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

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Hi Everyone,

This week I had the privilege of sitting down and recording two fascinating episodes with two of the founding members of the Placenta Accreta Spectrum Team from here at KEMH, Dr Matt Epee-Bekima and Dr David Owen. In this first episode we discuss the following:

King Edward Memorial Hospital website – The Placenta Accreta Spectrum guideline

The post 139 The Placenta Accreta Spectrum Team at KEMH Part one appeared first on obsgynaecritcare.

Hi everyone,

Welcome to part 3 of a 3 part series we have put together – 3 hypothetical cases involving anaemia / patient blood management scenarios. Thanks to the two great colleagues who made these discussions with me, Dr Anastazia Keegan Head of Haematology here at KEMH and Assoc Prof Nolan McDonnell a colleague from our Department of Anaesthesia.

These cases might sound familiar to any registrars who have attended the Thursday teaching run here over the last 8-9 years!

We had a lot of fun discussing these three cases and I hope there is a lot of great learning for those of you listening – thanks Anastazia and Nolan for giving up a few hours to put these together!

The post 121 PBM Case discussion with Anastazia and Nolan part 3 blood is not an option. appeared first on obsgynaecritcare.

Hi everyone,

Welcome to part 2 of a 3 part series we have put together – 3 hypothetical cases involving anaemia / patient blood management scenarios. Thanks to the two great colleagues who made these discussions with me, Dr Anastazia Keegan Head of Haematology here at KEMH and Assoc Prof Nolan McDonnell a colleague from our Department of Anaesthesia.

These cases might sound familiar to any registrars who have attended the Thursday teaching run here over the last 8-9 years!

We had a lot of fun discussing these three cases and I hope there is a lot of great learning for those of you listening – thanks Anastazia and Nolan for giving up a few hours to put these together!

The post 120 PBM case discussion with Anastazia and Nolan part 2 postpartum anaemia appeared first on obsgynaecritcare.

Hi everyone,

Welcome to part 1 of a 3 part series we have put together – 3 hypothetical cases involving anaemia / patient blood management scenarios. Thanks to the two great colleagues who made these discussions with me, Dr Anastazia Keegan Head of Haematology here at KEMH and Assoc Prof Nolan McDonnell a colleague from our Department of Anaesthesia.

These cases might sound familiar to any registrars who have attended the Thursday teaching run here over the last 8-9 years!

We had a lot of fun discussing these three cases and I hope there is a lot of great learning for those of you listening – thanks Anastazia and Nolan for giving up a few hours to put these together!

Safety of Intravenous Iron Following Infusion Reactions Stojanovic et al The Journal of Allergy and Clinical Immunology: In Practice Volume 9, Issue 4, April 2021: 1660-1666 – A great paper discussing the different types of reactions to i.v. including the Fishbane reaction and how they were managed in over 13000 iron infusions at the Alfred Hospital in Melbourne. Unfortunately it is an Elsevier publication and you will need some sort of institutional access to read it in full.

The post 119 PBM case discussion with Anastazia and Nolan part 1 preop anaemia appeared first on obsgynaecritcare.

Hi everyone,

Recently Graeme and I were asked to help run a workshop here in WA for the ANZCA Emergency Response CPD programme – thanks for your help Graeme and Paras. Some of the key concepts were understanding blood products and the strategies / philosophies which have been used when deciding what to give in a major haemorrhage. We decided that this would make a great podcast discussion and so voila – here it is!

We discuss:

– massive transfusion protocols utilising empiric ratios of blood products (often heavy in FFP / plasma) versus the more targeted approach often based on rapid assessment of haemostasis using viscoelastic tests such as ROTEM / TEG.

– the four deficits in haemostasis which can develop; 1 fibrinolysis, 2 fibrinogen deficiency, 3 platelet deficiency, 4 thrombin deficiency.

-a description of the types of blood products available their pros / cons.

– why the use of large volumes of plasma probably doesn’t make sense and may in fact involve some harm to patients.

– an alternative strategy for empiric therapy when rapid tests of coagulation are not available empiric treatment with tranexamic acid and fibrinogen.

Thanks for another great dicsussion Graeme!

1. Study showing decreased massive transfusion rate in trauma after change to goal directed ROTEM therapy in Switzerland.
   Anaesthesia. 2017 Nov;72(11):1317-1326. doi: 10.1111/anae.13920. Epub 2017 May 23. Change of transfusion and treatment paradigm in major trauma patients.
2. Before and after the introduction of ROTEM guided fibrinogen concentrate at Liverpool Womens Hospital and improved outcomes. Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage. Anaesthesia. 2015 Feb;70(2):166-75. doi: 10.1111/anae.12859. Epub 2014 Oct 7

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Hi Everyone,

This week we have a great four person discussion around the importance of assembling the right team when confronted with a high risk complex case in the after hours period. Interesting points covered include still doing the team huddle and introducing everyone even at midnight, a detailed discussion around manual aortic compression – the IVC, and how to monitor effectiveness – and also using a posterior hysterotomy to deliver the fetus when everywhere else looks bad!

Thanks to IKEA for their contribution to our high tech podcast studio!

Thanks also Parvesh, Matt Epee-Bekima & Matt Rucklidge for this great discussion.

(* The patient discussed in this podcast gave us explicit written consent for her case to be used in this deidentified discussion)

The post 048 – After hours critical cases discussion about assembling a good team and communication. appeared first on obsgynaecritcare.

Hi everyone,

Welcome to part 2 of our series on cell salvage in obstetrics and gynaecology!

Last week we had a great discussion on the basics of cell salvage and focused on what the team in the surgical field need to know to do a great job. If you haven’t listened to that yet check it out here:

Link

This week we welcome back Dr Matt Rucklidge and we have the recording of the talk he gave our department recently on the latest thoughts surrounding the use of cell salvage in obstetrics. If you haven’t been watching this space closely over the last few years you may be unaware that there has been a definite change in approach to many aspects of how obstetric cell salvage is now done. Listen to Matt present a very balanced and thoughtful discussion on the following:

Some of his talk is based on the following recent articles:

https://www.dropbox.com/s/x19ximgn0d814rn/Cell%20Salvage%20update%20August%202018.mp4?dl=0

National Blood Authority guidelines for intraoperative cell salvage: https://www.blood.gov.au/ics

Great resource from the UK pdfs and free slides on all the various aspects of cell salvage: https://www.transfusionguidelines.org/transfusion-practice/uk-cell-salvage-action-group/intraoperative-cell-salvage-education

If you want to revise the benefits of autologous blood (i.e. the patient’s own blood) then listen to this earlier episode:

The post 041 – Obstetric cell salvage an update, what only one suction, no filter and more with Dr Matt Rucklidge appeared first on obsgynaecritcare.

Hi Everyone,

Welcome to part 1 of a two part series on the use of cell salvage in obstetrics & gynaecology!

This week Part 1 focuses on the basics of how cell salvage works and what the staff in the surgical field (nursing and surgical) need to know to do it properly!

Next week we hear from Dr Matt Rucklidge who discusses all the latest controversies and developments in the arena of cell salvage during obstetrics – can we use a single suction, what about amniotic fluid in the collection system, do we always need a leukodepletion filter and how can we organise our practice so that we utilise cell salvage during those unexpected emergency cases?

These two episodes are audio extracts taken from a great combined presentation given at our local department meeting here in August. The audio from these presentations are great but for those of you who are interested in viewing a video version of this talk where you can also see the slides and images referred to in the talk feel free to watch using the link below:

https://www.dropbox.com/s/x19ximgn0d814rn/Cell%20Salvage%20update%20August%202018.mp4?dl=0

National Blood Authority guidelines for intraoperative cell salvage: https://www.blood.gov.au/ics

Great resource from the UK pdfs and free slides on all the various aspects of cell salvage: https://www.transfusionguidelines.org/transfusion-practice/uk-cell-salvage-action-group/intraoperative-cell-salvage-education

If you want to revise the benefits of autologous blood (i.e. the patient’s own blood) then listen to this earlier episode:

023 – Stored blood versus fresh salvaged blood

The post 040 – Cell salvage basics for the person holding the sucker – with Cheryl Dane Stewart appeared first on obsgynaecritcare.

You are in a peripheral hospital without onsite laboratory support after hours and you are involved in the care of a young parturient with uterine atony who has now bled over 2litres. Although you have called in someone to do some laboratory testing – you know that these results will be at least 45-90minutes away. How likely is it that this woman has become  coagulopathic? What approach should you take in this setting? Should you use empiric coagulation supportive therapy? FFP? Fibrinogen? TXA?

Hi everyone,

This week we have the audio of a great talk Nolan wrote for the obstetric intensive care symposium held in Adelaide earlier this year, and which he then kindly presented to our department in April.

Pregnancy is a procoagulant state and during haemorrhage obstetric coagulopathy is actually relatively rare. The underlying mechanisms are different to trauma and other patient groups and we should use this knowledge to help us in our use of blood product therapy especially when rapid coagulation testing (eg viscoelastic tests like ROTEM) are not rapidly available.

However there are some exceptions to this rule – beware early onset of coagulopathy in women with abruption, HELLP, and AFE!

Obstetric Intensive Care Symposium Adelaide 2018

If you want to watch the video of this talk with it’s powerpoint slides:

https://www.dropbox.com/s/y57pf26ge9mry8g/Obstetric%20coagulopathy%20Nolan%20KEMH%20dept%20talk%20version.mp4?dl=0

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