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Opinion


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  • 243

Opinion

Critical Care Pattern 4 – Tracheostomy

Dr Swapnil Pawar July 28, 2019

Although increasingly less frequent, placement of a tracheostomy has become a viable alternative to prolonged endotracheal intubation, with the benefits of improving patient comfort, reducing need for sedation, lowering airway resistance, and allowing for easier airway care. There has been considerable debate on the technique, timing and selection of ICU patients. In this review, I cover what’s the current consensus and share my preferred approach.

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  • 29

Opinion

Critical Care Pattern 3- ARDS

Dr Swapnil Pawar July 14, 2019

ARDS is a syndrome and our current approach of “one size fits all” is probably not the right approach to deal with this beast. In this doodly, I managed to summarise my evidence based approach in a graphical way. We need to be cautious while interpreting the evidence and should not jump to the conclusion about certain interventions such as recruitment.

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  • 11

Opinion

Critical Care Patterns

Dr Swapnil Pawar June 7, 2019

Critical Care Patterns Intensive care is about recognizing the right pattern and then treating accordingly. It’s similar to game of Chess, where grand masters look at the board, recognize the pattern and make a next move. In this series, I will bring different critical care patterns, which will be helpful to all ICU trainees for their exam preparation and day to day patient management.

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  • 22

Opinion

Networking as a Medical Educator

Dr Swapnil Pawar January 1, 2019

by Swapnil Pawar and Mike Gisondi What is Networking? Networking is the sharing of ideas through a conversation between individuals who have something in common. It’s that simple. The word, ‘networking’, carries a negative connotation, an activity carried out by the ruthless to get ahead. Not true of networking in medical education. The wonderful example of the power of networking in medical education is ALiEM: Academic Life In Emergency Medicine.  ALiEM is a globally distributed digital community of practice hosted as a blog and podcast out of the United States. The organization has grown and enriched over the past 5 […]

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  • 35

Opinion

Acute RV Failure

Dr Swapnil Pawar July 20, 2018

The left ventricle (LV) gets the glory typically. Any echo request usually relates to LV ejection fraction, filing status or regional wall motion abnormality. Perhaps this is fair enough as the LV is a significant contributor to blood flow and organ perfusion, but as Pinsky said at the CICM ASM in Hobart “Right ventricle (RV) function is not considered important for cardiac function until it is … and then it’s everything”. RV dysfunction is rife in the ICU: as a direct result of diseases such as sepsis, and indirectly by mechanical ventilation or pulmonary hypertension, and it is strongly associated […]

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  • 8

Opinion

Post-Cardiac Arrest Management – Time to Say Goodbye to Self Fulfilling Prophesy

Dr Swapnil Pawar July 3, 2018

Robert Rosenthal defined the Pygmalion effect as “the phenomenon whereby one person’s expectation for another person’s behavior comes to serve as a self-fulfilling prophecy” (1) 2015 ILCOR guidelines (2) seem to sway away from self-fulfilling prophesy approach in prognostication post cardiac arrest patients. Successful return of spontaneous circulation (ROSC) is the first step towards the goal of complete recovery from cardiac arrest. The complex pathophysiological processes that occur following whole-body ischemia during cardiac arrest and the subsequent reperfusion response during CPR and following successful resuscitation have been termed the post-cardiac arrest syndrome. The post-cardiac arrest syndrome comprises post-cardiac arrest brain […]

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  • 4

Opinion

Mechanical Chest Compression Devices, are we looking at the new MAST suit?

Dr Swapnil Pawar July 2, 2018

Similarities between the implementation and withdrawal of the military antishock trousers (MAST suit) and the implementation of mechanical chest compression devices are made. The MAST suit has a specific place in the history of prehospital care and emergency care rising in popularity and being withdrawn over a period of approximately 30 years. Both devices demonstrated effectiveness against the surrogate markers of raising blood pressure for the MAST suit and improving perfusion under CPR for the mechanical chest compression devices.  Unfortunately, both have provided disappointing results against the ultimate outcome marker of survival. The possibility that the chest compression devices will […]

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  • 4

Opinion

HepatoRenal Syndrome- Contain the Beast, if You Can

Dr Swapnil Pawar May 8, 2018

Introduction Hepato-renal syndrome is a major complication of decompensated cirrhosis, entailing significant morbidity and mortality in the absence of liver transplant. It still remains a clinical diagnosis of exclusion due to lack of specific diagnostic markers. It is classified as either rapidly developing acute kidney injury (AKI) HRS type 1 or slowly developing chronic kidney disease (CKD) type 2. Both types of HRS are associated with significant decrease in renal blood flow and GFR. The median survival after diagnosis is roughly 1 month for HRS type 1 and 6.7 months for HRS type 2.(1) History and Pathophysiology The association of […]

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  • 2

Opinion

Negotiation in Health Care- Opportunity Not Obstacle

Dr Swapnil Pawar September 30, 2017

In life you don’t get what you deserve, you get what you negotiate for, says Ziad Abdelnour.A day doesn’t do by where we don’t negotiate. We negotiate with our partner/spouse, kids & sometimes even with your self. In hospital settings, we negotiate with an organisation for better work-life balance, we negotiate with colleagues for swapping shifts and we negotiate with families over treatment limitations. However, often our notion is “negotiations are tough and need special skills”. Thus we try to avoid them. One of the reasons for this apathy is lack of training and lack of understanding of principles. What […]

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  • 17

Opinion

All Bleeding Stops Eventually

Dr Swapnil Pawar July 10, 2017

Treating hypovolemic shock secondary to haemorrhage seems very simple. Replace blood for blood. As I grew in my career, I realised that this is far more complex than I thought. James Blundell was the first to notice the importance of blood transfusion, as he observed many females were dying in postpartum period due to PPH. In 1829, he invented first blood transfusion set and saved lives of many. Thereafter, transfusion medicine has evolved rapidly. Why bother? The most dangerous complication of massive transfusion is DEATH. This is attributed to well-known TRIAD of Death, which comprised of Hypothermia, Acidosis & Coagulopathy. […]

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