The RURAL DOCTOR UPDATE series is borrowed from fifty shades of brown (KIdocs.org) – a guide of what to do when the shit hits the fan for rural doctors.
The themes are mostly around resuscitation and as such should be of interest to any rural doctors who’s work involves emergency on call.
RURAL DOCTORS UPDATE – BURR HOLES IN THE BUSH [14 mins, 45 secs]
I hooked up with an old classmate from medical school in London, Mr Mark Wilson. Whereas I am a country doctor in rural Australia, Mark is a neurosurgeon and HEMS doctor. Leaving aside his disastrous career trajectory (Mark reckons he is a frustrated rural GP), we chat about the practicalities of performing burr holes in remote environments. After all, it’s not exactly brain surgery, is it!
RURAL DOCTORS UPDATE – DOCTORS BAG [25 mins, 38 secs]
When I started out, I reckon I had enough kit in my bag to do a laparotomy. Nowadays for simple GP home visits and day-to-day stuff, I just carry BP cuff, stethoscope, otoscope, Medicare forms and a MacbookAir for remote log in to clinic to access and record consultation notes and download results.
However for responding to emergencies as part of RERN (Rural Emergency Responder Network) I carry a more extensive kit supplied by SA Ambulance. NB : I do NOT carry a pulse oximeter or ECG/defib – that is carried by the ambulance who will call RERN doctors as backup. If acting as solo or first responder I would suggest investing in a fingertip pulse oximeter as the minimum…
BASIC AIRWAY ADJUNCTS [7 mins, 22 secs]
Maintaining an airway is a core skill of any doctor. This video gives a short talk through the basics including some pearls & pitfalls on oro- and nasopharyngeal airways.
STYLETS & BOUGIES [12 mins, 51 secs]
We all know that simple adjuncts like stylets & bougies are useful when performing intubation. But how well do YOU know to use them? And does your airway assistant have the same mental model of what is needed as you. This video covers concepts such as optimal ‘straight-to-cuff’ stylet shape, use of the bougie including the ‘Kiwi’ or ‘pistol’ grip and oxygenating bougies such as the Frova.
LARYNGEAL MASK AIRWAYS – UPDATE [12 mins, 13 secs]
LMAs have come along a long way since the Archie Brain classic LMA. Useful to maintain an airway when unable to intubate, the LMA has become a mainstay. This video discusses second generation devices such as the Supreme LMA and explores pros/cons of intubating LMAs – specifically the FastTrach iLMA and the Air-Q II iLMA. Think you knew it all? This video should teach you something new…
AIRWAYS ON A BUDGET [13 mins, 7 secs]
In 2012 I surveyed rural GP-Anaesthetists in Australia, specifically asking about their access to and experience with difficult airway equipment. There are ANZCA Professional Standards (PS56) and recognised difficult airway algorithms – and accordingly one would expect rural doctors to have access to appropriate equipment to manage such a problem, especially in light of the lack of immediate specialist support. Sadly results suggested that many rural doctors lacked access to the appropriate kit. You can read the paper here.
This video demonstrates an affordable airway toolkit for rural doctors – featuring equipment for Plans A, B, C & D of the Difficult Airway Society Algorithm, with assistance from Winnie the Wallaby. Includes the Levitan malleable fibreoptic stylet through an AirQ-II iLMA and novel use of a laryngoscope blade as a bottle opener for those warm Aussie nights…
AIRWAY PLANNING [19 mins, 44 secs]
Performing an intubation is perhaps the “highest stakes” procedure for a rural doctor – especially in an emergency. We are taking a patient from spontaneous ventilating to a state of obtunding consciousness (and hence airway reflexes) and using a paralysing agent. To make a mistake could be disastrous. Airway planning is more than passing the tube – this video discusses airway planning and is jammed pack full of pearls for the ‘occasional intubator’.
WHAT’S NEW IN RAPID SEQUENCE INDUCTION/INTUBATION? [39 mins, 11 secs]
Building on from the ‘airway planning’ video, this vodcast discusses the finesse of rapid sequence intubation, with concepts trawled from the FOAMed world. Gran yourself a cup of something refreshing, settle down and for the next 45 mins let’s rattle through the latest in RSI…
EPISTAXIS IN A SMALL RURAL HOSPITAL [8 mins, 42 secs]
I am not a big fan of nosebleeds. They can be messy and fiddly to deal with. This short video uses a classic piece of medical drama to highlight the potential seriousness of epistaxis, then explores ways to deal with it. We even get to stick a RapidRhino up a fellow rural doctors’ nose…
IV ACCESS & RAPID INFUSER CATHETER [ 4 mins, 37 secs]
I am not going to tell you how to put in an IV! But this video demonstrates conversion of a 20G IV to a 7Fr “hose pipe” using both plastic and animal models. Great to pour in blood when dealing with a major haemorrhage…
FLUID WARMING – AFFORDABLE KIT [5 mins, 50 secs]
Of course if we are pouring in blood products and fluids, we should avoid the lethal triad of ACIDOSIS, COAGULOPATHY & HYPOTHERMIA. A fluid warmer is useful for rapid warming of IV fluids in theatre or the resus bay. Here I show off an affordable piece of kit we purchased on Kangaroo Island – the En-Flow fluid warmer.