This is a discussion with Garry Swann. Garry is the Consultant nurse lead in the Emergency Department at the Heart of England NHS Trust and is one of the main driving forces behind the development of the Advanced Clinical Practitioner roles at this trust. This is an innovative way of solving some of the medical staffing and capacity issues that are problematic in the NHS at the current time. Garry talks about some of the issues involved and how he has tried to solve them.
It looks like there are some interesting times ahead in the trust....
The link below is to the TED talk I mention in the podcast. This is a very interesting presentation and raises some great points.
Tom, one of my colleagues from the Critical Care Outreach Team and I discuss this paper and its findings reaching our own conclusions. Deferring Arterial Catheterisation in Patients with Septic Shock.
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We return to our 48-year-old patient: jaundiced, hypotensive, drowsy, and bleeding. In decompensated cirrhosis, every treatment targets a disrupted system — splanchnic vasodilation, portal hypertension, toxin accumulation, and renal hypoperfusion.Although these patients look fluid overloaded, they are effectively hypovolaemic. Start with small aliquots of balanced crystalloid, avoiding 0.9% saline. In hepatorenal syndrome or tense ascites, 20% albumin is
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In this episode, I walk through the real-world critical care management of acute decompensated alcohol-related liver disease, using a high-risk ICU case to anchor the discussion. The focus is on understanding the underlying physiology—portal hypertension, rebalanced haemostasis, hepatic encephalopathy, infection, and hepatorenal syndrome—and translating that physiology into clear first-hour priorities at the bedside. Listeners are
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