Another round of Gen Med

I almost made a major major mistake today.

A fever and a rash and a headache. How can I, as a medical registrar, say it’s not meningitis without having a lumbar puncture?

Didn’t really matter if she’s been febrile at the subacute site for the last 48 hours.

The abnormal liver function test was a red herring, well, almost.

Saved by the LP that was clear. Otherwise, it would be a contact tracing for possibly hundreds of people.

Another lesson learnt.

Just when you thought you are doing well, particularly, as an experienced (i.e. failed RACP exam) medical registrar.

Shall keep that in another locker in my brain.

“Gen Med is very simple. There are always three issues with each patients. One, the reason they come in. Two, the reason they still have to be an inpatient. Three, the reason preventing them from their discharge destination”


Anesthetic words of wisdoms

Thanks to Jellio I went looking for the book “How to survive in anaesthesia: A guide for trainees” by Neville Robinson and George Hall. Just a couple to add to her list 🙂

Never start ananaesthetic until youhave seen the whites of the surgeon’s eyes.

Always pee before starting a list.

If you are feeling tired the three ‘S’s’ is a good reviver – a shit, a shave and a shower (politically incorrect but we do not know the female equivalent).

ABC of anaesthesia: always be cool, always be cocky!

Remember KISS – Keep It Simple, Stupid.

Anaesthesia is ‘awfully simple’ but when it goes wrong is ‘simply awful’.

If in doubt, ask for help. There is no place for arrogance in anaesthesia.

Big syringe, little syringe, white knob, blue knob, big purple knob – good for most things.

First rule of anaesthesia, if there is a chair in theatre, sit on it.

Never panic. This applies particularly when the patient is trying to die and you have no idea why.

Where there is cyanosis there is life – just!

If in doubt, take it out. This applies to tracheal tubes and many other things in life!

There are three things to respect in anaesthesia: the airway, the airway and the airway.

When all else fails, disconnect the catheter mount and blow down the tracheal tube.

Careless ‘torque’ costs lives – don’t let breathing tubes kink.

The laryngoscope is a tongue retractor, not a tooth extractor.

Nobody dies from failure to intubate the larynx, they die from failure to ventilate and oxygenate.

Fix tracheal tubes as if your life depended on it – the patient’s life does!

The first five causes of sudden hypoxia in an intubated, ventilated patientare the tube, the tube, the tube, the tube and finally the tube. The tracheal tube may be dislodged, disconnected, blocked, kinked or the cuff herniated.

‘Sniffing the morning air’ position for tracheal intubation can be described as the position of the head when taking the first sip from a pint of beer.

Never say to the patient ‘just a little prick’ before inserting a cannula, you are likely to be told that is exactly what you are!

Thiopentone solution can look like augmentin and antibiotics do not induce anaesthesia.

For a rapid sequence induction always have two doses of suxamethonium ready in case one goes over the floor/ceiling etc.

Be professional – try to emulate Humphrey Bogart’s definition of a professional as somebody who can still give their best performance when they feel least like it!