Today Simulation Class

The climate of learning for today simulation learning in our department was so fun, because the anaesthesia consultant in charge had tried her best for the teaching process. She initiated the thinking process and encouraged the learners to think, although it may be both tricks and treats, but overall the session was good, and we would like to thank you our consultant to make such a good teaching and learning day.

One Medical student Response to an Incident

From a 5th year Med Student response in an essay examination about a nurse call asking you to evaluate and manage a patient with BP 84/50, RR 30, and loss of consciousness, she told you that it was the time to record the patient's vital signs after 1 hour interval in the immediate postoperative period. 

He said :
1. Understand the situation: make a short list of the main problems waiting now: unconscious, hypotension, tachypnoea
2. Gathering an essential information
- more patient history : anything important for a diagnosis
- physical examination : especially the consciousness and the CVS 
3. Make a likely diagnosis: because hypovolaemic shock had to be ruled out then surgical site should be assessed
4. Management to the appropriate diagnosis and re-evaluate again whether or not the treatment given is working

Good, isn't it?

Join us in Japan ? An Abstract submission

JCS 2013 in Yokohama

Anyone fancies going to japan? This cardiovascular event is such a big meeting I ever joined, and the registration fee is quite cheap compared to other headline meeting.

We have submitted an abstract about teaching medical student with simulation in the shock management theme a couple of days ago, will update you later on whether we have a nod by the organising committee to let us share our beginning step ( only a year experience in teaching with simulation ).

If you are interested in the meeting web site, have a click on the uppermost section.

Cardiac Rhythm : Electorcardiogram

We do have to maintain the normal sinus rhythm (NSR), if it is possible or there are some correctable causes. The reason for this may come from the NSR would result in better cardiac filling in the diastolic phase when the heart rate is low, however, when your patient become tachycardic from any cause, the systolic time which is normally fixed and cannot be reduced, the diastolic period will definitely be reduced, then your patient will have shorter time for the heart to relax and result in lower cardiac output due primarily to small stoke volume.

This is also applied to the abnormal atrial contraction rhythm which the normal atrial kick would increase the significant amount of cardiac filling volume, Look at the lower part of the figure: you can learn that in this patient although the heart rate is quite low, Premature Atrial Contraction can cause an absent of adequate output in each abnormal beat on the arterial tracing waveform, We cannot the low blood pressure in the screen, but we can see the obvious lower cardiac output.

24th September is Mahidol Day

On this Special Day, we, the healthcare personnel around the Kingdom will pay the tribute to the Prince Mahidol Na Songkhla who was the King's Father. He was named the Father of Modern Medicine for the Kingdom, because he had done so much to improve of the healthcare services for the ordinary people of his Kingdom.

Besides the Surname of the Royal Family, Mahidol is also recognised for a prestigious health award. There are two disciplines medical service and public health service, the awardees will receive the award in the Royal Grand Palace Hall.

In the morning there will be many health clusters with parade to pay respect to the Prince Mahidol.

Fluid Responsiveness! Less is More...

Every mirror has two faces, so the treatment arm has to be balance with the harm or side effects as well. When we administer our patients the fluid therapy, it is true that when we are facing with the low blood pressure, we would start with fluid management or resuscitation at the very first step. However, sometimes or many times that we are endangering our patients loading them too much fluid, because it is simply as they are not the ones who are responsive to the treatment.

I can recall my experience working at the Surgical ICU, there was a granddad with a history of postoperative bilateral nephrectomy, therefore, he was totally dependent on his regular haemodialysis since he did not have his kidneys any more. We treated him, dried him, when he was presented to us because of  the acute heart failure just within 48 hours of his discharge from our unit, there was a call to bounce him back because an episode of hypotension and the first think the uro residents did was fluid loading.

Fluid input requires the way out as well or Fluid output, when your patient has impair cardiovascular tree, the kidney failure will soon follow. Fluid also moves to where it does not belong, for example the lungs, it would cause impair oxygenation and increase work of breathing, when it moves to skin or muscle it would be very easy to detect because you are increasing your patient's body weight and making tissue oedema. When this bad things happen, it would increase the days your patient would need to stay in the ICU or in the hospital, increasing the risks of infection and ventilator support.

You may require more monitoring technique to differentiate whether or not you should load your patient with fluid therapy, if it is the case that your patient does not deserve it, you don't have to do so.

A recent report about the harm of too much fluid for critically ill neurologic/neurosurgical patients on SCCM page can be accessed here. 

Yesteryear Once More!

During working at the department office we discussed a lot about Competency Based Learning, so we wandered around and I can find some photo I took in Last May (2011/2554) during I attended the Asia Pacific Conference about Simulation in Health Care.

From the Speaker of National University of Singapore, he mentioned about the Competency the new 1st year Anaesthesia Residents should be able to perform after a period of one month can be shown here. The baby MO = Medical Officers.

If you are looking for the previous post about the meeting click here.

Compare to Simulation the traditional way of teaching is....

Student Feedback from SBL.

Debriefing period, and the things that our students should get with them out of the class is indeed the new way of thinking.

What's Simulation? This question was the response from my Department Chair, She really did ask me when I submitted her an article about the way of teaching medical students with this means.