Obsgynaecritcare

A 28 yr old woman at 36/40 G2P1 presents with a few days history of mild headache, nausea, anorexia, and some upper right abdominal pain. You do some observations and some blood testing and find she has a BP 150/95, mildly hyperreflexic and bloods showing a Hb107, Plts 88, schistocytes on the film, raised AST / ALT /LDH and bilirubin. Hi Everyone, Acknowledging that we are still in the midst of a world wide pandemic we hope you are all safe. This week we thought it would be nice to take a break from COVID related matters (which we are sure like us has invaded most of your minds over the last few months) and turn to a fascinating obstetric critical illness. Join Graeme and I as we discuss this interesting and serious pregnancy related condition. What causes this condition?What do they die from? What are the important differential diagnoses? How do we manage them? We also share a few sh***e dad jokes, reminisce about ANZAC Day, the COVID pandemic and have another crack at one of our quizzes! Doct

Join Matt and I as we discuss some of the issues we have been grappling with in our planning for how to manage obstetric patients suspected of or known to have COVID-19. Is pregnancy a risk factor for worse disease severity?What is the appropriate PPE for women in active labour? Is active labour an aerosol generating procedure?What about the use of inhaled (and therefore exhaled) nitrous oxide in these women?What about the need for emergency or urgent procedures such as caesarean sections or post partum haemorrhage - how do we get them safely around the hospital? LINKS https://soap.org/education/provider-education/expert-summaries/interim-considerations-for-obstetric-anesthesia-care-related-to-covid19/ https://www.oaa-anaes.ac.uk/OAA_COVID19_Resources

(*Hypothetical Case) A woman is brought into your emergency dept by her husband at 14 weeks gestation. He tells you that she has been "really sick" for almost two months now. He states that they have seen their GP multiple times and have "tried almost everything". This is the second time they are presenting to your ED - they came 2 weeks ago where he recounts she was given some IV fluids and antiemetics before going home - but they were reluctant to come back because a member of staff was quite dismissive to them last time apparently she told them that if she ate ginger and sipped water she should be fine and "it all stops at 15 weeks anyway so not to worry it will be over soon". This time he tells you that she has practically eaten nothing in the last 4 weeks and she is now having trouble getting out of bed, because of almost 4 weeks of continuous vomiting. He thinks she has probably lost at least 8-10kg since becoming pregnant. He is "super-worried" and "she is just not herself anymore - please do so

(* Hypothetical Case) You are asked to see a pleasant 31 yr old woman in the antenatal clinic who is pregnant for the first time because as an adolescent she had an extensive scoliosis repair and now has Harrington Rods in her lumbar and thoracic spine. She tells you that she "is worried about being in a lot of pain during labour" and she wants to know what her options are. Hi everyone, This week three of us sat around our new AV equipment (thanks Trilby) to discuss the interesting and somewhat controversial topic of remifentanil PCA use for analgesia in labour. We discuss the history, the concerns regarding safety especially respiratory depression or apnoea, efficacy and some of the new evidence recently published. Links The RESPITE study in Lancet 2018 : Intravenous remifentanil patient-controlled analgesia versus intramuscular pethidine for pain relief in labour (RESPITE): an open-label, multicentre, randomised controlled trial IJOA August 2019 Serious adverse events attributed to remifen

Hi Everyone, This week I am joined by Prof Mike Paech, Mike has dedicated most of his career to both the research and practice of obstetric anaesthesia. Join us in this podcast where we sat down to discuss the myriad of changes he has witnessed in Obstetric Anaesthesia over his career. We have now started an interactive poll where you the listeners can make suggestions to us about topics you would like to hear discussed! At this stage we are not making any guarantees but if there are certain topics that seem to be very popular and if we can find someone who feels empowered enough to talk on the topic we will see if we can make it happen! (If you can also supply someone to talk - even better - send us a separate email). Go to the home screen and scroll down to find the poll - see link below: https://www.obsgynaecritcare.org/

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