Vigilance and Happy New Year 2556

As an anaesthetist, the practice of Vigilance should be plenty in blood and all cells. You have to be careful, have an alternative plan when thing goes in an unexpected way or you have to anticipate the worst and be ready to solve it if it does happen.

Enjoy your holidays and Happy New Year.

Anaesthesia and Critical Care with Technology

Fluid management is the centre of shock management, but only in the early phase of shock, your patient will finally not respond to your additive fluid by the end, at that time point, you will have to find more ways to augment your patient's haemodynamics.

Will the application of ultrasonography, the TOE, transoesophageal echocardiograph, will be another helpful equipment to help and guide your making decision. It will help you to differentiate your patient's CVS status. The diameter of great vein either Superior vena cava or Inferior vena cava is an index to demonstrate the dynamic haemodynamics monitoring parameter. If both vessels can be collapsed or compressible, SVC by the breathing from mandate breath by IPPV or IVC from abdominal pressure linked closely to intrathoracic pressure, it would mean that your patient will be improved after you give him/her more fluid. This is shown in the condition 1 and 2 where the SVC is difficult to orientate during inspiration phase, and the diameter is significantly smaller than the expired time. The SVC collapsibility and IVC collapsibility are essential dynamic haemodynamic parameter that will be helpful in the situation that you have to decide whether or not to give more fluid to your patient. If your patient has the condition 3, you give more fluid in, you are endangering your patient, because at this point, your patient does not need fluid loading any more, and he/she would not have fluid responsiveness either.

 

No White Christmas here, Just another Sunny Day

Indeed, we are in the tropical area very close to the Equator, so how we could have white christmas. We just hope that cool wind would stay with us some days longer than a couple of days, so that we can have some cool days approaching the year's end.

Time flies, so you do have to be quick to start something new, question yourself what you have learn as a something new by the end of every single day, so that you would have time to consider and think and reflect to yourself and you will not lose the value of time flow.

Hope you have a good time this coming year's end. 

Anaesthesia & Critical Care get along with Basic Science

In the situation that you have to make a decision to correct your patient's haemodynamics instability, you must gather your patient's details about what went wrong and what you can intervene. Fluid resuscitation is one intervention that is usually performed in the face of severe hypotension. It is the centre of therapy in the early phase of shock management, but in the later phase it may not work in all patients.

You have to assess your patient's cardiac function where your patient's cardiac contractility is by the applying the data you can evaluate on the Frank-Starling cardiac function curve to see where it is. If it lies in the steep portion of this curve, it would mean that your patient can respond to have augmented cardiac output or venous return by just simply fluid loading to increase right atrial pressure or passive leg raising. On the figure below, if you can shift your patient's status from 1 to 2 (right shift), it is safe to proceed your fluid administration, and your patient responds so well with that.

This figure can be accessed from Chest, it is nearly 5 years old, but is an important landmark that you should not miss so that you will not give your patient too much fluid, and keep in mind "less is More" concepts.

Another Video from Chest : severe LV dysfunction

Video : Cardiac function from Chest

Summative evaluation for the 20th Group

Some of these dialogues came from this afternoon session for the summative evaluation by the medical students of the group 20th.

Med Student5: I am nervous and excited all the time especially when I have to do new thing at the very first time.
501: Relax a bit, all new things or the first can happen every single day.

MS5: Learning by simulation is good, have a chance to think, although my ideas can be formed, but I am not sure whether or not my opinion is right.
501: Good, you can think, however, just think and keep it in your head or your mind is not enough, you have to express out and share with others, don't ask can mean either you know it so well or it shows that you are not interested in the topic being discussed. Don't forget the policy "don't ask, don't tell". Everyone who receives your question would be definitely happy, because when you ask, you have to learn something or must know something, and then you have processed your ideas and form a final question out from your brain. It is an essential skill for your generation, the 21st Century skill.

MS5: Would love to have more than one session of the Sim Based Learning, because it is a very good way to learn, is it possible that we can have an examination with this method?
501: You do have to omit three lectures, so that we can have some more vacant space to accommodate another simulation teaching, let us know which lectures  you would like to get rid of. We in this department have waited for a big move forwards from other departments which have more time to teach you especially the department who has more than six weeks working with you, there should be at least three classes of simulation during your study. We have been waiting and still waiting to see major departments start their real high fidelity simulation class like ours which has only 10 days or just 8 days and a half to spend with you.

For the examination or assessment with SBL is a very expensive one and have to invest in the time being with  you, indeed it is a very good way for examination, but you may need a 3-hour period just for a group of 10 for three stations. It has to be done by the faculty policy.

501: What's about preoperative evaluation and preparation? we have been told not to teach you this area, because you have been taught a lot! during your surgical rotation.
MS5: Indeed, we have been lectured about the preoperative evaluation, but it may be theoretical not in the practical way. Co-existing diseases have never been discussed during the rotation especially when the patient has multiple drug therapy such as for management of hypertension, we have no ideas about which one to continue or which should be discontinued. It is also the problem of medical patients, we have never been taught about if our patient need an operation what we should do next on our patient in the continuous care.

It is the Water Sport Day ^.^

The department has been assigned the Orange, and we have done our best to participate this event with smile. It is just one day or once a year for this competition.

Professor Jariya Lertarkayamanee is the department chair person and she was there with us, and she has been assigned to award the medals to the winners too. Thanks for being with us.

g

As for the relay team our girl can do it.