Rob Fleming
@robjimfleming.bsky.social
Specialist (SAS) Anaesthetist | Clinical Associate Professor | UK | He / him | FRCA | Award winning irreverence | "non-sea lion" | Part of @SAScollective.com | #SASsix | #PERUSEbeforeYouInfuse
Opinions many, all very much mine!
Opinions many, all very much mine!
Reposted by Rob Fleming
We are delighted to welcome Dr Alice Humphreys, as newly elected member of the SIVA committee.
Alice works in a major trauma centre in the south of England and her interests include neuroanaesthesia, transfer and retrieval.
Welcome!
#SIVA25
Alice works in a major trauma centre in the south of England and her interests include neuroanaesthesia, transfer and retrieval.
Welcome!
#SIVA25
November 27, 2025 at 6:20 PM
We are delighted to welcome Dr Alice Humphreys, as newly elected member of the SIVA committee.
Alice works in a major trauma centre in the south of England and her interests include neuroanaesthesia, transfer and retrieval.
Welcome!
#SIVA25
Alice works in a major trauma centre in the south of England and her interests include neuroanaesthesia, transfer and retrieval.
Welcome!
#SIVA25
Reposted by Rob Fleming
Sessions 1, Day 1's presenters taking questions from the audience to close the session.
It has been an absolutely fascinating couple of hours.
#SIVA25
It has been an absolutely fascinating couple of hours.
#SIVA25
November 27, 2025 at 3:12 PM
Sessions 1, Day 1's presenters taking questions from the audience to close the session.
It has been an absolutely fascinating couple of hours.
#SIVA25
It has been an absolutely fascinating couple of hours.
#SIVA25
Reposted by Rob Fleming
Session 2 of Day 1 of #SIVA25 gets cracking.
This session is focussed around the science, and is chaired by the always excellent Professor Tony Absolom.
The first talk is Dr Douglas Eleveld, speaking to us from Groningen about developing the model that shares his name.
This session is focussed around the science, and is chaired by the always excellent Professor Tony Absolom.
The first talk is Dr Douglas Eleveld, speaking to us from Groningen about developing the model that shares his name.
November 27, 2025 at 4:01 PM
Session 2 of Day 1 of #SIVA25 gets cracking.
This session is focussed around the science, and is chaired by the always excellent Professor Tony Absolom.
The first talk is Dr Douglas Eleveld, speaking to us from Groningen about developing the model that shares his name.
This session is focussed around the science, and is chaired by the always excellent Professor Tony Absolom.
The first talk is Dr Douglas Eleveld, speaking to us from Groningen about developing the model that shares his name.
Reposted by Rob Fleming
Next up this afternoon we have SIVA's Honorary Secretary, Dr Mark Barley, @chronotrope.bsky.social.
A controversial topic, potentially, Mark is speaking to us about RSI with TIVA TCI.
#SIVA25
A controversial topic, potentially, Mark is speaking to us about RSI with TIVA TCI.
#SIVA25
November 27, 2025 at 2:14 PM
Next up this afternoon we have SIVA's Honorary Secretary, Dr Mark Barley, @chronotrope.bsky.social.
A controversial topic, potentially, Mark is speaking to us about RSI with TIVA TCI.
#SIVA25
A controversial topic, potentially, Mark is speaking to us about RSI with TIVA TCI.
#SIVA25
Reposted by Rob Fleming
Next up at #SIVA25 is Dr Paul McConnell, speaking about defending the brain from the effects of anaesthesia, and the "Safe Brain Initiative".
Post-operative delirium and cognitive dysfunction exist within the spectrum of neurocognitive disorders, which may pre-exist and be worsened by our choices.
Post-operative delirium and cognitive dysfunction exist within the spectrum of neurocognitive disorders, which may pre-exist and be worsened by our choices.
November 27, 2025 at 2:50 PM
Next up at #SIVA25 is Dr Paul McConnell, speaking about defending the brain from the effects of anaesthesia, and the "Safe Brain Initiative".
Post-operative delirium and cognitive dysfunction exist within the spectrum of neurocognitive disorders, which may pre-exist and be worsened by our choices.
Post-operative delirium and cognitive dysfunction exist within the spectrum of neurocognitive disorders, which may pre-exist and be worsened by our choices.
Fascinating talk by @chronotrope.bsky.social on "pump assisted" TIVA RSI, after all, every RSI is intravenous, isn't it?
Every RSI is also undeniably "modified".
Position, cricoid pressure, drugs used, laryngoscope used, etc. have all changed in the decades since RSI first arose as a concept.
Every RSI is also undeniably "modified".
Position, cricoid pressure, drugs used, laryngoscope used, etc. have all changed in the decades since RSI first arose as a concept.
November 27, 2025 at 2:20 PM
Fascinating talk by @chronotrope.bsky.social on "pump assisted" TIVA RSI, after all, every RSI is intravenous, isn't it?
Every RSI is also undeniably "modified".
Position, cricoid pressure, drugs used, laryngoscope used, etc. have all changed in the decades since RSI first arose as a concept.
Every RSI is also undeniably "modified".
Position, cricoid pressure, drugs used, laryngoscope used, etc. have all changed in the decades since RSI first arose as a concept.
Reposted by Rob Fleming
Opening the afternoon session of day 1 of #SIVA25 is our President, Dr Alistair Baxter.
He tells us there are no more places available at tonight's dinner. Sorry folks!
He tells us there are no more places available at tonight's dinner. Sorry folks!
November 27, 2025 at 1:35 PM
Opening the afternoon session of day 1 of #SIVA25 is our President, Dr Alistair Baxter.
He tells us there are no more places available at tonight's dinner. Sorry folks!
He tells us there are no more places available at tonight's dinner. Sorry folks!
Reposted by Rob Fleming
Getting ready for the second start of the day.
To the folks who attended a workshop this morning, hello again!
To the folks just arriving, welcome to Liverpool and #SIVA25!
Our next talks are focussed around some of the practicalities of TIVA, in the "how I do it" session.
To the folks who attended a workshop this morning, hello again!
To the folks just arriving, welcome to Liverpool and #SIVA25!
Our next talks are focussed around some of the practicalities of TIVA, in the "how I do it" session.
November 27, 2025 at 1:31 PM
Getting ready for the second start of the day.
To the folks who attended a workshop this morning, hello again!
To the folks just arriving, welcome to Liverpool and #SIVA25!
Our next talks are focussed around some of the practicalities of TIVA, in the "how I do it" session.
To the folks who attended a workshop this morning, hello again!
To the folks just arriving, welcome to Liverpool and #SIVA25!
Our next talks are focussed around some of the practicalities of TIVA, in the "how I do it" session.
Reposted by Rob Fleming
Several of our #SIVA25 workshops this morning are all about brains. Monitoring our end organ seems a good idea, for a lot of reasons.
We have a workshop on processed EEG interpretation for beginners, as well as one for folks seeking to consolidate existing expertise.
We hope you are enjoying them!
We have a workshop on processed EEG interpretation for beginners, as well as one for folks seeking to consolidate existing expertise.
We hope you are enjoying them!
November 27, 2025 at 10:30 AM
Several of our #SIVA25 workshops this morning are all about brains. Monitoring our end organ seems a good idea, for a lot of reasons.
We have a workshop on processed EEG interpretation for beginners, as well as one for folks seeking to consolidate existing expertise.
We hope you are enjoying them!
We have a workshop on processed EEG interpretation for beginners, as well as one for folks seeking to consolidate existing expertise.
We hope you are enjoying them!
Reposted by Rob Fleming
Morning all! Welcome to everyone arriving in Liverpool for day 1 of #SIVA25.
We look forward to seeing some of you this morning at our workshops, or the seminar sponsored by Arcomed, which starts at 1300.
Our main scientific content starts after a welcome from our President, Alistair, at 1325.
We look forward to seeing some of you this morning at our workshops, or the seminar sponsored by Arcomed, which starts at 1300.
Our main scientific content starts after a welcome from our President, Alistair, at 1325.
November 27, 2025 at 7:43 AM
Morning all! Welcome to everyone arriving in Liverpool for day 1 of #SIVA25.
We look forward to seeing some of you this morning at our workshops, or the seminar sponsored by Arcomed, which starts at 1300.
Our main scientific content starts after a welcome from our President, Alistair, at 1325.
We look forward to seeing some of you this morning at our workshops, or the seminar sponsored by Arcomed, which starts at 1300.
Our main scientific content starts after a welcome from our President, Alistair, at 1325.
For the next few days I am curating @sivanaesthesia.bsky.social as well as my own account, and @sascollective.com.
Anyone want to wager how long it will take me to post from the wrong account? If I make it to 24 hours, I will be delighted.
You should follow both of these accounts though. Yes you.
Anyone want to wager how long it will take me to post from the wrong account? If I make it to 24 hours, I will be delighted.
You should follow both of these accounts though. Yes you.
November 26, 2025 at 6:01 PM
For the next few days I am curating @sivanaesthesia.bsky.social as well as my own account, and @sascollective.com.
Anyone want to wager how long it will take me to post from the wrong account? If I make it to 24 hours, I will be delighted.
You should follow both of these accounts though. Yes you.
Anyone want to wager how long it will take me to post from the wrong account? If I make it to 24 hours, I will be delighted.
You should follow both of these accounts though. Yes you.
Being on the tenth floor of a multistorey car park at least gets you a view.
It is indeed a bit chilly though.
#SIVA25
It is indeed a bit chilly though.
#SIVA25
Nice view of the famous Liverpool skyline from up here! Both cathedrals, and the Radio City tower are visible. Bit chilly right now though.
Liverpool is a brilliant city.
We are looking forward to welcoming our delegates at tomorrow's Annual Scientific Meeting #SIVA25.
See you there!
Liverpool is a brilliant city.
We are looking forward to welcoming our delegates at tomorrow's Annual Scientific Meeting #SIVA25.
See you there!
November 26, 2025 at 5:37 PM
Being on the tenth floor of a multistorey car park at least gets you a view.
It is indeed a bit chilly though.
#SIVA25
It is indeed a bit chilly though.
#SIVA25
Reposted by Rob Fleming
Nice view of the famous Liverpool skyline from up here! Both cathedrals, and the Radio City tower are visible. Bit chilly right now though.
Liverpool is a brilliant city.
We are looking forward to welcoming our delegates at tomorrow's Annual Scientific Meeting #SIVA25.
See you there!
Liverpool is a brilliant city.
We are looking forward to welcoming our delegates at tomorrow's Annual Scientific Meeting #SIVA25.
See you there!
November 26, 2025 at 5:36 PM
Nice view of the famous Liverpool skyline from up here! Both cathedrals, and the Radio City tower are visible. Bit chilly right now though.
Liverpool is a brilliant city.
We are looking forward to welcoming our delegates at tomorrow's Annual Scientific Meeting #SIVA25.
See you there!
Liverpool is a brilliant city.
We are looking forward to welcoming our delegates at tomorrow's Annual Scientific Meeting #SIVA25.
See you there!
Reposted by Rob Fleming
Hello Bluesky!
Ahead of our Annual Scientific Meeting, which starts tomorrow, we thought we would get this account up and running.
It will be curated by @robjimfleming.bsky.social for the next couple of days at least.
Hopefully we will see some of you in sunny Liverpool!
Ahead of our Annual Scientific Meeting, which starts tomorrow, we thought we would get this account up and running.
It will be curated by @robjimfleming.bsky.social for the next couple of days at least.
Hopefully we will see some of you in sunny Liverpool!
November 26, 2025 at 2:16 PM
Hello Bluesky!
Ahead of our Annual Scientific Meeting, which starts tomorrow, we thought we would get this account up and running.
It will be curated by @robjimfleming.bsky.social for the next couple of days at least.
Hopefully we will see some of you in sunny Liverpool!
Ahead of our Annual Scientific Meeting, which starts tomorrow, we thought we would get this account up and running.
It will be curated by @robjimfleming.bsky.social for the next couple of days at least.
Hopefully we will see some of you in sunny Liverpool!
Reposted by Rob Fleming
The @rcphysicians.bsky.social have been important allies to the #SASsix campaign.
We agree entirely with President Mumtaz Patel in her rapid response to this weeks @bmj.com article.
Bravo!
We agree entirely with President Mumtaz Patel in her rapid response to this weeks @bmj.com article.
Bravo!
‘Once a doctor has been employed in the same specialty by the same trust for more than two years, they should be moved to a nationally negotiated SAS contract.’
👉 Read our rapid response to a @bmj.com investigation revealing thousands of LEDs are trapped in insecure contracts: ow.ly/m9sm50XwQot
👉 Read our rapid response to a @bmj.com investigation revealing thousands of LEDs are trapped in insecure contracts: ow.ly/m9sm50XwQot
Rapid response to BMJ investigation: Thousands of NHS doctors are trapped in insecure “gig economy” contracts
ow.ly
November 24, 2025 at 8:21 PM
The @rcphysicians.bsky.social have been important allies to the #SASsix campaign.
We agree entirely with President Mumtaz Patel in her rapid response to this weeks @bmj.com article.
Bravo!
We agree entirely with President Mumtaz Patel in her rapid response to this weeks @bmj.com article.
Bravo!
Someone needs to invent a thermal immersion circulator (as used in sous vide) for baths.
Getting a bath to the right temperature is a pain, and the temperature starts dropping as soon as you get in.
If the technology exists for cooking a steak, it could be used for warming my ass on a cold day.
Getting a bath to the right temperature is a pain, and the temperature starts dropping as soon as you get in.
If the technology exists for cooking a steak, it could be used for warming my ass on a cold day.
November 23, 2025 at 5:05 PM
Someone needs to invent a thermal immersion circulator (as used in sous vide) for baths.
Getting a bath to the right temperature is a pain, and the temperature starts dropping as soon as you get in.
If the technology exists for cooking a steak, it could be used for warming my ass on a cold day.
Getting a bath to the right temperature is a pain, and the temperature starts dropping as soon as you get in.
If the technology exists for cooking a steak, it could be used for warming my ass on a cold day.
Reposted by Rob Fleming
Twitter now displays where accounts are from and it has confirmed that too many of the political accounts are out of country bots.
Why are folks still there? To argue with bots? A waste of precious time while enriching the richest man on Earth.
Delete your account.
Why are folks still there? To argue with bots? A waste of precious time while enriching the richest man on Earth.
Delete your account.
November 23, 2025 at 2:56 PM
Twitter now displays where accounts are from and it has confirmed that too many of the political accounts are out of country bots.
Why are folks still there? To argue with bots? A waste of precious time while enriching the richest man on Earth.
Delete your account.
Why are folks still there? To argue with bots? A waste of precious time while enriching the richest man on Earth.
Delete your account.
Reposted by Rob Fleming
This is an extremely important thread for all of us in NHS secondary care and includes a great piece from @emmajourno.bsky.social and @abirimmer.bsky.social.
My concern is, as we try to stay off Twitter, these pieces disappear into the ether.
There was a valiant effort to make #MedSkyDebate...
My concern is, as we try to stay off Twitter, these pieces disappear into the ether.
There was a valiant effort to make #MedSkyDebate...
1/ The medical workforce and the #SASsix, a Saturday morning thread...
The eagle-eyed among you may have spotted two related publications relating to workforce this week. Taken together, they paint a stark picture of the current medical workforce.
The eagle-eyed among you may have spotted two related publications relating to workforce this week. Taken together, they paint a stark picture of the current medical workforce.
November 22, 2025 at 2:28 PM
This is an extremely important thread for all of us in NHS secondary care and includes a great piece from @emmajourno.bsky.social and @abirimmer.bsky.social.
My concern is, as we try to stay off Twitter, these pieces disappear into the ether.
There was a valiant effort to make #MedSkyDebate...
My concern is, as we try to stay off Twitter, these pieces disappear into the ether.
There was a valiant effort to make #MedSkyDebate...
Bearded clown alert. Page 182 of today's BMJ.
There are successful, progressive careers to be had for doctors outside of rotational training. However, we have to decide as a profession to make it normal for all, and the NHS has to stop behaving like a 'gig economy' employer.
#SASsix
There are successful, progressive careers to be had for doctors outside of rotational training. However, we have to decide as a profession to make it normal for all, and the NHS has to stop behaving like a 'gig economy' employer.
#SASsix
November 22, 2025 at 11:37 AM
Bearded clown alert. Page 182 of today's BMJ.
There are successful, progressive careers to be had for doctors outside of rotational training. However, we have to decide as a profession to make it normal for all, and the NHS has to stop behaving like a 'gig economy' employer.
#SASsix
There are successful, progressive careers to be had for doctors outside of rotational training. However, we have to decide as a profession to make it normal for all, and the NHS has to stop behaving like a 'gig economy' employer.
#SASsix
You really should read this with your coffee this morning folks. It just might change your perspective and it could save the medical workforce.
Plus, there are graphs. I like graphs.
#SASsix
Plus, there are graphs. I like graphs.
#SASsix
1/ The medical workforce and the #SASsix, a Saturday morning thread...
The eagle-eyed among you may have spotted two related publications relating to workforce this week. Taken together, they paint a stark picture of the current medical workforce.
The eagle-eyed among you may have spotted two related publications relating to workforce this week. Taken together, they paint a stark picture of the current medical workforce.
November 22, 2025 at 8:24 AM
You really should read this with your coffee this morning folks. It just might change your perspective and it could save the medical workforce.
Plus, there are graphs. I like graphs.
#SASsix
Plus, there are graphs. I like graphs.
#SASsix
Reposted by Rob Fleming
NHS private finance diverts money away from healthcare, towards the pockets of private shareholders.
Cat Eccles MP’s motion can force the government to drop their NHS private finance plans from the Autumn Budget.
✉️Take 2 mins now to email your MP to sign the motion and protect patients.
Cat Eccles MP’s motion can force the government to drop their NHS private finance plans from the Autumn Budget.
✉️Take 2 mins now to email your MP to sign the motion and protect patients.
November 20, 2025 at 5:43 PM
NHS private finance diverts money away from healthcare, towards the pockets of private shareholders.
Cat Eccles MP’s motion can force the government to drop their NHS private finance plans from the Autumn Budget.
✉️Take 2 mins now to email your MP to sign the motion and protect patients.
Cat Eccles MP’s motion can force the government to drop their NHS private finance plans from the Autumn Budget.
✉️Take 2 mins now to email your MP to sign the motion and protect patients.
Reposted by Rob Fleming
Instead of having a coherent workforce plan, the NHS is now part of the gig economy, writes @kamranabbasi.bsky.social in this new Editor's Choice
www.bmj.com/content/391/...
www.bmj.com/content/391/...
November 20, 2025 at 4:58 PM
Instead of having a coherent workforce plan, the NHS is now part of the gig economy, writes @kamranabbasi.bsky.social in this new Editor's Choice
www.bmj.com/content/391/...
www.bmj.com/content/391/...
Reposted by Rob Fleming
BMJ finds that thousands of locally employed doctors are being ‘exploited’ by NHS Trusts using contracts that deny them training, progression and nationally agreed benefits. Many of these doctors are international graduates and from ethnic minorities
www.bmj.com/content/391/...
www.bmj.com/content/391/...
Revealed: Thousands of NHS doctors are trapped in insecure “gig economy” contracts
Thousands of locally employed doctors—many of them international graduates and from ethnic minorities—are trapped in insecure NHS contracts with no access to training, career progression, or national ...
www.bmj.com
November 21, 2025 at 6:31 AM
BMJ finds that thousands of locally employed doctors are being ‘exploited’ by NHS Trusts using contracts that deny them training, progression and nationally agreed benefits. Many of these doctors are international graduates and from ethnic minorities
www.bmj.com/content/391/...
www.bmj.com/content/391/...
“We believe that locally employed doctors should be offered the appropriate permanent SAS contract for their work. As well as employment rights, this would give these folks the professional identity they are currently being denied.”
#SASsix
www.bmj.com/content/391/...
#SASsix
www.bmj.com/content/391/...
Revealed: Thousands of NHS doctors are trapped in insecure “gig economy” contracts
Thousands of locally employed doctors—many of them international graduates and from ethnic minorities—are trapped in insecure NHS contracts with no access to training, career progression, or national ...
www.bmj.com
November 20, 2025 at 8:04 PM
“We believe that locally employed doctors should be offered the appropriate permanent SAS contract for their work. As well as employment rights, this would give these folks the professional identity they are currently being denied.”
#SASsix
www.bmj.com/content/391/...
#SASsix
www.bmj.com/content/391/...
Reposted by Rob Fleming
A new #BMJInvestigation finds that thousands of locally employed doctors are trapped in insecure NHS contracts with no access to training, career progression, or national safeguards.
Experts warn that the NHS is effectively “behaving like a gig economy employer”
www.bmj.com/content/391/...
Experts warn that the NHS is effectively “behaving like a gig economy employer”
www.bmj.com/content/391/...
November 20, 2025 at 12:18 PM
A new #BMJInvestigation finds that thousands of locally employed doctors are trapped in insecure NHS contracts with no access to training, career progression, or national safeguards.
Experts warn that the NHS is effectively “behaving like a gig economy employer”
www.bmj.com/content/391/...
Experts warn that the NHS is effectively “behaving like a gig economy employer”
www.bmj.com/content/391/...