Leaning on Fenceposts

Jim and Lucinda discuss urological issues in rural settinsg

Ruth and Lucinda chat about Vascular emergencies

Lucinda and Robin discuss cognitive biases

Lucinda and Robin Chan chatting Medical Tribalism

Paediatric infectious diseases with Prof Tony Walls

Transgender care

ACC

Capacity assessment

Management of trauma in rural settings

Scott (RHM and GP from Dargaville) and Lucinda discuss the red eye. There is no video edition for this episode to protect patient privacy.

Matilda rejoins Lucinda to discuss oncological emergencies

Lucinda and Mark discuss general surgical issues.

Lucinda and Matilda discuss lung cancer therapy and pitfalls for a rural context

Elayne, Hannah and Marek are the guests with Lucinda discussing haematology things

Dave, Joel, Jono and Marcus chat with Lucinda about managing critically unwell people in rural settings

Clinician Wellbeing with Jo and Lucinda. Audio only from the webinar series.

Toxidromes in rural practice. Audio recording of the the webinar (found on you-tube channel or blogs.otago.ac.nz/rural) with Dr. Bill Boroughf and Lucinda

Hematology: beyond iron studiesSeptember 2022Dr. Elayne KnottenbeltHost: Dr. Lucinda Thatcher

Lucinda and Garry chew the fat.

Key toxicology pearls for rural medicine with Dr. Adam and Lucinda. Live from the CME workshop. Webinar available( https://www.youtube.com/playlist?list=PL_6usD2dc40Gg5nB91os4oNtv5ZsQi6dr) and slides are available on leaning on fenceposts

 

Will Taylor and Lucinda discuss inflammatory joint disease. Webinar available: https://youtu.be/3DqlFBJHjo8 

Lucinda, Richard and Rich discuss IBD in a rural setting

Steve and Lucinda have a chatSteve's paper: https://blogs.otago.ac.nz/rural/changing-the-model-ashburtons-experience/

Lucinda discusses Covid in 2021 with Jared Green, Jeremy Webber, Rachel Thompson, Mark Smith and Steve Withington

Lucinda discusses obstetric emergencies with Celia and Brendan

Matilda and Mike Foss discuss acute pain management. There are additional resources found at https://blogs.otago.ac.nz/rural/podcast-episode-…n-with-mike-foss/

Garry, Rory and Matilda discuss management of heart failure.

Audio from the webinar. Show notes can be found @ https://blogs.otago.ac.nz/rural/2020/08/20/webinar-4-diabetes-management/

Matilda and Lou discuss COVID preparation and experiences in Queenstown Hospital

This is the second episode of the podcast, this time focusing on the sick patient. Apologies for the presenter - the pro (Matilda) will resume shortly. Markus is an intensive care specialist and anaesthetist in Dunedin, as well as an avid triathlete.FiO2:PaO2 calculator: can enter both mmHg and KPaVentilator guideFront of neck access.Steve Withington shares Ashburton\'s thoughts:Rural Hospitals have been very busy so far in the NZ fight against COVID, though reporting so far disguises this, as all is at DHB level. In Ashburton so far we have been mostly in preparation mode. One recent rural modification we have made that might work for you is repurposing our operating theatre. We have no negative pressure rooms in Ashburton, which is not ideal in times of COVID, particularly for aerosol generating procedures. However, our operating theatre – which in recent times has only been used for elective gastroscopy procedures (now suspended) – has, like all theatres, a positive pressure ventilation system. Our engineer has kindly reverse engineered this (And assures me it is not that hard), converting it to a negative pressure environment. That will allow us to perform more high risk procedures, like intubation, in that environment without risk of contaminating elsewhere in the admitting unit.A recent EMRAP (https://www.emrap.org/episode/emraplivecovid1/emraplivecovid) discussion of COVID-19 and airway management discussed a number of issues relevant to rural hospitals, for example, what to do when the ventilators run out, and we are left with the patients in rural. High flow nasal O2 is probably not as concerning as we think for aerosolisation and risk to staff, but, in a negative pressure environment, with appropriate PPE, this may result in bridging of time to ventilation. Similarly, using CPAP, may buy some time though the window may also be very short and transfer arrangements need to be discussed urgently. It seems that higher pressures than usual, are important in recruitment of small airways in the COVID-19 lung disease, and may extend the usefulness of CPAP, both in pre-oxygenation and potentially maintaining someone for a while.One method of providing CPAP in an ongoing way, without using up our one NIV machine, is to connect a CPAP mask with a Bag Valve Mask (connected to high flow O2) via a viral filter, pressuring the line with O2 (6 l/min) via the CO2 port, and using a PEEP valve on the BVM, titrated up higher than usual, as necessary (to 15-18cm) (https://emcrit.org/pulmcrit/cpap-covid/). No machine so less staff-intensive. We hope this will prove a viable way to look after a cohort of sick people in a time of restrictive ICU spaces, but at least it may help with pre-oxygenating someone prior to intubation. With a well-fitting CPAP mask the risk of aerosolisation should be small (but we should use N95 masks around these people for sure). Low threshold for some ketamine dissociative dosing to stop lots of coughing, fighting the mask, and risking infection control breaches.There has been a lot of discussion around PPE, and clearly intubation needs the highest level of protection: with N95 masks, full visor, neck protection, gown, gloves, viral filters, and also videolaryngoscopy if possible – to maintain maximum feasible distancing from the infected airway. Having someone supervise the removal of PPE after procedure is finished is crucial as this is probably as risky a procedure as the intubation itself. Evidence from Singapore on PCR testing of air and environmental samples in 3 symptomatic patient rooms for PCR detection supports continued use of surgical masks as aerosolisation was not detected, though environmental contamination highlighted the importance of PPE and regular cleaning. (https://jamanetwork.com/journals/jama/fullarticle/2762692).I’m keen to hear if people have rural hospital related issues with COVID-19 so I can try to escalate these to the Ministry of Health via the College. And let’s keep sharing potential solutions as we find them that work for our environments.Cheers, Steve ([email protected])

Jared and Matilda discuss COVID-19; The virus, presentation and infection control issues.Jared is a infectious disease specialist and rural hospital doctor who currently works at Waikato hospital, Waikato DHB.Matilda is a rural hospital doctor who works at Taupo hospital and is a convener on GENA 728 cardiorespiratory medicine in rural hospital medicine and the Continuing Medical Education Chief for the Rural Postgraduate programme.