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Jonathan Begley Profile picture
@SpontVentGA
May 1, 2019 • 5 tweets • 2 min read • Read on X
Astronaut Dr Michael Barratt talking of lost collages and friends and space flight safety.
#ASM19KL Image
Very high risk tolerance, but lots of unknown unknowns too.
Predicted decompression illness rate was >20% for space walking, but they did it anyway. Turns out this never eventuated, but other unpredicted health effects did. Image
This slide should bring joy to any risk-assessment junkies out there! Image
At any time an astronaut on the ISS can be in a tertiary hospital within 24 hours.
#ASM19KL Image

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Jonathan Begley Profile picture
Sep 24, 2020
Random physiology / physics / HEMS / airway thread here! 🥳🧐😋
Everyone knows that as you go up in altitude the pressure in an ETT cuff, or a bag of chips, increases, right? But have you ever tried to explain why?
Hints:
- It's not Boyle's law, and
- Technically, it doesn't!
"😠 WHAT!?" I hear you exclaim. "Of course the pressure increases! Anyone who's taken a bag of chips on a plane can see that! Look; it's even been proven:"
doi.org/10.1111/j.1365…

Sure, OK, but then why?
This has confused a lot of people. Most papers and textbooks will 'explain' this by make a passing reference to Boyle's law and quickly moving on. But @drtlowes figured this out and published a nice explanation in 2004. (Give him a follow! 👍)
doi.org/10.1111/j.1365…
Read 21 tweets
Jonathan Begley Profile picture
Jun 22, 2020
THREAD!! 🥳😁
Why @josimpson11’s paper on intubation barrier devices (that is, aerosol boxes AND plastic drapes) is, by a good margin, the most important thing that’s been published on these devices.
@Anaes_Journal
onlinelibrary.wiley.com/doi/abs/10.111…
Here's the first thing I LOVE about this paper: an engineer is an author!
Doctors are so frequently happy to step into other fields (law, stats, engineering, etc) without ever asking the experts for their input. Not these guys- they actually got an engineer involved!
They used a quantitative technique to measure the actual aerosol levels (in five different sizes, no less) at the intubator's head. No exploding fluorescent balloons in this study! They obtained actual aerosol numbers, measured objectively, which were generated with a neb.
Read 17 tweets
Jonathan Begley Profile picture
Jun 18, 2020
Surely if the stakes are higher we should be more careful in our decision-making, not less. If you’re not willing to treat one patient based on a press-release, why would you be willing to treat one hundred?

(Thread...)
And while people who were involved in recruiting for the study may feel like they can evaluate it just from a 3-line summary, it shouldn’t surprise anyone that those of us elsewhere do not feel that a press release is enough for us to decide to safely change our practice.
And, it was only two weeks ago that we were burned by the retraction of a major peer-reviewed trial in a top-notch journal.
nytimes.com/reuters/2020/0…
Read 13 tweets
Jonathan Begley Profile picture
Jun 15, 2020
My thread on the @Anaes_Journal @IntubateCovid paper, and why it doesn't say what you might think it does.
There's also a really important finding that hasn't received anywhere near the attention it needs... but that's a teaser for the end of the thread!
@IntubateCovid used (and still uses) an online app to prospectively record clinicians' exposures to intubating suspected or actual COVID-19 patients, and then follow to see which developed symptoms and/or the disease.
Data is still being collected: link: intubatecovid.org/info
The authors must be congratulated for this novel and swift study! They’ve collected critical data prospectively, and as they continue to collect and publish more I think we'll gain a much better understanding of the risk of COVID-19 intubations.
You can contribute at link above!
Read 22 tweets
Jonathan Begley Profile picture
Apr 6, 2020
Let's do a 'deep dive' into this @NEJM intubation-box paper. Although it won't be too deep; the paper itself is only a page long!
nejm.org/doi/full/10.10…
The first thing is that this paper is not a 'study'; it's a Letter to the Editor. Letters are not peer-reviewed and it's not actually fair to the authors to critique it as a study either.
(It also means you may not get CPD points for reading it... if that's important to you! 😅)
Still, it's a very unusual letter with the page being visited almost every second of the day! It's not entirely surprising as this is the only journal publication in the world's literature to discuss intubation boxes. (Someone please correct me if I'm wrong).
Read 13 tweets
Jonathan Begley Profile picture
Mar 31, 2020
When this is all done, I think we Australian doctors need to write a joint letter to our public health specialists apologising for thinking that our three-months of reading and experience made us more qualified to respond to a pandemic than them.
A couple of points to clarify based on responses:
- Politicians are not public health physicians! My tweet wasn’t about politicians.
- While some PH specialists are not commenting publically, many are. Some agree with AHPPC and some don’t. That’s fine! Listen to their discussion, but don’t mistakenly think that qualifies you as a PH expert. Listening to two neurologists disagree doesn’t make you a neurologist.
Read 7 tweets

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