As we celebrate our nation's independence day, let us be reminded of our leaders and people in the past who made all these possible. MERDEKA! MERDEKA! MERDEKA!
Sunday, August 30, 2020
Merdeka ke-63!
Tuesday, August 11, 2020
ATLS overview (OSCE)
Definition:
- ATLS : life threatening with pulse
- ACLS(cardiac): life threatening, no pulse
Common emergency cases: (ATOMTC)
- Airway obstruction
- Tension pneumothorax - silent chest, trachea deviated
- Open wound
- Massive hemothorax
- Tracheobronchio dissociation/ fistula
- empysema
- crepitus, poor air entry
- corrective surgery
- do X-ray - is it hyperventilated?
- Cardiac tamponade - JVP, increase HR, muffled heart sound
- Pericardial effusion?
OSCE ATLS steps:
1. What to do when the patient came in with emergency? (DR. AVPU)
- Danger
- access the situation, ensure you are safe first
- Response & role
- check for patient response and
- ask someone around you(assistants)to help
- prepare airway apparatus +cervical support
- chest tube, needle tube, SP02
- IV line - for fluid & BT & crossmatch
Check their response to...
- Alert
- Verbal
- Pain
- Unconscious
2. If all above indicates emergency case signs proceed with ABCDE
Airway - jaw thrust - open the mouth and inspect for foreign substances (yonker suction could help
removing them) - check for gag reflex -
- cervical support - can be confirmed by using the NEXUS criteria
(cervical spine evaluation in trauma)
Breathing - ventilation,
- inspection: check for ATOMTC (common emergency cases, in first paragraph)
- palpation: trachea location, rib intact? fracture?
- percussion: hyper-resonance? dull?
- auscultation: Air entry? Heart rhythm, HR?
- check Respiratory rate
- intubate if needed
Circulation - bleeding
- IV 2 large bonula
- IL warm NS
- BT urgent panel
- inspect head to toe for bleeding
- EENT, abdomen (peritonitis), pelvis(spring fracture), genitalia (hematoma, scrotum, perianal bleeding, urethral)
- peripheral bleeding (fracture)
Disability - pupil
- GCS scale!
Exposure - environmental - do they need a blanket? (hypothermia?)
- log roll for back examination (examine the spine - stepping sign)/ rectoperitoneal bleeding / prostate high riding / pelvic injury / abdominal injury / thoracolumbar injury
- DRE? anal tone lac?
Simple Management mnemonic:
2(CBD, NG tube)
+
2(X-ray : chest and pelvic)
+
2(drugs and analgesia IPTT)
+
2 investigation(ECG, FAST u/s)
other links:
Friday, August 7, 2020
Breaking bad news: Down syndrome
How to explain to the parents about Down Syndrome?
First, you will need to know what is the problem and understand before
explaining to them.
The parents will be worried, anxious and some might even cry upon receiving
the news. Be ready to comfort them and help them through this journey of
hardship but understanding their children together.
As a doctor, you are to tell them the truth and at the same time, comfort and
reassurance.
Resources are from: https://canadiem.org/breaking-bad-news/
So.. how should you start your conversation?
1: Express your concern
- Greet the parents, introduce who you are and why are you here.
Setting
- Before telling them about their child's condition,
ask if they need someone to accompany them or
if their family member is here (if they are alone).
Example: Before we go ahead, can I just ask, would you like to be with
someone now?
Perception
- Ask what they realise that is abnormal about their child.
- This helps us to understand how much
they know about the situation, so we know where to start.
Invitation
Tell them about the news:
Example: Unfortunately, I do not have good news, I am sorry to tell you
that... ...
*wait for them to react before you continue your explanation*
👇
2. Explain and educate
Knowledge
- Explain the nature of down syndrome. definition, symptoms and signs
- Genetic Issue
- Intellectual Aspect
- Health Aspect
- To tell them their child would probably need
a lot of follow up on potential health issues
- TO explain the prognosis is poor
- average lifespan is around 50-60years old,
-possible health issues of the heart, gastrointestinal,
eyes and bones,
👇
3. Advice the parents
- Their character and behaviour infront of the child
- try to be encouraging to the child
- be patient and kind
-To discover the child's talent
- the child might not do well in studying but might excel
in cooking, music or sports
- Diet
- to ensure good nutrition provided and not neglect the
child
- they need the same/ more attention compare to normal
children of the same age.
- Advice to look for special care school
- there are special school's which teaches kids who have the
same problem
- opportunity to know other parents who face the same issue
and share experiences
👇
4. Future follow up
- to come regularly for normal vaccination
- to check calcium development regularly
- ensure proper growth and reach their age milestone
- Series of check up for their child in the future : Eye checkup, bone
density, X-ray, echocardiogram, etc.
👇
5. Encourage the parents to join a parents group
Summary
- we can give them leaflets (if available) to understand down's syndrome
better
- provide reliable sources (websites) so they can read to help with the
understanding
- encourage them to not give up and keep persevering till the end. the child
is a gift from god, and we are to take care of them with love and care.
Example: Don't blame yourself. There is nothing that could have been done
to stop this from happening. What you need to do now is to... ...
👇
-Reassurance
Example:
- I understand you are worried
but...
- Do you need some time to rest?
- We will keep an eye on your child for his (results), so we can
provide the treatment earlier.
- The doctor/professor who is in charge of your child is an expert on
this syndrome and would try
his/her
best to help your child.
- I will give you a follow up date with us in the
clinic, will you be available on the ... ...?
👇
6. Empathy (throughout the whole session)
** Always ask if they understand what you are trying to say before going to
the next point.
**ask if they have questions to ask you concerning their child and their
worries.
Example: Do you understand what I am trying to explain?
Do you have any questions?
- Look them in the eye while you are talking and show that you care about
them.
- If there is a break down (crying), pause the conversation and try to offer
tissue or suggest them to come at a later date with their family/support.
- Have empathy and to try answer their questions at the same time.
Sunday, August 2, 2020
Tips on using the E-HO system
1st : Be prepared
download this manual to understand how it works.
https://www.moh.gov.my/moh/resources/Manual_e-Housemen.pdf- One of the ways that you could do is to write down the things you need to fill up on a piece of paper. This will help you while you are using E-HO.
- Think carefully which hospital you really want to go and write them down as well. So if the hospital you want did not appear, you can still choose the next available option.
2nd: Check internet speed
- either check the one in your house or in the cyber cafe near your area. You can just ask for the availability and remember when they start business.
- Speed and Ping
As long as the Ping is below 10, it is consider good
- Cyber Cafe Spots
- someone made this list and it has been quite helpful, thanks to those who contributed for this list.
3rd: Check browsers available
- open a few browsers to try and try again till you get into the website.
 |
| A poll from those who used E-HO |
4th Reach early!
- Some CCs are more famous and good then the others which causes a lot of candidates flood the CC. Make sure you reach early so you can book one seat!
- You can try asking to see if they allow you to book in advance before the actual day of E-HO (usually 3 days after you get the email.)
- So far they always starts opening the system on 12pm SHARP.
5th : Pray and hope you can get what you want
Warning
All this serves as a reference only, there is still possibility that you could not get the hospital you want due to unforeseen circumstances.
I am so sorry if you did not get what you want. If you are willing to wait for another round and didn't want to regret on the decision you made, to go somewhere you do not want. I suggest you defer your houseman-ship. If you already waited for 10 months why not wait for another 2 months to get a better offer?
Do not panic and not to choose a random hospital !
- if you cannot get the hospital you want, wait for another few minutes and refresh again. there are possibilities the hospital you want will reappear.
There are students who tries swapping hospitals but the possibility of it being successful is very low.
If you are wondering if there are pre-housemans' out there, join the Pre-HO group in telegram for updates.
Wish you all the best and good luck!
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