Remember this small booklet that everyone of us has when we r in Paeds rotation?
I still keep a copy in my locker coz sometimes we do have paeds cases lodger in our HDU/ICU. Now I can carry it in my PDA.
Download the demo for free or buy it for $10 @
DrugDoses. 
So there it is... We were just talking about it the other day
over here right? And the news came out that night itself...
Well, I think this is a long awaiting raised that every govt doctors welcome. However we are still far behind in compensating the sacrifies a doctor or even other paraclinicals have to put up in the service.
Active call houseman gets rm4.17/hr and MO gets rm6.25/hr. Are we happy now? Shall we? How about the working environments? My JMO still have to sleeps on the floor/sofa/patient's trolly when they are on call - if they get too sleep. The hostile working environments with top men in our own ministry calling us "Tardy doctors" and many more...
Anyway, it's still a positive sign and the effort taken by the Minister, the SCHOMOS, and all the others involved is very much appreciated!
"Boss kelab malam"
This is the nick given to me by one of my JMO. Why? Coz usually most of my call night r very bz. Party all night long in OT! haha..
The day b4 was my last call of the month. The OT was bz the whole night with 3 laparotomies + a thoracotomy and 2 LSCS.
The pt Mr B who had both laparotomy and thoracotomy was sent to HPP for cardiothorasic team to take over in the morning. He bled 4L of blood from the chet tube before our surgeon opening up his thorax.
Mr B bled >7L of blood, transfused 12 units of WB, 2 courses of DIVC regime and the 3rd in progress when we packed him to Cardiothorasic.
On departure from our ICU, he was haemodynamically stable without any inotropes, in mild ARDS but still in coagulopaty,
This is the case
Gasman mention in his blog
here.
Read this from
Waking Up Costs: "Neuromuscular blocker binders around the corner?"
If this Org 25969 get to the market, we can all dump Sux away and use Esmeron for all the emergency airway right? Wonder how is the cost like?
Anaesthetic nightmare - Malignant Hyperthermia
We have a case of
Malignant Hyperthermia last week. A 66 y.o. male came for elective thyroidectomy for his
papillary carsinoma. Preoperatively he is euthyroid clinically and biochemically. No obstructive symptoms but imaging shows some invation to the trachea.
In view of possible difficult airway, my colleague induce him with IV Fentanyl, IV Thiopentone and IV Succinylcholine. Anaesthesia was maintain with Isoflurane and Tracium.
About 3 hr after induction, noted patient's ETCO2 going higher and higher. Did every thing usually done to correct hypercapnia but still persist. Then noted the whole body muscle regidity and petient was 42 degree C. IV Dantrolene Sodium started, and cooling down body with ais and cold saline infusion and lavarge done. By the time patient transfered to ICU, he is less regid and 36 degree C. He was put on ventilator support and needed 4 types of inotropes. Sedated with midazolam and pethidine. IV dantrolene continue with 1mg/hr.
On day 5 post op, patient developed Acute Renal Failure (late complication) Urea 20 and Creatinine 330. Urine output was about 10-20/hr for 3 hr inspite of CVP 26 and IV Frusemide 20+20mg given. BP adequate (SBP >120) with maximum inotropes (Dobu/Dopa/Adrenaline/NorAd at 20/20/20/20). Urine comming out adequately after starting of Lasix infusion.
He further complicated with ARDS on ARDS ventilator setting strategies.
Currently he is still holding on with lower ventilator setting and also lower inotropes support.
I'm on-call tomorrow and will see how he is doing. Hopefully he can make it.
White coat again!
Today we are all reminded by our HOD that we too have to wear our white coat
whenever we are seeing patients outside OT and ICU! i.e during premed rounds, APS rounds, resuscitation etc...
This is really crazy! I'm gonna continue to wear scrub shirt and pants whenever I get an urgent referal to see in the ward or A&E.
Again I'd like to state that white coat and tie had been
proven a source of nosocomial infection. I personally think that putting patient's and own's health at risk is not professionalism as opposed to what our DG thought. It is OK for him to wear a white coat for his once a week rounds in Selayang but not for us running the frontline work in the wards.
P/S:
Microbial flora on doctors' white coats.
The Palmdoc Chronicles: "Palmdoc" blog about this "
Easy Pulse" the other day. I always wanted to have such a nice handy gadget.
However after reading
this that MRSA and VRE survive on keyboard more then 24hr, I'm little reluctant to whip out my Palm when I'm 'handling' patient. Especially now that I have 2 little 6 months old at home. :)
Did anyone out there try to culture what's growing on his/her handphone/PDA? I might want to do it soon and will report back to u guys.
![[Valid Atom]](valid-atom.png "Validate my Atom feed"){kind=small}