Pras
@PrasMao
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Specialist consultant in EM, PEM, ICU, PICU. Likes to design stuff to make work simpler. Creator of @TinysaurusCards and
New Zealand 🇳🇿
Joined October 2014
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Celebrating 5,000th
@TinysaurusCards
shipped out today to Taupo! 🥳
Thanks to all the ED, ICU, paeds wards, theatres and urgent care clinics throughout New Zealand for making them a success.
There are still some left at
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Pay our nurses more. Stop making them pay for parking at work. Create proper rest areas for them. See their hard work and make them feel valued. It’s not hard. We are haemorrhaging.
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Proud of my mum who retired this week.
Survived the Khmer Rouge labour camps and slaughter of her family. Escaped across the border where I was born. Came to NZ as a refugee. Brought up two kids. Learnt English. Retrained as a doctor. Served her community as a GP for over 20 yrs
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Resuscitating a flat newborn, delivered through thick mec and not breathing, and then delivering that baby into mums arms 20 minutes later pink and squeeling, is one of the most satisfying things I’ve ever done.
And they told me paeds would be boring ✌🏻
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Lockdown project:
Designed these paediatric ICU lanyard cards for our department because I always have trouble remembering doses and calculations. I’m quite happy with how they’ve turned out.
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Have been developing our new airway trolley over the last few weeks, as part of our resus room redesign for COVID. Really happy with the end result.
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The other regs have accused me of accepting too many soft referrals. Look, I’ll never decline any referral if someone is asking for help. Even if the referral was “please can you see this kid because I’m not sure”, I will see that kid, no questions asked.
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I used to think the best doctors were superhuman. But the more I do this job the more I realise the importance of just being human, and how uncommon this trait exists in our profession.
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Thinking about the nurses today who, had it not been for lockdown, would have been out fighting for safer work conditions, better staff safety and pay equity.
Instead, as usual, they are at work risking their own health to look after our snotty lot 💜
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Saw a very frightened little 4 year old. I sit down next to him, we chat about dinosaurs.
Told him I had to do a nose swab.
He hated it and cried, but as soon as it was done he said “thank you doctor”, still tearing, and gave me a big hug.
Kids are the best 🥲
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My tip for trainees near the end of training:
Find a place to work where you’re valued and wanted. Don’t chase the ivory tower place for the prestige.
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The truth is this:
If you got sick, you would be incredibly lucky to be cared for by the dedicated people at Middlemore, people who care deeply about the community they serve and who sacrifice so much to do so.
That is my tweet.
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After tonight’s crazy shift in the ED, I realise we escaped health system meltdown by the skin of our teeth; had this covid outbreak occur just a few weeks earlier during the RSV tsunami, people and kids would have been harmed. The system is teetering at breaking point.
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What I take from this story is that we often forget about our leaders and senior colleagues at the top. They bear the weight of everyone and suffer too, often in silence. We could do better to check up on them and ask “are you doing OK?”
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I have some awesome news! At the end of this year I will finish my 4th specialty
✅EM
✅ICU
✅PEM
✅PICU
I have been offered a consultant job as paediatric intensivist at Starship PICU, and will also be returning back to
@MiddlemoreICU
working split as an adult intensivist 😊
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That one time I invited a role-mode to lunch, and he came.
He is even more inspirational, humble and kind than he is on telly.
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Chuffed my paediatric lanyard cards have taken off in ED, ICUs and paeds departments across NZ.
Due to demand, I've updated to V2 (you'll have to catch them all like Pokemon).
If you are a dept in NZ and interested in some please DM me as I'm about to get another batch created.
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After spending too much time in the wilderness of training in three specialties, I'm super excited to be coming "home", at last, to Middlemore ICU as a consultant from December 😊
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A doctor introduced themselves to me as “the anaesthetist” today… only for me to learn later that they were a junior
registrar.
Should trainees be calling themselves anaesthetists/intensivists if they haven’t yet completed training?
It led to a lot of confusion on my end!
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I’ve spent my pre-call day worrying about how many covid patients I’ll be having to intubate tomorrow, and not having enough nurses/beds to care for them, or anyone else who needs ICU for that matter.
This is 💯 real so please get vaccinated.
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Proud to graduate FCICM tonight. Extra special with the ASM being in my home town Wellington.
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Great tweet to keep in mind
Note how CXR shows very little consolidation or even interstitial change, but the CT looks "cray cray"
Learning point:
Consider COVID-19 in the patient with a "normal" looking CXR, but a disproportionate severe respiratory failure.
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My bronchiolitis feeding calculator has now been rolled out across the hospital including the paeds ward, ED and ICU.
It’s working a treat and just in time for winter. I love making our work simpler by using simple human factors based design concepts!
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My work involves caring for critically sick patients with sepsis, trauma, heart attacks and those who have had life saving surgery and other emergencies.
Where will we care for them once our ICU beds are filled with unvaccinated patients with COVID?
No Vaccine = everyone loses
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Finally get to be a goofy PEM doctor again after a two month hiatus due to restrictions. Will I get in all my lines? How many hugs (and bugs) will I get today? Stay tuned…
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If I lived in Australia and could do it again, I think I’d train to be a rural generalist. They are crazy talented and pretty badass…
Plus living rurally sounds nice.
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Gosh it’s wonderful having this kind of leadership and transparency in communication, in this country.
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Very proud of my awesome partner, who gave up being a senior ED nurse to retrain in medicine, and has now won the top prize in clinical medicine across all the Otago clinical schools
@bathgate_andrea
Now I can finally switch off and rest 🤓🥳🌈. Very honoured and indeed proud to say the least.
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To all valued UK colleagues who have moved to NZ and Australia. Please stop calling ICU “ITU”.
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I live in Māngere and I work in Middlemore ICU. I have to face this virus doing the worst harm to the best people each and every day.
I got vaccinated to protect myself, my work whānau and my community, all who I deeply care about.
Why did you get vaccinated?
#SuperSaturday
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Did paeds teaching with the
@WellingtonICU
registrars this week and these two slides are the crux of my talk.
Children are more like adults than they are like little gherkins. If you are ever unsure what to do, just treat them like adults… 1/2
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@DocOnSkis
Haha having worked in rural NZ this is accurate 💯
Farmer comes in with sore finger
Me: “how did you do that?”
Farmer: “oh I got rammed and trampled on by a bull”
😳
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My secret for putting in difficult paeds lines: pulling up a seat and sitting down. It feels like I have all the time in the world when I’m comfortable.
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This NY I found myself close to 40 and realised the last two decades of my life has been consumed by study and medicine. This year will be about stepping back and finding *life* again. Looking forward to it.
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Bronchiolitis PICU referrals:
Things I don’t worry about
❌ Work of breathing
❌ CO2
Things I pay attention to
✅ Alertness
✅ FIO2
✅ HR
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Why are officials pushing the narrative that the health system is ready to cope with an omicron outbreak?
It is not.
There are going to be a lot of broken people at the end of this.
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Starship PICU consultant position just advertised. Be quick these are as rare as hens teeth. Come and work with a great team in the only PICU in New Zealand!
@MichWinter1
@Matt_Marvey
@drsmileyarun
@fionam_miles
@alex_hussey
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ANZCA conference: when dozens of anaesthetists suddenly show up on twitter for 5 days before disappearing into the abyss again.
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First week down and my suspicions have been confirmed: being a registrar is bloody hard work.
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When you’ve got to take a flight at 8am and crime to fight at 10am…
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After three years of extra training and a hard slog through further assessments, my fourth fellowship is done!
People kept telling me I couldn’t do it.
Now onto consultant life.
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Tomorrow I start a new job as a registrar again, after working as a consultant for a while.
I’m not looking forward to being infantilised and patronised… I’ve endured through enough of that already in my training 😄😄
Has anyone been in this position and have any good advice?
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Farewell Middlemore… You will always be home. For now, new adventures await…
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Kids I have seen this winter
Flu + Pneumonia
Flu + Wheeze
Flu + D&V/dehydration
Flu + Sepsis
Flu + Meningitis
Flu + Growth failure
Flu + Neuromuscular weakness
Flu + Myocarditis
Flu + Migraines
Flu + Low platelets
Yip flu can be bad.
Vaccines free for kids 3-12yrs from 1st July
If you have a child aged 3-12y, please take up the offer of free influenza vaccines for them. Influenza is hitting the country this winter, a good move by MoH.
This is especially important for preterm children and those with lung problems & other health conditions
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Stay calm, and
Stay the course.
Thanks,
From your friendly neighbourhood intensivist
Loving the direction of this curve. Level 4 working its magic.
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Seeing my name on the same roster as consultants I admire and look up to - had a massive panic attack and sense of overwhelming imposter syndrome. Any advice on how to overcome this medtwitter?
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The most important treatment for bronchiolitis if they are not hypoxic is to stop looking at the child and *sit on your hands*
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I’ve had a week away from work and realise now, after come up for air, that medicine can be all consuming. It’s easy to lose sight of life and all the wonderful things outside of the hospital walls.
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Colleague: So do you know what to do if this kid with a tracheostomy has problems breathing?
Me: umm… I think so. I wrote the guideline 🤷🏻♂️
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New Starship fever guideline released today! Significant change in practice with regards to risk stratification for well babies
⭐️ < 21 days high risk; full septic screen
⭐️ 21 to 28 days mod risk; partial septic screen.
⭐️ > 28 days low risk; urine only
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Proud to launch our new website
In time we hope to share some of our paediatric tools and other resources here as part of
#FOAMed
. There is also information here if you would like to join our great team.
@HorsleyCarl
@RobBevan76
@TheRealKiraS
@KazemiAlex
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At the current vaccination rate, many more babies and children will get covid, including newborns.
Vaccination isn’t just about protecting ourselves, it is about protecting everyone else we love around us, including our babies and children who can’t yet protect themselves. 1/2
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@EMSwami
@MelHerbert
As a kiwi EM doc I find this sort of bravado peacocking embarrassing 🤦🏻♂️
#behumble
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South Auckland it’s not too late to get the jab. Several places are open late
#SuperSaturday
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I’ve seen a spike in paediatric Influenza A in the last week. With COVID still widely circulating this is not good news. It’s going to be a busy winter!
Please get your children vaccinated against COVID and flu if they are eligible
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We don’t need a third medical school. It’s all smoke and mirrors.
The bottle neck is having enough specialist training positions, ensuring we have a solid pipeline with consultant jobs at the end of it, and focusing on valuing and retaining doctors, particularly GPs.
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Four weeks in. Questioning why I’m doing this. Being a reg is very hard work for not very much pay, and not much down time. Huge respect for trainees.
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Healthcare professionals are tired. Each day we risk our lives (and the lives of our families) to take care of people who chose not to protect their own.
COVID is now a preventable disease.
Please get vaccinated.
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These decisions are premature and the timing is wrong.
There is still community spread and vaccination no where near enough. We should not be loosening restrictions.
Thinking about all my health care colleagues at this time and feeling exhausted for the work to come.
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Tried to make a reservation but all the nice restaurants in Wellington are booked out.
Just found out on twitter that there are 1000+ anaesthetists in town for a conference. Didn’t stand a chance 😂
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Working on the Bronchiolitis parent pamphlet for babies admitted to the ICU (still in draught form).
Although with how little bronch there is around right now, this may be a fraught activity...
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Awesome to see many more hospitals around New Zealand adopting my bronchiolitis parent information brochure.
Ive spent the day customising it for individual paediatric departments.
Making a small difference.
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Due to the popularity of our bronchiolitis parent pamphlets, I have converted them into an electronic resource available here for all to use:
@middlemoreicu
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Thanks to all those wishing to purchase these. They need to go through a quality process first and perhaps then I’ll see how I could market them in a non-profit way
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Fiji has been amazing. A reminder to me of how much more there is to life than medicine, which can sometimes be all consuming. Here’s a photo of the Fiji sunset without any filters.
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I’ve been doing acute medicine for so long I’m really struggling with outpatient clinic work (like working up a child with a chronic cough)
A nice reminder for the future, about how tough, scary and steep the learning curve is for our registrars who come from other specialties.
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All ICUs have that one room where all the sad news gets given. I feel like I’ve spent too much time in that room lately…
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💯 agree, vaccination is the best way to protect pregnant women and their baby from COVID.
It is supported by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists
@ranzcog
…
Dr Ashley Bloomfield says pregnant women should get vaccinated. There are “no additional risks”. He says some pregnant women have been arriving at hospital with Covid 19 very unwell
@1NewsNZ
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Feeling sad
About what could have been
Had we been a little more patient
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@KazemiAlex
I recently learnt the Maori terms for Autism and ADHD and they are not only beautiful but have helped my understanding
Takiwātanga (autism)
"in their own time and space"
Aroreretini (ADHD)
"mind that can focus on many things"
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Just realised that all this training has really been about learning to do a good ICU ward round. The ultimate culmination of knowledge, judgement, humanity, care, teamwork, communication and a bit of performance on the side 🙃
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The best thing about our new children’s hospital are the Kaitiaki who watch over our patients. There is one on each floor.
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It should be called the intensive nursing unit to be fair.
What makes up the ICU is not the machines. It’s the experienced staff (especially nursing staff) who intensively care for patients 1 on 1, minute by minute. It’s the “Intensive Care Unit” not the “Lots of Ventilators Unit”.
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All this chatter in the news about booster vaccinations is unnecessary noise and distracts from the real issue of getting everyone fully vaccinated first. That’s the most important thing right now in beating this virus.
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Today in the middle of a resuscitation I turned to find a friend, who i had last worked with in another city two years ago, on the airway. Amongst the chaos we shared a surprised smile, and I was glad he was there. NZ is truley a small place.
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A sad reminder to put yourself, family and life first above all else. We are just cogs easily replaceable in a system that won’t remember us when we’re gone.
After 29 years work for the NHS, 23 for 1 Trust, 17 as a consultant, it’s been humbling to feel so valued and appreciated.
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In paediatrics help is everywhere if you know where to look. Don’t be afraid to ask for help… NICU for instance are fantastic help with difficult access in neonates and can do echos. Paediatrics is a team sport 2/2.
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Thanks to our parents/grandparents who got themselves vaccinated, we are lucky to now live in a world where the Polio virus has virtually been eradicated.
It is our turn now to do the same for our children.
They should not have to grow up and live in a world surrounded by COVID.
I work at a thrift store and found this vaccine card from 1956. Felt weirdly timely
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Designed this new bronch feeding calculator and algorithm for the new hospital, to streamline practice, encourage early feeding and to make it more nurse led. Hopefully will be rolled out soon before winter and before I leave!
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Over and out
@WellingtonICU
thanks for having me. A great unit with great people if anyone is interested in working there. Im going back to paeds land next and I’m a little bit excited by that.
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We already have a third medical school called the UK… recently providing us with a steady supply of junior doctors 😅
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It's a safety issue because there are times I need to be having consultant-to-consultant level discussions.
We have a lot of UK doctors working in ANZ currently, and given the cultural differences in the use of terminology, perhaps we need to be more careful here about mixups.
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I'm not sure what a "burning temperature" is. These children have a fever. Use of click-bait emotive scare-mongering language like this is not helpful.
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I’m blown away by the popularity of the
@TinysaurusCards
. They have now been adopted into theatres and urgent care clinics across NZ! ☺️
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This is legit the best thing you’ll watch this week.
The people of French Polynesia were terribly please to see President Macron yesterday.
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