don't blame radiology if they hate us. Write more in the clinical details box and check what you've written. The low points on this admin shift so far have been "? cough" and the positively cryptic "Pissed HF".

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Andrew J

@EM_Dr_Jacklin

10 months

I thought this was both interesting and nice.

Ground-breaking medical course marks first graduates - BBC News

The student doctors have qualified after a university course aimed at those from poorer backgrounds.

www.bbc.co.uk

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Andrew J

@EM_Dr_Jacklin

6 months

V is for Venous Access. This requires you to build a spaceship capable of flying about 120 million miles and landing on a rocky planet with a dense atmosphere. Or at least that is the way it feels sometimes at 2am with a patient with no veins.

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Andrew J

@EM_Dr_Jacklin

5 months

Clearly the way to increase your Twitter reach is to post an opinion that pretty much everyone will disagree with then double down hard. You should use local anesthetic 50% of the time you do ABGs. Randomly.

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Andrew J

@EM_Dr_Jacklin

3 years

Here's my #TipsForNewDocs When you are making a referral tell the person what you want from them, and justify why they should give it to you. Be aware of the psychology of the person you are referring to and also what specialities need/want for a referral. 1/n

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Andrew J

@EM_Dr_Jacklin

3 years

In my e-mail today: college wants a chairperson for the sustainable working practices committee. It's an unpaid role which doesn't get you any time off work to do it.

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Andrew J

@EM_Dr_Jacklin

6 months

@_PhilWhite Let's face it: as a part time consultant in a DGH with a small child and a mild video game addiction this probably _is_ the highlight of my career.

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Andrew J

@EM_Dr_Jacklin

6 months

O is for oxygen. Oxygen is a molecule which is delivered via nasal cannula or a mask. Because we are running out of it some people like to try and collect as much of it as possible by taking ABGs and getting the machine to recycle it.

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Andrew J

@EM_Dr_Jacklin

5 months

When I was starting at SHO level I loved the diagnosis of sepsis. If they hit a few physiological parameters, write up IV antibiotics and IV fluids, refer on to the medical team. So simple. However medicine is not simple and simplistic responses to complex problems cause harm.

Scott

@dob86

5 months

The lift when you get called to review a tachycardic CTG and a febrile mum.

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Andrew J

@EM_Dr_Jacklin

2 years

Night registrar off sick with Covid. Late consultant (me) still recovering from Covid so able to stay another two hours before bailing and leaving the poor on call consultant to it. This living with covid strategy not going great from a healthcare perspective.

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Andrew J

@EM_Dr_Jacklin

1 month

Trial suggestion: head injured patients at a small DGH with CT findings needing observation for 24-72 hours but otherwise GCS15 and well. Usual care: admit. Trial arm: discharge with instructions if concerns to represent but to the big centre that actually has neurosurgery.

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Andrew J

@EM_Dr_Jacklin

2 years

@StephenMakin @OGdukeneurosurg Probably would have been a consideration for the authors of the original journal article.

Ten self-inflicted intracranial penetrating nail gun injuries - PubMed

Penetrating craniocerebral injuries from nail gun use are rare. We describe a case of 10 self-inflicted nail gun injuries with intracranial penetrations. We also review the literature and discuss...

pubmed.ncbi.nlm.nih.gov

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Andrew J

@EM_Dr_Jacklin

5 months

What do you want for Christmas #MedTwitter ? All I want is a phone that connects me to two specialities at the same time. I explain the problem with the patient to them both then politely put the phone down so they can decide which one takes the patient.

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Andrew J

@EM_Dr_Jacklin

8 months

A very sensible approach. I'd just add that I increasingly feel that the mislabelling (and overtreatment) of the frail elderly coming to the end of their life as 'sepsis' is one of the worst things about modern medicine.

Louella Vaughan

@DrLKVaughan

8 months

I never use the word 'sepsis' in my diagnostic formulations. So I would get null points in this study. Why don't I use the word? Because 'sepsis' is defined as infection with organ dysfunction. It is woolly and esp unhelpful when it comes to determining treatment. 1/

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Andrew J

@EM_Dr_Jacklin

2 years

Someone collapsed in The Queue but they gave them a nice hot drink and they were fine. That's the opposite of what I thought would happen if you had a long queue tea.

Neil Stone

@DrNeilStone

2 years

Theres actually a live video stream on the BBC of the long Queue to see the Queen lying in state I'm calling it the Long Queue Vid

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Andrew J

@EM_Dr_Jacklin

2 years

Rule of Emergency Medicine #25 : the amount of time, effort and energy you expend to avoid actually seeing the patient is likely less than the amount people will expend to get you to see the patient, and also the amount would have expended just to see them in the first place.

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Andrew J

@EM_Dr_Jacklin

1 year

Thankfully my briefing included that I wasn't the best at waking up to phone calls so I think he took three calming breaths, adopted his most tolerant tone of voice and rang me back again.

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Andrew J

@EM_Dr_Jacklin

6 months

K is for ketone. This is the particular timbre and character that occurs when you press a note on the piano. Sadly people keep writing it wrongly as ketone so we get very confused.

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Andrew J

@EM_Dr_Jacklin

3 years

Imagine an emergency medicine shift where all the specialties admitted the patients they are supposed to.

David Naumann

@davidnnaumann

3 years

Imagine a surgical on-call where surgeons only had to admit patients who needed surgery.

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Andrew J

@EM_Dr_Jacklin

2 years

@JonBedford Be grateful they didn't stick their knob in it this time?

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Andrew J

@EM_Dr_Jacklin

2 years

Should you/would you put a DATIX in for CPR done on: -a patient with a DNACPR/ReSPECT that was misplaced? -an frail, elderly septic inpatient not for ITU? -a previously stable but frail, demented nursing home resident?

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Andrew J

@EM_Dr_Jacklin

1 year

Why can't I see how many WPBAs consultants and registrars are filling out within my department easily? I've asked the ePortfolio team at @RCollEM who have kindly forwarded it to the management team to consider it. Who else would be interested in something like this?

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Andrew J

@EM_Dr_Jacklin

1 year

@DrOliBol But looking at your profile pic: DAMN YOUR BARBER IS WORTH IT.

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Andrew J

@EM_Dr_Jacklin

2 years

@Dr_DeanS I'd go further then this and say it's not even our job to try and persuade a person with capacity to stay. It's our job to ensure they have the information about any potential risks and then they can make up their own mind.

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Andrew J

@EM_Dr_Jacklin

3 years

Learning point of the day to juniors: if someone has just started on three different chemo agents and neither you nor I have even heard of two of them it is 100% OK to ring haematology.

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Andrew J

@EM_Dr_Jacklin

2 years

I really, really dislike this one because it suggests to me either that CPR wasn't properly explained, or that instead of fully resolving this issue with the family it's just been left for some poor soul to try and manage it with less resources at a time of crisis. 6/n

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Andrew J

@EM_Dr_Jacklin

1 year

@hyams_margaret @mrlongdenextra @bethdanger Your picture wasn't from today Margaret...

Queen’s Platinum Jubilee: well-wishers from far and wide share a moment in history

There were tears in the crowd as thousands of people from across the globe descended on The Mall for the start of the Queen’s historic celebrations.Some royal fans had camped for days for a prime...

www.thetimes.co.uk

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Andrew J

@EM_Dr_Jacklin

2 years

"Not for admission to hospital." Which is always a bit perplexing when they turn up in hospital and you have to figure out why. How about "For admission to hospital in case of failure of symptom control or family coping mechanisms at home." 2/n

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Andrew J

@EM_Dr_Jacklin

2 years

@EmergencyBod You got it upside down. It summons beverage serve bot. Who also has it upside down.

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Andrew J

@EM_Dr_Jacklin

5 months

The SI unit of time on UK #MedTwitter is the #FlemingInterval This is the length of time between someone posting the phrase "consultants, juniors and GPs" and @RobJimFleming appearing to politely but firmly remind us of the existence of SAS doctors.

2

8

91

Andrew J

@EM_Dr_Jacklin

2 years

More cost cutting measures... they've replaced the Optilube with this and PRs taking _much_ longer.

8

1

90

Andrew J

@EM_Dr_Jacklin

2 years

Still find it bizarre to find myself referred to as 'Consultant' in e-mails and letters. At least I've stopped with the phone blurb 'Hi it's Andrew, one of the ED registrarsnoshitwaitconsultant.

7

0

91