11 years ago @bscottsegal would have stopped here. However, things have moved forward. Protocolized GDM care decrease morbidity, improved fetal outcomes. #SOAPAM2023
Just being included in a @cmqcc bundle made a difference. Protocolized oxytocin administration has improved outcomes. But what about the personalized #OBAnes care we could provide? #SOAPAM2023
Personalized care is not sliced bread. It’s either future, fantasy or fraud. Genetic testing takes too long. Some significant other concerns or challenges. #SOAPAM2023
AI can deal with big numbers but some big concerns. Objections: Can’t protocolize everything, cookbook medicine, skill loss.
A reminder that best chefs keep cookbooks close to start them thinking rather than replace thinking (@Nigella_Lawson may or may not confirm - @GongGasGirl… twitter.com/i/web/status/1…
How do we treat 2 disparate patients the same way? Scotch sounds like a difficult character. “There is one best way” is an erroneous assumption. Protocols don’t answer every question. #SOAPAM2023
Do protocols work? Maybe, occasionally, minority. Adherence is important. >2000 years we have known that treating patient is more important than the disease. #SOAPAM2023
Protocols remove the patient from the equation. Some times individual choice makes a difference. #SOAPAM2023
Changing protocols is “exciting”. Vince Lombardi (football coach): keep it simple, focus on basics. Personalized care has to actually be “personalized”. Goodhart’s Law. #SOAPAM2023
And @HansSviggum wraps up the CON argument. Good protocols are rare and need to be living documents. Put patient at centre of care. Cannot assume the protocol will save you. #SOAPAM2023
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Dr Brian Bateman moderates the #SOAPAM2023 Gertie Marx Research Competition. #OBAnes
Number 1. @LilianeErnstMD presents The ED90 of Hyoerbaric Bupivacaine for Cesarean Delivery in Super Obese Patients #OBAnes#SOAPAM2023
Background. Pre-pregnancy obesity increasing across racial groups. A large percentage in grade 3 obesity, racial differences. Super Obese patients more likely to have cesarean section. High block was more common in BMI > 50. #SOAPAM2023#OBAnes
Now it only took the first slide (next tweet) to draw my full attention, and mean that I will be catching up with recordings later. This raises VERY important questions for #OBAnes in light of recent #SOAPAM2023 chats
Neuraxial anesthesia as a sedative…
Sensory deafferentation dependent sedation - an example of a full stomach being sedated that #OBAnes do routinely @VeenaGraffMD (oh wait it gets better) #RAUK23#SOAPAM2023
Patient age and sensory block level significantly affect relationship between propofol Ce and sedation (I added the graphs from Roh et al’s study). Regional techniques dynamically reduce neural traffic. #RAUK23#SOAPAM2023
The allergist team are ready and waiting for your referral, poised to leap into action with different testing modalities. When would they do a drug challenge? To test cross reactivity, exclude allergy and confirm diagnosis #RAUK23
Skin testing (a positive latex allergy) includes a negative spot (saline to rule out dermographia) & a positive histamine spot to check for antihistamines in system)
Intradermal testing uses low dilutions for specific drugs. Here a 1:10,000 dilution of sugammadex illicited a… twitter.com/i/web/status/1…