Obsgynaecritcare
Gratis podcast

Obsgynaecritcare

Podcast af Roger Browning - Anaesthetist

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

Denne podcast er gratis at lytte på alle podcastafspillere og Podimo-appen uden abonnement.

Alle episoder

132 episoder
episode 132 The soiled airway with Nathan Blakely artwork
132 The soiled airway with Nathan Blakely
A woman collapses with abdominal pain in a restaurant & then the initial evaluation in the ED she is diagnosed with suspected ruptured ectopic pregnancy. She is brought straight into your theatre and you perform a rapid sequence induction. You place your video laryngoscope into her mouth and all you see is vomitus and fluid, your yankauer sucker is blocked with food and doing nothing………… Hi everyone, This week I am joined by Dr Nathan Blakely one of our enthusiastic trainees to discuss an area he has taken a personal interest in —- the management of the soiled airway. Thanks Nathan! Blood in Airway: [https://www.obsgynaecritcare.org/wp-content/uploads/2024/07/image-1024x768.png] [https://www.obsgynaecritcare.org/wp-content/uploads/2024/07/image-1.png] [https://www.obsgynaecritcare.org/wp-content/uploads/2024/07/image-2.png] [https://www.obsgynaecritcare.org/wp-content/uploads/2024/07/image-3-1024x575.png] [https://www.obsgynaecritcare.org/wp-content/uploads/2024/07/image-4.png] [https://www.obsgynaecritcare.org/wp-content/uploads/2024/07/image-5.png] USEFUL LINKS / REFERENCES https://youtu.be/Jaq-vHbcGi0 https://youtu.be/oMXkGgoRMpE * Cook T, Woodall N, Frerk C, Project FNA. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. British journal of anaesthesia. 2011;106(5):617-31. * Kei J, Mebust DP. Comparing the effectiveness of a novel suction set-up using an adult endotracheal tube connected to a meconium aspirator vs. a traditional Yankauer suction instrument. The Journal of emergency medicine. 2017;52(4):433-7. * Andreae M, Cox R, Shy B, Wong N, Strayer R. 319 Yankauer outperformed by alternative suction devices in evacuation of simulated emesis. Annals of Emergency Medicine. 2016;68(4):S123. * Cox R, Andreae M, Shy B, DuCanto J, Strayer R. Yankauer suction catheters with “safety” vent holes may impair safety in emergent airway management. The American Journal of Emergency Medicine. 2017;35(11):1762-3. * Nikolla DA, King B, Heslin A, Carlson JN. Comparison of Suction Rates Between a Standard Yankauer, a Commercial Large-Bore Suction Device, and a Makeshift Large-Bore Suction Device. The Journal of Emergency Medicine. 2021;61(3):265-70. * Weingart SD, Bhagwan SD. A novel set-up to allow suctioning during direct endotracheal and fiberoptic intubation. Journal of clinical anesthesia. 2011;23(6):518-9. * Han S, Fisher JA. Airway Management During Persistent Flooding Of the Oropharyngeal Airway. * DuCanto J, Serrano KD, Thompson RJ. Novel airway training tool that simulates vomiting: suction-assisted laryngoscopy assisted decontamination (SALAD) system. Western Journal of Emergency Medicine. 2017;18(1):117. * Root CW, Mitchell OJ, Brown R, Evers CB, Boyle J, Griffin C, et al. Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management. Resuscitation Plus. 2020;1:100005. * Chrimes N. The Vortex: a universal ‘high-acuity implementation tool’for emergency airway management. BJA: British Journal of Anaesthesia. 2016;117(suppl_1):i20-i7. * Finke S-R, Schroeder DC, Ecker H, Böttiger BW, Herff H, Wetsch WA. Comparing suction rates of novel DuCanto catheter against Yankauer and standard suction catheter using liquids of different viscosity—a technical simulation. BMC anesthesiology. 2022;22(1):285.
15. jul. 2024 - 46 min
episode 131 Hyperkalaemia in Pre Eclampsia a discussion with Natalie Smith artwork
131 Hyperkalaemia in Pre Eclampsia a discussion with Natalie Smith
[https://www.obsgynaecritcare.org/wp-content/uploads/2024/06/ECG_Hyperkaemia_L.jpg] As the DA you are paged to come to PACU to review a patient with pre-eclampsia who has just had a PPH and a repair of a perineal tear after delivering in labour ward. The O&G team ordered a VBG because she was febrile and they want to assess her lactate and start her on some antibiotics. The O&G registrar is concerned however because her potassium / K has come back as 7.8 mmol/L…. Join Natalie and I as we discuss the issue of hyperkalaemia specifically in the context of women suffering from pre-eclampsia. Why are they at risk of this important electrolyte abnormality and what are the principles of management? We also review a recent paper addressing some of the myths surrounding the treatment of acute hyperkalaemia (thanks to Casey at Broomedocs.com [https://broomedocs.com/2024/03/first10em-journal-club-march-2024/]for bringing this paper to our attention). USEFUL REFERENCES Gupta AA, Self M, Mueller M, Wardi G, Tainter C. Dispelling myths and misconceptions about the treatment of acute hyperkalemia.  [https://broomedocs.com/wp-content/uploads/2024/03/hyperK.pdf]Am J Emerg Med. 2022 Feb;52:85-91. doi: 10.1016/j.ajem.2021.11.030. PMID: 34890894 [https://pubmed.ncbi.nlm.nih.gov/34890894/] LITFL, ECG library, Hyperkalaemia https://litfl.com/hyperkalaemia-ecg-library A case of probable labetalol induced hyperkalaemia in pre-eclampsia. https://pubmed.ncbi.nlm.nih.gov/25370900 [https://pubmed.ncbi.nlm.nih.gov/25370900] Hypocalcaemia and hyperkalaemia during magnesium infusion therapy in a pre-eclamptic patient https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614650 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614650] Oh’s Intensive Care Manual. 7th Edition. Chapter 93 – Fluid and Electrolyte Therapy. Bersten A, Soni N et al. 2014.
18. jun. 2024 - 32 min
episode 130 Coagulopathy in abruption a discussion with Graeme artwork
130 Coagulopathy in abruption a discussion with Graeme
[https://www.obsgynaecritcare.org/wp-content/uploads/2024/06/Blausen_0737_PlacentalAbruption.png] You receive a page from labour ward. A woman at 35/40 weeks gestation has just arrived in the hospital very distressed in a lot of pain. A quick bedside ultrasound by the obstetric team has unfortunately demonstrated a large abruption and fetal death in utero. She is contracting strongly and beside herself in pain, the team would like you to come down and place an epidural for analgesia. The team are hoping she will deliver vaginally in the next few hours. What is your approach in this situation? Join Graeme and I as we discuss this complex and challenging clinical condition and the coagulopathy that can occasionally occur. Here is a link to cases we have had in the past here at KEMH in the ROTEM Real Cases Discussed section: Case 6 – Abruption and fetal death in utero [https://www.obsgynaecritcare.org/wp-content/uploads/2018/02/Abruption-and-fetal-death-in-utero.pdf] Case 11 – Abruption and severe coagulopathy [https://www.obsgynaecritcare.org/wp-content/uploads/2018/02/Abruption-and-severe-coagulopathy.pdf] REFERENCES Coagulopathy and placental abruption: changing management with ROTEM-guided fibrinogen concentrate therapy 2015 Liverpool Womens Hospital [https://www.obstetanesthesia.com/article/S0959-289X(14)00157-5/abstract] – this is not open access but available through the ANZCA library or your hospital library. It contains 4 very interesting case reports Fibrinolytic and thrombotic DIC an explanation 2023 [https://www.researchgate.net/publication/373616037_Phenotypes_of_disseminated_intravascular_coagulation] – This paper explains how there are two types of DIC one predominantly causing microvascular thrombosis and eventually factor depletion. The second which is possibly the mechanism seen in some abruptions is massive activation of fibrinolysis and fibrinogenolysis. WARNING this paper is highly technical!
05. jun. 2024 - 30 min
episode 129 Is there a doctor on the plane – a discussion with Ilan. artwork
129 Is there a doctor on the plane – a discussion with Ilan.
You recline your seat back, adjust your neck pillow, eye mask and close your eyes. Finally you are about to have that well earned nap. It was exhausting having to get up at 3am to head to the airport for this unpleasantly scheduled early flight. As your mind drifts towards sleep your thoughts are interrupted by a loud announcement by one of the cabin crew. “If anyone with medical experience is onboard can you please make yourselves known to the cabin crew?” You gently pull your mask aside and see two cabin crew applying oxygen and crouching over a passenger lying supine at the front of the aircraft. You quietly glance around the aircraft – no one else seems to have volunteered to help…….. If you have any medical, nursing or paramedical training and you occasionally fly on an aeroplane then this talk could well be relevant to you! This week I am joined by Ilan, one of our anaesthetic fellows and the current education fellow. Ilan is also a licensed pilot and has an interest in inflight medical emergencies and their management. Join us as we discuss the physiology, epidemiology, legal issues and share some anecdotes on this fascinating topic. Thanks Ilan! [https://www.obsgynaecritcare.org/wp-content/uploads/2024/05/Screenshot-2024-05-18-at-2.15.17-pm-1024x266.png] [https://www.obsgynaecritcare.org/wp-content/uploads/2024/05/Screenshot-2024-05-18-at-2.19.50-pm-1024x599.png] REFERENCES * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789915/ [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789915/] – In flight medical emergencies Western J Emerg Medicine 2013 * https://jamanetwork.com/journals/jama/article-abstract/2719313 [https://jamanetwork.com/journals/jama/article-abstract/2719313] – In flight medical emergencies JAMA 2018 * https://onepagericu.com/in-flight-medical?rq=flight [https://onepagericu.com/in-flight-medical?rq=flight] – * https://www.casa.gov.au/ [https://www.casa.gov.au/] – Australian Aviation Governing Authority where all the legal requirements for flight operations in Australia can be found * https://insightplus.mja.com.au/2017/39/what-is-my-duty-to-assist-in-emergency/ [https://insightplus.mja.com.au/2017/39/what-is-my-duty-to-assist-in-emergency/] – Duty to Assist in MJA * https://www1.racgp.org.au/newsgp/professional/medical-good-samaritans-and-the-law-what-gps-need [https://www1.racgp.org.au/newsgp/professional/medical-good-samaritans-and-the-law-what-gps-need]
18. maj 2024 - 1 h 8 min
episode 128 Uterine rupture a discussion with Dr David Owen artwork
128 Uterine rupture a discussion with Dr David Owen
[https://www.obsgynaecritcare.org/wp-content/uploads/2024/04/Rupture_Tranverse.jpg] You are called to review a woman in labour ward. When you arrive you are told her epidural is no longer working. The epidural was placed by a colleague 5 hours ago and was working well. However in the last 20-30 minutes she has developed breakthrough pain despite a top up and pressing the PCEA a few times. You look at her back and the epidural dressing looks fine – no obvious explanation there. Upon further questioning you are told that she had a caesarean in her previous pregnancy and she is attempting a VBAC. She tells you that since you arrived in the room the pain has changed. Now it is constant and she has developed pain in her shoulder. Suddenly the CTG deteriorates and within a few minutes the team are calling a code blue caesarean to theatre…..This is recollection of a real case from an evening shift a few years ago. As you can probably guess this week we are discussing the important and somewhat scary topic of uterine rupture. This week we are joined to discuss this topic by Dr David Owen. David is a senior obstetrician, who previous to WA worked at Liverpool Women’s Hospital and was a psychiatrist in a previous life. Thanks David! REFERENCES Uterine Rupture: A Seven Year Review at a Tertiary Care Hospital in New Delhi, India [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4746953/] Tocogram characteristics of uterine rupture: a systematic review [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225169/]
09. apr. 2024 - 30 min
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