It is on our ABC

It is quite inactive blog for a while, but we are frequently posting on the facebook page. On that page, we have asked for comments from our readers. So, if you are interested in anaesthetics, we are still there, however, we are still here too.

ABC

Shared Airway

We have posted about shared airway between surgical team and anaesthetic team before, but today it was about a share between our team and the dentist!

In order to promote grow in children with difficulty eating/ swallowing, they must pass through this.

enjoy

Teachers' Day

Today Jan 16th, here in the Kingdom we cerebrate the Teachers' day, some schools are closed, some are business as usual. Even the Google web page still runs a special event for this occasion.

As a medical teacher, I would say that I never ever need a smart with high score ranked students or residents, but I would be proud when they are good guys or gals, do everything right not cheated, not selfish, with their best quality heart.

The link below is a music video on youtube about this special day. Enjoy...
A Reward for Teacher

Fibreoptic Assisted Endotracheal Intubation II

The previous post that I mentioned that I cannot upload the video, so i tried a new means of doing it, upload vial the Google+.

So, it you are interested in the real event happened at the operating theatre, please move to the G+ link to the clip below.

enjoy

The Original Clip

Scoring an ESSAY

A MedStudent Response to an ESSAY about an aged man with anemia and colonic mass

1. Hypochromic microcytic anemia is likely iron deficiency from lower GI bleeding. The consequences of anemia is reduced oxygen content leading to hypoxaemia which will stimulate the peripheral chemoreceptor and sympathetic system to increase the work of breathing, and stimulate the CVS to increase cardiac output to increase tissue oxygenation and myocardial oxygen demand.
Therefore, we have to concern hypoxia and myocardial ischaemia during his anaesthetics

2. An ageing man: look for his hidden underlying diseases; DM, hypertension, with lower metabolic rate and reduced renal function would affect the motabolism and drug excretion, and prone to drug toxicity

3. Colonic mass : the mass could affect peristalsis, bowel function, increase the risk of delayed gastric emptying then prone to pulmonary aspiration, delayed feeding in postoperative period and malnutrition

Great, isn't it?

Fibreoptic Assisted Endotracheal Intubation

What I tried to add the original video clip for the anaesthetic management for this patient, but I cannot do it, may be the size of the original one is so large that it will never happen in the blogger, so i did try to repost it with the utilisation of my not smart phone.

You have to differentiate the plan in airway management especially the expected difficult airway, when the plan is organised for a known difficult airway, the scene will be smooth as silk if the essential airway devices are in position and ready to be used. In the other way round, the unexpected difficult airway is usually problematic and can induce a chaos if you cannot help ventilate your patient 's lungs. In this video, the patient was an employee of the Electricity Generating authority, when he was injured, it caused him scar contracture which can reduce the airway motion and create a difficult airway to challenge anaethetist in charge of him.

Can't help with the quality of the clip, but it is better than nothing...

A review of Anatomy: Vid clip w/o Sounds

It is a post to remind you about preoperative evaluation in your patient, with modern technology you do have to review the film by yourself so that you can learn something about it. You may read the report of any imaging studies by the radiologists, but after that reading you should get back to the plain film or slide to identify where the pathology is hidden.

For this video clip, what you can learn from it? After you have evaluated the patient, then you can make your plan how to manage the patient's airway, what you can do and cannot do to help him/her.

enjoy....

Teachable Moment : Seize it or Lose it!!

Working with medical students can initiate some ideas what to teach them or educate them, because some time we do not know what should be the first lesson of the day. Getting some good questions from what they have observed during their friend was practicing can be a good start of the day, yeah indeed, some questions are good to talk about and pay more time on it, it really depends on the consultant whether they can catch this teachable moment or not.

For example: the Lesson of pre-emptive analgesia
Med Student : Why the surgeon has to infiltrate the local anaesthetics before her incision? we have put our patient in to general anaesthetics, haven't we?
501: Indeed, we induced our patient to deep GA. What do you think about the benefits of LA in this patient?
MS : It helps prevent blood loss.
501 : Really, it creates vasodilatation, doesn't it?
MS : But, it was mixed with adrenaline.
501: Oh, I see. Any more benefits and how it works?, you can use and search via your smart-phone.
MS : It inhibits the Na channels.
501 : So, this is physiology and pharmacology, remember that I told you before that nothing new has been discussed here. Although you have administered GA to your patient, but you have to realise that the nerve ending and nerve conduction pathways are still intact, so that the pain induced from the surgical procedure can be transmitted to the brain. Have you recalled anything about nerve conduction pathway, the spino-thalamic tract?
MS : yes.
501 : This will be emphasised again in pain lecture. If you inject the LA in pre-incisional time, the result is much better than post-incisional period. Prevent is better than Cure!

.... Some discussion were on and on, Stay Tuned

From Google+

Have time to find out during your private time, think, consider and then reflect out whether or not you are satisfied with it.

Have a Look Here

A new way of learning by a new Mind

Working with med students today was fun, and pointed them about the way of anaesthesia education by looking things in an integration way, instead of thinking of anaesthesia rotation as a hand skill learning to do those and these. Explained them, why don't they look that what we are doing in every single day in the operating theatres, in Surgical ICU, in Pain clinic, acute pain services and Pre-anaesthetic clinic is really the things they have been learnt, taught, and practiced for years.

Nothing new has been taught, I am afraid, is what we have discussed in the OR.

It is just Anatomy : when the laryngoscopic view was asked after they just put an endotracheal tube in place, when you just inserted the iv cannula wasn't that Anatomy?, told me where the brachial plexus is? and explain how the spinal cord ends?

It is Physiology : it displays on your monitoring screen, it is really the clinical application of monitoring, from an ECG, oxygen saturation, end-tidal CO2 tension, arterial blood pressure, airway pressure. You have to know what goes on from the surgical side or the other side of the OR border, such as you see an episode of hypoxaemia in a lady who underwent Sentinel Lymph node dissection, can you explain how this happens? Thinking of oxygen-haemoglobin dissociation curve, then apply it in real life, if all your patient have 100 % oxygen saturation, does it really mean that everyone has a really good or perfect lung function?

It is Pharmacology : it is just in our magic box, induction agent, pain killers, or a nail to pin your patient not to move during surgical procedure. In a vascular suite, there was a patient scheduled for vascular access, he does not have any urine for ages, what the first thing reaches your mind right now besides the diagnosis of a plain ESRD. A guy on the table has 4 kinds of antihypertensive agents, so can you explain why he developed hypotensive after an induction dose of propofol and even the endotracheal was placed in his trachea which should have been a painful stimulus.

It is also Pathology : a very closed friend to anaesthetists, we share many similar things, we know everything from head to toe. In the hypertensive guy, can you explain what really happens in hypertensive patient, the SVR, any change in circulating blood volume from normotensive changed to hypertensive patient.

Happy Holiday would be fading away, Welcome your new life with a New Mind-Set.