Tag: Terence Yuen

Medicine and Gardening

As a junior doctor, choosing a career path can be difficult. We all have differing priorities and desires, and ultimately, we are all different people. One danger of this time in our careers, is drifting into a state of inertia.

Although this may seem harmless at the time, the ongoing effects of this state can take hold and continue to affect our development as doctors for years to come.

Like plants, our careers are either busy growing, or busy dying. It goes without saying, that we should aim to grow. Like plants, this growth can be small and gradual, and imperceptible to the eye day to day, but over time, we see the benefits of a growth approach.

The slides below provide a visual representation of the elements essential to ongoing growth.

So, ask yourself: What makes you grow?



Non-invasive ventilation – basics

Presented below is Dr Terence Yuen’s presentation on the basics of non-invasive ventilation (NIV) which was deferred from March 16th 2016.



Also consider this brief troubleshooting guide from Life in the Fast Lane:




Please also see these relevant Western Health policies:

Guideline for Non Invasive Ventilation (NIV) in the Cardiac Care Unit (CCU) – last review September 2012

fine print of note:

  • other contraindications listed in the policy include
    • upper airway obstruction from foreign body (intervention required clearly different)
    • chronic restrictive lung disease (consider pressures and alarms, also check for limitations of treatment)
    • unilateral lung disease (undefined in policy)
    • Raised intracranial pressure
    • Pre-existing hyperinflation (unsure if this means asthma and obstructive lung disease)
    • Compromised cardiac output related to hypovolaemia (NIV may still be a necessary intervention with other adjuncts eg. fluid / inotropes)
    • Patients who have had a Fontan Procedure performed (a paediatric cardiac procedure for congenital cyanotic disease)
    • Normal lungs (presumably a trigger to consider alternative diagnosis other than APO)

Admission and Discharge to the Intermediate Respiratory Care Unit (IRCU) – last review May 2010

fine print of note:

  • re: NIV, other than patients with COPD and type 2 respiratory failure, IRCU will also admit (if indicated) patients with
    • obstructive sleep apnoea
    • non-respiratory conditions eg. neurological or neuromuscular; consider first however if these patients will require HDU
  • IRCU also accepts patients with non-NIV related issues such as:
    • acute asthma on low-dose adrenaline infusions
    • tracheostomy management
  • IRCU does not accept patients who require invasive monitoring