Hi everyone,

Sepsis is an important cause of mortality and morbidity in our patients. It is common but can be difficult to diagnose, challenging to manage and sometimes downright scary.

After being inspired by listening to an episode from “The Critical Care Commute Podcast” (with Dr Mervyn Singer a UK intensivist involved in sepsis 3.0), Graeme and I sit down to discuss some of these thought provoking areas of sepsis which are controversial and are still actively being researched.

Thanks again Graeme!

The Critical Care Commute Podcast

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Hi Everyone,

This week I sat down with Declan to discuss a fascinating therapy which is used in many areas of medicine.

This podcast has a bit of everything, a quiz, a part one viva, dubious animal experimentation, discussions about laxatives, and even some references to cosmology and the Big Bang.

Thanks Declan for another entertaining episode.

The post 143 Magnesium in medicine with Declan appeared first on obsgynaecritcare.

Hi everyone,

This week I am joined again by Dr David Owen an obstetrician here at KEMH. We sit down to discuss uterine inversion – an acute obstetric emergency. Luckily this condition is relatively rare – however because of this there can be challenges in recognising and treating this condition even amongst experienced individuals.

Should you be unlucky enough to encounter this rare condition, now having listened to our discussion you will be better prepared and confident you know what is required!

Thanks again David for your research and preparation for this episode!

Uterine inversionPararajasingam, S.S. et al.BJA Education, Volume 24, Issue 4, 109 – 112

Unfortunately (as of Feb 2025) this article is not yet open access – but it is very good if you can get it through your hospital or college library..

Uterine Inversion for the layperson – Cleveland Clinic

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Hi Everyone,

Welcome to Part Two of our discussion with two of the founding members of the Placenta Accreta Spectrum Team here at KEMH Dr Matt Epee-Bekima and Dr David Owen. This team was conceived in 2017 and began operating in 2018 – and has now cared for over 75 women with PAS – including 24 alone this year (2024). In this episode we continue our initial discussion with a more detailed dive into:

Thanks Matt & David for sharing the experiences and knowledge learnt by the PAS team over the last 7 years.

https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Placenta-Accreta.pdf?thn=0

The post 140 The Placenta Accreta Spectrum Team at KEMH Part two. appeared first on obsgynaecritcare.

Hi everyone,

This week I sit down with Jacob one of the provisional fellows in our department and we discuss the findings from the latest UK National Audit Project – NAP7 – which this time investigated Perioperative cardiac arrest.

NAP7 – Royal College of Anaesthetists

The post 133 NAP7 a discussion and review with Jacob appeared first on obsgynaecritcare.

A woman collapses with abdominal pain in a restaurant & then the initial evaluation in the ED she is diagnosed with suspected ruptured ectopic pregnancy. She is brought straight into your theatre and you perform a rapid sequence induction. You place your video laryngoscope into her mouth and all you see is vomitus and fluid, your yankauer sucker is blocked with food and doing nothing…………

Hi everyone,

This week I am joined by Dr Nathan Blakely one of our enthusiastic trainees to discuss an area he has taken a personal interest in —- the management of the soiled airway.

Thanks Nathan!

Blood in Airway:

The post 132 The soiled airway with Nathan Blakely appeared first on obsgynaecritcare.

As the DA you are paged to come to PACU to review a patient with pre-eclampsia who has just had a PPH and a repair of a perineal tear after delivering in labour ward. The O&G team ordered a VBG because she was febrile and they want to assess her lactate and start her on some antibiotics. The O&G registrar is concerned however because her potassium / K has come back as 7.8 mmol/L….

Join Natalie and I as we discuss the issue of hyperkalaemia specifically in the context of women suffering from pre-eclampsia. Why are they at risk of this important electrolyte abnormality and what are the principles of management?

We also review a recent paper addressing some of the myths surrounding the treatment of acute hyperkalaemia (thanks to Casey at Broomedocs.com for bringing this paper to our attention).

Gupta AA, Self M, Mueller M, Wardi G, Tainter C. Dispelling myths and misconceptions about the treatment of acute hyperkalemia. Am J Emerg Med. 2022 Feb;52:85-91. doi: 10.1016/j.ajem.2021.11.030. PMID: 34890894

LITFL, ECG library, Hyperkalaemia

A case of probable labetalol induced hyperkalaemia in pre-eclampsia. https://pubmed.ncbi.nlm.nih.gov/25370900

Hypocalcaemia and hyperkalaemia during magnesium infusion therapy in a pre-eclamptic patient https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614650

Oh’s Intensive Care Manual. 7th Edition. Chapter 93 – Fluid and Electrolyte Therapy. Bersten A, Soni N et al. 2014.

The post 131 Hyperkalaemia in Pre Eclampsia a discussion with Natalie Smith appeared first on obsgynaecritcare.

You receive a page from labour ward.

A woman at 35/40 weeks gestation has just arrived in the hospital very distressed in a lot of pain. A quick bedside ultrasound by the obstetric team has unfortunately demonstrated a large abruption and fetal death in utero. She is contracting strongly and beside herself in pain, the team would like you to come down and place an epidural for analgesia. The team are hoping she will deliver vaginally in the next few hours.

What is your approach in this situation?

Join Graeme and I as we discuss this complex and challenging clinical condition and the coagulopathy that can occasionally occur.

Here is a link to cases we have had in the past here at KEMH in the ROTEM Real Cases Discussed section:

Case 6 – Abruption and fetal death in utero

Case 11 – Abruption and severe coagulopathy

Coagulopathy and placental abruption: changing management with ROTEM-guided fibrinogen concentrate therapy 2015 Liverpool Womens Hospital – this is not open access but available through the ANZCA library or your hospital library. It contains 4 very interesting case reports

Fibrinolytic and thrombotic DIC an explanation 2023 – This paper explains how there are two types of DIC one predominantly causing microvascular thrombosis and eventually factor depletion. The second which is possibly the mechanism seen in some abruptions is massive activation of fibrinolysis and fibrinogenolysis. WARNING this paper is highly technical!

The post 130 Coagulopathy in abruption a discussion with Graeme appeared first on obsgynaecritcare.

You are called to review a woman in labour ward. When you arrive you are told her epidural is no longer working. The epidural was placed by a colleague 5 hours ago and was working well. However in the last 20-30 minutes she has developed breakthrough pain despite a top up and pressing the PCEA a few times. You look at her back and the epidural dressing looks fine – no obvious explanation there.

Upon further questioning you are told that she had a caesarean in her previous pregnancy and she is attempting a VBAC. She tells you that since you arrived in the room the pain has changed. Now it is constant and she has developed pain in her shoulder. Suddenly the CTG deteriorates and within a few minutes the team are calling a code blue caesarean to theatre…..This is recollection of a real case from an evening shift a few years ago.

As you can probably guess this week we are discussing the important and somewhat scary topic of uterine rupture.

This week we are joined to discuss this topic by Dr David Owen. David is a senior obstetrician, who previous to WA worked at Liverpool Women’s Hospital and was a psychiatrist in a previous life.

Thanks David!

Uterine Rupture: A Seven Year Review at a Tertiary Care Hospital in New Delhi, India

Tocogram characteristics of uterine rupture: a systematic review

The post 128 Uterine rupture a discussion with Dr David Owen appeared first on obsgynaecritcare.

A maternal death is always a tragic event for the mother, the child, the family and society at large. Unfortunately in some parts of the globe this is still a much too common event. Luckily for those of us living in higher resource countries it has now become relatively rare.

This week Matt and I sat down together to discuss the history of maternal mortality reporting, and all the useful knowledge we have been able to learn over the years from these important resources.

What are direct, indirect and coincidental maternal deaths? We touch on some aspects of the recent Australian reports and then go into depth on the long history of the UK reports which have many strengths such as their national funding, compulsory reporting, anonymous nature and very long history.

Thanks Matt

Maternal Mortality Report Australia

Maternal Mortality World Health Organisation WHO

MBRRACE-UK Maternal mortality reports UK

We don’t share email addresses and we don’t send spam

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