Obsgynaecritcare

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://academ...

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 Pete...

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 an...

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 &#8...

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 / po...

(*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 deliver...

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...

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...

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...

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 particularl...

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 ana...

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...

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 salva...

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 epidur...

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...

(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...

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...

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 o...

(*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 an...

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...

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...

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...

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...

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&#82...

(*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. The...