KIWI CHRISTMAS IN FLORIDA 2015

The Fascinating Culture Of Japan

Bonny and I traveled to Japan September 23rd to October 6th 2015 and were intrigued by the Japanese culture. We learn the following #1their incredible Reverence Of Nature

#2 Attention To Detail

#3 Interdependence

#4 Never Say No

#5 Gift Giving

Emergency Temporary Tansvenous Pacing Via The Right External Jugular In Anticoagulated Patient With A Inferior Myocardial Infarction

One day on rounds I examined a elderly individual who had presented late with a inferior MI and was on Dabigatrin anti coagulation for chronic atrial fibrillation. He had not called for help because he awoke in the middle of the night with chest pain. He presented the next morning pain free and was not given thrombolytics. I was latter summoned to the CCU to find him in atrial fibrillation at a rate of 20-40 min on Isoproternol drip he was hypotensive and hypo perfused looking a dusky blue.

We initiated external pacing which worked but was very painful. As I called for emergency fluoroscopy to help place a temporary pacemaker I worried about the risk of  a bleeding complication in obtaining central venous access in this anti coagulated patient. The preferred route of access for temporary trans venous pacing is the right internal jugular vein followed by the subclavian and femoral veins*. However to my relief the patient had a large right external jugular vein which would allow venous access without the danger of arterial puncture.  I was able to quickly cannulate the right external jugular vein and with fluoroscopy guidance place a temporary wire into the right ventricle and successfully paced the patient.  With pacing his blood pressure returned to normal and a pink color returned to his face. He received a permanent pacemaker the next day and was able to walk out of the hospital the following week.

• *The preferred route of access for temporary transvenous pacing is the internal jugular vein followed by subclavian and femoral veins. However, all the major venous access sites (internal and external jugular, subclavian, brachial, femoral) have been used and each is associated with particular problems
• The right-sided veins should be used when possible.

Royal College of Physicians

King Henry the VIII founded the Royal College Of Physicians in 1518.  The founding charter decreed, this college would ‘curb the audacity of those wicked men who shall profess medicine more for the sake of their avarice than from the assurance of any good conscience.

By joining the Royal Australasian College this weekend I have committed myself to the principles of this tradition that dates back to the 14th century.

"Up Skill" To Insert Reveal LINQ Cardiac Moniter

This week I had the opportunity to learn a new surgical technique implantation of a miniature cardiac monitor the Reveal LINQ. Under the supervision of my colleague and the medtronic representative I successfully inserted inserted 2 devices. The first device insertion was a little nerve racking and the patient looked up at me after the procedure and asked "is this the first one you've put in"? I smiled proudly and said yes. She returned 3 hours after having the device implanted with a answer to her palpitations, rapid atrial flutter/fibrillation, lasting a few seconds but recorded on her new Reveal device.

Example of how the device can track Atrial tachycardia/Fibrillation

Is It Really A Heart Attack? NON STEMI VS NON SCHESTEMI

Today the house staff were perplexed when a female patient with a low level troponin elevation and with a terrible story for unstable angina  had a normal coronary angiogram. Why would a patient with the diagnosis of a non ST elevation MI have normal coronary arteries they asked? The answer is a troponin elevation is sensitive but not specific and does not equal MI without 12 lead ECG changes or segmental wall motion abnormalities (2D Echo). Low level troponin elevation without ECG changes is a NON SCHESTEMI. So this day forward a poor story for unstable angina without ECG changes or wall motion abnormalities and with a normal coronary angiogram is a NON SCHESTEMI (Should of CHecked the EcgSTEMI).

Milford Sound Queenstown

                The most beautiful glacial lake in the world in the Southern Alps of New Zealand

The Tui, song bird of New Zealand

                          The Tui with it's distinctive white, double, throat tuft of curled feathers

New Zealand in World Cup Finals!

Grant Elliot down to the last two balls hits a 6 to raise the roof in Eden Park! Black Caps reach World Cup Cricket Final!!!!!

Cricket World Cup Fever hits New Zealand!

We went to our first cricket match since coming to New Zealand on Saturday March 21st and it was a cracker! The Black Caps defeated the West Indies in Wellington. The match started very slowly with their captain and best batsman Brendon McCullum going out early. Then Matin Guptill set a World Cup record scoring 237 and energizing the 35,000 Kiwi's. Everyone was on their feet clapping and chanting Guptill, Guptill! The crowd went wild when he hit a 6 out of the stadium and onto the roof.

Bonny and I never thought cricket could be so exciting.

Now it's off to Eden Park in Auckland were every television in New Zealand will be tuned in to watch the Black Caps defeat South Africa on Tuesday March 23rd in the Cricket World Cup semi- finals. Kia Ora from the land of the long white cloud!

Sponsored by Gatorade 

ADVENTURE DOWN UNDER

My son Christian and his girlfriend Brooke decided to come back with us after Christmas for a adventure down under. We started in Queenstown with a champagne lunch on a mountain lake.

                                                   Followed by a snowball fight on a glacier.

                                              Then it was Skydiving over lake Wanaka.