Thursday, September 20, 2012

W2 D3 : Gloomy




1) You know every H.Os and M.Os were given a Pre-Inked Stamp bearing their own Name with Pegawai Perubatan UD41, HTAA on it. If they do not have the stamp, and they must write down their name on every patient's report, I bet their handwriting could not be easily recognized. Then we will have problems finding the doctor who wrote the terribly written report. Patients' progress cannot be read, proper treatment cannot be provided and patients' life might be in danger!

So you see the importance of the Name Stamp now :P

2) It's frustrating when you could not understand what was written due to the not-so-clear handwriting of dearly doctors. For me, every time I read Patient's Progression Note, I have this tendency to see who's writing the report with such handwriting.

And again, the Name Stamp helps a lot ;)












3) Tutorial Session with Dr.Khairul Azhar (DKA) was unnerving. The topic was Gastrointestinal Bleeding. He asked each one of us taking turns to write on the whiteboard on Definition, Signs & Symptoms, Causes and Investigations of GI Bleed.

a-Definition: 

x Upper GI Bleed - Bleeding above Ligaments of Treitz
x Lower GI Bleed - Bleeding below Ligaments of Treitz

Ligaments of Treitz arises from right crus of diaphragm and inserts into third and fourth portions of duodenum (duodenojejunal flexure).

b-S&S:
x Upper GI Bleed - Hematemesis (vomiting blood), Melena (black tarry stools) 
x Lower GI Bleed - Hematochezia (bright red blood in stools), Colicky abdominal pain
and S&S for Anemia (fatigue, shortness of breath, headache, palpitations, pallor) and Shock (Cold clammy skin, dizziness, hypotension, tachycardia, low urine output, rapid shallow breathing, fast weak pulse) etc.

c-Causes:
x Upper GI Bleed - Peptic Ulcer (NSAIDs in elderly and H.pylori in young), Esophagitis, Mallory-Weiss Tear, Esophageal Varices, Malignancy etc.
x Lower GI Bleed - Hemorrhoids, Anal fissures, Diverticulosis, Iscahemic Colitis, Infectious Colitis, Inflammatory Bowel Diseases, Angiodysplasia, Tumour etc.

d-Investigations:
FBC, BUSE, OGDS, CXR, Colonoscopy, CT Scan, Barium Enema, Blood C&S etc.

When the session ended, we all breathed a sigh of relief. I made a mental note to prepare myself well before his class starts next time.

4) At about 3.15pm in the Ward, a patient's heart rate suddenly dropped (bradycardia). Doctors were called and CPR was done immediately.

I could hear a nurse said to a H.O who performed CPR on the patient, 'Doktor, macam mana Dr. buat CPR ni..'. I could see clearly that the H.O did not have enough confidence to do the chest compressions on the patient. The patient's condition did not even improve.

Then the staff nurses took turns to do the CPR. What I noticed was that, staff nurses performed CPR way better than the H.O, I could see it in their face. They were all sweating and looked very determined to save the patient. In the end, it was the H.O who got praised by the Doctor who came afterwards to have a look at the patient. The nurses did not take credit for their work. Hats off to them.

But sadly, the patient was stabilised only for a short while because his heart was too weak to be saved. The patient's wife cried and his family gathered around his bed to say goodbyes.

5) We also saw Incision and Drainage (I&E) Procedure done on a patient with Abscess on his sole of foot. It looked very painful, the patient was given local anesthetic beforehand.

Then, we watched H.Os took blood sample from a patient who had Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection. They wore aprons, gloves and used sterile equipments. We helped them calming the patient down.

We also saw a H.O performed Venepuncture for Blood Culture in a patient with Retroviral Disease (RVD) aka HIV. He used sterile equipments too.

I've got more to tell you, but this post is long enough. Till next time then :D

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