i just want to give you a really warm welcome to this course the abc's of anesthesia boot camp and
yet just a little bit about me so i'm a consultant anesthetist at western health um obviously
i really enjoy teaching like a lot of us and a lot of you will hopefully in the future as well
um i do a lot of simulation inside you teaching and theater and a lot of online stuff because
that's really all the time we have during zoom um sorry during covert uh because there's not much
else we can do really um i started this course back in about 2012 uh in a much smaller way i used
to just give these morning tutorials at 7am and it's really just grown from there because i think
i'm trying to fill in this gap of giving a lot of practicality to introductory trainees outside of
the usual stuff that they get taught as well as the usual first part stuff um that you know
you seem to need to need to know very early on a little bit about me and my resources so
a lot of you may already know the abc's of anesthesia face facebook group is available
um this course you can always reach me at abc's of anesthesia at gmail.com i'm always able to get me
any questions or any results you'd like um and also run a small website called the anesthesia
collective so www.anesthesiacollective.com and i'll just keep posting more things there and if
there's anything you guys want to contribute in the future feel free to ask me as well
um just recently started this youtube channel and i'll just keep adding content so yeah please
subscribe and ask for notifications so i can just get stuff after you if you need
and also a couple of podcasts coming out soon and just with a couple of colleagues who
are really good at this stuff as well actually just wanted to try this would everyone
just press their space bar now and just say hello and i just want to see what that sounds like
hello excellent hey that's the sound of 100 people saying hello that's great an obvious disclaimer
i'll give you lots of medical information here but it's all general okay so obviously i don't expect
anyone will actually treat patients based on this information alone but um yeah this is all general
information and if you're treating your patient make sure you do that in consultation with your
treating team and your boss now this is something i definitely didn't have during my training um
but i think i was lucky um so i think this is one of the hardest times and i think what trainees go
through now is far harder than what i went through just with everything that's happening with covid
and all the limitations on training positions all that kind of stuff but i just want you all to keep
the perspective that you've already won at life um you know the fact is you're a doctor living
in australia in 2020 and regardless of what how bad 2020 is you've you're still you know amongst
the luckiest people who ever lived um and life has never actually been better for anyone ever in the
history of time um so even if you fail everything from here on i just want you to remember
you're still all good i say this because during my training every two years really really sadly
a colleague of mine committed suicide and it was just this thing that happened every couple years
and people didn't really think of it as the it was just a tragedy but it wasn't something that was um
you know spoken about it really you know it wasn't something that was acknowledged in the same way
it is now um so i just wanted to put that out there that you know it's it's it's never going
to be that bad um and to keep keep things in perspective and if things are getting difficult
you know make sure you have a gp you know have a friend to talk to keep your keep your connections
and your contacts your family and friends the most important things throughout your life and
career uh you know i i hate saying this because i was always so focused on career but korea should
always come second to that thing in my opinion and there's lots of resources out there um
this final book that i've just put up there also human really chilling and very very poignant
because you know i i essentially all the stories there are so intimately relatable to what we go
through during our training so if you if you haven't read it already it's a really really
great book to book to read by a psychologist who was in the teaching space of teaching consultants
how to teach but then transitioned into more career counseling and psychological counseling
there's a basic assumption i have of everyone i believe that everyone here is intelligent capable
cares about doing the best and wants to improve so you know i'm going to pick on people i'm going
to ask people questions ask people the answers and sometimes you're going to say an absolutely
amazing answer other times you're going to see an answer that isn't that great and you wish you
could have said it differently but just remember no one cares i don't care this is about improving
slowly multiple failures is what success is made out of and i really want you guys to just embrace
the fact that you know get all the stuff wrong especially now um because it'll just you know
it'll just make you better um yeah so i just just everything will be framed in that setting as well
so um why is anesthesia challenging now i think those of you who have already done a bit of
anesthetics will realize that you've got a very short space of time in your early years you work
with a different consultant every day and even every session there's so many different opinions
and you can probably put your hands up now if you know you heard one consultant say this is
definitely the way you need to do it and another consult for the next day saying oh yeah you should
definitely do it this way we are so opinionated about stuff and i often those things don't
matter that much and i'm going to acknowledge that completely the thing is that most of the
things that we don't disagree we don't disagree on we don't even talk about you know if someone
needs a tube you put a tube in 99.9 of the stuff is all agreed upon but you will be faced at the
brunt of things that are often different opinions and you only have six weeks to three months to
really consolidate that um often you have multiple tasks to recall and perform and none of these are
similar to the ward jobs you've had previously and i think that's really obviously challenging as
well also anesthesia is one of those times where you know what i love about this specialty is that
it's so accountable you know the time from action to disaster is very very short you know it's in
you know seconds to minutes to hours whereas most other specialties it's hours days to weeks
so there's very little time for reflection and research and you know consulting google
so your knowledge and skills are tested very very quickly imagine every induction that you do
when you start off there's so many things going on it's very hard to reproduce and practice that
so hopefully what i'll give you then is a really solid robust framework to hang that knowledge on
as you go through those first few weeks and even your later training and also you've had
yeah probably very few anaesthetic very very few anesthetic days uh maybe one to seven days in med
school and that's about it now what i hate is the fact that at the end of your rotation you
may have then recognized the patterns and formed a routine um but that's at the end of your rotation
and you know why not do it at the very start so this this course this session is all about trying
to get you that framework so that you don't have to have the aha moment at the end of your rotation
and hope you'll have lots of those moments on a solid framework from the very start
so what i can give you in this course i want to give you the knowledge and skills from day one
i want to acknowledge that some people have done the anaesthetic rotation they're about to do it
or they're in you know within their anaesthetic rotation again it doesn't matter so much it's very
hard to time the course perfect for everyone but just know that wherever you are the course will
give you something slightly different and what i care about is the fact that you have all of
these resources hopefully you've printed out your workbook or it's on your ipad and you can always
refer to that to train whatever skill you want to train that day maybe one day you're thinking about
assess patient assessments the next day you're thinking about airway assessments and you've
got a framework to hang all of that knowledge and all of those little bytes of information on
so i want to give you that knowledge and skill and framework from day one
um i want to give you a standard approach to the start of your journey i know a lot of the cons so
a lot of consultants will have differing opinions to me but just be rest assured that this framing
that you'll get is a very reasonable framework that not many people would consider controversial
so if you want to vary from a starting point this is a pretty good starting point
i also want to give you an awareness of different consults and opinions at each step
so i may just offer that something's a gray area or something like that
and again in the chat if someone's told you something really different please put it out
there i definitely want you to challenge me on stuff i've got no ego about this plenty of times
i get a good question and i learn from it as well so please challenge me on anything in the chat
um and i'll definitely try to answer that i'll give the resources and references to do that
um i want i also want to give you an awareness of the direction you should head to to increase your
independence and competence and the example i give is like saying the airway the job of
you as a resident is to give me the confidence to give you enough rope uh to get the experience that
you deserve so what i hope to do in this course is give you a lot of these knowledge elements
you know anesthesia is a very technical based professional it's a lot of skills
and obviously i can't teach you those skills of intubation but what i can teach you is
i can give you the chat and the talk so that as you're intubating you know to talk about
what you're seeing that you can see the epiglottis that now you're going to ask for the bougie and
burp and maybe ask for a video laryngoscope if you are talking through everything that i would
do normally then there's no reason for me to take that opportunity away from you whereas someone
who's intubating who is silent i don't know what you're thinking and therefore i'm gonna intervene
far quicker because you haven't earned the right to do the intubation if that makes sense so this
this um this whole talk this whole session will be about be giving you the hopefully the confidence
and the knowledge to then give your consultants confidence in you to give you enough rope for
the experience that you deserve that's your whole training game um i just think about this is what i
did time and time again during my training so i i like to think that at the end of my training like
you know i had so many more of those experience sets than other trainees may have done because
i had that ability to you know just constantly talk about what what i was doing to my consultants
so to keep going the way i think about your early training in the first 12 months you might
do about 500 cases if you're doing 12 months of full-time anesthesia occasionally you'll have a
real teaching moment and this course is about concentrating that experience so let's drill
the hardest parts into introductory training the hardest practical parts in this one session in
one day again it's a long day with lots of information but why not do that because you
can always review the stuff even if you're a bit fatigued at the end who cares right so high reps
focus training i want your brain to turn from this into this and that's what we're going to be about
by the end of your first rotation with the knowledge and frameworks in this course
hopefully you get anesthesia this faster learning curve safer practice increased ability
and then again improve your chance of getting into whatever training program program you need so
um i've already sent people uh links to a talk about getting the most out of the rotation
i thought that i really want to focus usually i run through this in this session but what i
thought we'd do is we'd actually just um you know you'll be able to watch that video and you can
always email me any questions after watching those videos which i'm really happy to answer again the
more questions you ask me i a lot of the material that i've created is just simply from questions
that you ask me and i really enjoy doing it um you know what else am i going to do in covert right
so yeah please feel free to message with that throughout this session i'll just um put up qr
codes um if anyone isn't aware how to use those uh just you know use your qr reader on your phone or
use the camera on your phone and that will set up a link if you just point your camera at this
qr code and that will and i'll do that for various things throughout that way you can just go to that
video bookmark it or whatever you need to do and you can watch it at a later date the way we're
going to organize this i think the chronological approach is by far the best because that just is
exactly how you will end up uh in theater in in in the hospital as you're uh you know as you're you
know visiting your patient making a plan you'll do it all chronologically so what we'll go is
we'll go through a bit of anaesthetic assessment but the practical and harder elements of that
simple optimization steps a perioperative risk benefit profile the consent some surgical issues
to think about a basic anesthetic plan how to present the case to your consultant then
we'll go so that's all of the um before theater tasks we'll then go through the theater tasks
the pre-anesthesia checklist how to decide on medications for your anaesthetic a basic induction
which i won't go through in too much detail and then finally the extubation that's all of the
chronology of what you'll do in anesthesia we'll go through all of that now a lot of that might be
quite straightforward for people who've done maybe you know a full six months of anesthesia um but
even if it if it is the stuff that you don't i'll guarantee that a lot of the things that i'll talk
about maybe you haven't thought about and would be worthwhile with this exercise doing the exercises
anyway after that i've just tried to highlight the most high-end scenarios which i thought are
either taught very late in your piece or taught differently and just very high yield so the the
patient with a cardiac issue for non-cardiac surgery will go through airway management crisis
and problem solving crisis resource management and then critical anesthesia inductions you