Dr Amit Pawa💉🎙️ Profile picture
Oct 1, 2020 37 tweets 11 min read Read on X
This time on the otherside of the webinar situation!!
Looking forward to learning from @ICUltrasonica @Wilkinsonjonny @PARADicmSHIFT and crew! 💪🏽💪🏽💪🏽
First up... @PARADicmSHIFT
Lots of TEE studies/courses available
FICE
FATE
FEEL
FUSIC
FUSIC HD
BSE level 1 and 2
A focussed study helps to answer a q about “why is my patient hypotensive?”
Focussed studies are:
quick (2 views)
Easy - only needs 50 scans for logbook.

Epiphany often occurs around scan 15!
What are the fundamentals of echo...
You can’t get all the views in all the patients all the time! - 😅!

Ideally- assume the position & get these views
PLAX - parasternal Long axis
Parasternal Short Axis view!
Apical@4 Chamber view
Now Subcostal View...
Wifi can’t handle all this activity! Gonna focus on learning now!
Now @Wilkinsonjonny talking abound the acutely unwell pt
@Wilkinsonjonny tells a lovely story about lung scanning in a clinical scenario where a pt drops saturations after an interscalene block for shoulder surgery
Next ...
Check out this PLAX - showing normal view followed by kissing ventricles...
Check out the IVC response in this hypotensive patient to filling...
Now - your next patient of the day...
Now - this is a right base view... what is the heart doing here?!
The EPSS shows this patient has a failing ventricle and in another view (not shown) shows a very large proteinaceous Pleural effusion- the Patient needs further management and optimisation before surgery
Spot diagnosis ?... this is the trauma patient from earlier who has plusus alternans on ECG and a swing on arterial line
Jonny has demonstrated Pneumothorax, Hypovolaemia, Pleural effusion and Cardiac tamponade! 👏🏽👏🏽👏🏽
Why do we need more than focused echo?..

1. Experts aren’t always available
2. Experts aren’t always experts
3. Existing training doesn’t fit

The level we need in Anaesthesia and intensive care is probably the highlighted part here...
Finally @Echotrainer ...
Contents of the talk
The history of accreditation
Why do we need accreditations/certificates?

To enable recognition of special competence against an objective standard , by the broader medical community.
Anaesthesia/Perioperative accreditation is probably met by FICE.
Super cool heartworks simulator!
Guidance for Trainees, but what about old people like me?! 😂
What if you are a trainer?...
Lots of quality and standards out there and @ICUltrasonica is an author on many of them! 😁
GPICS guidelines for archiving and reporting...
These are GPICS recommendations
What about medicolegal implications?
So - this IVC is collapsing, so the patient needs fluid right?....

Wrong... watch till end!
Excellent work @PARADicmSHIFT @Wilkinsonjonny @ICUltrasonica @Echotrainer !

Thanks for taking the time and educating us all .

I am inspired to get learning properly now!!

Many thanks @Assoc_Anaes 👏🏽👏🏽👏🏽

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More from @amit_pawa

Jan 19, 2022
Coming soon, An #RAUKISURA22 🧵 on our Bruce Scott Lecturer @colinjmccartney & his Favourite Five Publications!

Watch this space!

#RegionalAnesthesia

#McCartneysFavouriteFive Image
Ok- its time to start our #RAUKISURA22 Bruce Scott Lecturer. @colinjmccartney ‘s series of #McCartneysFavouriteFive papers Image
Here is Number 5

Available here- pubmed.ncbi.nlm.nih.gov/15277930/

The purpose of this study was to determine whether either regional anesthesia (RA) or general anesthesia (GA) provided the best analgesia with the fewest adverse effects up to 2 weeks after ambulatory hand surgery. ImageImageImage
Read 13 tweets
Nov 14, 2021
So I was wondering today, as an eternal student, a regional anaesthetist,and Past @RegionalAnaesUK president - what would make me want to attend #RAUKISURA22 on the 5-7th May 2002 in Edinburgh? So - Here Comes a mini thread!
@RegionalAnaesUK has been working hard to change the way we deliver education in #RegionalAnaesthesia
Check out some of highlights from #RAUK19 in Belfast organised by @LloydTurbitt @rosie_hogg @PeterMerjavy @davejohnston24 & Mike Jones ra-ukmeetings.com/past-events
The Belfast meeting was the first time we used on stage symposia to bring an engaging feel to the event, & the first time we had such a North American & Canadian presence at our meeting + #POCUS with @KiJinnChin , @shaskinsMD , @SLKoppMD, @JanBoublikMDPhD
Read 15 tweets
Feb 10, 2021
Looking forward to #POCUS webinar with @ASRA_Society with @jattarab @KalagaraHari @dr_melissabyrne and team!
@dr_melissabyrne first up on cardiac US.
When Learning a new technique...
1. Set realistic goals for learning
2. Improve workflow efficiency
3. Scan based on pathology

Use the 4W approach
When to apply pocus
Where to place probe
What do images mean
What to do next
Some clever ways to use POCUS When performing a Regional anaesthesia procedure
Read 31 tweets
Feb 9, 2021
I love regional anaesthesia and working with surgeons, & am also sad that I have finished Schitt’s Creek. Here is a thread of experiences as a regional anaesthetist..

The reaction of a new surgeon the first time you state you’d like to site a nerve block... for a trauma patient
The reaction of the anaesthetist when the surgeon states that blocks will slow the list down, and “The operation isn’t that painful anyway”
The activity in the anaesthetic room when we get the “go ahead” to put a nerve block in a patient- “as long as it’s quick and it works”
Read 12 tweets
Feb 9, 2021
In the run up to #RAUK21 -5-6th May 2021 ,& to introduce some of the many publications of our Bruce Scott Lecturer @EMARIANOMD - I thought I’d start tweeting 10 of his papers to get you inspired about #RegionalAnaesthesia #RegionalAnesthesia - I’ll add them all to this thread...
In the first of 10 of @EMARIANOMD‘s papers, lets start by looking at this one on Continuous interscalene brachial plexus block via an ultrasound-guided Posterior approach #RAUK21 #MarianoTopTen 1/10

ncbi.nlm.nih.gov/pubmed/1937235…

insights.ovid.com/anesthesia-ana…
The second of 10 of @EMARIANOMD’s papers is on #PedAnes! This paper is on the Feasibility of ultrasound-guided peripheral nerve block catheters for pain control on pediatric medical missions in developing countries. #RAUK21 #MarianoTopTen 2/10

ncbi.nlm.nih.gov/pmc/articles/P…
Read 9 tweets
Jan 25, 2021
So here is a quick thread about the #PlanABlocks from @RegionalAnaesUK that feature in the tweet below - I feature links to the RA-UK book chapter 📖, Video 🎥 & Posters in the thread below...
The concept came from an excellent editorial from @LloydTurbitt , @EMARIANOMD & @elboghdadly

One of the key points of the editorial was to focus on a small number of high-value blocks, and to train everyone in them, and then implement into pathways👇🏼

…-publications.onlinelibrary.wiley.com/doi/10.1111/an…
The First of these blocks is the Interscalene Brachial Plexus Block

RA-UK 📖: ra-uk.org/index.php/inte…

RA-UK🎥 : adobe.ly/3nTlHAX

RA-UK Poster: ra-uk.org/index.php/post… 👇🏼
Read 12 tweets

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