Tuesday, November 05, 2013

Monday night oncall

Oncall last night was with Mr.Ariff. We stayed at the hospital until 1 am! I reached home at 130am. I could count the few number of cars on the road last night - it was so peaceful! Some restaurants were still open though, people hanging out, eating, watching TV inside. Restoran Alif near my house was bright and open to business! It's one o'clock in the morning, why do those guys are still at the restaurant, dont they have anything better to do? - like sleeping!!

Let's talk about last night's cases. First, a 7-year-old female child with supracondylar fracture of left humerus (Gartland type I : undisplaced fracture). Mechanism of injury : FOOSH. Fall on outstretched hands. When MO asked the father what had happened, he said that he didnt know because he was working at that time. And so in the case note, it was written unsure mechanism of injury.

I clerked the kid and her father before the houseman at Green Zone did. I asked directly to the kid about how she fell. I demonstrated to her using my hands - and she said that her left hand was in extension, elbow not flexed. 

A question : Is it okay to obtain history from a 7-year-old kid? Is it reliable? Hmm. I dont knowww.

The houseman ordered her XRay elbow (AP and Lateral) for both right and left. I asked him why both sides, he said that it was for comparison purpose. Since she is still a child, and the physeal plates are not fused yet, so it is easier when we have a normal and abnormal XRay to compare, and then plan our management from there. I followed the kid to XRay room, and saw how XRay was done. She didnt have to wear any XRay vest. And it was a really quick process! Smooth!

Then we went to Yellow Zone, to see a case of suspected TB Spine. He is an IVDU, presented with neck pain and swelling. Cervical XRay showed fusion of C5 and C6. TB workout was ordered : AFB, Mantoux, C&S. Mr.Ariff said that we have to know about Tuberculosis inside out, it's important. Might come out in exam.

After that, we went up to 5B. The pakcik from Muadzam who had cast of right Upper Limb, and full length back slab of left Upper Limb. He had fractures of distal end radius ulnar of both wrists. Dr planned him for an operation, but he needs to pay RM1000 deposit. I talked to him earlier in Yellow Zone, so I did know a little bit about his financial status.

He works as a security guard, and his wife is a cleaner. The monthly income is only RM1,500. His 3 children live with him, as well as 3 grandchildren. His children are not working - two of them are in the process of getting divorce. So, how can he pay the RM1,000? When Mr.Ariff told him about the fee, he closed his eyes - maybe thinking. Is he sad? Is he okay? I wish I can read minds.

Then the case of a 26-year-old Bangladeshi construction worker who had industrial injury. He is a chronic smoker for 8 years, 20 sticks per day. NKMI, no allergy. Right hand dominant. He was working when the accident happened. He was using a metal grinder when it suddenly slipped from his hand, fell and hit his left dorsum of foot - then hit his right forearm near the wrist. He had lacerations and tendon cut. Wound debridement, wound exploration and tendon repair operation was planned.

Next the pakcik with gouty tophi! You can see multiple tophi on both his feet, and hands! He had right ankle gouty arthritis, so an operation was planned : Incision and drainage, wound debridement and arthrotomy washout.

In Ward 2A, there was the Chinese aunty with bilateral lower limbs swelling for a week duration. The impression was cellulitis with ddx of necrotising fascitis. She was given painkiller and antibiotic. Close monitoring.

Then the makcik who had done Incision and Drainage for her left ankle abscess. Wound inspection was set on Wednesday morning. That was the last case we saw that night.

Oh. And Mr.Arif did include some Islamic Input in the discussion as well. Introduction to IIIO, he said. He mentioned about the reason why smoking is forbidden in Islam. As UIA students, we need to know about these kind of things too, because we need to explain about it to public when we become a doctor later.

Why Islamic scholars came to the conclusion that smoking is haram? Sheikh Al-Qaradawi says: “On such matters, when doctors say that something is certainly harmful, Islamic scholars have no option but to pronounce it as forbidden.” You can read a bit more at aljazeerah here and more quranic verses on this website.

Then Mr.Ariff talked about vaccination and why it is needed in the community, asthma inhaler in fasting and some other stuff that I couldnt quite remember. Hehe

Okayyy so that's about all. Enough writing for now! :D

Awal Muharram!You have a GREAT dayy aheadd!! :)

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