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Tim Norfolk @icmtim.bsky.social · 1d

In honor of spooky month, share a 4 word horror story only someone in your profession would understand

“Remember that patient you…”

Shai @shaiuk.bsky.social · 1d

In honor of spooky month, share a 4 word horror story only someone in your profession would understand

“They’re for FULL escalation”

🌈Dr. Franken Frizzle 🎃 @swilua.bsky.social · 1d

In honor of spooky month, share a 4 word horror story only someone in your profession would understand

“papers in IEEE format”

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Reposted by Tim Norfolk

josh farkas 💊 @pulmcrit.bsky.social · 4d

normal mentation *doesn't* indicate adequate systemic perfusion

especially in cardiogenic shock, people can mentate well despite terrible CO & systemic perfusion

poor mentation is sometimes an early sign of *septic* shock, but often a very late indicator of other shock states #EMIMCC

Sad Sad Bean GIF

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Tim Norfolk @icmtim.bsky.social · 3d

One memorable patient for me, transitioned to palliative care for decompensated advanced heart failure. They had a CVP ≈25 and a MAP in the 40s & were mentating just fine for quite some time. There was very little perfusion pressure/CO but the brain clung on til the last possible moment 😢

a man in a suit and tie is asking if he can get an amen ?

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Tim Norfolk @icmtim.bsky.social · 16d

a cartoon man with a mustache is sitting in a chair and the word seconded is written below him

ALT: a cartoon man with a mustache is sitting in a chair and the word seconded is written below him

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Tim Norfolk @icmtim.bsky.social · Sep 6

My argument is that experiencing pain is patient focused, even when there is no recall. For example: when people reduce fractures using morphine/midazolam & pts scream in agony, before minutes later asking if anyones pulled their ankle yet. They HAVE suffered, & we should strive to do better.

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Tim Norfolk @icmtim.bsky.social · Sep 6

You can do this without lying, which is virtually always the preferable option

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Tim Norfolk @icmtim.bsky.social · Sep 6

If our scientific understanding evolves to suggest our current practice is leading to a degree of awareness that causes suffering, even if not recalled by patients, we have a moral imperative to change our practice, and not accept the current standard of care (or by extension, option 1)

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Tim Norfolk @icmtim.bsky.social · Sep 6

So Pete forgive my ignorance around the IFT literature, but have people tried doing it and instead of asking squeeze my hand, saying squeeze my hand if you’re suffering (or something akin to this)? Then we could delineate if the experience at that time was one we should strive to avoid

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Tim Norfolk @icmtim.bsky.social · Sep 6

I don’t think you can genuinely be a number 1 can you, if using any normal/non-IFT definition of awareness. Would you agree to undergo an operation with awareness but the guarantee of being given a perfect amnesiac at the end so you forgot the whole tortuous experience?

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