Obsgynaecritcare

Hi Everyone, This week I am joined on the show with a new guest, consultant anaesthetist Dr Chris Mitchell. Chris is a colleague who also used to work with us at our women’s hospital and is already famous for his range of USS regional anaesthesia needles (now manufactured by pajunk). Today we discuss the issue of the adverse environmental effects of our profession. In particular we focus on...

Hi Everyone, Thanks to Mason Habel from Northern Health in Victoria, who contacted us a few months ago and suggested this topic to us. Join Graeme and I as we try to tackle this topic in a comprehensible manner. We do jump around a little bit, chasing anecdotes, interesting historical facts and the occasional dodgy dad joke but hopefully we get there in the end! LINKS 054 – Neurological injuries a...

Hypothetical case: You are called to a code blue medical on the gynaecology ward. A patient in her late 60s has collapsed in the bathroom. You are told she was admitted earlier that day for investigation of a probable pelvic cancer. She is conscious, has a heart rate 130/min, NIBP 90/45, SPO2 94% on hudson mask, and is mildly SOB with a respiratory rate 30/min. This patient undergoes investigation...

Hi everyone, This week I am joined by Matt & Graeme to discuss induction drugs and adjuncts used in general anaesthesia for caesarean delivery, with a few obligatory dad jokes thrown in at the end if you make it that far! Hypothetical cases we discuss: 1 – Healthy woman rushed to theatre with cord prolapse and fetal compromise 2 – A woman with severe preeclampsia needs urgent caesa...

Hypothetical patient: You get called by an anaesthetic registrar to come and help them with a woman in labour ward. They tell you that they have been struggling for a number of hours now to get a woman comfortable. They have placed three epidurals and topped them up aggressively with generous doses of the usual bupivacaine and fentanyl medications but none of them seem to have been effective. The...

You receive a call from an obstetrician: “I have a term patient booked for induction of labour this morning. She had an MRI of her brain 4 years ago after a car accident and was told she has an Arnold-Chiari malformation. She is very keen to have an epidural – can she have one?” Hi everyone, This week Graeme is back and we sit down to discuss Arnold – Chiari malformations a...

You are called to a code blue medical on labour ward. A woman who has been in labour attempting a VBAC has just collapsed whilst pushing during the second stage. She is unresponsive, not breathing and looks “bad”. This week I am joined by my two colleagues, also consultant anaesthetists, Dr Emelyn Lee and Dr Lip Ng. Join us for this interesting conversation where we discuss all things...

Hi Everyone, This week I sit down again with Graeme. We discuss WA’s isolation & covid bubble, exchange a few crap jokes and have a go at the thorny topic of shivering under neuraxial anaesthesia. Big thanks to everyone who helped with the OSCAR trial all those years ago, Yelena for teaching me a new trick to stop shivering and to Dr Tim Pavy for giving me two weeks leave to write up my...

Hi Everyone, This week is our first episode of our journal club to discuss interesting recent relevant research papers. We are hoping to do this on a regular basis interspersed amongst the other regular episodes where we choose a topic and explore it in detail. In this inaugural episode I am joined by a couple of colleagues who have both been on the podcast before. We have decided to choose articl...

Case History (*hypothetical patient) A 33yr old woman presents to a GP complaining of hair loss, cold intolerance, dizziness, extreme fatigue and weight gain. On further questioning the patient states this is her third attempt to seek help over a number of years. She initially sought help for amenorrhoea after her second delivery and was started on oestrogen / progesterone tablets. The second doct...

Hi Everyone, This week on the podcast I am joined by Dr Andi Atkinson one of the obstetric and gynaecology trainees here in WA. A few years ago Andi took time off during her training to spend time working in Africa for MSF on two separate occasions and we sat down to record an interview where she explains the processes involved in working with MSF and reflects on some of her experiences during her...

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...

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 i...

(*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...

(* 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...

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...

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 th...

“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 coup...

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...

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 b...

  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...

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...

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 g...

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 labou...

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 fo...