🔥The unexpected consequence of too much sitting 🔥

The negatives of a sedentary lifestyle are widely known❗️

One issue that doesn't get mentioned enough is GLUTEAL AMNESIA, also known as the "dead butt syndrome".

Thread - Read more 👇

“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial

Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)

Why does huge volume IV fluid ‘resuscitation’ consistently occur?

Lots of reasons, including FALSE beliefs:
🛑 IV fluid always “treats AKI”
🛑 Hypotension = hypovolaemia
🛑 Lactate >2 means fluid deficiency
🛑 Septic patients are very hypovolaemic

The rule with IV fluids and AKI is to remember this 5 word phrase:

💥 💥 Aim for euvolaemia, then stop💥 💥

Fluid status is like Goldilocks - hypovolaemia is bad for the kidneys BUT excess volume is also harmful for renal function and will cause other complications too.

It is easy to say “target euvolaemia” - but we agree it is more difficult to do!

Fluid status assessment is certainly made harder by a belief that we must only rely on a snapshot assessment of examination features which are NOT specific / sensitive / reliable to elicit like.…

I'm not pro-murdering babies.
I'm pro-Becky who found out at her 20 week anatomy scan that the infant she had been so excited to bring into this world had developed without life sustaining organs.

We’ve done menstruation, let’s talk about the menopause! Because only women however they present can have the menopause although men who have had treatments for prostate cancer can have symptoms mimicking the menopause. There’s nothing scary about

the menopause. It’s a perfectly natural function of the body but it’s tied up with a thousand stereotypes of women, ageism and ‘old women are frightening’. True, old women are often very frightening to young men because look! A woman who doesn’t give a rat’s

arse what you think of her now all her mating hormones have gone and with it your charm as a potential mate. Now you’re just another annoying lad. That’s gotta hurt. Menopause means Wisdom, like it or not and it’s not always nice or cosy. Old women

are encouraged to refer to themselves as ‘young at heart’ and ‘as young as you feel’ and other such crap and told to ‘never give in to age’ which is ludicrous. Cosmetic surgery is now a thing but I can tell you what the surgeons and marketing

men won’t - it does not make you look young. You’re just an old woman who looks like at best, she’s had a great holiday and at worst like she was was trapped in a wind tunnel. Old is good. Old is meritorious. Old is survival. Old means you didn’t die young

1/23 We haven't had a lot to celebrate during this pandemic. But achieving the milestone of offering vaccine to the over 70s, health and care workers and the most clinically vulnerable just before target date is a huge cause for celebration, given the scale of the achievement.

2/23 When Margaret Keenan got her first jab in Coventry on December 8th last year, who’d have thought that, by Valentine’s Day, we’d have vaccinated over fourteen million people across the UK in just ten short weeks? Amazing, extraordinary and truly, really, world class!

3/23 I’ve been struck by how much joy and relief has been brought to those doing the vaccinations and those receiving them. A GP told me yesterday that nothing had given him greater pleasure in his long career. And that the patient's relief was sometimes overwhelming.

4/23 It's vital to recognise the extraordinary contribution of the staff and volunteers who have made this happen. One of my close family had their jab yesterday and was in awe of the volunteer standing outside in the freezing cold for a four hour shift meeting and greeting.

5/23 What I wanted to share in this thread was the slightly untold story of some of the extraordinary challenges the NHS has had to overcome to deliver this target. Requiring superhuman effort from NHS leaders and staff, way beyond the call of duty. Five challenges set out below.