Tuesday, September 11, 2012

2nd Day in IM

1. This morning, Shake and I observed Femoral Catheterization done by H.O Dr.Nurul and Dr.Rasnaizam. The patient is an elderly with Glycophosphate Poisoning ( Dr kata, pakcik ni makan racun :O ). So, the indication for the procedure was urgent hemodialysis access. 

Femoral triangle anatomy.

I was merely an observer, with only a limited knowledge of Lower Limb Anatomy. What I was sure of at that time was the fact that the Femoral Vein was at the medial side of the thigh and the Doctors would like to do a procedure to insert a catheter into the vein.

Only then now I know that the technique used is called Seldinger technique, to gain the central venous access. Basically, the patient is asked to lie down in supine position. You put antiseptic widely over the femoral region, cover with sterile drapes. 

Then you inject Lidocaine at the skin + subcutaneous tissue over the region to numb the area. You locate femoral vein and gain access. At this step, the doctor used some kind of wire and syringe/needle to get into the vein.

You put Dilator to provide easy passage of the catheter. After that, you push the catheter intravenously. I saw the doctor push the catheter inside the vein, it was a long catheter and I couldn't imagine having that long tube inside my thigh.

The doctor connected the catheter with two kind-of-syringes and put stopper on top. He then sutured a bit to secure the catheter. Dr.Rasnaizam covered the two syringes with dressings and plastered them together. Dr. Nurul placed sterile dressings over the catheter region and put a big RM15 plaster on it ;)

And that's the end of the procedure.

2. After that, Shake, Aina and I went to a bed of a 19-year-old boy to practise our physical examination (PE) skills. The patient is suspected to have an Autoimmune Disease, I forgot the name of the disease, it's too long and I've never heard of that before. You can see many rashes on both legs of the patient.

We did cardiovascular, respiratory and abdominal examinations on the patient. But all the systems are normal, obviously. 

3. Then we went back to UIA at 12.30pm because a Seminar on HIV was held at Lecture Hall KOM at 2.30pm. The Seminar was very informative. In the Q&A session, Dr.Kuan (Supervisor) explained very clearly regarding some questions asked. He used simple words and he made sure that all of us could understand him.

He asked questions too, but he did not get angry when we gave the wrong answer. I like him.

4. A friend of mine asked the patient:

Friend: Dalam family adik, mak ayah ada hypertension tak?
Patient: Er.. hypertension tu macam mana ye?
Friend: Oh, darah tinggi. Mak ayah adik ada darah tinggi tak?

It was unintentional, I understand.

We took a lot of time thinking what to call Rash in Bahasa Malaysia.

Then the patient's friend answered: Ruam.

Oh. Is it? =.=''

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