Tag Archives: obstetrics

Personal reflection – Cognitive bias

Case of acute and evolving intrinsic cord lesion in pregnancy presenting as unusually bizarre, but evolving neurology, referred as ‘cauda equina?’

When faced with an unusual presentation, particularly if it does not fit with anything ever seen before, and even if on probability it is very unlikely to be pathalogical, need to exclude the relevant and not be biased towards preliminary diagnosis planted by others. Consider Bayesian modelling.

Have an open mind and think broader than the problem presented. Is this something that we have neither yet considered nor ever seen before? How to prove/disprove this? Consider safety nets and worst case scenario. Accept uncertainty in an uncommon, undeclared situation rather than over-confidence. Observe evolution over time with multiple snap shots and opinions.

GAT conference take home messages

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
NICE guidelines on trauma
Kirkpatrick model (for simulation)

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.