Obsgynaecritcare

Informações:

Synopsis

A podcast discussing critical care, anaesthesia and pain medicine in obstetrics and gynaecology

Episodes

  • 045 – Avoiding or managing the accidental dural puncture a discussion with Dr Matt Rucklidge

    19/02/2019 Duration: 20min

    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

  • 044 – Lung ultrasound a discussion with Dr Parvesh Verma

    17/12/2018 Duration: 16min

    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

  • 043 – Anaphylaxis discussion part 1 with Chong

    03/12/2018 Duration: 30min

    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

  • 042 – Great case discussed – perioperative anaphylaxis

    23/10/2018 Duration: 20min

    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

  • 041 – Obstetric cell salvage an update, what only one suction, no filter and more with Dr Matt Rucklidge

    01/10/2018 Duration: 29min

    Hi everyone, Welcome to part 2 of our series on cell salvage in obstetrics and gynaecology! Last week we had a great discussion on the basics of cell salvage and focused on what the team in the surgical field need to know to do a great job. If you haven't listened to that yet check it out here: Link This week we welcome back Dr Matt Rucklidge and we have the recording of the talk he gave our department recently on the latest thoughts surrounding the use of cell salvage in obstetrics. If you haven't been watching this space closely over the last few years you may be unaware that there has been a definite change in approach to many aspects of how obstetric cell salvage is now done. Listen to Matt present a very balanced and thoughtful discussion on the following: it's ok to be collecting amniotic fluid during cell salvage the use of only one suction is now routine in many centres a softening in the stance on the need for use of leukodepletion filters when reinfusing salvaged obstetric blood. Some of

  • 040 – Cell salvage basics for the person holding the sucker – with Cheryl Dane Stewart

    24/09/2018 Duration: 12min

    Hi Everyone, Welcome to part 1 of a two part series on the use of cell salvage in obstetrics & gynaecology! This week Part 1 focuses on the basics of how cell salvage works and what the staff in the surgical field (nursing and surgical) need to know to do it properly! Next week we hear from Dr Matt Rucklidge who discusses all the latest controversies and developments in the arena of cell salvage during obstetrics - can we use a single suction, what about amniotic fluid in the collection system, do we always need a leukodepletion filter and how can we organise our practice so that we utilise cell salvage during those unexpected emergency cases? These two episodes are audio extracts taken from a great combined presentation given at our local department meeting here in August. The audio from these presentations are great but for those of you who are interested in viewing a video version of this talk where you can also see the slides and images referred to in the talk feel free to watch using the link below:

  • 039 – Rectus sheath catheters for analgesia with Dr Matt Rucklidge

    17/09/2018 Duration: 25min

    Case scenario: Mrs A Nonymous is a 67 yr old woman with a diagnosis of probable ovarian cancer who is booked for a midline laparotomy and debulking cancer surgery. She is a smoker, has a BMI of 50 and weighs 115kg. She was diagnosed with OSA 5 years ago but doesn't use CPAP because she couldn't tolerate it. She has had longstanding back pain for many years which she blames on an epidural which she had during childbirth 30 years ago. She has had 2 previous back operations "which didn't help" and now takes 3 analgesics for this pain which include moderately high dose oxycodone, pregabalin, and tramadol. She tells you that she definitely will not consent to any spinal or epidural because of all of her previous back issues... She is opioid tolerant and at high risk of serious opioid related respiratory adverse effects - how are you going to manage her pain, get her mobilising and avoid any technique that involves a needle in the back! Hi everyone, This week we have an interview with Dr Matt Rucklidge, a colle

  • 038 – Simulation in Obstetrics and Gynaecology with Dr Katrina Calvert

    11/09/2018 Duration: 24min

    Hi Everyone! This week I am joined on the podcast by Dr Katrina Calvert a senior trainee in Obstetrics and Gynaecology here in WA.  Katrina has a long career spanning both sides of the globe in medical education and has a real passion for the use of simulation in O&G. We discuss all things simulation: what makes good simulation? do you need expensive hi-fidelity equipment? what does the future hold? what are the barriers to the use of simulation and how can we overcome them? we also share some interesting anecdotes of participants who have perhaps become a little "too immersed" in their particular scenario! Thanks Katrina for a very enlightening discussion - we look forward to getting you back on the podcast soon! Links To Courses in Australia Maternity Emergency Management:  Simulation day for obs emergencies NOVICE – basic skills in O&G for RMO’s PHO’s https://www.matereducation.qld.edu.au/Professional-development-learning/Maternity-Infant-Care For those interested in developing their sim educ

  • 037 – Intravenous lidocaine infusions for analgesia with Dr Kevin Chan

    04/09/2018 Duration: 32min

    (Real Case: De-identified) You receive a call from a frantic ward nurse who tells you they have a 32 yr old woman who had laparoscopic surgery for treatment of endometriosis earlier in the day and she is in severe pain despite having had 3 doses of sublingual buprenorphine and 4 doses of tramadol since theatre 4 hours earlier. You head up to the ward and read her notes - she has had chronic pelvic pain since a teenager, she has been on analgesic drugs chronically for many years and been managed by her GP and a chronic pain service. She has a history of anxiety and depression and sexual abuse as an adolescent. Her current preoperative regimen involved tapentadol SR, amitriptyline, celebrex, pregabalin and prn oxycodone. In theatre she had a volatiel anaesthetic and a number of multi-modal analgesic medications including a small dose of methadone, ketamine, lignocaine. She needed a lot of fentanyl in recovery and since arrival on the ward has been very hard to control. You go and see her, she is definitely not

  • 036 – Sci hub, earthquakes, listener mail, pirate jokes and another quiz!

    23/08/2018 Duration: 20min

    Want to put together a tutorial? See someone with an unusual condition in clinic and want to access some up to date knowledge to look after them? The first thing most of us do is search the current literature - but then often we face this - look familiar? What is Sci Hub? If you're lucky you are an employee of a hospital / university or college that has a subscription and you can usually gain access eventually through these channels. But what if the journal is not included in their bundle or spare a thought for our colleagues living in less affluent conditions - how will they access up to date knowledge and research?? Join Graeme and I this week as we discuss earthquake stories, Sci-hub, open access publishing, pirate jokes, respond to some listener mail and I try out another quiz! This Weeks Quiz Who is this famous person? - I am an obstetrician! Sci-Hub Open Access Related Links Wikipedia Sci-hub page Online Petition against Elseviers fees > 17200 academics  Wikipedia academic publishing page German

  • 035 – Labour epidural analgesia regimens discussed – Nolan McDonnell

    09/08/2018 Duration: 38min

    Hi Everyone, This week we have the audio from another great talk given at our departmental meeting by our colleague Assoc Prof Nolan McDonnell on labour epidural analgesia. This talk was originally given at the Obstetric Anaesthesia special interest group meeting held in Sydney in early May. Nolan discusses many important aspects of the physiology and pharmacology of labour pain, and the history of how the regimen we use in our institution has evolved over the last decade. The second part of the talk centres around the evidence for what is the best epidural analgesia regimen to use in labour and what might the future hold? Thanks again Nolan! For those who would like to view this as a video with the powerpoint slides you can do so here: Video recording - Labour epidural analgesia regimens Nolan Mcdonnell.

  • 034 – Gastric ultrasound in anaesthesia with Dr Mark Sharples

    01/08/2018 Duration: 16min

    (*hypothetical patient) You have a young woman booked for an emergency D&C for a miscarriage. She is in a lot of discomfort from the misoprostol given earlier that day. She hasn't eaten for exactly 6 hours but feels a bit nauseated and has had some oxycodone during the day. According to the 6 hour rule you assume she should be fasted - but she has had opioids because of her pain and you wonder whether she does still have solids in her stomach and will it be safe to just use a supraglottic ariway or should you give her an RSI and used a cuffed endotracheal tube? Is there anyway you can get more information to help you make a decision?? Hi Everyone, This week I am joined by Dr Mark Sharples to discuss gastric ultrasound a fascinating technique which could be the new frontier in perioperative aspiration risk assessment. USEFUL LINKS Gastricultrasound.org NAP4 - airway audit project in the UK  

  • 033 – Perioperative management of tracheostomies with Dr James Anderson

    23/07/2018 Duration: 34min

    The emergency pager goes off - code blue medical on the gynaecology surgical ward. As you enter the ward a frantic grim faced nurse waves you into the side room where you discover an elderly woman who is obviously cyanosed, not really conscious and struggling vigorously to breath. She has a hudson mask on her face and there is an obvious tracheostomy tube protruding from her neck. One of the nurses tell you she had a laparotomy for ovarian cancer earlier that day and that she has a long term tracheostomy after having had a throat cancer resected 5 years ago..... Hi Everyone, This week I am joined by another anaesthetist, Dr James Anderson to discuss the perioperative management of tracheostomies. Before seeing the light and jumping the drapes to become an anaesthetist James spent a year working as an ENT registrar and now he has an interest in teaching both perioperative and crisis management of patients with tracheostomies. He helps run tracheostomy crisis management courses at Fiona Stanley Hospital and h

  • 032 – Part 2 perioperative acute pain management tips with Sonya Ting and a second attempt at quiz 4

    18/07/2018 Duration: 25min

    Hi everyone, Join us on the podcast where this week we have part 2 of the discussion with Dr Sonya Ting on tips for management of acute perioperative pain. We explore some advice on how to manage a tricky obstetric patient with post caesarean pain issues. I also failed dismally to entice any responses to last weeks quiz entitled "Anaesthetist or serial killer". In one final last ditch attempt to rescue this quiz from abject failure I have now rebranded it. I have supplied you with a small crossword which can be used to get some hints as to the name of the individual who is pictured - and then I am guessing using the power of  the internet someone should be able to figure out who this is! QUIZ 4 - Anaesthetist or serial killer? Who is this person?

  • 031 – Perioperative acute pain management advice part 1 with Dr Sonya Ting

    10/07/2018 Duration: 20min

    Hi everyone, This week I am joined again by my colleague Dr Sonya Ting - where I attempt to pick her brains for some useful advice in managing difficult perioperative pain issues. Sonya's first episode on the opioid epidemic has already taken first place on the podcast download list as the most popular episode so far! Hypothetical Patient A 50yr old woman is on your list and scheduled to undergo a laparascopic hysterectomy. You see her in the preoperative area: Q - What issues / history should you explore to identify if this patient is at risk of perioperative pain issues? Q - How are you going to explain to her the plan for her perioperative pain management, what are the goals and what strategies fo you use to manage her expectations? Q - What communication strategies can you use, what about non-verbal and verbal communication? Listen to Sonya and I discuss these issues on the podcast - and finally have a crack at the latest instalment of our quiz below: Anaesthetist or Serial Killer? Quiz 4 Is the fo

  • 030 – Doctor I only have half a heart – the parturient with a Fontan circulation - Obsgynaecritcare

    04/07/2018 Duration: 40min

    You are the anaesthetic consultant on call and you are woken (again) at 2am on a Saturday night by your registrar. They tell you they have been asked by the obstetric team to see a pregnant woman who has just arrived in the hospital contracting with ruptured membranes at 30 weeks gestation and is telling everyone "I only have half a heart"! The registrar tells you they have had a look through what they describe as a very large set of patient notes. They tell you it appears that they have been seen by a lot of specialists in the antenatal period but no-one in the overnight team is exactly sure what the plan is for this woman. She is starting to get quite uncomfortable and is asking for some pain relief. The patient herself is not the greatest help - she has told your registrar that she too is confused and that a final decision on how she is going to give birth hasn't been made yet - but everyone seems to be really worried about it! What is the Fontan circulation and what implications does this have for pregna

  • 029 – Great cases discussed crash caesar in a patient with congenital heart disease and another quiz! - Obsgynaecritcare

    22/06/2018 Duration: 12min

    Hi everyone, This week Graeme and I discuss an interesting case from the past involving a parturient with a partially corrected congenital heart condition who presented a bit of a conundrum in the middle of the night. Before we get into the case discussion however we unpick the prospects for the football (soccer) world cup and admire the Iceland viking clap. Graeme does a bit of a "trump" when he attempts to bluff his way through our world cup conversation by first deploring the antics of the Italian team attempting to fake fouls and he then even picks the Netherlands to win! - and of course neither of these teams are even at the 2018 world cup! Fake news! QUIZ! Finally to beef up this relatively short episode we have another quiz. Who is the person pictured below and why are they famous in the world of obstetrics? Once again no prizes but we will give you a mention on the next episode for a bit of brief internet fame!

  • 028 – The Opioid Epidemic a discussion with Dr Sonya Ting - Obsgynaecritcare

    04/06/2018 Duration: 33min

    (*Hypothetical case) You are a busy gynaecologist working in a large public hospital. You are contacted by a GP on the phone about a young 19yr old patient who you operated on 3 weeks ago - she underwent a laparoscopic ovarian cystectomy. The GP tells you that he referred her to your service for investigation of intermittent pelvic pain about 5 months ago and hasn't seen her since. They inform you that today she turned up for an appointment asking to get a renewal of her Targin 20mg bd which was prescribed by the inpatient team on discharge and which she has been on for the last 3 weeks since leaving hospital. The GP is not very happy! They inform you " she still has the same pelvic pain but now I also have to manage a 19yr old who is hooked on a fairly decent dose of opioids!". They rightly point out that she was a bit depressed before they sent her to you but arguably now she is much worse than she was before and they want to know what you are going to do to help............. What is the "opioid epidemic"

  • 027 – LAST – local anaesthetic systemic toxicity - Obsgynaecritcare

    30/05/2018 Duration: 32min

    (*Hypothetical case) You are the anaesthetist on for obstetrics and a young woman is rushed from labour ward into your theatre for an emergency caesarean for fetal distress. Your registrar is talking with the patient and so you help with the team time out discussion. The obstetrician leading this asks "can you please give 2g of Cefazolin?". No worries - you grab the 20ml syringe and give the antibiotics over the next 30seconds whilst you help slide the patient onto the table and you instruct your registrar to start topping up her epidural. Your registrar says "no worries" but then looks confused and turns to ask you "where is my syringe?" With a sudden sickening feeling building in your stomach you look down at the now empty 20ml syringe in your hand. You slowly roll it over to reveal a previously hidden sticker....................... "bupivacaine 0.5%" Do you ever use local anaesthetics? This sort of local anaesthetic misadventure is one of those life threatening scenarios which make most anaesthetists br

  • 026 – Emergency Vascular Access Options and another quiz! - Obsgynaecritcare

    23/05/2018 Duration: 26min

    (*Hypothetical Case) A 26 yr old woman with a suspected ruptured ectopic pregnancy is rushed to theatre in haemorrhagic shock. The patient has a history of IVDU with a naltrexone implant. The team in the emergency department have been unable to get vascular access. She has a heart rate of 150/min and a BP of 75/45. She is now very distressed and unco-operative from both the abdominal pain but also the repeated painful attempts at vascular access with large needles by lots of different healthcare staff! Join Graeme and I as we discuss the various different options for gaining vascular access to allow resuscitation, but also induction of anaesthesia so definitive surgery can occur. We discuss the following various options: USS guided peripheral IV access Intraosseous drills External Jugular peripheral IV cannulation Internal Jugular peripheral IV cannulation  -  "The Rapid IJ" Large bore central cannulation (eg MAC line, swan sheath, haemodialysis catheters) - usually Internal jugular (IJ) and sub

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