Richard Bauld
@rbauld.bsky.social
Alt text says… scrambled egg…
November 29, 2025 at 7:31 PM
Alt text says… scrambled egg…
There is a reason why Wes’ top performing hospitals are mostly “cold” highly specialised sites.
And this is why most hospitals don’t want their outpatient activity to move to the community. Significant loss in income.
And this is why most hospitals don’t want their outpatient activity to move to the community. Significant loss in income.
November 28, 2025 at 7:36 AM
There is a reason why Wes’ top performing hospitals are mostly “cold” highly specialised sites.
And this is why most hospitals don’t want their outpatient activity to move to the community. Significant loss in income.
And this is why most hospitals don’t want their outpatient activity to move to the community. Significant loss in income.
2. Moderate net income - elective activity, varies a little according to specialty and indication.
3. Net loss - Emergency activity. Including ED, emergency surgery, direct admissions to medicine/surgery, etc.
3. Net loss - Emergency activity. Including ED, emergency surgery, direct admissions to medicine/surgery, etc.
November 28, 2025 at 7:35 AM
2. Moderate net income - elective activity, varies a little according to specialty and indication.
3. Net loss - Emergency activity. Including ED, emergency surgery, direct admissions to medicine/surgery, etc.
3. Net loss - Emergency activity. Including ED, emergency surgery, direct admissions to medicine/surgery, etc.
Break it down by income generation:
1. High net income -
a. Outpatient activity, less so diagnostics, but still significant. Generates large income and usually props up acute hospitals.
b. Highly specialised services. Either political need or additional nationally agreed income.
1. High net income -
a. Outpatient activity, less so diagnostics, but still significant. Generates large income and usually props up acute hospitals.
b. Highly specialised services. Either political need or additional nationally agreed income.
November 28, 2025 at 7:35 AM
Break it down by income generation:
1. High net income -
a. Outpatient activity, less so diagnostics, but still significant. Generates large income and usually props up acute hospitals.
b. Highly specialised services. Either political need or additional nationally agreed income.
1. High net income -
a. Outpatient activity, less so diagnostics, but still significant. Generates large income and usually props up acute hospitals.
b. Highly specialised services. Either political need or additional nationally agreed income.
They’re not going to release Half life 3…
November 21, 2025 at 2:07 AM
They’re not going to release Half life 3…
I’ve wondered the same, Tim. Throwing colour Doppler over hepatisised lung can be quite a spectacular explosion of colour.
November 17, 2025 at 3:22 PM
I’ve wondered the same, Tim. Throwing colour Doppler over hepatisised lung can be quite a spectacular explosion of colour.
Yep.
It’s like ankle oedema is always amlodipine. But most vasodilators cause oedema, to different degrees according to arteriolar vs venous dilation.
It’s like ankle oedema is always amlodipine. But most vasodilators cause oedema, to different degrees according to arteriolar vs venous dilation.
November 16, 2025 at 6:41 PM
Yep.
It’s like ankle oedema is always amlodipine. But most vasodilators cause oedema, to different degrees according to arteriolar vs venous dilation.
It’s like ankle oedema is always amlodipine. But most vasodilators cause oedema, to different degrees according to arteriolar vs venous dilation.
They do just get better.
But, if an adult DKA patient has true cerebral oedema, I’d put good money on the fact that their vasoactive requirement is spinning in one direction to the other and you’re just gonna want the acidosis resolved.
But, if an adult DKA patient has true cerebral oedema, I’d put good money on the fact that their vasoactive requirement is spinning in one direction to the other and you’re just gonna want the acidosis resolved.
November 14, 2025 at 10:10 PM
They do just get better.
But, if an adult DKA patient has true cerebral oedema, I’d put good money on the fact that their vasoactive requirement is spinning in one direction to the other and you’re just gonna want the acidosis resolved.
But, if an adult DKA patient has true cerebral oedema, I’d put good money on the fact that their vasoactive requirement is spinning in one direction to the other and you’re just gonna want the acidosis resolved.
CRRT with a concomitant hypertonic infusion is a potential way to resolve the metabolic milieu, while the insulin is shutting down the ketogenesis and provide much more bicarb than we’d give peripherally. Not saying definite. And I rarely have used CRRT for DKA even in sick L3’s as
November 14, 2025 at 10:10 PM
CRRT with a concomitant hypertonic infusion is a potential way to resolve the metabolic milieu, while the insulin is shutting down the ketogenesis and provide much more bicarb than we’d give peripherally. Not saying definite. And I rarely have used CRRT for DKA even in sick L3’s as
But, cerebral oedema in DKA is more complex than just osmolality. If it was just osmolality their brains should be shrunken beans. And there are MRI cases of cerebral oedema before treatment has even started.
But, if I have a case of definite cerebral oedema of a metabolic cause, low exchange
But, if I have a case of definite cerebral oedema of a metabolic cause, low exchange
November 14, 2025 at 10:10 PM
But, cerebral oedema in DKA is more complex than just osmolality. If it was just osmolality their brains should be shrunken beans. And there are MRI cases of cerebral oedema before treatment has even started.
But, if I have a case of definite cerebral oedema of a metabolic cause, low exchange
But, if I have a case of definite cerebral oedema of a metabolic cause, low exchange
Fair point. I’d caveat it to say that almost always an adult DKA patient is unconscious because of the metabolic/perfusion effects of the DKA. Then it’s because of the trigger for the DKA (CNS path, etc), and then well down the list is cerebral oedema. Never seen a positive CT.
November 14, 2025 at 10:10 PM
Fair point. I’d caveat it to say that almost always an adult DKA patient is unconscious because of the metabolic/perfusion effects of the DKA. Then it’s because of the trigger for the DKA (CNS path, etc), and then well down the list is cerebral oedema. Never seen a positive CT.
+1 for Tim’s answer. I’d try and drop the CO2 if there was evidence of imminent coning.
If the CT doesn’t show overt oedema, revert to standard management. If it does, more hypertonics plus the big-bicarb drip (CRRT).
If the CT doesn’t show overt oedema, revert to standard management. If it does, more hypertonics plus the big-bicarb drip (CRRT).
November 14, 2025 at 4:40 PM
+1 for Tim’s answer. I’d try and drop the CO2 if there was evidence of imminent coning.
If the CT doesn’t show overt oedema, revert to standard management. If it does, more hypertonics plus the big-bicarb drip (CRRT).
If the CT doesn’t show overt oedema, revert to standard management. If it does, more hypertonics plus the big-bicarb drip (CRRT).
I’ve had my phone set to silent for as long as I can remember, but now I do NROC I obviously have the ringtone on. It’s genuinely disconcerting when it goes off. “That’s an odd fire alarm…” “why’s there a sound coming from my pocket…”
November 12, 2025 at 3:17 PM
I’ve had my phone set to silent for as long as I can remember, but now I do NROC I obviously have the ringtone on. It’s genuinely disconcerting when it goes off. “That’s an odd fire alarm…” “why’s there a sound coming from my pocket…”
Than you for including links to your earlier reporting, as that article doesn’t contextualise the raid very well
November 12, 2025 at 12:01 PM
Than you for including links to your earlier reporting, as that article doesn’t contextualise the raid very well
And, like with everything else, a move towards public health strategies that
A. Reduce the need in the first place
B. Improve knowledge and opinion on donation
Rather than fiddling the system that’s in place on one of the worst days our families will ever experience.
A. Reduce the need in the first place
B. Improve knowledge and opinion on donation
Rather than fiddling the system that’s in place on one of the worst days our families will ever experience.
November 9, 2025 at 8:18 AM
And, like with everything else, a move towards public health strategies that
A. Reduce the need in the first place
B. Improve knowledge and opinion on donation
Rather than fiddling the system that’s in place on one of the worst days our families will ever experience.
A. Reduce the need in the first place
B. Improve knowledge and opinion on donation
Rather than fiddling the system that’s in place on one of the worst days our families will ever experience.
I agree. The reality is ”on the ground” is that opt out hasn’t changed anything. What makes a difference is early identification, involvement of a good SNOD and careful discussions with the family.
November 9, 2025 at 8:11 AM
I agree. The reality is ”on the ground” is that opt out hasn’t changed anything. What makes a difference is early identification, involvement of a good SNOD and careful discussions with the family.
Nudge theory has been discredited in several different areas. And this is a good example of one of them.
But, yeah, I’m concerned when people start floating the idea of bypassing familial consent.
But, yeah, I’m concerned when people start floating the idea of bypassing familial consent.
November 8, 2025 at 9:26 PM
Nudge theory has been discredited in several different areas. And this is a good example of one of them.
But, yeah, I’m concerned when people start floating the idea of bypassing familial consent.
But, yeah, I’m concerned when people start floating the idea of bypassing familial consent.
Though having 10 different log-ins is annoying, I would rather have multiple well designed task focused apps than one behemoth. Just sadly that description can rarely be used either.
November 5, 2025 at 5:45 PM
Though having 10 different log-ins is annoying, I would rather have multiple well designed task focused apps than one behemoth. Just sadly that description can rarely be used either.
“Reduce the norad”. They’re to treat hypovolaemia and improve perfusion, not to spare norad.
2. The 2 inodilator trials I have used in septic shock without cardiac dysfunction have gone spectacularly badly. But thankfully, reversible badly.
2. The 2 inodilator trials I have used in septic shock without cardiac dysfunction have gone spectacularly badly. But thankfully, reversible badly.
October 29, 2025 at 5:57 PM
“Reduce the norad”. They’re to treat hypovolaemia and improve perfusion, not to spare norad.
2. The 2 inodilator trials I have used in septic shock without cardiac dysfunction have gone spectacularly badly. But thankfully, reversible badly.
2. The 2 inodilator trials I have used in septic shock without cardiac dysfunction have gone spectacularly badly. But thankfully, reversible badly.
Using echo early and repeatedly, and occasionally using higher MAP targets if I have a pre-test probability of success. And, eventually accepting I can’t improve the micro circulatory dysfunction regardless of what I do.
2 additional points:
1. I really wish we’d stop giving fluids to try and
2 additional points:
1. I really wish we’d stop giving fluids to try and
October 29, 2025 at 5:57 PM
Using echo early and repeatedly, and occasionally using higher MAP targets if I have a pre-test probability of success. And, eventually accepting I can’t improve the micro circulatory dysfunction regardless of what I do.
2 additional points:
1. I really wish we’d stop giving fluids to try and
2 additional points:
1. I really wish we’d stop giving fluids to try and
With my predetermined bias, don’t think this will change my practice.
That is: identifying source and/or achieving source control, using CRT as ONE marker of perfusion, only giving fluid if I have evidence perfusion improves with it, not minding how much norad the patient is on if perfusion is good
That is: identifying source and/or achieving source control, using CRT as ONE marker of perfusion, only giving fluid if I have evidence perfusion improves with it, not minding how much norad the patient is on if perfusion is good
October 29, 2025 at 5:57 PM
With my predetermined bias, don’t think this will change my practice.
That is: identifying source and/or achieving source control, using CRT as ONE marker of perfusion, only giving fluid if I have evidence perfusion improves with it, not minding how much norad the patient is on if perfusion is good
That is: identifying source and/or achieving source control, using CRT as ONE marker of perfusion, only giving fluid if I have evidence perfusion improves with it, not minding how much norad the patient is on if perfusion is good