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Finger on the pulse.

The origin of the term "finger on the pulse" comes from the literal meaning--to have knowledge of one's own heartbeat. The C in our first aid ABC refers to circulation, determined by manually accessing for a pulse with a finger (or two). A heartbeat can become increased or less rapid depending on a person's circumstances and health, which we see every day in the medical field. Figuratively speaking "Finger on the pulse" refers to someone who has a good understanding of and monitors changes closely in a certain area.

Around 100 participants came to the annual Hawkes Bay Perioperative Nurses College seminar on August 18 to do just that: keep current on situations where every moment counts.

Held in the Education Centre of Hawkes Bay Hospital, the seminar committee was up at the crack of dawn to welcome participants from the Hawkes Bay District Health Board (Hawkes Bay DHB), Royston Hospital and even nurses from Gisborne.

We kicked off without delay with the surgical management of an acute aortic aneurysm presented by Hawkes Bay's own vascular surgeon, Albert Lo. He touched on the ethical responsibilities of a surgical decision in these cases and made a great comparison of open vs closed (endoscopic vascular aortic repair or EVAR) surgical approaches.

Dr Lo is a man who makes complicated, frightening situations look very simple, partly due to his surgical skill but mostly due to his very admirable humility.

This was followed by an out of town speaker, Rob McHawk. Currently based in Wellington with the Ministry of Health, Rob gave us an overview of his PHD thesis which by his own admission he is doing by accident (it was started as a master's degree). Rob's thesis will be based on a combination of two or three studies of Middlemore recovery unit to determine if an updated patient scoring system could improve patient outcome and length of stay in PACU.

Obstetrics & gynaecology

No seminar discussing emergencies would be complete without mention of emergency obstetrics and gynaecology. Our first presenter, Elaine White, a very animated surgeon from Scotland, gave us a detailed timeline of categories 1-4 of caesarean sections used to communicate the urgency of surgery requirements. Dealing with two lives instead of one is a great reminder of why circumstances and therefore categories, can change within minutes and why obstetrics is often theatre's best customer.

Sarah Sew Hoy, an anaesthetist doubly qualified with two fellowships in obstetrics, explained why pregnant mothers differ to other patients for several important reasons such as increased demand for oxygen. Sarah compared spinals vs epidurals, when general anaesthetic is necessary and the complications of these.

Scott Morgan presented a statistical analysis of how Hawkes Bay DHB is tracking in terms of its elective and acute surgical cases. Volumes appear steady compared to 2017 but this is perhaps more indicative of surgery being outsourced, not less work being done. Nationally the board appears to be tracking well, but then again not all statistics were made available. It is also important to remember population numbers and overall health of various district health boards differ and that not one size fits all. Complex patients such as the elderly or obese require more time in the operating theatre but statistically these factors are not always easy to represent in a positive way.

Morning tea, lunch and afternoon tea were beautifully catered for by Pure Catering from Havelock North and included a great spread of wraps, soup, chicken curry, fruit, sweet slices and more. Participants had the opportunity to network, enjoy fantastic food and be surrounded by several delightful floral arrangements compliments of the talented Flowers by Tania in Hastings.

After lunch we separated into our concurrent sessions which included the following:

* Acute theatre coordinator role by Kerry Oughton and Jan Marie Wilson;

* Awake fibre intubation by Allanah Scott;

* Ureteric stone management by Leanne Shaw;

* Managing the complex pain patient through the perioperative unit by Jill Gauld;

* Anaphylaxis and anaphylactic trends by Paul Lockington;

* Acute laparoscopic cholecystectomy by Betrand Jauffret.

I attended the session on orthopaedic neurovascular compromise--otherwise known as compartment syndrome--a dangerous condition caused by pressure build-up in the tissues due to internal bleeding and swelling. This is a true orthopaedic emergency which requires swift surgical management to avoid permanent damage or loss of the affected limb.

This talk was presented by one of Hawkes Bay DHB's orthopaedic registrars Kenan Burrows.

Bernie McEntee gave us an overview of large and small bowel obstruction which can threaten the livelihood of the digestive tract if left untreated due to ischaemia and tissue death.

Gastric bleeding was the next topic and included signs, symptoms and surgical intervention. Most of the audience was surprised to learn that coffee ground vomiting is not indicative of active gastric bleeding.

Ange Russel presented a dynamic view on the trials and tribulations of flight nursing. Ange spoke on the complications of flying with sick patients and that environmental conditions in the sky vary greatly with those on the ground.

Ange took us through the simulations that they undergo to be sky ready, such as having to empty out a fire hydrant on a fire and jumping out the plane in the event of a flying emergency. After explaining how often one would have to take some anti-nausea medication, Ange asked for any takers on learning how to become a flight nurse. Not too many jumped on board!

Our final speaker, physiotherapist Sarah Shanahan, spoke on what it was like to be on the other side of an emergency. Fit and healthy, Sarah was quickly admitted to Hawkes Bay DHB for monitoring after becoming profoundly pre-eclamptic. Sarah was kept in hospital for several days before the decision was made to induce labour. Sarah did end up with an emergency caesarean section but made special mention of the calm she felt whilst in the care of the theatre team that day.

A special thanks must be made to Peter and Jean Koorey. Jean is one of our lifetime Perioperative Nurses College (PNC) members and the original driving force behind our seminars. They have provided educational funding for two of our PNC delegates, Sarah Hasselman and Nicola Hall. These lucky nurses travelled to Nelson in October for the annual PNC conference.

An absolute huge congratulations must be made to the seminar committee--Sally Bone, Nicola Hall, Rochelle Holder, Amanda Martin, Janya McLean and Rebecca Rawnsley--for putting together a seminar that was professional, informative and fun. These nurses through their hard work provide us all with the opportunity to keep our "fingers on the pulse".

About the author: Joanne van der Spuy attained her four year degree at Stellenbosch University in South Africa then worked as a registered nurse for three years in theatre followed by eight months in ICU. After emigrating to New Zealand, she worked in the HBDHB operating rooms for 12 years before moving on to various private healthcare facilities in the last ten months, based mainly now in Royston theatres. Joanne has been a member of HB PNC for many years and served on the committee as secretary and chairperson. She has been attending HB PNC seminars for many years now and believes the quality of education is impeccable and valuable in maintaining our professional standards and development.
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Article Details
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Title Annotation:regional reports
Author:Spuy, Joanne van der
Publication:The Dissector: Journal of the Perioperative Nurses College of the New Zealand Nurses Organisation
Article Type:Conference news
Geographic Code:8NEWZ
Date:Dec 1, 2018
Previous Article:Medical Imaging and PACU sessions well attended at Auckland-Northland education days.
Next Article:Perioperative Nurses [College.sup.NZNO]: CHAIRPERSON'S ANNUAL REPORT 2017-18 presented at AGM October 13, 2018.

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