I recently submitted a “Letter to the Editor” of the BJA in response to the clever study by Zhong and colleagues demonstrating that the use of high fresh gas flows (FGF) during TIVA produces a cost-saving with, importantly, no adverse environmental consequences. My letter was responding to their conclusion regarding the impact of high FGFs on humidification of inhaled gases, and specifically the issue of heat and moisture exchangers (HMEs).
The letter was edited and shortened significantly during the review process, so much so that I felt some important discussion around a commonly misunderstood device was missing. The published letter is now available here, but I felt it might be helpful to make the full text of the original letter (with some minor corrections) publicly available, so I have presented it below.
Continue reading “Fresh Gas Flows, Filters, HMEs and Humidification”
Juno recently released a TGA-approved pre-filled syringe containing metaraminol. However, not long after release, multiple issues were identified by anaesthetists who were using them. There was a fair bit of discussion and sharing of information and experiences on Twitter, and many anaesthetists have stopped using them, and some hospitals have now withdrawn them. Several people have contacted me regarding the syringes, and I thought I would aggregate some of the information I’ve collected in one place to make it easy for people to access it if they want to.
Continue reading “Juno Pre-filled Syringes”
Edit: Obviously many of the Twitter links are now broken. Apologies, and I will try to rectify it as soon as I get a chance.
This is where I’ll be picking my way through all the dirty #DudScrubs laundry. Tighten those side-ties, because there’s a lot to get through!
For an explanation of what #DudScrubs is all about, read my more detailed post on it here.
Below I’ve started organising the various tweets into different categories to make them easier to find, and because different aspects may be of more interest or importance to different people. But I think it is the overall picture that makes the case for change so compelling, and that hospitals need to sit up, take notice, and start asking their staff what they can do to make their scrub provisioning system more fit-for-purpose. Continue reading “Sorting the #DudScrubs Laundry”
An unavoidable part of working in operating theatres is the requirement to wear what is formally known as “Perioperative Attire”, but casually known as “scrubs”. While the term “scrubs” is now used to refer to similar clothing worn anywhere in the hospital, the primary purpose of theatre scrubs is to reduce the introduction of environmental pathogens into the theatre environment, thereby reducing the incidence of surgical site infections. Most hospitals require staff to wear scrubs supplied and laundered by the hospital. So essentially, scrubs are a mandatory workplace uniform, supplied by the hospital, to be worn by staff to improve patient outcomes.
Continue reading “It’s Time to #ScrubOut #DudScrubs”
I spent three months at the end of 2012 working in Suva, Fiji as the ASA Pacific Fellow, which was a position they created and funded in order to help prepare anaesthetic trainees for their exams. At the end of the stay I wrote a short piece describing some of the practical aspects of living there with my young family, in case it proved helpful to other Fellows that came after me. I thought I’d re-post here for similar reasons, but also as an historical snapshot as a significant part of my medical career that has had a lasting impact on me and my family. Fiji is a strategic hub for training doctors working all around the South Pacific, so if you get the chance to contribute in some way, I highly recommend you do.
Continue reading “Day-to-Day Living in Suva c.2012”
Part of my job as an Anaesthesia Quality and Safety Fellow is to monitor reports made though our Anaesthesia Safety Monitoring Project, which allows staff to report latent safety threats, near-misses, faulty or badly designed equipment and pretty much anything that might pose a threat to patient safety. Below is the text of a “Letter to the Editor” that I wrote explaining how we were able to quickly and cheaply respond to an issue highlighted by one of these reports. The letter was published in the Canadian Journal of Anesthesia, and it can be accessed here (login required) or viewed online here by anyone.
Continue reading “A Purple Patch for a Power Problem”
I was deeply saddened to hear of the passing of Professor Geoff Cutfield earlier this year. He’s had a lasting impact on me as a doctor, anaesthetist and a human being. Following his death, people who were unable to make the funeral in New Zealand were given the opportunity to provide something to be read out at the service to help celebrate the phenomenal life he lead. Below is my contribution to that celebration.
Continue reading “Vale Professor Geoff Cutfield”
I occasionally give some tutorials to anaesthetic trainees sitting the ANZCA Primary Exam. I thought it would be worth collecting some of the resources I use into one location so that I can provide a link for pre-reading, revision etc, but also in case anyone else outside my hospital network might find them useful. I may well add additional content and links to post over time, so it may be worth checking in again at some point.
Click here to go straight to the tutorial resources.
Continue reading “ANZCA Primary Exam Tutorials & Resources”
Take a look at the image below and see if you can spot the differences between these two IV giving sets:
Maybe the packaging will help?
How did you go? There are actually a few differences between them, but there is one in particular that I am interested in, and you should be too. Can you guess which one it is? Yes, that little white bit circled in red is what’s called a “one-way”, “back check” or just “check” valve. As the name suggests it ensures fluid in the line can only move one-way i.e. from the IV fluid bag and into the patient. This valve is there so that if you are running a secondary infusion it will flow into the patient, rather than back up the primary line and into the fluid bag. A visual representation of what this valve does can be seen in this video:
Continue reading “Valvular Insufficiency”
In recent months the “Theatre Cap Challenge” has been picking up steam on Twitter & has had significant coverage on mainstream media as well. In case you’re wondering what all the fuss is about, you can check out my video in this post or check out the twitter feed below.
While it’s been great seeing this initiative gain momentum, it seems that a significant number of people are hitting a hurdle in adopting it because their hospital doesn’t allow reusable cloth caps citing infection control concerns. In Australia, the ACORN standard is usually cited as the reason for not allowing them, though not all hospitals are interpreting the standard in the same way, and the standard itself allows individual hospitals to develop their own policy on cloth caps.
Continue reading “A Challenge to Cloth Theatre Caps”