Foto from our FB

Three photos shown here are recently posted on our facebook page, so you can find more details of each event there.

The upper most one was about we just began to keep our students away during the examination. The middle photo was about the cannot intubate crisis, the one who finally put the tube in place was our ex-chairman for our department, there were two professors there within the room. While the last photo we discussed about rapid sequence induction with cricoid pressure, and manual in line cervical stabilisation in an unfortunate guy with previous treacheal resection

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Crisis management in Anaesthetics

When you have put your patients under anaesthetics adventure, you have to realise what priority after anaesthetics induction you have to do further more. You may need to monitor the blood pressure after the induction dose is given which may reduce the systolic blood pressure, therefore, you must have vigilance to anticipate what may come up next, let the more important things be on your watch lists so that you would not lose your patient contact and delay in your patient management.

In an anaesthetics for a grandpa for robotic surgery, you knew that he was a big guy, so you have to prepare for adequate ventilation support after a successful endotracheal intubation, you can definitely preset your ventilator setting, so that you can switch it on when the time comes. Instead of looking at your patient response to ventilator setting, one was busy in an IV cannulation while the other one was concentrated on more monitoring probes, so it took seven minutes to detect that your patient was hypoventilated and the first response was just after that time point.

What you think??

You have successfully given spinal anaesthetics for a mom-to-be, everything went well and smooth, after a delivery you gave some med to promote uterine contraction, and then antibiotics prophylaxis for her.
You still observed the paedritician taking care for the newborn, it was quite longer than expected, then he came towards your patient telling her that her NB was in need of closed neonatal care because of respiratory difficulty.

So, can you explain what has happened in this scene for a poor newborn?

NPO time

You picked up a call, it told you that at the MRI suite there was an uncooperative lady waiting for you. She had something in her head, and the MRI technician mentioned about the follow up scan to evaluate the patient's prognosis. You hurried, you ran, you walked very fast to be there as soon as possible. When you arrived there, the technician told you that the patient had dinner approximately two hours ago.

So, what you are going to tell her daughter who is actually anxious about her mom's condition? and would you proceed the procedure as plan or just run away?

After had a provisional diagnosis of Septic shock, a med student would manage something with higher priority first,,,,
1. hypovolaemia with rapid fluid loading with balanced salt solution then re-evaluate the response together with data gathering from patients' relatives
2. full PE : conscious, pulse, pulse pressure, RR, airway, ventilator adjustment, JVP for volume status, then re-evaluate again, if the patient is still unstable, give another fluid loading with vasopressor
3. closed observe, continuous ECG monitoring, control fever

how many stars you would give to this student???

an Essay response from a med student about patient care after GA with a tube: he says,,,,,,,,,,,
1. evaluate conscious, verbal command, stable vital signs, regular RR, tidal volume, airway reflexes, muscle power, oxygenation
2. if all above are good then extubate, and transfer to PACU area to observe for conscious, oxygenation, ventilation, haemodynamics, complications (nausea, vomit, pruritus) and pain control
3. use aldrete score for discharge criteria, and advise about self care for OPD or send patient back to ward with good pain control

good, isn't it?

A survived mode not Fighting mode

In the morning we discussed about the curriculum of Anaesthetics for medical students in another university in Bangkok, we had been informed that those students in that particular school would have a 4 week time slot, three weeks for the skills practice in the operating theatres, and one more week for the surgical critical care service teaching. Compared to our school which is focusing on preoperative evaluation and preparation with only an hour for SICU topic.

That has brought us a flashback when we were informed by the department chairperson that from now on we would have only two weeks for med students, not as three weeks, she just told us after she had promised the dean that we would be able to teach our students in a two-week slot, so we just a good follower, when our boss just gave a nod, we did have to do so. The curriculum has been five years old now with only two weeks, with a minor change nearly 2 years when a simulation was introduced to this course, we did not fight back after we have found out that it is a worldwide trend at the time from Ottawa to Melbourne just a two week slot. Although we have time with them only two weeks, but we are not the least, many schools in the kingdom do not have their anesthesiology grade on their student transcripts any more.

In the school with have a week longer into four weeks, we supposed that their faculties have united and fought back and realised what would be beneficial to their students. We will update this when we have more details, but for sure the mode between us and them is indeed totally different.

Bangkok Judgement Day

An election for the mayor of Bangkok happened here today with the unexpected rain shower in the hot winter time.

Independent candidates need to do more to get a nod from a bangkokian.