Should Reach 3000 Hit Tonight ^___^

It took nearly 2 years to reach the readers of this blog for the first 1000 hits, then it took another two-month period for the second thousand hits.

I expect that by the end of the day here in Bangkok, There must be more than 3000 hits which is approximate a month time from the second thousand hit in August.

Keep on posting, keep on reading, however the thing we can improve this blog is how I can get some feedbacks from the readers, speak out something share your ideas so we can discuss on this blog.

Thank you for visiting this blog and hope you all enjoy the show.

More Photo from Simulation Teaching Room

From the CCTV camera we have two different angles so that we can earn the upper and middle photo which were quite close for the sequences happened at the scene.

In this last photo was in the nearly ended period of the session, we were talking about what went wrong and unnoticed by our students, and of course what they have learned which was the most important part of this learning method.

More photo of the same date of the scenerio or more in the past, turn to our Facebook page, ABC.

Simulation For 5th Year Medical Students

We teach our beloved medical students for a year now, and this is the most recent photo taken from our brand new CCTV inside the room.

Wait and Stay tuned, more photo to come from the recorded video.

Summative Evaluation : from Group 14/ 2555

At the end of two week rotation for the fifth year medical students to our Anesthesiology Department, we always ask them what we can improve to better serve them and any defects we can get rid of. Yesterday, Friday 14th Sept, 2555, we asked this 14th group about what they can get from our department with their two hands and anything they would suggest us.

They were mostly happy with the rotation that we really hope that they should feel that way. We cannot help them much about to become competent because the time would be definitely too short and the experience for each student would not be adequate for them to become an expert, they must keep on practising wherever the chance arrives. We teach them just the very first step, they need to find their own ways to practise more.

We are also happy that they knew more what we actually do each day in the operating theatre, one student mentioned about her understanding about the anaesthesia record, actually it is an essential document because the anaesthesia team would record the important event happened in the theatre, sometimes about the medications given in the OR so that the surgical team would make their appropriate decision about when the next dose would be.

Some students mentioned about their good time learning in the simulation means, we asked them whether or not it was worth trading their important working in the theatre to learning in the simulation lab, they all agreed that it was definitely worth doing so, because they were trading a hand skill learning with real patient to learning with the machine and most students aimed to learn about airway management skills with us. We have a hope that bigger departments would soon start their teaching with the Simulation means, a year has passed, we have not yet seen any move.

They told us that they understand more about preoperative evaluation and preparation, we hope that they can apply this principles to other rotations in their patient care.

Thank you so much for their comments, good luck and good bye.

Complications from Regional Anaesthesia

Indeed regional anaesthesia can harm your patient as well as general anaesthetics, however, it will depend on the technique employed and patients' conditions. Sometimes choosing the best appropriate choice between GA and RA is done because of the patients' conditions and anticipation which one would harm the patient more, and sometimes RA could lead to complications.

First of all we have to learn and know about the agent utilised for the regional or local application, so you can  beware what to look for such as systemic toxicity can present with CNS or seizures or with the cardiac or Ventricular tachycardia/fibrillation or even cardiac arrest.

Then we have review the route of drug administration; epidural, spinal, caudal or just peripheral nerve blockade, because each inject site will lead to its own subsequences.

The Thai Medical Council now just recommends new medical graduates to know just the technique and know just this is RA, do not have to perform this, but it asks everyone to be able to perform lumbar puncture but no need for spinal/ intrathecal anaesthesia.

Sepsis : Anaesthetics Management

There was a patient presenting to us for his source control procedure, he had an infected dry gangrene of his toe. He has diabetes, hypertension, end-staged renal disease and peripheral vascular disease, he receives regular haemodialysis for nearly two months now. His baseline creatinine was somewhere around 2 mg/dl, but after he developed congestive heart failure, respiratory failure requiring an ICU admission, his creatinine rose to 6 mg/dl, and has a double lumen catheter for regular haemodialysis.

When he was scheduled for toe amputation, he may also had the problem of hospital acquired pneumonia, the temperature in the prep area was 38.8C, the heart rate of more than 120/min, his blood pressure was quite all right, but he had oxygen saturation with room air at 93-95%. He appeared to be drowsy however he could respond to verbal command.

When he was at the operating theatre prep area, the nurse at the waiting area told you that he had just been dialysed and was sent from there.

What are your anaesthetic considerations for this man?

His anaesthetic management is just right here;

Sepsis

The meaning of sepsis syndrome has to be learned, one has to remember that sometimes it happens before surgery or as a cause brought our patients to us, or it can occur in the perioperative care pathway as complications.

Sepsis is the combined SIRS with Infection, therefore when you receive a septic patient transferred to you it seems to be a source of infection somewhere in his/her body, it can be that surgical cause such as peritonitis from hollow viscus perforation or as complications such as hospital acquired pneumonia. While SIRS (Systemic Inflammatory Response Syndrome) is comprised of 4 items, there are tachycardia, fever or hypothermia, tachypnea or respiratory alkalosis, and leukopenia or leukocytosis. However, you have to search for more detials of each content about the number for each criteria.

Giving anaesthetics to these challenging patients is also a challenge for anaesthetists, you have many things to do in the intraoperative period, anticipate the problems that may occur on the operating table, and plan wisely for the postoperative course.