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C7RKY's profile
John Clarke
John Clarke
John Clarke
@C7RKY

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John Clarke

@C7RKY

Of course views all mine. All without prejudice. Just a regular chap after all. Oh...and RT's may equally imply ridicule as endorsement.

UK
Joined December 2011

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    1. Joanne Fraser‏ @JFr4ser 18 Jan 2016
      Replying to @C7RKY

      @C7RKY @ResusCouncilUK Procedure is the wrong word. This is about escalation of treatment including where that treatment occurs

      1 reply 0 retweets 0 likes
    2. John Clarke‏ @C7RKY 18 Jan 2016
      Replying to @JFr4ser

      @JFr4ser @ResusCouncilUK Let's call it what consent guidelines call it - treatment options. Even a change/escalation still requires consent.

      2 replies 0 retweets 0 likes
    3. Joanne Fraser‏ @JFr4ser 18 Jan 2016
      Replying to @C7RKY

      @C7RKY @ResusCouncilUK Yes. I say to the patient Id like to swap your face mask for ... Because.... They agree which is consent.

      1 reply 0 retweets 0 likes
    4. John Clarke‏ @C7RKY 18 Jan 2016
      Replying to @JFr4ser

      @JFr4ser @ResusCouncilUK Hmmm.. not *entirely* sold on that process. Maybe not best example, but what about other options/risks discussion?

      2 replies 0 retweets 0 likes
    5. Joanne Fraser‏ @JFr4ser 18 Jan 2016
      Replying to @C7RKY

      @C7RKY @ResusCouncilUK What other options are there for oxygen therapy? Some form of mask or a ventilator. Without it no survival

      1 reply 0 retweets 0 likes
    6. John Clarke‏ @C7RKY 18 Jan 2016
      Replying to @JFr4ser

      @JFr4ser @ResusCouncilUK I know more about consent than this area of medicine, tbh. Trying to grasp the specifics as they apply here.

      2 replies 0 retweets 0 likes
    7. Joanne Fraser‏ @JFr4ser 18 Jan 2016
      Replying to @C7RKY

      @C7RKY @ResusCouncilUK < oxygen, fluids, escalating to HDU, central venous line, non-invasive ventilation, inotropic drugs, ITU ventilation>

      2 replies 0 retweets 0 likes
    8. Joanne Fraser‏ @JFr4ser 18 Jan 2016
      Replying to @JFr4ser

      @C7RKY @ResusCouncilUK < from what would be offered what would be acceptable to them. Even with no co-morbidity I could refuse any of those

      1 reply 0 retweets 0 likes
    9. John Clarke‏ @C7RKY 18 Jan 2016
      Replying to @JFr4ser

      @JFr4ser @ResusCouncilUK They can only select from options they get told about though. What do you mean by 'I could refuse any of those'?

      3 replies 0 retweets 0 likes
    10. Joanne Fraser‏ @JFr4ser 18 Jan 2016
      Replying to @C7RKY

      @C7RKY @ResusCouncilUK You have the right to say no to anything offered. If I was so determined that I didn't want any treatment so be it

      1 reply 0 retweets 0 likes
      John Clarke‏ @C7RKY 18 Jan 2016
      Replying to @JFr4ser

      @JFr4ser @ResusCouncilUK Got you. TY. Back to our earlier chat re only offereing perceived best option then? Pt must know options, to choose

      11:20 AM - 18 Jan 2016
      2 replies 0 retweets 0 likes
        1. New conversation
        2. Joanne Fraser‏ @JFr4ser 18 Jan 2016
          Replying to @C7RKY

          @C7RKY @ResusCouncilUK treatment offered is evidence based and along professional practice guidelines. Can't offer ineffective treatments

          1 reply 0 retweets 0 likes
        3. John Clarke‏ @C7RKY 18 Jan 2016
          Replying to @JFr4ser

          @JFr4ser @ResusCouncilUK There are thousands of evidence based treatments available. But nobody gets to do ANY of them without pt's consent.

          2 replies 0 retweets 0 likes
        4. Joanne Fraser‏ @JFr4ser 18 Jan 2016
          Replying to @C7RKY

          @C7RKY @ResusCouncilUK And this is no different. Can I give you non-invasive ventilation - yes or no. Can I do laparotomy - yes or no

          1 reply 0 retweets 0 likes
        5. John Clarke‏ @C7RKY 18 Jan 2016
          Replying to @JFr4ser

          @JFr4ser @ResusCouncilUK As I said, not my area. But 1st thoughts are: Risks? Alternatives? Consequences of doing nothing? Do opinions vary?

          3 replies 0 retweets 0 likes
        6. Joanne Fraser‏ @JFr4ser 18 Jan 2016
          Replying to @C7RKY

          @C7RKY @ResusCouncilUK A large part of medical expertise is understanding the balance of those risks in the clinical context of the pt

          1 reply 1 retweet 1 like
        7. John Clarke‏ @C7RKY 18 Jan 2016
          Replying to @JFr4ser

          @JFr4ser @ResusCouncilUK Agreed. And helping the pt understand that so they can make an informed choice, is a large part of pt consent too.

          1 reply 0 retweets 0 likes
        8. Joanne Fraser‏ @JFr4ser 18 Jan 2016
          Replying to @C7RKY

          @C7RKY @ResusCouncilUK Understanding can be a difficult goal as in this context will involve loss and grief. Agreement might be best you get

          1 reply 0 retweets 1 like
        9. John Clarke‏ @C7RKY 18 Jan 2016
          Replying to @JFr4ser

          @JFr4ser @ResusCouncilUK Depends on the pt. Personally, I want to know *everything*. And I get very upset if I find something was missed out

          1 reply 0 retweets 0 likes
        10. 2 more replies
        1. New conversation
        2. Joanne Fraser‏ @JFr4ser 18 Jan 2016
          Replying to @C7RKY

          @C7RKY @ResusCouncilUK A calm discussion with GP can go through benefits/drawbacks of treatment but in acute situation can change their mind

          1 reply 0 retweets 1 like
        3. John Clarke‏ @C7RKY 18 Jan 2016
          Replying to @JFr4ser

          @JFr4ser @ResusCouncilUK As is their right. I understand that.

          2 replies 0 retweets 0 likes
        4. Joanne Fraser‏ @JFr4ser 18 Jan 2016
          Replying to @C7RKY

          @C7RKY @ResusCouncilUK Yes to an extent. If ventilation agreed not appropriate when well and calm still not appropriate when frightened.

          1 reply 0 retweets 0 likes
        5. John Clarke‏ @C7RKY 18 Jan 2016
          Replying to @JFr4ser

          @JFr4ser @ResusCouncilUK Pt's right to change their mind is always their own. Though they can't demand inappropriate treatment, I appreciate

          1 reply 0 retweets 0 likes
        6. Joanne Fraser‏ @JFr4ser 18 Jan 2016
          Replying to @C7RKY

          @C7RKY @ResusCouncilUK It is. Within the context of inappropriate treatment. Acuity/fear influence decision making tho,not always as expect

          1 reply 0 retweets 0 likes
        7. John Clarke‏ @C7RKY 18 Jan 2016
          Replying to @JFr4ser

          @JFr4ser @ResusCouncilUK Again... I can understand that. Fear can make people behave in unusual ways & may influence decisions.

          0 replies 0 retweets 0 likes
        8. End of conversation

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