VENTING YOUR FRUSTRATIONS – Dr Stacy Turner
Hamilton Ventilator Simulator: https://www.hamilton-medical.com/
take away points:
low pressure, low volume
optimise expiratory time if obstructive pathology
titrate FiO2 (88-95%), then adjust PEEP to FiO2
trouble shooting:
check compliance/resistance
MV depends on the patient – if awake patient has higher RR (eg: DKA, sepsis), need to raise RR to normalise pCO2 to awake patient compensation
set alarms to AUTO, check peak pressure set to “40”
“Deterioating patient” algorithm
TAKOTSUBO TRICKS – Dr Ross McNaught
Stress induced cardiomyopathy with normal coronary arteries – emotional stress, sepsis, respiratory failure
Usually completely recovers in weeks to months, may recur
Pathophysiology – catecholamine excess
Atypical features – no chest pain
ECG shows ST elevation, anterior leads
Echo – most common is left ventricular “ballooning” and apical hypokinesis
Consider concurrent LVOT: AVOID inotropes
b-blockers
fluid resuscitation
Restraint with Restraints
Medical duty of care – restraints required to complete medical responsibilities safely
RED form
Mental Health Act forms – must notify on-call psychiatrist
Document forms + in patient notes, maximal time for medical review is 4 hours – review of restraints must also be documented on forms and in notes
“Consent” – must inform patient or next-of-kin of use of restraints, document “consent” or why obtaining consent was inappropriate