The plan for the talk. Your patient - straight after new bag sats drop…
NOT Swiss cheese (@girardDev), Emmental(?) model #OAA3dc2022
What are human factors? Resilience engineering Aims to stack the @Toyota (everything keeps going right) side of the scales: make it easy to do it right, difficult to do wrong. (Nothing is foolproof, for the talented fool) #OAA3dc2022
Our aspiration is #patientsafety, influenced by several pieces. Skill becomes habit becomes behaviour. Ideally avoid error completely, trap it before it does harm, if it does harm mitigate it. 3 key issues to human factors. #OAA3dc2022
Simplest model of the mind - the working memory = bottleneck between long term memory & skill. How many tasks can working memory handle? Miller & Cowan optimistic when stress involved.#OAA3dc2022
Nadirs of human performance (sleep urge is key, presenting after lunch is bad). A Topgun quote - under pressure we sink, we don’t rise. @NASA$&&&$$$$ have a check list. #OAA3dc2022
What do you do to make a positive contribution to relationships & team climate? Rude surgeons, sure. Rude anesthesiologists probably just as detrimental to team performance. #OAA3dc2022
Talking about @Airwayman1’s pyramid - was awareness due to thiopentone or drug error? #lookalike vials don’t avoid error. Storing them side by side doesn’t trap it. Not the only example (@ruthi_landau), levobupivacaine makes a lousy diluent. pharmacists not immune. #OAA3dc2022
@GongGasGirl would agree, aviation analogy is flawed.
Humans not designed for anesthesia, seldom working properly when need it, no spares, little redundancy, poor service history. Situational awareness is key. #OAA3dc2022
What can you do? @Airwayman1’s 4C’s CONTROL what you can, COPE with what you can’t, CONCENTRATE on what counts, stay CALM. Apply the pyramid to your workspace. Algorithms can bridge the bottleneck. #OAA3dc2022
Hungry Angry Late Tired slide - all affect situational awareness. Sleep is essential. Bats sleep a lot? Fiona Kelly’s 8 things (@Airwayman1’s additions on right) - bridge or widen the bottleneck! #OAA3dc2022
@euklaas from @asznl presents on PDPH: new perspectives at #OAA3dc2022. (As promised by teaser) August Bier = father of PDPH, a surgeon started it not #OBAnes 😉
Current perspective on PDPH. ICHD-3 definition, tied to CSF pressure & volume as is pathophysiology. #OAA3dc2022
New anatomical perspectives challenge the classic CSF hypothesis. Choroid plexus not main site of production, CSF doesn’t circulate unidirectionally.
Bulat-Kiarica-Orešković hypothesis: osmotic & hydrostatic forces are main determinants of CSF movement, pulsates
Everyone needs to be on #Medtwitter@StephenLap! Watching @obstetriciasati talk about Obstetric hemorrhage I notice a trend observed at #OAA3dc2022 continuing: manual external aortic occlusion (a REBOA without surgeons or balloon catheter)
@ArviPalanisamy presents his philosophy on the Future of #OBAnes Research in this final session of #OAA3DC2022: practical, aspirational, inspirational (skipping the queue to catch a train, @noolslucas & @OAAinfo) very accommodating in view of train/tube strikes affecting London)
#OBAnes research has plateaued, advancing in increments. A change in thinking is required. Several low hanging fruit, #MindTheGap between #OBAnes research and practice - implementation science something for future? #OAA3dc2022
One subject ripe for implementation science study is awareness. DREAMY study factors associated are known, awareness common (perhaps we’re losing a skill?) & linked to PTSD. #BridgeTheGap#OAA3DC2022
@girardDev presents on managing the obese parturient at #OAA3dc2022. He sets the bar high for the future of presentations at #SOAPAM2023, #OAA23, #ASM23SYD: a QR code that links to all his references as well as a pdf of his slide deck - perfect for #OBAnes#SoMe & #FOAMed.
The value of PERI-oxygenation in obesity is not to be ignored. All patients will go blue, perioxygenated ones take 52 seconds longer (how long it feels depends on the sats?). We all remember the troop pillow, but do we remember the stool? Ergonomics of intubation #OAA3dc2022
@mbrrace meeting 10 November. Hope to see some live tweets of key messages @SusannaStanford. “We are ALL part of the solution” #OBAnes and obesity is definitely part of the puzzle, preventing it part of the solution. #OAA3dc2022
Sawubona @DavidGray37! He’s presenting on Tranexamic acid at cesarean section: Drug Error Deaths. An unforeseen result of Woman trial. Potentially life saving in LMIC, deadly in drug error. Disproportionately #OBAnes in district/ rural settings. TXA a new drug there #OAA3dc2022
A recent situation. Warning from @ArviPalanisamy and Dr Kinsella. A characteristic presentation - unfortunately very similar to eclampsia, in an environment used to poor antenatal care & eclampsia. Both bupivacaine & TXA now generic, no control of similar packaging. #OAA3dc2022
And #lookalike vials are a problem, a BIG one. 7 recent cases in SA only from 2 provinces, 5 fatal & 2 major neurological morbidity. Getting worse, under reported. Guidance provided, it’s own complication though #OAA3dc2022