okay this first section now that we're going to go through uh is the summary statement
um so really how the way i see it is how to pass the vibe before you've even begun
the summary statement is all about simplifying complex situations
thinking like a boss and trying to predict predict the direction of the viva before it's
even begun the vibra has changed a lot so like a lot of things in life things can become cliches
and that's completely fine so back in the day the vive a stem would be something very general and
a summary statement would be something that was really really useful to say just to show that you
understood and you've got what this vibe was about but the vibe has definitely changed so i'm
going to completely contradict myself and tell you that there's very little space to state a
summary statement at the start of your vibe so i just want to repeat that you'll get a question a
stem that's very specific 55 year old female for a left collar with hypertension in the pre-admission
clinic what are the causes of hypertension it'd be very illogical for you to start stating a summary
statement when there's a direct question of what are the cause of hypertension that said i think
there's still value in it so what as i'm saying you should just go ahead and mention the cause of
hypertension what i do in that first couple of minutes of pre-reading is i just write out the
summary statement because i'm trying to identify and prime my brain to think of the major issues
whether they're stated or not and but that's what we'll go through in this exercise so you might
say where on earth will i actually use the summary statement while we're practicing it this is going
to be simply a drill of trying to predict what are the priorities or what are the critical issues or
points of difference in this case and imagine what even though the first stem might be very specific
they'll always they'll often come a time in the viva where you're talking with the examiner and
you both don't really understand what each other's saying maybe you've missed a point and i think
this is a really good spot for something like a summary statement where you can just say look
i'm not exactly sure i'm not exactly sure if i'm giving you the right answer or exactly what you're
saying but i think that this is the situation i believe these things are very important
in this situation and this is what i'm going to do so i think it does help you to identify some
some very important issues regardless so that said let's get into some of these exercises so firstly
what are the magic words um so agent gender obvious stratification tools that you know
primes our mind to think of specific disease and progresses in the operating theater and anesthesia
risk level high or low and just to point out that this isn't the acc aha level of risk this is just
your perception of the risk of a situation and to be honest you know this is going to be a vibe of
where you're going to be tested generally speaking the risk level is going to be high is it elective
or emergency or urgent surgery or futile obviously really important when you frame things if it's
emergency you really have to crack on with minimal or fast optimization whereas elective surgery you
know you do have time for optimization finally the critical issue and this is just a really
you know three points maybe two about what you think is most important about this situation
that you believe the vibra is going to try to use to discriminate against you know between
candidates and we'll go into that in a second as well finally something we haven't often had
to have to you know think about in our tertiary hospital practice as most anesthetic trainees
are in is the location of hospital and theater and just remembering that anscer needs to get
people accredited understanding that most denises are probably going to work in small
private hospitals scattered across the country so appreciating the location is really important
finally who do i need so what i might get you guys to do right now
is just take a minute or two to write down a wish list who are all the people
you refer to all the common things you might need in an emergency you know in a in very
special very specialties very specialty assistance think of obstetrics and pediatrics and you know
triple a's and what you do for that and just take a couple of minutes and i'll
just ask someone to run through as the first activity so take a couple of minutes now
technicians hematologists cardiologists cardiothoracic surgeons um uh radiologists
um that's probably all i wrote down yeah sounds good and when i think of hematologists i try to
bundle things a lot in whatever i'm thinking about for example if i think of hematologist
i'm thinking blood loss right and who else might you need in a blood loss case that you could just
rattle off pretty quickly so you definitely need more hands-on days yeah so in terms of techniques
and nurses to check and administer blood you may need a second anesthetist um so that you can have
someone as a hands-off leader um and uh surgeon obviously speaks to bleeding and radiologists
and the other one i think with blood is like blood blank perfusionist cell saver um as a bit of a
bundle bundle of care as well um uh yeah so um and other people i want would be post-op for icu care
and i would consider like um if there was period optimization so from cardiologists endocrine
and and then if there was an obstetric emergency you'd want your obstetrics your arms midwives
pediatricians and potentially niku yeah fantastic so in in my mind i'm grouping these things that
there's you know the blood loss stuff there's pediatric obstetric
stuff and then there's all the specialists that i would refer to and the reason i say this is
definitely when i was going through i felt like for some reason i had to know everything about
every specialty and and we often get feel that we need we we need that kind of level expertise but
i guess i want to give you the confidence if at this stage you're not aware of something
you probably need to refer it up and that's probably a very safe thing to do in the exam to
if you feel like you don't know the area particularly well it is time to refer that across
and that's mainly the reason why we go through that let's get on to the actual exercise so you
read the viva stem you panic a little then you say something like this is an elderly male for
a high risk emergency procedure in a patient with critical cardiac disease requiring tertiary level
care and input from cardiology and icu post up as an example and so what i'll get everyone to do
so this is the first case robert is a 74 year old male with a ruptured triple a for laparotomy who's
rushed into the ed by ambulance past history usual staff vascular disease stents hypertension and
blood pressure 85 on 40. um so i want you guys to take 30 seconds now uh take it in turns and just
talk to your partner and literally go through that format of age gender elective emergency risk level
a couple of critical issue points that you think are the most important things about the situation
and your ideal location and if you need anyone else this should be a quick sentence so it
doesn't have to be a whole spiel uh take 30 seconds now uh so this is an elderly uh
gentleman uh who's high risk uh with the ruptured aaa which is an emergency lifesaving procedure
uh his critical issue is hypovolemic shock uh related to blood loss um he's hot in here at the
moment that needs to be rushed to a vascular theatre so potentially a combined theatre
location um i'm gonna need uh additional anesthetic assistance um uh probably a second
anecdote a massive transfusion um protocol with assistance from the lab um additional
anesthetic nurses and probably a symbolist as well as a vascular surgeon yeah fantastic so i
completely agree i like that you were very brief in an elderly male high risk emergency procedure
and i agree with your dominant patient issue there's obviously so many things that you need to
think about but in real life when you're in this case all i care about is getting that cross clamp
on right so it's all about transfer to theater and that's its own task in itself the cardiovascular
instability instability and the fact that you'll you know need a reasonable transfusion again
i've mentioned here your situation may be vague from the stem so i just use phrases like this
should ideally be done in a tertiary hospital so i'm thinking of that um and also having all your
supports vascular surgeon blood bank icu perfusion and self-safe hematologist um i so i've said
something that i'll just make mention to now i've said cardiovascular instability or you
know i'm prepared for that just to make sure that you realize that if if i do say something
that's vague like that i can easily and quickly follow it up in the exam with more details for
example to say someone has a hemodynamically stable induction gives the examiner no real
information of what you know about what this human dynamic should be or how you will achieve that
so you i just want to make mention that you don't want to say vague terms or cliches but if you do
you can follow it up quickly with more detail about what that means so i just want to give
a bit of a mention that this is generally about giving yourself an ability to understand what the
whole environment is so shelley 50 year old female presents with a grade 3 subarachnoid hemorrhage to
a small suburban hospital with no neurosurgery and you're asked to assess her so here we've got a 50
year old lady who's at high risk deterioration who's presented for an emergency procedure
at a hospital which is not optimized to deal with her given that it does not have neurosurgery a
dominant patient issue is to be able to adequately mitigate the risk of rapidly rising into cranial
pressure and transfer her to a safe location um the people that i would specifically need would be
the team to stabilizer which would include critical care positions like the incentivists
um as well as a second easter senior training um i would need to rapidly engage services of a
transport service as well as a receiving tertiary centre that does have neurosurgery
i would also like to have a neurosurgical team on the phone to give advice
um as well as the receiving analysis to be able to specifically directly optimize
yeah that sounds great so and i'll just give you my my answer for that 50 year old female
urgent risk urgent high risk condition and i've just very broadly said dominant patient issue
is complex neurosurgical pathology depending on the situation and the question and what the
examiner is saying i might go into the detail of preventing rupture cerebral perfusion icp issues
um and just to know that i have that ability to go through that and i've just said recurring transfer
to center with neurosurgical services and post-op care um and one important thing to mention you
know harsh mention that he's kind of doing this on the fly that i think it's really important to be
able to do that because while the stem the stem gives you two minutes of prep time most of all
most of this vibe is going to be you thinking and talking out through reasonable situations
situations in a reasonable manner on the fly so i think it's really important to be able to
you know be able to do that and think about um you know good answers to complex situations
next case 30 or female g1 p0 29 weeks presents to the labour ward with a blood pressure