Category Archives: study day

The Art of Being Brilliant

Take home messages:

  • Make a TO BE list rather than a TO DO list
  • how would the best version of oneself go in to work? – energetic, creative, resilient, positive, confident, upbeat, happy
  • Zig Ziggler
  • Vipassana Vendatta
  • Can choose to be positive vs be a mood hoover
  • Do not moan. ‘get over it’ choose to be positive, be grateful
  • If you did know the answer what would it be? If we were the best team, how would we act?
  • ratio of good/praise to bad/negativity:
    • 1:1 high risk
    • 2:1 at risk
    • 3:1 – minimum for good relationship
    • 6:1 – high performing team
    • 8:1 – children
  • 1st FOUR MINUTES = be the best self.
  • Reframing positively e.g. ‘was it good, great or amazing?’
  • Appreciative enquiry – meeting and discussing what went WELL

Andrew Cope

The Art of Being Brilliant – mentoring update

@beingbrillaint

Anaesthesia for the obese patient

Beware of:

‘Apple’ fat distribution (central obesity)

Metabolic syndrome (3 of central obesity, hyper-tension, cholesterol, sugars, lipids)

 

Tips:

Pre-op: STOPBANG >5 = high risk of disordered breathing/OSA

AR: Consider test dose of 50mcg fentanyl pre-induction for sensitivity for opioids

RSI: No evidence

Drug dosing: Ideally use LBW. Practically IBW + few kg. For all drugs except suxamethonium and neostigmine

Position: Reverse trendelenburg with pillow under shoulders for tragus above sternum, rather than break in the bed

Extubation: consider NPA with lidocaine

Post-op: avoid ‘tying’ to the bed e.g. with a-line, infusions

 

GAT conference take home messages

Tips:
Give IM atropine with IM sux
In obese O2 consumption is significantly greater during SV rather than IPPV
Epidural blood patch recommend 20ml
Dural puncture: inject 20ml normal saline down intrathecal catheter
NSAIDs may affect  platelets and clot strength of EBP
In difficult airway consider nasendoscopy.
AFOI topicalise. Reduce secretions by suction catheter or Yanker (also tests topicalisation)
Legal position: Prudent doctor  -> prudent patient
Coding – appropriately – gets the organisation appropriate money
Quality measures – e.g. length of stay
How to add value ? Outcome or quality / cost
In a report, if used a guideline say so
Detail discussions with patients, including apologies
References to read/watch/review:
‘Perfect storm NHS funding’
Cardiac arrest in neurosurgery patients

Cliff Reid YouTube videos
DOLS
NICE guidelines on trauma
BATLS, ATACC course
Kirkpatrick model (for simulation)

Age Anaesthesia Meeting

Take home messages:

In the elderly, hypotension is BAD. Keep MAP>55 and systolic no more than 10% less than baseline systolic. Consider running pressor infusion c.f. obstetric spinals

Always consider regional, BIS, no/less opioids (though not at expense of adequate analgesia)

Consider heavy prilocaine for hips & knee – if surgeon is experienced/quick

Oxycodone > morphine

Predict and treat delirium. HELP principles. Might be context specific therefore do better in own home. Involve geriatricians.

New anticoagulants – ideally need 73 hours but is balance of risk (given that mortality with #NOF increases per day)

Prehabilitation (exercise!). Not just walking. Remember strength training (stand from siting) and balance (stand on one leg with eyes closed)

EPOCH take home themes: data = power, engage and involve everybody, have a systems thinking approach, develop leadership & project management skills

Use frailty scoring systems e.g. Edmonton Frail Score

Take-home messages from Maternal Critical Care study day

Pregnant women have lower oncotic pressure so have a lower threshold for pulmonary oedema.

TTP. Do not give platelets. Femoral vascath & plasma exchange.

Placental abruption. Causes DIC so give blood products early and aggressively.

To do regional in bleeding diathesis? If diathesis is corrected then its fine.

Renal disease in pregnancy:

  • In pregnancy normal values are Cr 50/Ur 3.3 (compared to 70/4)
  • Treat the cause
  • Avoid NSAIDs/toxins
  • Keep on dry side (as pul oedema is worse than AKI)
  • Talk to nephrologist
  • Hypertensives do worse than normotensives

Cannot bronchi down a size 7.0 ETT so use a larger size if possible.