Mohan Sai Gudela, MD
@drmohansai
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Anaesthesiologist from AB8. Learning Critical Care Medicine skills.
Jodhpur, India
Joined November 2013
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Anesthesiology is versatile. Its scope goes from neonates to geriatric patients and is ubiquitous. OR, ICU, Pain OPD, ED, endoscopy, cath lab, MRI suite, & so on! We study a lot of topics in depth to be able to give our best. Here are my go-to books/resources:
#MedTwitter
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I will be joining DM Critical Care at AIIMS Jodhpur in the next few weeks.
From reading my first Critical Care book in 2013 to joining DM Critical Care course in 2023, it is my dream come true 😃
#Gratitude
Anaesthesiologist first. Intensivist next ✌️😎
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That's precordial thump in between chest compressions.
Electrical shock is known to cause VT/VF. Precordial thump has Class IIb recommendation in case of witnessed, monitored, unstable VT if a defibrillator is not immediately available.
I am happy to know that the child
𝑫𝒐𝒄𝒕𝒐𝒓 𝑷𝒆𝒓𝒇𝒐𝒓𝒎𝒔 𝑪𝑷𝑹 𝒐𝒏 𝒓𝒐𝒂𝒅, 𝒔𝒂𝒗𝒆𝒔 𝒍𝒊𝒇𝒆!
In Vijayawada, a 6-year-old boy faced a life-threatening situation after an accidental electric shock left him unconscious.
A doctor passing by noticed a distressed father carrying his son and immediately
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My mom travelled to Jodhpur from Vijayawada within few hours of intimation and gave me documents required to submit in the office for my DM admission. I was in panic mode when i realised some documents were missing. She managed the situation so well. Nothing short of MI.
#Blessed
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Okay! This is a lovely table on low-dose corticosteroids for severe pulmonary infections.
#CriticalCare
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Good article. Great Insights, especially regarding sodium bicarbonate administration in DKA!
#CriticalCare
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Seen this patient in PAC clinic. Primary infertility scheduled for VEA surgery. He had no other complaints. Left upper lobe crept on auscultation. Thats his Chest X ray. Connect the dots!
#anaesthesia
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This view motivates me to give my best shot at work every day ✌️
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Birthday + Weekend mat on call + amazing team = A memorable one! Loved welcoming my birthday twins 🌚
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SPM/PSM/Community Medicine/ Public health is a contact sport like any other branch of medicine. If working in ER/OR is tough, it’s equally tough to go on a Field trip in adverse conditions. Two sides of a coin! Appreciating efforts and contributions of Public health Physicians 👏
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Well, i am happy with my job 🌚✌️
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I thought hyperparathyroidism is just about “stones, bones, groans and psychic moans”. I was wrong! My patient had pancreatitis due to hypercalcemia, splenic artery pseudo aneurysm, pancreaticopleural fistula & vocal cord palsy leading to aspiration😓
#endocrinesx
#anaesthesia
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Back to emergency shift after 10 days. Emergency C section. Spinal given. 1 hour into surgery, Systolic drops to 70. Sats drop to 75%. 100% oxygen,fluids and vasopressors given. Vitals back to normal. Transient air embolism may be. Scary! But that’s the job.
#Anaesthesia
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AB8 forever 🙏
AIIMS has made me a better person and physician. Such a lovely place ❤️
Convocation done right :)
Proud Anaesthesiologist ✌️
#AIIMS
#Convocation
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Learning never stops at AIIMS!
Pic 1 - Senior resident puts his first USG guided subclavian central line.
Pic 2 - Critical care resident teaching POCUS to junior residents.
#Anaesthesia
#CriticalCare
#POCUS
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I couldn’t intubate a patient in emergency today. CL grade was III. Early call for help, DAS guidelines, Bag Mask ventilation & Video laryngoscope saved the patient. I quickly switched between intubation, SGA placement & Bag mask ventilation. Adrenaline rush for 2 hours. Phew!
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First independent bronchoscopy in ICU. Happy that secretions were sucked out and LUL collapse would be taken care of. But then left shoulder troubled a lot later 🌚
#CriticalCare
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New Diagnostic Criteria for Hepatorenal Syndrome!
Interesting point - Presence of underlying kidney disease does not exclude a diagnosis of superimposed HRS-AKI and HRS-AKI may co-exist with other causes of AKI.
#CriticalCare
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One of patient’s blood culture isolated Candida vishwanathii. I was curious about the origin of the name & tried searching the literature. Species was named after Prof.Raman Vishwanathan sir. Aka “Father of Chest Medicine in India”. You can know more here
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Yesterday was my first emergency shift at burns and plastic centre! Managing burns is a real challenge. Airway, vascular access, Hemodynamics, IV fluids, Infection control and what not. Thoroughly enjoyed work in casualty and ICU. Lot to learn ✌️
#CriticalCare
#Anaesthesia
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Big case in OT today! Relatively big vascular pheochromocytoma posted for excision🙊 Home work done and looking forward for dance with the Hemodynamics🌚
#anaesthesia
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Yesterday IR fellow ordered a burger for me when he got to know that I couldn’t go for lunch because of sick cases in the list. Appreciate his gesture 👏 Workplace becomes better when we are kind and acknowledge each other’s work 🙏
#Anaesthesia
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Always have Pneumothorax as primary differential anytime when you see high peak airway pressures in severe ARDS patient on ventilator. I am not gonna forget this case! What is the sign of pneumothorax you can see here btw?
#CriticalCare
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Small academic achievements in DM so far:
- First seminar (My fav topic: Antimicrobial Stewardship:)
- First bedside case presentation
- First individual night shift
- Counselling patient attendants and make them believe in the process!
#CriticalCare
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Love this Mind map on the role of Adenosine in managing Narrow QRS Tachycardia!
#CardioTwitter
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Anaesthesiologist is next to mother. Worried about the last meal you had 😎🌚
Gynaecologists are best motivational speakers
They inspire us to “Push more” .
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MD in Anaesthesiology, Pain Medicine and Critical Care from AIIMS, New Delhi. Done ✌️
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Quiet an eventful emergency shift. It had everything. Anaesthesia, Resuscitation and Palliation. Work satisfaction at the end of the day ✌️
#Anaesthesia
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Why everyone started behaving as if surgeries are done by surgeons and speciality physicians in the operating room? Got MS/MCh by learning on simulation alone? Speciality physicians have given anaesthesia to a sick case? Answer is a big NO!
#Anaesthesia
only looks easy.
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Seems staph aureus is the most common bacteria causing infective endocarditis 🙊 Source: Harrison 21st Ed.
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Thoracotomies are tricky. They bleed badly sometimes. 4 litres loss but team work saves the day.
#Anaesthesia
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Kindly do not skip anaesthesia residency to prepare for Critical Care Super speciality. Knowledge of Anaesthesia helps us to give better care to sick patients every single time. You feel helpless without good resuscitation skills (get it from anaesthesia residency when you can)
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Post spinal hypotension is dramatic especially when the patient is chronic hypertensive with superimposed pre eclampsia & is on labetalol. I felt overwhelmed during that moment but had no option to express. All I did was to calm myself down quickly & resuscitate.
#Anaesthesia
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I haven’t attended my 2018 NEET PG counselling. My rank was around 5k. Instead I prepared for central institute exams. My reasons were the same. Better education, pay and opportunities. It was a calculated risk and I am happy that it worked!
Why you should not wait for NEET PG counselling and instead aim for Nov- INI:
No bond
Better salary
Better Academics
Brand- helps in SRShip, fellowships, US experience.
MCC is notorious in postponing PG counselling. Once it starts, the whole process is so messy.
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Airway secondary to facial burns and inhalation injury sorted out with Ketamine, bougie and video laryngoscope! Intubated in first attempt in all cases so far. Boon to anaesthesiologist 🙏
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Patient prior to endoscopy: How do they insert such big long endoscope inside me? I am worried.
Me: Take this lignocaine lozenge. We shall sedate you on top of it. You will be comfortable during the procedure.
Patient after procedure: Done? I was dreaming actually
#Anaesthesia
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Took some time to teach white, black and grey images (POCUS) to JR’s yesterday (Holi) during the emergency duty!
They have done 2D ECHO, DVT scan and Lung USG in the appropriate clinical scenarios. Day to remember✌️
#POCUS
#MedTwitter
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Reflector telescope to begin with 😋Thanks to my junior Chandramouli for inspiring me to get one. PS: That’s Jupiter in view as a tiny dot 😅
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Anaesthesiology made me a better physician and more importantly a better human being.
Calm and composed during emergencies. More empathetic while dealing with pain.
Can’t ask for more.✌️
Happy World Anaesthesia Day to all my fellow colleagues 🥳
#Proudfeels
#MedTwitter
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"World Anaesthesia Day" "Restart a Heart Day" & "World Spine Day" - all are celebrated on October 16. By providing safe anaesthesia for surgeries, being the best hands for resuscitation & relieving acute as well as chronic pain, Anaesthesiologist celebrates all the 3 occasions!
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“National Emergency Life Support Course (NELS)” is India’s first indigenous emergency life support course to provide standardized skill-based training in management of common emergencies. Spread the word
#MedTwitter
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Sunset therapy - Best way to recover from hectic emergency duty fatigue ❤️
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Proud of my anaesthesia and surgical team who did extremely well in managing a moribund (ASA V) case in the odd hours. Peritonitis, huge lung consolidation and multi organ dysfunction were big obstacles for us. Satisfaction at the end of the duty ✌️
#Anaesthesia
#Surgery
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We were taught that Bag mask ventilation will save the life. It did!
We were taught that oxygenation is more important in difficult airway scenarios.
Patient had full sensorium after resuscitation.
Mixed emotions. Phew!
#Airway
#CriticalCare
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Happy to see this! Anesthesiology is a wonderful branch. It made me a better person as well as a good doctor ✌️
#MedTwitter
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Intubating a difficult airway in emergency is indeed a cloud nine moment for an Anaesthesiologist/Intensivist.!
#CriticalCare
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Nice table on aetiology of seizures in dialysis patient.
Source: “CKD, Dialysis, and Transplantation - Companion to Brenner & Rector’s The Kidney”
#CriticalCare
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This is like the child complaining about not getting a chocolate 😂
No end to Surgeon Vs Anaesthesiologist atrocities!
We know our capabilities. We know yours as well 😎
#Anaesthesia
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@spkalantri
You can ask the same question to those who have survived acute illness, got treated in ICU and discharged to home sir. Palliative care is a realisation in many places and people are embracing it. Please refrain from making negative comments. Thank you sir.
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Reading suggestion - International Consensus on Standardized Clinic Blood Pressure Measurement − A Call to Action.
#MedTwitter
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Super proud of health workers (special mention to anaesthesia residents/faculty) in safe evacuation of patients from OR, endoscopy and wards. Great team effort 🙌👏
When the fire broke out today, healthcare workers at
@aiims_newdelhi
along with other staff, risked their lives to ensure that all our patients are shifted to safer places before evacuating the building!
Super proud of my colleagues, juniors and seniors who helped out! ♥️
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I believe that extracorporeal support is no more a luxury. It is an essential component of care for many critically ill patients. I am fortunate to learn it from teachers at my institute ✌️
#CriticalCare
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Delhi’s weather being dramatic in the span of 15 minutes ❤️
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Yesterday's learning from Cardiology colleague - InterTAK Diagnostic scoring for differentiating Takotsubo and ACS.
- Score ranges from 0-100
- Score more than 50 is the cutoff for differentiating Takotsubo and ACS.
#CriticalCare
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"Improvement of kidney function after diuresis in patients with elevated filling pressures suggests that these patients might actually have hepato-cardio-renal syndrome, which was misdiagnosed as HRS (albeit based on available widely-used criteria) given similar clinical
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@nihar_nayak2
Another important situation is when the patient is already intubated & mechanically ventilated. Ventilator settings are to be optimised else it would hamper the cardiac output during CPR. VCV mode, FIO2 = 1, RR- 10/min, Trigger - Off, PEEP - Off is recommended in such situations
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Pre MBBS: Oncology
MBBS: Neurosurgery
Now: Happy Anaesthesiologist ✌️
#MedTwitter
What did you want to specialise in and which speciality did you end up in?
For me:
Pre MBBS - I wanted to be a Cardiologist
During MBBS - I wanted to be a CTV surgeon
Now - I am a Radiologist
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Static vs Dynamic bronchogram?
PS: Carefully look for the column movement inside the lung 🌚
#POCUS
#CriticalCare
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Yesterday was my first emergency shift at surgical block. Little apprehensive initially. May be because of the shift from obstetrics to surgical emergencies. Got to do some POCUS and USG blocks as well. Happy with the USG guided ESP block. Patient was pain free :)
#Anaesthesia
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How common is Terlipressin induced Pulmonary edema?
I think it's very common 🥲
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Views from Surgical block 😎 Any workplace with access to watch sunset and sunrise is the best 😁
#Anaesthesia
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Me and my senior were having a discussion about Crohn's vs. abdominal TB in a patient admitted to ICU. It all appears the same, but they have important differences. The following review article by
@drvishal82
sir & team is exceptional and clarifies the important differences
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@rjVACHAS
Interns at AIIMS New Delhi lack basic medical skills (observation during my MD and senior residency from 2018-2022)
For many, Cracking entrance >>> Doing internship is the mantra.
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I am glad to have completed AHA-certified Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) provider courses. More happy to do so by achieving Instructor Potential.
Thankful to my faculty for this 🙏
Looking forward to becoming an Instructor and teaching
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So WHO has released a priority list of fungal pathogens. Here is the summary of “Azoles”on this occasion 😁
#MedTwitter
Fungal pathogens can cause illnesses and death.
They are becoming increasingly common and resistant to treatment.
Yet, too little is known about them.
The 🆕 WHO fungal priority pathogens list is an important step to boost urgently needed research:
📌
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Accidental Endobronchial ET tube displacement resulted in left lung collapse. One hell of challenging bronchoscopy (with senior) to drain out secretions from the collapsed lung:)
Examining the tube position once per shift avoids such complications.
#CriticalCare
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APASL clinical practice guidelines on the management of acute kidney injury in acute‐on‐chronic liver failure
Do not miss going through this guidelines. Every aspect of AKI management in ACLF is thoroughly discussed🙌
#CriticalCare
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Tough one for both Surgeon and Anaesthesiologist . Appreciate surgeons for taking out such big mass via lap only. Huge hemodynamic swings. 4 hours of adrenaline surge in both patient and Anaesthesiologist 😅 patient got extubated on table and shifted to ICU for monitoring. ✌️
Big case in OT today! Relatively big vascular pheochromocytoma posted for excision🙊 Home work done and looking forward for dance with the Hemodynamics🌚
#anaesthesia
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Electrical Cardiometry! Another non invasive cardiac output monitor in non cardiac OT. Can’t wait to get hands on!
#Hemodynamics
✌️
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Sharing a few important learnings from the POCUS workshop, Vijayawada.
"Currently all the medical specialties are embracing POCUS for better patient care. We are witnessing rapid development in the field of POCUS" - Introduction to POCUS by
@KalagaraHari
sir
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@whyanviwhy
I invested in iPad 7 in 2018 when I joined my MD. Worth every rupee. Still working best without any lag. Huge number of academic articles + books in iPad (advantage of quick look) and hard copies of essential books = Best combo!
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@anujtiwari11
True Dr.Anuj. Normal ECG is seen in 10% Acute MI cases. Thanks to 2021 AHA/ACC guidelines, evaluation of chest pain was very well described.
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Learning from yesterday’s duty: Persistent severe pain near lower segment uterus despite good labour analgesia in patient with history of previous LSCS - Always rule out uterine scar dehiscence and impending uterine rupture. It was scary!
#ObsAnaesthesia
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What could be this pulsatile round structure in lung USG? Doppler is not picking up any colour flow.
@NephroP
sir
#CriticalCare
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Today’s theme: Pediatrics 😁
Have seen some interesting cases. 1)West syndrome - Infantile spasms well controlled with ACTH, 2)Operated case of DORV, 3)Severe Anaemia (2g/dl), 4)Goldenhar syndrome, & 5)TEF.
Loads of learning from interactions with kids & parents.
#Anaesthesia
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5 hours and counting. Stable Hemodynamics & minimal opioid requirement. All credit goes to USG guided axillary nerve block. Wish child wakes up pain free!
#Anaesthesia
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Approach towards surveillance-based diagnosis of acute respiratory illness in India: Expert recommendations
Interesting!
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I am grateful for the opportunity given by Srinivas Sir and Ghanshyam Sir :)
Disclmair: lil lags & tiny mistakes happened 😄
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The pathophysiology of "Trauma-Induced Coagulopathy" is very well described in "Trauma" (authored by Mattox & Moore) 9th edition.
#CriticalCare
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