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Cliff Reid Profile picture
@cliffreid
Mar 15, 2019 • 3 tweets • 2 min read • Read on X
So who's coming to #EMSWolfpackFightclub at #SMACC on 26 March? Would be good to have an idea of numbers
@HumanFact0rz are you in?
@jrparamed are we welcoming novices? Would be good to offer a taster

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More from @cliffreid

Cliff Reid Profile picture
Apr 7
🧵 We use an Extubation Readiness Checklist on the ICU which goes through the letters A-L.

We now call it 'The Extubation Clock'

1/8 Image
But before we start going through the A-L checklist, we should ask ‘Have we addressed the original reason for intubation?'

For example have the overdosed drugs cleared, is the pneumonia better, etc?

2/8 Image
The first component of A should be ‘Ask the Nurse’

An experienced bedside ICU nurse will often have already assessed them and concluded yes or no, or will have identified issues you’ve missed.

A hard ‘no’ would be foolhardy to overrule

3/8 Image
Read 8 tweets
Cliff Reid Profile picture
Nov 17, 2024
🧵 Managing Challenging Behaviours in Resuscitation Teams: A Thread for Team Leaders (1/13)

Every resuscitation team leader can face difficult team dynamics

Here are 6 key challenging behaviours you'll encounter and how to manage them effectively in real-time 🚨 Image
The Dominant/Overconfident Member 🦁 (2/13)

- Takes over without authority
- Dismisses others' input
- Makes unilateral decisions

Solution: Acknowledge expertise and redirect energy to specific tasks "Thank you Dr. Smith, I need your expertise on airway management right now." Image
The Anxious/Overwhelmed Member 😰 (3/13)

- Freezes under pressure
- Hesitates repeatedly
- Shows visible stress

Solution: Give clear, simple tasks and pair with experienced team member

"John, focus on recording vitals. Sarah will help you."

Give immediate positive feedback Image
Read 13 tweets
Cliff Reid Profile picture
Oct 13, 2024
Extubation Readiness: A to L Checklist

We're obsessed with safe intubation, but what about taking the tube out?

How do we assess extubation readiness?

Here's my simple, alphabet-based A to L checklist:

1/17Image
A - Airway: MAINTENANCE & PROTECTION

Check:

Neuromuscular tone (correlates with consciousness)

Risk of airway swelling (prolonged intubation, difficult intubation, burns) - consider cuff leak test (deflate cuff and assess for leak. Dexamethasone might be indicated)

2/17Image
A (cont'd):

Protective reflexes (swallowing, cough reflex, secretion management)

Are secretions excessive? Thick?

Will the patient be able to clear them unaided?

3/17Image
Read 18 tweets
Cliff Reid Profile picture
Sep 29, 2024
Early 40s male with chest pain and collapse, looks horrible, SBP 80, lactate 7.
Previous large PE with pulmonary hypertension on echo 2 months ago, discharged on apixaban
POCUS on arrival shows:



The POCUS findings are consistent with cor pulmonale but in view of his previous echo, how do we know this is the acute cause of his shock? Should we thrombolyse?
His ECG shows right axis deviation and T wave inversion. This was NEW compared with the ECGs on record from his previous admission Image
Read 19 tweets
Cliff Reid Profile picture
Jul 19, 2024
Here’s how I think we often fail our patients when treating ’sepsis’

a 🧵

1/11
In my capacity as both an emergency medicine and intensive care specialist I’ve observed that we sometimes:

- 1. Inappropriately diagnose other shock states as sepsis

2/11
- 2. Fail to use System 2 thinking when faced with hyperlactatemia

- 3. Fail to examine septic patients mindfully with a thorough ‘sepsis secondary survey’

3/11
Read 11 tweets
Cliff Reid Profile picture
Nov 23, 2023
WTF is a ‘difficult airway’?

A 🧵

1/14
I avoid the term ‘difficult airway’ altogether

How we describe a situation can have a psychological framing effect that can affect our performance

2/
Mindset, confidence, and therefore performance are likely to be worse if you expect the airway to be ‘difficult’ rather than prepare for it to be ‘potentially challenging’

3/
Read 14 tweets

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