Obsgynaecritcare

Hi everyone, Welcome back to part 2 of our discussion on the use of abbreviations and acronyms in healthcare. We discuss the results, go through some of the more obscure ones and then have a bit of a serious discussion about the advantages but also the dangers inherent in using these for communication in healthcare. Below are the correct answers and some "interesting" responses from the Ob / Gyn abbreviation quiz which Sneha compiled using some of the abbreviations found here in our women's hospital. If you want to have a go first - look away - and navigate back to the preceding post 060. Correct Answers "Interesting Answers" Do you have any interesting abbreviations or acronyms? Send them in!

"Where the f**k is the anaesthetist! I asked for the epidural 45min ago, those obstetric doctors took five goes to put in my drip, the midwife has turned up the hormone drip and now I am going crazy! Aaarghhhh!" Seem familiar? Hi everyone, Welcome back this week I am joined by long time listener and first time interviewee - Dr Sneha Neppali who sits down with me to discuss a couple of projects she has recently completed - epidural analgesia response times and the use of abbreviations in healthcare - specifically obs / gynae ones used during her recent time here at our women's hospital. How many of these abbreviations do you know? Want to see how Sneha faired on her recent TV appearances follow the links below: The Chase  https://www.youtube.com/watch?v=tEG7JZUTgyk&feature=youtu.be&fbclid=IwAR1DGM7uQtduFBX3kxL-DLJq4GPUf5wXV2NvmWa7m7l_4dq5HwIekNXE63A Millionaire Hot Seat https://www.youtube.com/watch?v=DcVJyd5j_9A&feature=youtu.be&fbclid=IwAR3amg4KC2CmAggv2foCplyzjXWnrwbxIO

Hi everyone, Once again I am joined by Graeme where we discuss an interesting obstetric case of Takotsubo cardiomyopathy that we were involved with and then do a deep dive into this fascinating condition! We are not cardiologists or experts in this condition by any means and all of our statistics and facts that we quote come directly from the recent 2018 international consensus documents from the European Heart Journal which I have referenced below. Finally we don't get a lot of feedback here on the podcast :(, if anyone knows any good jokes or has suggestions for future topics they would like us to explore please let us know! References 1 - International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. 2 - International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management

Hi Everyone, This week I am joined again by Nolan who was involved in writing the recently published international consensus guidelines on the use of uterotonic drugs at caesarean section. We discuss the pharmacology and mechanisms of all the different drugs used in clinical practice.  From a practical point of view these guidelines differentiate between oxytocin naive women, those who have been exposed to oxytocin (in labour) and those practitioners working in less well resourced settings. A big thank you to Trilby for helping to setup the new audio equipment! Hopefully the quality of these podcasts will start to improve over the next few episodes as we get to grips with how to use all this new stuff! Link International consensus statement on the use of uterotonic agents during caesarean section. https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14757

  Hi Everyone, This week is part two of a series where Dr Mark Johnson and I discuss the emerging field of onco-anaesthesia. An increasingly enormous number of people every year undergo anaesthesia in order to have cancer surgery. Many different aspects of their surgical, anaesthetic and post surgical analgesic care are known to have effects on the immune system, the inflammatory response to surgery and some drugs act directly on receptors on cancer cells themselves. Is it possible or even probable that there are aspects of the techniques and drugs we use that could effect our patients long term cancer outcomes? Links How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676329/ Influence of perioperative anaesthetic and analgesic interventions on oncological outcomes: a narrative review https://youtu.be/Qj_MifzPGzo

Hi Everyone, This week I am joined by Dr Mark Johnson for part 1 of a two part series where we discuss the emerging field of onco-anaesthesia. An increasingly enormous number of people every year undergo anaesthesia in order to have cancer surgery. Many different aspects of their surgical, anaesthetic and post surgical analgesic care are known to have effects on the immune system, the inflammatory response to surgery and some drugs act directly on receptors on cancer cells themselves. Is it possible or even probable that there are aspects of the techniques and drugs we use that could effect our patients long term cancer outcomes? Links How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676329/ Influence of perioperative anaesthetic and analgesic interventions on oncological outcomes: a narrative review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC65

Hi Everyone, This week we are joined by a colleague Dr Adam Mossenson. Adam sits down and over a cup of coffee we discuss his recent fellowship year spent overseas at Dalhousie University in Nova Scotia, where he was involved in designing and implementing a new anaesthesia simulation training course in Rwanda. This has now been so successful it is now being expanded to other locations around the globe. If anyone has any old (or new) ipads to donate to the program you can contact Adam through the VAST website below: Links https://vastcourse.org Adam also recently gave a talk to our local Anaesthesia Dept for those who would like to watch that: https://youtu.be/oABIjqLN8AE  

You are the duty anaesthetist and you receive a phone call from a midwife on the postnatal ward asking if you can come and review a woman who gave birth yesterday. She is 29 years old, with a BMI of 39 and gestational diabetes. She had an epidural placed in labour ward for analgesia - which she describes as being a difficult and unpleasant procedure. Following a prolonged and difficult labour she was taken to theatre and required an instrumental delivery in theatre under epidural - this too was difficult and she was in the lithotomy position for well over an hour for both the delivery and then the subsequent perineal repair. Today she is complaining of a "numb left leg". She and the midwife are concerned she has a nerve injury from the epidural. What should be your approach to this difficult situation? Hi everyone, Join Graeme and I for the second part in our series on complications of central neuraxial blockade and postpartum neurological injuries. We will discuss the specific issue of neurological pro

You are the anaesthetist allocated to the anaesthetic outpatient clinic and you are asked to see a pregnant patient who is expecting her second child in a few months time who has been referred by a midwife from the antenatal services. She tells you that she had her first child three years earlier and that it was a very difficult and unpleasant experience. After a long difficult labour she asked for an epidural for pain relief. She describes that it was a very painful experience being placed and then it didn't work properly and despite being numb in her left leg she was still in a lot of pain. She then went to theatre for an emergency instrumental delivery - the anaesthetist there replaced it with "a new epidural" and she says she almost passed out and had trouble feeling her hands and breathing for about 30min. After delivery she had a numb patch on her left thigh and some musculoskeletal back pain for 6 months which she says a number of people have told her "were probably due to the epidural". She is very an

Hi everyone, This week Parvesh and I catch up to discuss some more serious issues - fatigue and burnout. Join us as we discuss these issues, share some anecdotes and even muse about the correct management of snake bites in pregnancy! Useful Articles https://academic.oup.com/bjaed/article/17/10/334/3865410 http://www.uapd.com/wp-content/uploads/Maslach-Burnout-Inventory-MBI.pdf https://academic.oup.com/bjaed/article/14/1/18/336242 https://anaesthetists.org/Fatigue Useful Resources a checklist that is also used in aviation that has been adapted to anaesthesia: https://anaesthetists.org/Portals/0/PDFs/Wellbeing/Fatigue/Fatigue%20Resources%20I'm%20safe.pdf?ver=2019-06-03-125010-637 fatigue tool useful at handover: https://anaesthetists.org/Portals/0/PDFs/Wellbeing/Fatigue/Fatigue%20Resources%20fatigue%20tool.pdf?ver=2019-06-03-125055-170  

Hi Everyone, This week I am joined by one of our provisional fellows and we discuss the serious topic of bullying in healthcare and anaesthesia. Unfortunately this sort of behaviour is more common than we appreciate...... Take home messages from Peter's talk • This does happen to us • It is not something that should be ignored • I think good change is happening Want to listen to Peter's department talk as well? Follow the link to our presentation page: https://www.obsgynaecritcare.org/education-presentations/ Links https://www.beyondblue.org.au/ http://www.anzca.edu.au/documents/anzca-policy-on-bullying-discrimination-and-harass.pdf

Hi everyone, Recently Graeme and I were asked to help run a workshop here in WA for the ANZCA Emergency Response CPD programme - thanks for your help Graeme and Paras. Some of the key concepts were understanding blood products and the strategies / philosophies which have been used when deciding what to give in a major haemorrhage. We decided that this would make a great podcast discussion and so voila - here it is! We discuss: - massive transfusion protocols utilising empiric ratios of blood products (often heavy in FFP / plasma) versus the more targeted approach often based on rapid assessment of haemostasis using viscoelastic tests such as ROTEM / TEG. - the four deficits in haemostasis which can develop; 1 fibrinolysis, 2 fibrinogen deficiency, 3 platelet deficiency, 4 thrombin deficiency. -a description of the types of blood products available their pros / cons. - why the use of large volumes of plasma probably doesn't make sense and may in fact involve some harm to patients. - an alt

Hi Everyone, This week we have a great four person discussion around the importance of assembling the right team when confronted with a high risk complex case in the after hours period. Interesting points covered include still doing the team huddle and introducing everyone even at midnight, a detailed discussion around manual aortic compression - the IVC, and how to monitor effectiveness - and also using a posterior hysterotomy to deliver the fetus when everywhere else looks bad! Thanks to IKEA for their contribution to our high tech podcast studio! Thanks also Parvesh, Matt Epee-Bekima & Matt Rucklidge for this great discussion. (* The patient discussed in this podcast gave us explicit written consent for her case to be used in this deidentified discussion) High Tech Podcasting Studio (Thanks IKEA for your plastic bin!) Links https://www.obsgynaecritcare.org/017-prof-yee-leung-obstetric-and-surgical-management-of-abnormally-invasive-placenta/ https://www.obsgynaecritcare.org/015-p

Hi Everyone, This week I had the privilege to sit down and chat with Dr Casey Parker (or is that Paraka? - apologies a little inside joke ). Casey works up in Broome as a GP anaesthetist, in emergency medicine, the HDU, is an enthusiast for point of care ultrasound and is involved in FOAMed and a huge number of other educational initiatives. Casey has had his own very successful website / podcast / blog (www.broomedocs.com) for over 7 years and he was one of the original people who encouraged me a few years ago. This week I sat down and quizzed him about his own journey in the FOAMed world, what he has learnt along the way, what his favourite podcasts are and if he has any advice for people out there who are also interested in getting involved. Thanks for sitting down and sharing your wisdom Casey! FOAMed Blogs / podcasts mentioned in our discussion https://emcrit.org/ http://accrac.com/ www.topmedtalk.com Home Other Links https://www.nosuchthingasafish.com/ www.hamishandandy.

(*Hypothetical patient) You are called to review a woman who recently arrived in your hospital and is now a few hours postpartum after a pre-term vaginal delivery at 35 weeks. She tells you that she has felt unwell for the last few days with a little bit of vomiting, diarrhoea and her asthma has been playing up and needing quite a few puffs of her ventolin. She went into preterm labour and delivered quickly 2-3 hours ago. She has received 3-4 litres of crystalloid to treat her "dehydration" and the at times non reassuring CTG over the last 24hours. She isn't febrile, but is tachycardic at 115/min, hypotensive 95/45 and she looks a little short of breath with Sp02 92% on room air and a respiratory rate of 20/min. She can talk in sentences and is walking around her room so you are reassured by this. After taking a history and examining her you decide to have a quick look at her heart and lungs with your USS machine (you have recently completed a point of care ultrasound course so are always looking for an

Scenario: You are called by a midwife to review a patient on the ward who had a vaginal delivery yesterday with an epidural for pain relief and now she has a bad headache. They are concerned that maybe she has a postdural puncture headache. Join Matt and Roger again as this week they discuss the management of a patient with possible or proven post-dural puncture headache. Links "What I wish I knew about post-dural puncture headaches before I got an epidural" Todays Parent Postpartum headache: diagnosis and management BJA Education 2011 Free article https://www.obsgynaecritcare.org/016-sphenopalatine-ganglion-block-for-postdural-puncture-headache/

You are called down to labour ward to put an epidural into a woman who is extremely distressed, in the throes of established labour who is thrashing around the bed in agony. You introduce yourself and she looks up at you and says "you ain't gonna give me a terrible f**** headache like that a******* who did ma epidural three years ago are ya?" This week we are joined again but Dr Matt Rucklidge for a discussion on what is arguably still the most common serious problem which continues to plague obstetric anaesthetists. Ever since August Bier and his trusty assistant Hildebrandt inflicted this condition on eachother in the late 1800s when experimenting on themselves at the very birth of spinal anaesthesia we continue to struggle with this important and pressing problem. August Bier - Father of spinal anaesthesia. He also personally experienced a 9 day postdural puncture headache! Interesting Links "What I wish I knew about post-dural puncture headaches before I got an epidural" Todays Parent The C

You are called down to your HDU to review a 81 year old woman who is day one following a major laparotomy for ovarian cancer surgery. The nursing staff are worried because "she is not quite right". She hasn't made much urine over the last 3 hours, her blood pressure is a little low and she has also developed low peripheral oxygen saturations on room air and is now needing 3l/min via nasal prongs. She had a unit of blood earlier this morning and has had 4-5 litres of intravenous fluid now both during and after her operation. What to do? Should you give her a 500ml bolus of fluid to help her urine output and maybe boost her BP a little? But why are her saturations low - what if you push her into florid pulmonary oedema? Why are her sats low? Does she have pleural effusions? atelectasis? early pulmonary oedema? Should you give her a vasopressor? some frusemide? some physio? some more fluids? Aaarrgggh! You get out your stethoscope - her lungs are quiet at the bases and she is slightly breathless but you are s

Hi everyone! Better late than never. This week Chong and I have finally got around to our discussion on anaphylaxis. What are the common causes of anaphylaxis? How is the severity of anaphylaxis graded? How / when should we administer adrenaline and what are the pitfalls of this drug which has a  narrow therapeutic window? We focus mainly on discussing the common causes in hospital and particularly the peri-operative setting. Peri-operative anaphylaxis is now the leading cause of direct anaesthetic related death in Australia / NZ. We do offer a few quick thoughts on the common causes and management of anaphylaxis in the community (how many of you have been asked to help manage these reactions for example on a plane at a school or community event - where invariably someone says get so and so they're a doctor / nurse!). If you haven't I suspect it will only be a matter of time before someone ingests a peanut on a flight you're on! Do you know how to use an epi-pen? They are pretty straight forward but nice

Hi everyone, Anaphylaxis is an unpredictable scary life-threatening condition which unfortunately is more common than we would like. If you work in healthcare chances are you will have seen this condition or perhaps you may even be unlucky enough to have suffered an anaphylaxis yourself. To introduce the topic in this first episode, Graeme and I discuss a life threatening case of perioperative anaphylaxis to intravenous muscle relaxant, which occurred a few years ago. This case was pretty stressful and about as severe as it can get but it demonstrates a number of important aspects of this potentially life-threatening condition. (* The patient involved in this case provided written consent for the details to be used for education - some aspects of this case have also been published in a case report in the International Journal of Obstetric Anaesthesia). Next week we have a detailed discussion including the pathophysiology, talk about the NAP6 national audit into perioperative anaphylaxis in the UK, and of