Rob Fleming
@robjimfleming.bsky.social
Doctor / Academic | Specialist (SAS) Anaesthetist | Clinical Associate Professor | UK | He / him | FRCA | Award winning irreverence | "non-sea lion" | Part of @SAScollective.com | #SASsix | #PERUSEbeforeYouInfuse
Opinions many, all very much mine!
Opinions many, all very much mine!
Apparently 10 years ago was 2016.
It wasn't a perfect year, but it definitely had its moments. I quite liked this one.
It wasn't a perfect year, but it definitely had its moments. I quite liked this one.
January 19, 2026 at 10:07 PM
Apparently 10 years ago was 2016.
It wasn't a perfect year, but it definitely had its moments. I quite liked this one.
It wasn't a perfect year, but it definitely had its moments. I quite liked this one.
I enjoy #photography, and I would like to go out with a camera. If it could stop raining, that would be just swell.
If I look at enough old photos, maybe I can transport myself somewhere less grim than a busy Sunday in rainy Nottinghamshire.
If I look at enough old photos, maybe I can transport myself somewhere less grim than a busy Sunday in rainy Nottinghamshire.
January 18, 2026 at 12:02 PM
I enjoy #photography, and I would like to go out with a camera. If it could stop raining, that would be just swell.
If I look at enough old photos, maybe I can transport myself somewhere less grim than a busy Sunday in rainy Nottinghamshire.
If I look at enough old photos, maybe I can transport myself somewhere less grim than a busy Sunday in rainy Nottinghamshire.
Went out for a walk around sunset. Playing with exposure, and small apertures to create stars and flares. #photography
R7, wide end of Sigma 18-50 F/2.8. Shot at F8 or F16-22, depending on what I was trying to achieve.
R7, wide end of Sigma 18-50 F/2.8. Shot at F8 or F16-22, depending on what I was trying to achieve.
January 17, 2026 at 4:44 PM
Went out for a walk around sunset. Playing with exposure, and small apertures to create stars and flares. #photography
R7, wide end of Sigma 18-50 F/2.8. Shot at F8 or F16-22, depending on what I was trying to achieve.
R7, wide end of Sigma 18-50 F/2.8. Shot at F8 or F16-22, depending on what I was trying to achieve.
Dr Lyons continues. This is making for a very entertaining debate. This was a brilliant choice for the final session of the conference.
"Here is the slide covering the robust evidence that TIVA is superior for RSI than hand bolus followed by turning on a volatile."
#WSM2026
"Here is the slide covering the robust evidence that TIVA is superior for RSI than hand bolus followed by turning on a volatile."
#WSM2026
January 16, 2026 at 4:51 PM
Dr Lyons continues. This is making for a very entertaining debate. This was a brilliant choice for the final session of the conference.
"Here is the slide covering the robust evidence that TIVA is superior for RSI than hand bolus followed by turning on a volatile."
#WSM2026
"Here is the slide covering the robust evidence that TIVA is superior for RSI than hand bolus followed by turning on a volatile."
#WSM2026
Speaking against TIVA in this afternoon's #WSM2026 debate, Dr Craig Lyons first illustrates the number of ways in which we have also "modified" or allowed variation in practice when it comes to RSI.
There are apparently over 3000 combinations available on this slide alone.
There are apparently over 3000 combinations available on this slide alone.
January 16, 2026 at 4:44 PM
Speaking against TIVA in this afternoon's #WSM2026 debate, Dr Craig Lyons first illustrates the number of ways in which we have also "modified" or allowed variation in practice when it comes to RSI.
There are apparently over 3000 combinations available on this slide alone.
There are apparently over 3000 combinations available on this slide alone.
Mark Barley has a lot of style as a debater.
Talking about speed of onset for induction when using TIVA TCI for RSI, he asks "is it too slow?"
The paper he is quoting from would suggest not. He then adds...
"I know my opponent will agree with me about this paper. He wrote it."
#WSM2026
Talking about speed of onset for induction when using TIVA TCI for RSI, he asks "is it too slow?"
The paper he is quoting from would suggest not. He then adds...
"I know my opponent will agree with me about this paper. He wrote it."
#WSM2026
January 16, 2026 at 4:29 PM
Mark Barley has a lot of style as a debater.
Talking about speed of onset for induction when using TIVA TCI for RSI, he asks "is it too slow?"
The paper he is quoting from would suggest not. He then adds...
"I know my opponent will agree with me about this paper. He wrote it."
#WSM2026
Talking about speed of onset for induction when using TIVA TCI for RSI, he asks "is it too slow?"
The paper he is quoting from would suggest not. He then adds...
"I know my opponent will agree with me about this paper. He wrote it."
#WSM2026
Vice president at @assocanaes.bsky.social, generally splendid person Dr Robert Self ends this mornings wellbeing session at #WSM2026, with a talk on mentoring.
Learning relationships help individuals achieve their potential. We all need this from time to time.
Learning relationships help individuals achieve their potential. We all need this from time to time.
January 16, 2026 at 12:45 PM
Vice president at @assocanaes.bsky.social, generally splendid person Dr Robert Self ends this mornings wellbeing session at #WSM2026, with a talk on mentoring.
Learning relationships help individuals achieve their potential. We all need this from time to time.
Learning relationships help individuals achieve their potential. We all need this from time to time.
Resilience has become a bit of a dirty word in recent years, placing the emphasis on the individual rather than the system that is stretching them.
However, it is still useful to talk about it.
Definitions of resilience often come down to elasticity and flexibility, as here.
#WSM2026
However, it is still useful to talk about it.
Definitions of resilience often come down to elasticity and flexibility, as here.
#WSM2026
January 16, 2026 at 12:05 PM
Resilience has become a bit of a dirty word in recent years, placing the emphasis on the individual rather than the system that is stretching them.
However, it is still useful to talk about it.
Definitions of resilience often come down to elasticity and flexibility, as here.
#WSM2026
However, it is still useful to talk about it.
Definitions of resilience often come down to elasticity and flexibility, as here.
#WSM2026
Alan McEwen, international air traffic controller, talks about how to avoid error when the perceived risk is low, but the results of getting it wrong are catastrophic.
The first lesson is that it is really hard to "solve" the problem. It requires constant reinforcement and cultural shift.
#WSM2026
The first lesson is that it is really hard to "solve" the problem. It requires constant reinforcement and cultural shift.
#WSM2026
January 16, 2026 at 11:03 AM
Alan McEwen, international air traffic controller, talks about how to avoid error when the perceived risk is low, but the results of getting it wrong are catastrophic.
The first lesson is that it is really hard to "solve" the problem. It requires constant reinforcement and cultural shift.
#WSM2026
The first lesson is that it is really hard to "solve" the problem. It requires constant reinforcement and cultural shift.
#WSM2026
Wg Cdr Samantha Jones also reminds the room of the fatal triad of trauma.
Coagulopathy, hypothermia and acidosis each worsen outcomes, especially in combination with one another.
#WSM2026
Coagulopathy, hypothermia and acidosis each worsen outcomes, especially in combination with one another.
#WSM2026
January 16, 2026 at 10:09 AM
Wg Cdr Samantha Jones also reminds the room of the fatal triad of trauma.
Coagulopathy, hypothermia and acidosis each worsen outcomes, especially in combination with one another.
#WSM2026
Coagulopathy, hypothermia and acidosis each worsen outcomes, especially in combination with one another.
#WSM2026
Wg Cdr Samantha Jones ends this #WSM2026 session on war with a talk on critical care in the context of mass casualties.
In a mass casualty setting there are those who can't be saved, and those who will survive.
The outcomes for everyone else are dependent on the care we are able to provide.
In a mass casualty setting there are those who can't be saved, and those who will survive.
The outcomes for everyone else are dependent on the care we are able to provide.
January 16, 2026 at 9:57 AM
Wg Cdr Samantha Jones ends this #WSM2026 session on war with a talk on critical care in the context of mass casualties.
In a mass casualty setting there are those who can't be saved, and those who will survive.
The outcomes for everyone else are dependent on the care we are able to provide.
In a mass casualty setting there are those who can't be saved, and those who will survive.
The outcomes for everyone else are dependent on the care we are able to provide.
Lt Col Alex Kumar opens the war pain management talk at #WSM2026 with a quote attributed to Julius Caesar.
"It is easier to find people who will volunteer to die, than to find those who are willing to endure pain with patience"
Early opioids and continuous regional analgesia are the norm.
"It is easier to find people who will volunteer to die, than to find those who are willing to endure pain with patience"
Early opioids and continuous regional analgesia are the norm.
January 16, 2026 at 9:40 AM
Lt Col Alex Kumar opens the war pain management talk at #WSM2026 with a quote attributed to Julius Caesar.
"It is easier to find people who will volunteer to die, than to find those who are willing to endure pain with patience"
Early opioids and continuous regional analgesia are the norm.
"It is easier to find people who will volunteer to die, than to find those who are willing to endure pain with patience"
Early opioids and continuous regional analgesia are the norm.
Depending on the scale of future combat operations, and the number of military casualties being recovered to the UK, the NHS may need to be converted to increasingly look after military personnel. The NHS is where many casualties will be cared for.
We are currently at "RAMP (Operate)".
#WSM2026
We are currently at "RAMP (Operate)".
#WSM2026
January 16, 2026 at 9:20 AM
Depending on the scale of future combat operations, and the number of military casualties being recovered to the UK, the NHS may need to be converted to increasingly look after military personnel. The NHS is where many casualties will be cared for.
We are currently at "RAMP (Operate)".
#WSM2026
We are currently at "RAMP (Operate)".
#WSM2026
Starting his talk at #WSM2026, Col James Ralph, a military representative to @assocanaes.bsky.social, talks about echelons of care.
Role 2 is usually a military orthopaedic surgeon, general surgeon, multiples anaesthetists and ODPs. This is stabilising only.
Role 4 is "us" i.e. the NHS.
Role 2 is usually a military orthopaedic surgeon, general surgeon, multiples anaesthetists and ODPs. This is stabilising only.
Role 4 is "us" i.e. the NHS.
January 16, 2026 at 9:10 AM
Starting his talk at #WSM2026, Col James Ralph, a military representative to @assocanaes.bsky.social, talks about echelons of care.
Role 2 is usually a military orthopaedic surgeon, general surgeon, multiples anaesthetists and ODPs. This is stabilising only.
Role 4 is "us" i.e. the NHS.
Role 2 is usually a military orthopaedic surgeon, general surgeon, multiples anaesthetists and ODPs. This is stabilising only.
Role 4 is "us" i.e. the NHS.
Some of my favourite folks winning honours and awards at the end of today's @assocanaes.bsky.social #WSM2026.
A lot of work goes on nationally, by volunteers trying to make the world a better place.
I always like this bit.
A lot of work goes on nationally, by volunteers trying to make the world a better place.
I always like this bit.
January 15, 2026 at 8:23 PM
Some of my favourite folks winning honours and awards at the end of today's @assocanaes.bsky.social #WSM2026.
A lot of work goes on nationally, by volunteers trying to make the world a better place.
I always like this bit.
A lot of work goes on nationally, by volunteers trying to make the world a better place.
I always like this bit.
Dr Suzanne Farrell is quoting authors, poets, and Ghostbusters in her excellent talk about shared decision-making. I'm thoroughly enjoying it.
Also, I do love a slide with a forking path on it.
#WSM2026
Also, I do love a slide with a forking path on it.
#WSM2026
January 15, 2026 at 3:32 PM
Dr Suzanne Farrell is quoting authors, poets, and Ghostbusters in her excellent talk about shared decision-making. I'm thoroughly enjoying it.
Also, I do love a slide with a forking path on it.
#WSM2026
Also, I do love a slide with a forking path on it.
#WSM2026
Representing SOBA, Dr Eleanor Warwick talks about patients living with obesity, and how damaging stigma is for outcomes.
Where patients are made to feel shame, or judged, they will present late, and have more advanced disease at presentation.
This is not just true of obesity.
#WSM2026
Where patients are made to feel shame, or judged, they will present late, and have more advanced disease at presentation.
This is not just true of obesity.
#WSM2026
January 15, 2026 at 3:12 PM
Representing SOBA, Dr Eleanor Warwick talks about patients living with obesity, and how damaging stigma is for outcomes.
Where patients are made to feel shame, or judged, they will present late, and have more advanced disease at presentation.
This is not just true of obesity.
#WSM2026
Where patients are made to feel shame, or judged, they will present late, and have more advanced disease at presentation.
This is not just true of obesity.
#WSM2026
Previous @assocanaes.bsky.social Featherstone Professor @elboghdadly.bsky.social opens the afternoon session in the main hall, talking about the DAS guidance.
He talks about "peroxygenation" throughout rather than "preoxygenation". The oxygen you gave before induction won't last forever.
#WSM2026
He talks about "peroxygenation" throughout rather than "preoxygenation". The oxygen you gave before induction won't last forever.
#WSM2026
January 15, 2026 at 2:53 PM
Previous @assocanaes.bsky.social Featherstone Professor @elboghdadly.bsky.social opens the afternoon session in the main hall, talking about the DAS guidance.
He talks about "peroxygenation" throughout rather than "preoxygenation". The oxygen you gave before induction won't last forever.
#WSM2026
He talks about "peroxygenation" throughout rather than "preoxygenation". The oxygen you gave before induction won't last forever.
#WSM2026
Dr @sallyelghazali.bsky.social takes the final slot of this session of #WSM2026 with an update on ICU for the non-intensivist.
De El-Ghazali is former chair of the @anaesresidents.bsky.social. She is awesome.
First up, we are talking about peripheral administration of dilute noradrenaline.
De El-Ghazali is former chair of the @anaesresidents.bsky.social. She is awesome.
First up, we are talking about peripheral administration of dilute noradrenaline.
January 15, 2026 at 1:00 PM
Dr @sallyelghazali.bsky.social takes the final slot of this session of #WSM2026 with an update on ICU for the non-intensivist.
De El-Ghazali is former chair of the @anaesresidents.bsky.social. She is awesome.
First up, we are talking about peripheral administration of dilute noradrenaline.
De El-Ghazali is former chair of the @anaesresidents.bsky.social. She is awesome.
First up, we are talking about peripheral administration of dilute noradrenaline.
Useful take-home message in the first 15 seconds of the allergy talk at #WSM2026.
Food allergies rarely overlap with drug allergies to anaesthetic drugs. In particular, there is no need to avoid propofol in patients with allergy to eggs, soy or nuts.
Food allergies rarely overlap with drug allergies to anaesthetic drugs. In particular, there is no need to avoid propofol in patients with allergy to eggs, soy or nuts.
January 15, 2026 at 10:05 AM
Useful take-home message in the first 15 seconds of the allergy talk at #WSM2026.
Food allergies rarely overlap with drug allergies to anaesthetic drugs. In particular, there is no need to avoid propofol in patients with allergy to eggs, soy or nuts.
Food allergies rarely overlap with drug allergies to anaesthetic drugs. In particular, there is no need to avoid propofol in patients with allergy to eggs, soy or nuts.
Panel discussion after the first session at ##WSM2026.
BMA Council Chair Dr Tom Dolphin is asked how the BMA squares solidarity, with splitting the workforce between UK graduates and IMGs in the way yesterday's government bill does.
BMA Council Chair Dr Tom Dolphin is asked how the BMA squares solidarity, with splitting the workforce between UK graduates and IMGs in the way yesterday's government bill does.
January 15, 2026 at 9:49 AM
Panel discussion after the first session at ##WSM2026.
BMA Council Chair Dr Tom Dolphin is asked how the BMA squares solidarity, with splitting the workforce between UK graduates and IMGs in the way yesterday's government bill does.
BMA Council Chair Dr Tom Dolphin is asked how the BMA squares solidarity, with splitting the workforce between UK graduates and IMGs in the way yesterday's government bill does.
Consultant Anaesthetist and BMA Council Chair @tomdolphin.bsky.social talks about the importance of collective action and local organising.
If we want medicine to continue to be the viable career, the profession needs to behave as a group. Solidarity matters.
#WSM2026
If we want medicine to continue to be the viable career, the profession needs to behave as a group. Solidarity matters.
#WSM2026
January 15, 2026 at 9:25 AM
Consultant Anaesthetist and BMA Council Chair @tomdolphin.bsky.social talks about the importance of collective action and local organising.
If we want medicine to continue to be the viable career, the profession needs to behave as a group. Solidarity matters.
#WSM2026
If we want medicine to continue to be the viable career, the profession needs to behave as a group. Solidarity matters.
#WSM2026
England’s Patient Safety Commissioner, Dr. Henrietta Hughes OBE, gives today's first keynote talk at #WSM2026.
She opens by saying that Anaeathetists are often the guardians of patient safety.
She opens by saying that Anaeathetists are often the guardians of patient safety.
January 15, 2026 at 9:00 AM
England’s Patient Safety Commissioner, Dr. Henrietta Hughes OBE, gives today's first keynote talk at #WSM2026.
She opens by saying that Anaeathetists are often the guardians of patient safety.
She opens by saying that Anaeathetists are often the guardians of patient safety.
The always fabulous @tmeek.bsky.social opens #WSM2026.
Phones on silent, visit the stands and make sure to attend tonight's social, folks.
Phones on silent, visit the stands and make sure to attend tonight's social, folks.
January 15, 2026 at 8:55 AM
The always fabulous @tmeek.bsky.social opens #WSM2026.
Phones on silent, visit the stands and make sure to attend tonight's social, folks.
Phones on silent, visit the stands and make sure to attend tonight's social, folks.