Point of Care Ultrasound (POCUS) for Regional Anaesthetists

The following presentation was given by Dr Shahridan Fathil during the KoreAnesthesia 2020 International Conference on 7 November 2020. If you came here just for the video, here you go:

If you’re interested in how this presentation was made and how it affected the conversion into video, then follow on.

The presentation was actually a PowerPoint presentation with prerecorded audio. You can do this by using the Record Slide Show feature. Transitions are automatically added and played in accordance to the audio duration. Issues and tips to make it work better in the future:

1. The best transition between slides is…..none in my opinion. The presence of transitions puts gaps between the audio clips when the transition is in progress. This may not be a problem if there is no background sound in between periods of talking, which in the majority of setups naturally will have some wind noise (that I removed in post); the lack of wind noise between slides when it is present in the background actually sounds unnatural. But even if there was no wind noise in the original recording…

2. The timing needs to be perfect: transitions need to happen exactly after the end of each recorded audio. The way recorded slideshows work in PowerPoint is that each slide has an audio segment when you decide to record a presentation. But the problem with PowerPoint itself (and not the author) is that the app does not exactly match the timing of transitions with the actual duration of the audio clip. I noticed this when I tried to record while talking non stop and click through the slides: the slide duration was always shorter than the audio duration. On top of that in one of the slides, the audio was playing in the automated slideshow but not when exported as a video. And in another slide (in the video export), the transition occurred much later after the audio had already ended (despite setting the transitions manually and the part working when played as an automatic slideshow). These are all killer bugs with PowerPoint itself if you want to use it for public presentations with prerecorded presentations. Small deviations in the timing of transitions are seen (heard, actually) as clipped audio, along with the instances of no audio and delayed transition. In the final version above there was still some unusual weird sound effects even after matching the times. As for the missing audio, I simply copied from the presentation file and pasted it in. The case of the delayed transition was simply cropped out. The best way to get the exact time duration (if you want to fix it in post) is by playing the clip till it stops; I found that scrolling to the end of the audio clip does not actually show the duration of the audio clip (it’s off by fractions of a second). Even small deviations in the timings make the difference between hearing “ball rolling” versus “balll-”. But if you want to get it right the first time…

3. …I suggest that you pause before making any transitions. Trying to be mindful of this is annoying, but so is fixing the timings of all slides. And if you decided to play your presentation as a video instead of a slideshow, you may have audio that is not transitioned over or have buggy transitions. Going through your presentation before public consumption will have to be a must because of these bugs; Microsoft needs to fix them.

The timing here…

…And here need to match exactly. PowerPoint will mistime the duration short by fractions of a second. But fractions count.

No audio in one slide, and in another the transition came much later after the audio

Once the timings (including playing of video clips) are set, all you have to do is just play the presentation (if you want to stream with PowerPoint) or export as video (e.g. for uploading to video playing sites). If possible, I suggest playing the slideshow directly versus playing it as a movie whenever possible (due to the aforementioned bugs).

COVID-19 has brought out creativity in trying out solutions for teleconferencing, and we are seeing the pros and cons of the available solutions. Microsoft PowerPoint certainly has its uses for prerecorded presentations, but personally the bugs present can’t make me recommend it.

Virtual Regional Anaesthesia Workshop for Trauma and Emergency

It has been exciting to be involved with the following program that has been a collaboration between the Emergency and the Anesthesia departments of Hospital Kuala Lumpur. If you came just to watch the 2 hour video, here you go:

In the description of the video on YouTube are timestamps to skip to a particular segment.

And if you’d rather go to the production by the Emergency Department (going for a playlist of divided segments), you can go here:

The video was made using footage from a few sources:

1. Screen recording with audio via GoToMeeting

2. An iPhone 11 Pro with my Takstar SGC-598 on a Ulanzi U Rig Pro. Since this wasn’t my phone, I wasn’t sure regarding the available storage: I decided to record at 1080p 30 fps

3. A DSLR of the A&E (which I never bothered knowing what the model is nor its settings)

I must first thank the A&E Department for giving me access to their footage and apply my touches to post-production.

I find it amazing that good video can be produced without much sophistication. You would know which parts were recorded on the iPhone: all shots focused on the presenters were recorded with the 11 Pro’s telephoto lens. Even though the recording was in 1080 and not 4K, I still found the close up shots to be good enough. Only the Q&A session videos recorded with the iPhone had any color/sharpness editing as they were full screen versus the picture in picture style with the slide presentations.

This is my first project that really used any of the microphones I’ve purchased before. And again, I’m happy with the results. Most of the audio used in the project were taken from that microphone recording. There was a huge difference in audio quality between that recorded by the microphone versus that streamed via GoToMeeting. As usual, all of the audio sources were edited: denoised with Brusfi, compressed (with a -6 dB limiter), and some had EQ (to further remove wind noise) and deesser effects added. I find that even minute movements of the camera (and hence mic) can be heard as little shocks as I move a book below the tripod (versus just turning the tripod itself); I need to keep this in mind next time.

That third video source was initially dubbed as a “behind the scenes” video for postmortem purposes. However, during the Q&A session, the footage seemed good enough (focusing well on one of the speakers) such that I wanted to use it (after some color edits and sharpening).

The software used to stream the webinar was GoToMeet. The videos involved were those of the presentation slides and the prerecorded videos. I find that the way the Emergency Department used this application to be intuitive. The video quality looked good enough (of course it’s dependent on the quality of the upstream). The only few glitches involved times where some audio inputs weren’t turned off when they were supposed to and another where one of the video sources were not streamed (hint: the Q&A session). But if I didn’t tell you, you might not have noticed as there were sufficient backup methods to cover these things up. I wonder if using this for my department’s future would be the way forward. But I need to convince people to spend the money involved for the subscription to this service. At the moment I’m familiar with the free tier of Google Meet, but this does not allow screen recording by itself.

Hopefully the videos that have been published so far have good education and production value.

URTI's and Pediatric Anesthesia

Taking the time off work decaffeinating myself and writing some notes (among other things). This also while trying to get my thesis going and ramping up for exam season and cramming everything so that when I do get back to Melaka and meet again with my family (the new MCO has separated us longer than usual, again) I’m able to take care of the kids and take the burden off my wife’s back for her to cram her stuff. This leave was supposed to be for me to go back to Melaka for that very purpose.

But at least I’m now getting a lot of sleep and recovering much more while keeping my caffeine much more reasonable. In my last few calls, I was drinking a cup of coffee for every other LSCS case (during my current Maternity OT rotation), which meant a cup around every 4 hours. But at least the coffee is my self-made cold brew, facilitated by a new machine grinder (that I hope to review in the future): no added sugar and costs are much saved.