Posts Tagged ‘Medical studies’
For the sake of blogging….
Its kinda getting late, almost 11pm already. I better finish up this post and go to sleep fast. In this depart, we need to sleep early, in order to wake up in time and start our morn rounds at 6am. I began to feel ‘old’ recently. Sleeping early….
The condition in really challenging our patience. Imagine, its already almost 1 week, there was not a single pink branulla or opsite in the whole ward. I wonder what is the sisters doing. Is it the whole hospital is running low of branulla stock or is it plain laziness??? I dont understand. But this problem of low stock of equipments in the ward is really really making our job difficult and stressful.
Imagine, a patient came in with high grade fever associated with cough and SOB… We need to take blood C&S before starting antibiotics. If we start antibiotics without taking any culture, boss is gonna give us a ‘piece of his/her mind!’. But the whole ward, bottle for blood C&S NOT AVAILABLE! Geram betul…. Sometimes I just feel like knocking my head on the wall.
But what to do, this is part and parcel of being a houseman. Getting frustrated and irritated for things that are within our control… I seriously need the grace of God to keep me steady and cool in the midst of all this nonsense…
‘Traumatic PD’
I was oncall last 2 days. Tat was an eventful call, cuz i oncall with a ‘Jonah’ MO. That was this patient, referred from a peripheral hospital. 60 year old malay lady, known case of diabetes melitus, hypertension, congestive cardiac failure and chronic kidney disease. She complain of right abdominal pain with vomiting and diarrhea. The working diagnosis was, 1) Sepsis secondary to ? source, TRO Pneumonia, 2) Acute kidney injury on chronic kidney disease, 3) Underlying DM, HPT, Chronic kidney disease, Congestive Cardiac Failure. She was having spiking temperature with urea about 44.0 and ABG of metabolic acidosis.
Patient was attended by MO oncall in A&E. He then call me thru the ward and asked me to trace the PT/INR and then to do a Peritoneal Dialysis(PD) for this patient after reviewing the PT/INR. PT/INR results came back normal and I was requested to PD this patient.
So then I did the PD for this patient. I inserted the PD cathether into her abdomen. She complain of abdominal pain. Managed to run in 1 litre of hypertonic fluid. But when I tried the outflow, initially came out clear fluid, but then came out about 50-100cc of turbid, yellowish fluid with some whitish material. Being afraid of perforating her bowel, I quickly alerted the MO oncall.
MO came and see this patient. After looking at the PD fluid, he said ‘Its shit!!! And U r in deep shit!!!’ Then he said ‘Initially we planned this patient for maximum medical management, but now that u have perforated her bowels, we have to HD this patient!!!’ Now that he has tonnes of work to do, he was kinda irritated with wat I has done.
We then referred this patient to surgical, TRO Perforated viscus. Also refer to GA for Haemodialysis via femoral catheter. I got myself into writing referral the referral letters.
The following day, the surgical team came to review this patient, their impression was, TRO perforated viscua. They then planned this patient for exploratory laparotomy. Patient’s condition was optimised and then she went for exploratory laparotomy.
But, thanks to God’s wondrous grace. Post op diagnosis was appendicular abscess and pus collection over right illiac fossa. Bowel was normal!!! Patient was actually having sepsis secondary to appendicular abscess. and the turbid yellow fluid during my PD insertion was the pus discharge from the appendicular abscess.
I dunno whether I will be requested to present a morbidity review on this. But Im glad that, my so-called ‘Traumatic PD’ lead to the correct diagnosis. She is currently in ICU. Pray that she will walk out healthy….
Maximum Medical Management
Maximum medical management! This is a word that is not rare. I wonder who created this term. Some patients admitted with severely ill condition, sometimes our boss will say ‘This patient is for maximum medical management’. It simply means that patient is not for active resuscication should he ever collapse. For this group of unfortunate patients, should they ever collapse, we still resuscitate them. But we don’t intubate them. Mostly, its grave prognosis.
Usually its the elderly, known case of carcinoma and with multiple illness will be in the group ‘maximum medical management’. But the word maximum medical management means maximum. So their management should be maximized. Sometimes I noticed, their management is not maximized. Kinda disappointing….
Just finished my evening rounds. Here, we housemans do our rounds twice a day including saturday and sunday, which is actually good for patients, but not good for us. Cuz we dont get weekends off. Actually they shud just allow us to do rounds once a day on weekends. I tot of suggesting tis to Boss, but who am I. Im just the ‘know-nothing’ houseman. Boss surely gonna shut me off and give me a piece of her mind… Hahaha! Nevermind, take it as something tat is beneficial for our patients…
Living up our mistakes…
Surviving as houseman simply means surviving our mistakes. Lets admit it, no one is perfect. But, when we see a dr for treatment, we expect perfect treatment. Of course, because it involves our life.
But, the fact is, doctors also make mistakes. Commonly most of a doctor’s mistakes will be during his/her housemanship days. In this department, when our seniors found out our mistakes, they will come after us like a hungry lions. So if one of us makes a mistake, we will be in deep ‘misery’. One of my colleagues even slept in the hospital room, even she wasnt oncall. Cause she was too worried that she might make any mistakes. She change her ward shortly after that. Cant blame her oso, cuz the MO in charge of that particular ward has too high expectation on HO. Man… I hope they dun post me in that particular ward. All the patients inside there were unstable and can collapse anytime.
I remembered how I made a big mistake during my final year pro exam. In the long case, I made a wrong diagnosis. It almost cost me that whole exam. By God’s grace, I narrowly passed my Pro 3 exam. I was so worried that I didnt even went to hear the result announcement… If I didnt make it during that Pro exam, I may have not started my housemanship yet, and the little one in my family may have not started his therapy yet. Although we are still struggling with him now, but still I thank God, at least now after I started working, our family has started to move somewhere…
Its so so late dy, and I need to get an early sleep again. Hopefully I get a ‘bedsore’ call this wednesday….
Grateful
Today, I just got the news. A sister of my fren has passed away of stroke. Life sometimes can be so unpredictable. Someone we loved can be perfectly well today and then collapse in a split second. Good ppl die of serious illness. Hard to say whether will we breathe the next breath.We shud learn to appreciate those ppl around us. We never know, will we ever see them again…
I used to complain a lot bout being a houseman, complain about our workload and how we are treated. But now I realised, in the midst of us feeling that we are ill-treated, and bullied, there are many more unfortunate ppl around us. People who are sick, unwell and chronically in pain! People who have no source of help in their illness. They just relied on us, government doctors and nurses to cure them. Many end their life in hospital, which mostly is not the intended one.
I learned to count my blessings. Although being treated like slaves, get scolded like nobody business, I still thankful… At least I didnt have end stage renal failure or decompensated heart failure. People call me doctor and I still get my pay every month. I dun need to lie in the hospital for a long time… having to wait for the busy nurses to attend my needs. Being a christian and knowing that I’m saved is already the greatest blessing ever.
Its getting late, and my eyes are getting heavy. Tomorrow will be another challenging day. Keep in heart, we are blessed!
Faithfulness Forever
Exactly 2 more weeks I gonna face my Professional 3 exam. Feelings of anxiety and uncertainty begin filling my heart. So much to study, so much to clinical examination to practice. I really dunno how this 2 weeks is gonna be, what the outcome. I wish I could just turn back time and start all over again, but tats of course impossible.
We can try our best to achieve anything but, we cant guarantee anything in life.
With this I put my all my hope and trust in God. Whatever the outcome of this Pro 3, I will still praise Him.
“Do not be anxious about anything, but I everything, by prayer and petition, with thanksgiving, present your request to God.” Philippians 4:6
Hospital Pasir Mas
Its been a few days since I was posted in Hosp. Pasir Mas. Life here was really different than that in USMKK. Arrived here on thursday, I found the scenery here rather peaceful and quiet. There were 17 of us, 6 guys and the rest girls, one house for each. Two dutch students from Holland came and join us in this district posting. Wow, our life here will be much more interesting with their presence. The house was dirty, so the first day was all cleaning and mopping. One good thing we found is that, the previous groups left a map of Pasir Mas in our house, showing those popular food restaurants in Pasir Mas. These restaurants were also rated, imagine that? How creative they were?
The next day, we set out to check out those ‘hot’ restaurants in Pasir Mas, but unfortunately most of the reataurants are closed on fridays. We wanted to eat the ‘Lian Hong’ Loh Mee, but it was closed too. So we just settle down with wan tan mee nearby. That day was also one of our coursemate, Zie’s wedding party. Including her, there were already 4 ppl in group who are married, one of them is already a mother! I am still single.:-( So jealous of them… Anyhow the bride was so beautiful tat day. She was always pretty, but tat day was just extraordinary beautiful. We had another lunch at the wedding party and then took photos with the newly wed couple.
On day 3 which was Sat, We spend the whole day online, chatting, downloading movies. The line here was quite fast, so our computers were on most of the time. I brought my keyboard along and Viki brought his guitar. I taught Toh Jeng, my coursemate to play ‘My heart will go on’ on the keyboard and he was diligently practising it since then. Occasionally his gf (who is also our groupmate) will drop by listen to him playing. How sweet…:-)
Yesterday, was just the usual briefing, running in the wards, doing procedures. We are supposed to go Barkas in the evening, to do some research on the water in Kelantan but due to technical error, the trip was postponed. Tis morning, I went to the Labour room, and there was this patient, 28 year old female, gravida 2, para 1, about to give birth to her second child. No painkiller was given to her. Her active phase of labour was long and she was having difficulty pushing her baby down. Possibly due to her short contraction pain. It took almost 1 hour before finally the the baby’s head came out. Here in Pasir Mas, unlike HUSM, they dont give painkiller to pregnant ladies in labour. Imagine the pain they go thru? I really salute these ladies who choose to deliver in Pasir Mas.
Life here is rather slow paced, unlike in HUSM. People here are more relaxed and not in a hurry. I dont feel so much pressured here.
Mercy and strength
‘Let us then approach the throne of grace with confidence, so that we may receive mercy and grace to help us in our time of need.’ Hebrews 4: 16.
This verse struck to me as I was reading the Bible this morning. This week I gonna orthopaedic posting exams and by the end of the week, is SUKAD. Both stuffs giving a hard time this whole week. In final yr, orthopaedic posting is only 3 weeks, really not enof time for us to cover much. Especially my theory knowledge, i struggle a lot, even during our ortho posting in 4th yr.
In difficult times, we tend to use our own intelligence to solve problems rather than relying on God’s. We doesnt seek God, we figure out our own solutions. In the end, problems multiplied and worsen, we get stressed up. And then we blame God! We blame God because God didnt help us to solve our own problem (by using our own solutions). But I believe God is still faithful. He will never forsake us in times of trouble. We just need to pray n come back to Him… Learn to be dependant on Him!
What ever happens tis week, I juz hope tat it will be something tat glorifies God!
Causes of respiratory distress in term infants
PULMONARY CAUSES
Common
Transient tachypnoea of the newborn – Caused by delay in the resorption of lung fluid and is more common after birth by C-section. CXR may show fluid in the horizontal fissure and additional ambient oxygen may be required. Condition usually settles within first day of life but can take several days to resolve completely.
Less common
Meconium aspiration – Meconium is passed before birth by 8-20% of babies. Rarely passed by preterm infants and occurs increasingly the greater the gestational age, affecting 20-25% of deliveries by 42 weeks. Asphyxiated infants may start gasping and aspirate meconium before delivery. Meconium is a lung irritant and results in both mechanical obstruction and a chemical pneumonitis. In meconium aspiration the lungs are overinflated, accompanied by patches of collapse and consolidation.
Pneumonia – Prolonged rupture of the membranes, chorioamnionitis and low birthweight predispose to pneumonia. In this kind of case, we usually start broad spectrum antibiotics early
Pneumothorax – May occur spontaneously in up to 2% of deliveries. May occur secondary to meconium aspiration, RDS or as a complication of ventilation
Milk aspiration – More frequently in preterm infants and those with respiratory distress or neurological damage. Babies with bronchopulmonary dysplasia often have gastro-oesophageal reflux, which predispose to aspiration
Persistent pulmonary hypertension of the newborn – This life-threatening condition is usually associated with birth asphyxia, meconium aspiration, septicaemia, or respiratory distress syndrome. As a result of high pulmonary vascular resistance, there is right-to-left shunting within the lungs and at atrial and ductal levels. Cyanosis occurs soon after birth. CXR may show pulmonary oligaemia. Most infants require mechanical ventilation and circulatory support in order to achieve adequate oxygenation. Inhaled nitric oxide, a potent vasodilator, is often beneficial. Extracorporeal membrane oxygenation (ECMO), where infant is placed on heart and lung bypass for several days, in indicated for severe cases.
Other rare causes
Diaphragmatic hernia, Tracheo-oesophageal fistula, Pulmonary hypoplasia, Airways obstruction, Pulmonary haemorrhage
NON-PULMONARY
Congenital heart disease, Intracranial birth trauma, Encephalopathy, Severe anaemia, Metabolic acidosis
Surviving House Calls 