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!
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.
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
Enjoying the Midlands SAS Conference.
@michellepooley.bsky.social and @elliepattinsonnhs.bsky.social are always a highlight, and are today talking about the barriers faced by SAS doctors from an NHS Employers perspective.
Nice that the #SASsix and @sascollective.com got a mention or two.
@michellepooley.bsky.social and @elliepattinsonnhs.bsky.social are always a highlight, and are today talking about the barriers faced by SAS doctors from an NHS Employers perspective.
Nice that the #SASsix and @sascollective.com got a mention or two.
November 18, 2025 at 11:22 AM
Enjoying the Midlands SAS Conference.
@michellepooley.bsky.social and @elliepattinsonnhs.bsky.social are always a highlight, and are today talking about the barriers faced by SAS doctors from an NHS Employers perspective.
Nice that the #SASsix and @sascollective.com got a mention or two.
@michellepooley.bsky.social and @elliepattinsonnhs.bsky.social are always a highlight, and are today talking about the barriers faced by SAS doctors from an NHS Employers perspective.
Nice that the #SASsix and @sascollective.com got a mention or two.
Made some more soda bread to go with some wintery vegetable soup I made earlier.
It is the little things that keep you going.
Winter is my least favourite season, but the food is good.
It is the little things that keep you going.
Winter is my least favourite season, but the food is good.
November 15, 2025 at 3:19 PM
Made some more soda bread to go with some wintery vegetable soup I made earlier.
It is the little things that keep you going.
Winter is my least favourite season, but the food is good.
It is the little things that keep you going.
Winter is my least favourite season, but the food is good.
New mug.
I am very fond of Katsushika Hokusai's great wave. It is potentially the most reproduced image in the history of art, so apparently, a lot of people like it as much as I do.
Good mug. Good coffee. Happy Saturday folks. May your mornings be restorative.
I am very fond of Katsushika Hokusai's great wave. It is potentially the most reproduced image in the history of art, so apparently, a lot of people like it as much as I do.
Good mug. Good coffee. Happy Saturday folks. May your mornings be restorative.
November 15, 2025 at 9:01 AM
New mug.
I am very fond of Katsushika Hokusai's great wave. It is potentially the most reproduced image in the history of art, so apparently, a lot of people like it as much as I do.
Good mug. Good coffee. Happy Saturday folks. May your mornings be restorative.
I am very fond of Katsushika Hokusai's great wave. It is potentially the most reproduced image in the history of art, so apparently, a lot of people like it as much as I do.
Good mug. Good coffee. Happy Saturday folks. May your mornings be restorative.
Feeling nostalgic looking at old photos.
Went on a camping trip with dad 15 years ago. Dad was delighted to find seed pods from wild flowers and scatter the seeds.
These may have produced plants, then more seeds for generations by now.
I also look at his hands and see mine. The circle of life.
Went on a camping trip with dad 15 years ago. Dad was delighted to find seed pods from wild flowers and scatter the seeds.
These may have produced plants, then more seeds for generations by now.
I also look at his hands and see mine. The circle of life.
November 12, 2025 at 7:23 PM
Feeling nostalgic looking at old photos.
Went on a camping trip with dad 15 years ago. Dad was delighted to find seed pods from wild flowers and scatter the seeds.
These may have produced plants, then more seeds for generations by now.
I also look at his hands and see mine. The circle of life.
Went on a camping trip with dad 15 years ago. Dad was delighted to find seed pods from wild flowers and scatter the seeds.
These may have produced plants, then more seeds for generations by now.
I also look at his hands and see mine. The circle of life.
I like old cameras.
These were all taken with a Canon 40D. None of the lenses used were particularly expensive, and several were forty years old, from the film era.
There is something very satisfying about it all.
#photography
These were all taken with a Canon 40D. None of the lenses used were particularly expensive, and several were forty years old, from the film era.
There is something very satisfying about it all.
#photography
November 9, 2025 at 3:10 PM
I like old cameras.
These were all taken with a Canon 40D. None of the lenses used were particularly expensive, and several were forty years old, from the film era.
There is something very satisfying about it all.
#photography
These were all taken with a Canon 40D. None of the lenses used were particularly expensive, and several were forty years old, from the film era.
There is something very satisfying about it all.
#photography
Another successful open day in Lincoln.
I've had some great chats with some enthusiastic young folks and their families, and a few of them might choose our medical school. Hope so. I have also borrowed some of their enthusiasm. Hope they don't mind.
I really like this bit of my job.
I've had some great chats with some enthusiastic young folks and their families, and a few of them might choose our medical school. Hope so. I have also borrowed some of their enthusiasm. Hope they don't mind.
I really like this bit of my job.
November 8, 2025 at 4:10 PM
Another successful open day in Lincoln.
I've had some great chats with some enthusiastic young folks and their families, and a few of them might choose our medical school. Hope so. I have also borrowed some of their enthusiasm. Hope they don't mind.
I really like this bit of my job.
I've had some great chats with some enthusiastic young folks and their families, and a few of them might choose our medical school. Hope so. I have also borrowed some of their enthusiasm. Hope they don't mind.
I really like this bit of my job.
Had to walk around the edge of King's Mill reservoir to get back to my car.
As hospitals go, mine is pretty!
#photography
As hospitals go, mine is pretty!
#photography
November 6, 2025 at 6:07 PM
Had to walk around the edge of King's Mill reservoir to get back to my car.
As hospitals go, mine is pretty!
#photography
As hospitals go, mine is pretty!
#photography
Playing with cameras and found a few photos from the summer I hadn't transfered off the memory card.
I think this is a Ringlet. Not sure I've photographed on of these before or since. Glad to have found this.
90D, 28mm lens.
#butterflies #photography
I think this is a Ringlet. Not sure I've photographed on of these before or since. Glad to have found this.
90D, 28mm lens.
#butterflies #photography
November 4, 2025 at 10:33 PM
Playing with cameras and found a few photos from the summer I hadn't transfered off the memory card.
I think this is a Ringlet. Not sure I've photographed on of these before or since. Glad to have found this.
90D, 28mm lens.
#butterflies #photography
I think this is a Ringlet. Not sure I've photographed on of these before or since. Glad to have found this.
90D, 28mm lens.
#butterflies #photography
It is #Movember. I will be wearing my moustache with pride, like I do the other 11 months.
Movember is about raising awareness about men's cancers and men's mental health.
My mental health isn't sparkling this year, but I know I'm not alone. Solidarity, dudes. We'll get through it together.
Movember is about raising awareness about men's cancers and men's mental health.
My mental health isn't sparkling this year, but I know I'm not alone. Solidarity, dudes. We'll get through it together.
November 3, 2025 at 9:03 PM
It is #Movember. I will be wearing my moustache with pride, like I do the other 11 months.
Movember is about raising awareness about men's cancers and men's mental health.
My mental health isn't sparkling this year, but I know I'm not alone. Solidarity, dudes. We'll get through it together.
Movember is about raising awareness about men's cancers and men's mental health.
My mental health isn't sparkling this year, but I know I'm not alone. Solidarity, dudes. We'll get through it together.
Autumnal colours on a sunny day.
Canon R8, and ancient manual focus 50mm F/1.8 lens adapted. F8.
#photography
Canon R8, and ancient manual focus 50mm F/1.8 lens adapted. F8.
#photography
November 2, 2025 at 2:06 PM
Autumnal colours on a sunny day.
Canon R8, and ancient manual focus 50mm F/1.8 lens adapted. F8.
#photography
Canon R8, and ancient manual focus 50mm F/1.8 lens adapted. F8.
#photography
"That's no moon. It's a space station."
Clear night tonight. This was taken with a 500mm manual focus Tokina mirror lens from the 1970s, adapted onto my Canon R8.
I used the "loony 11" rule for exposure. It came out about right, ish. F/8, ISO 800, 1/1600s.
#photography
Clear night tonight. This was taken with a 500mm manual focus Tokina mirror lens from the 1970s, adapted onto my Canon R8.
I used the "loony 11" rule for exposure. It came out about right, ish. F/8, ISO 800, 1/1600s.
#photography
November 1, 2025 at 11:06 PM
"That's no moon. It's a space station."
Clear night tonight. This was taken with a 500mm manual focus Tokina mirror lens from the 1970s, adapted onto my Canon R8.
I used the "loony 11" rule for exposure. It came out about right, ish. F/8, ISO 800, 1/1600s.
#photography
Clear night tonight. This was taken with a 500mm manual focus Tokina mirror lens from the 1970s, adapted onto my Canon R8.
I used the "loony 11" rule for exposure. It came out about right, ish. F/8, ISO 800, 1/1600s.
#photography
Just recorded a talk for a webinar this week.
There was a time I gave a SAS careers talk every couple of weeks. I chalked up 30 one year, which now seems bonkers.
Alternative career pathways still need parity of esteem folks, even if I say it slightly less often than I used to.
#SASsix
There was a time I gave a SAS careers talk every couple of weeks. I chalked up 30 one year, which now seems bonkers.
Alternative career pathways still need parity of esteem folks, even if I say it slightly less often than I used to.
#SASsix
November 1, 2025 at 5:35 PM
Just recorded a talk for a webinar this week.
There was a time I gave a SAS careers talk every couple of weeks. I chalked up 30 one year, which now seems bonkers.
Alternative career pathways still need parity of esteem folks, even if I say it slightly less often than I used to.
#SASsix
There was a time I gave a SAS careers talk every couple of weeks. I chalked up 30 one year, which now seems bonkers.
Alternative career pathways still need parity of esteem folks, even if I say it slightly less often than I used to.
#SASsix
Happy Halloween, folks.
Don't let any ghosts bite your ornate squashes.
Don't eat too much chocolate.
7D, 24mm F/2.8
Don't let any ghosts bite your ornate squashes.
Don't eat too much chocolate.
7D, 24mm F/2.8
October 31, 2025 at 7:20 PM
Happy Halloween, folks.
Don't let any ghosts bite your ornate squashes.
Don't eat too much chocolate.
7D, 24mm F/2.8
Don't let any ghosts bite your ornate squashes.
Don't eat too much chocolate.
7D, 24mm F/2.8
October 30, 2025 at 7:09 PM
I realised I have found a new scene I like to photograph.
These three trees to the right of the horizon provide scale to the skyscapes.
Various cameras and lenses.
#photography
These three trees to the right of the horizon provide scale to the skyscapes.
Various cameras and lenses.
#photography
October 30, 2025 at 7:42 AM
I realised I have found a new scene I like to photograph.
These three trees to the right of the horizon provide scale to the skyscapes.
Various cameras and lenses.
#photography
These three trees to the right of the horizon provide scale to the skyscapes.
Various cameras and lenses.
#photography
The combination of the sunset and the clouds almost looked like fire and smoke tonight.
Every night, a different sky. Stay at home, and you'll miss it.
Nikon D80. Wide end of a cheap lens.
#photography
Every night, a different sky. Stay at home, and you'll miss it.
Nikon D80. Wide end of a cheap lens.
#photography
October 28, 2025 at 10:46 PM
The combination of the sunset and the clouds almost looked like fire and smoke tonight.
Every night, a different sky. Stay at home, and you'll miss it.
Nikon D80. Wide end of a cheap lens.
#photography
Every night, a different sky. Stay at home, and you'll miss it.
Nikon D80. Wide end of a cheap lens.
#photography
Another day, another dog walk, another photo of the same landscape. I need to travel more.
Nikon D80, wide end of a cheap lens.
#photography #scape
Nikon D80, wide end of a cheap lens.
#photography #scape
October 28, 2025 at 10:45 AM
Another day, another dog walk, another photo of the same landscape. I need to travel more.
Nikon D80, wide end of a cheap lens.
#photography #scape
Nikon D80, wide end of a cheap lens.
#photography #scape
I used to use something called "autostitich".
I quite like doing this too, but the multiple frames has a different aesthetic. Both fun.
I quite like doing this too, but the multiple frames has a different aesthetic. Both fun.
October 27, 2025 at 7:10 PM
I used to use something called "autostitich".
I quite like doing this too, but the multiple frames has a different aesthetic. Both fun.
I quite like doing this too, but the multiple frames has a different aesthetic. Both fun.
I quite like stitching multiple portrait orientation images together to make one big landscape. I do this with film too, but digital is much quicker!
Enjoyed the colours tonight a lot.
Nikon D80, wide end of a cheap lens.
#photography #scape #landscape
Enjoyed the colours tonight a lot.
Nikon D80, wide end of a cheap lens.
#photography #scape #landscape
October 27, 2025 at 5:51 PM
I quite like stitching multiple portrait orientation images together to make one big landscape. I do this with film too, but digital is much quicker!
Enjoyed the colours tonight a lot.
Nikon D80, wide end of a cheap lens.
#photography #scape #landscape
Enjoyed the colours tonight a lot.
Nikon D80, wide end of a cheap lens.
#photography #scape #landscape
Pretty colours tonight. The sky is a different painting every night. Remember to look up.
Nikon D80, wide end of a cheap lens.
#photography
Nikon D80, wide end of a cheap lens.
#photography
October 27, 2025 at 5:09 PM
Pretty colours tonight. The sky is a different painting every night. Remember to look up.
Nikon D80, wide end of a cheap lens.
#photography
Nikon D80, wide end of a cheap lens.
#photography
Is modern camera equipment "better"? Same scene, different ends of June 2025.
One of these was taken with a Canon 10D from 2003 and 28mm lens from 1987.
The other was taken with a 90D from 2019, and 28mm lens from 2012.
Which is which, folks, and which do you prefer?
I'll give the answer later.
One of these was taken with a Canon 10D from 2003 and 28mm lens from 1987.
The other was taken with a 90D from 2019, and 28mm lens from 2012.
Which is which, folks, and which do you prefer?
I'll give the answer later.
October 27, 2025 at 9:46 AM
Is modern camera equipment "better"? Same scene, different ends of June 2025.
One of these was taken with a Canon 10D from 2003 and 28mm lens from 1987.
The other was taken with a 90D from 2019, and 28mm lens from 2012.
Which is which, folks, and which do you prefer?
I'll give the answer later.
One of these was taken with a Canon 10D from 2003 and 28mm lens from 1987.
The other was taken with a 90D from 2019, and 28mm lens from 2012.
Which is which, folks, and which do you prefer?
I'll give the answer later.