art lines

There are lots of ill patients at the Austin, and giving anaesthesia to an ill patient always equals to an art line. Am I right? probably not.

There only several conditions in which an art line is absolutely mandatory, meaning you would put your heart and souls into getting one and will resort to desperate and brutal means of acquiring one and may even cancel the case if there is no art line.

These are in no particular order:

1.Liver transplants
2.Cerebral aneurysm surgery
3.Elective cardiac surgery
4.Carotid endarterectomies under GA
5.Carcinoid tumor resection and Pheochromocytoma resection.
6.Big people where a BP cuff wont fit.
7.Burn victims.

There's a whole list of situations where it will be nice to have one, but it will do jack shit for for patients.
There's an even bigger list where we put one as a safety blanket.

There's also a list of surgeries where we have no business doing an art line until (ironically) the patient is safe:

1.Hypotensive shock
2.In an actively bleeding patient
3.In a hypoxic patient
4. In an obtunded patient with raised ICP.
5. In awake, poor frightened patients going for cardiac surgery.

In bleeding patients, shocked, hyotensive patients we should try to keep them alive. When, a second pair of hands arrive, then second pair should help us keep the patient alive. When a third pair of hands arrive, that third pair should help keep patients alive.

There are thousands of things to check:
-enough crystalloids
-enough colloids
-do we need blood
-do we need products
-acidotic? -do we need a NaHCO3 solution to catch up?-no we dont an art line to dram blood sample!
-are we behind calcium
-does someone need to start an antifibrolytic
-is it time to organize the level one?
-is the patient freezing? can we do more-ask surgeon to apply warm packs? increase bair hugger temp, wrap his whole neck and head up, blah, blah,blah

our first duty is to the patient. when we sort out all this, then we can then make our monitering screen look pretty with an art line waveform. And it DOES look impressive, regardless of the sorry state of the patients BP!


What do we do when (gasp!) we dont have an art line?
use the NIBP cuff, ECG, watch the etCO2 to gauge cardiac output, watch urine output, CVP, pulse oxi waveform, and yes i know its crude and unscientific, but, believe it or not, we can actually PALPATE the brachial an carotid pulse and resusitate accordingly.

I am not against artlines, and would have hundreds. Its just that there's a time and place for everything.

First post 2012

My time at Western Health really flew. I have never known time to fly so fast. There is also talk about my a ten year reunion amongs my medical school friends. A whole decade!
Little Dahathri went for a tumor resection in his tongue. We are still waiting with fingers on the results. But I somehow feel everything will be fine. I obviously didn't do anything very clever, or design them in such a way, but all my kids are extremely durable. They will pull through most things in life.
I am sad to leave so many friends behind at Western, but it was immensely gratifying to work with such a great bunch. They are not the type to shower praise easily and I was extremely pleased with their opinion of me. They also did a lot for my little one!
The Austin is a larger setup then Western with more complex cases, and already the specialist seem to have a certain degree of confidense in me.
Back to hitting the books for now.

just moved into my new house. its nice and comfortable and the kids and wife really love it. mafeitz is having a wonderfull time here.

sometimes, i wonder if i bit off more than I can chew.....different country, new workplace, new home, formal project, exams.....

but then again, i have been struggling for such a long time, that if i get things my way i probably wont know what to do!

mafeitz landed in Australia yesterday. He's in Perth, technically, he much closer to KL than he is to Melbourne. getting somewhere with organizing stuff in my life. I think..my new ipad might help a bit.
Happy I got a five star rated review from my bosses during assessment time.
checking out for now.

the season is starting to change. the days are getting slightly longer and warmer, quite an interesting. studies are slow and i am not exactly in one of my most productive and progressive times. there are several important things to get done and i intend to get them organized soon. or maybe i just need a break....

new updates

for the first time in my life, I chickened out of an exam.....

went on a motor home tour with the family. we toured the great ocean road with the family, went to the grampians, halls gap, ballarat and back. took a whole week. wife and I were exhausted but it was a good experience and the kids loved it.

just came back from the mount baw-baw. it was snowing and we went toboganing. Shastri and Ardithya look like they had been born into the snow. Wife felt a little cold and retired to the heated for most of the trip....

BACK AT LAST

At last I managed to get my blog back! I had some major issues accessing it and never set down to resolve them.

Melbourne and my work has been treating me well. My consultants and supervisors and mentor had been very kind and accommodating. They were also happy that I seemed to settle down well.

I initially had a confidence issue. I am now out of my playground, in a developed country and clearly out of my comfort zone. I slowly learned that working in busy Malaysian hospitals has prepared well for working here. I am also more on my toes.

Workouts are fairly regular and I am nearly as strong as I was in early twenties!

The baby is a giant! Wife and I think he is even bigger than the oversize Shastri. He's only six months but is well the 15kg range, and he's not a chubby kid. Just a big, long guy. He's learning to cruise and can really scream! He screams and screams in anger whenever he doesn't get what he wants.

Shastri is still the tallest in his class, and sounding more and more like an Aussie everyday. Ardithya is his quiet self, he really smart and independent and really doesn't kick up a fuss or trouble anyone.

Wife is busy, but coping well and even started gym sessions.

All of us are into wildlife and we have visited the Melbourne Zoo, and two open range zoo's.

There was unexpected bad news, Dr.Maslina died suddenly. Shocker!

Some memories. Shukor's one year passing came and went....

Friends (except for good old Sam) made in through the finals. Sam will make it the next time. Happy for them. Well thats's not entirely true. One or two raise great concerns as future anaesthetist. I am kind of worried as most of my family is based in KL and should any need surgery, I really wouldn't want these odd characters floating around. Anyone reading this blog will have no trouble in listing them down....Well there are plenty of good up and coming anaesthetist amongs my friends and the odds of my family being anesthetized by these odd ones are as rare being struck by lightning, I think!