Yesterday I officially registered for the 14th ACA which will be held in Hanoi, Vietnam. This will cost me a boomshell if my Hospital doesn't approve my application for subsidise.
Looking forward to go there for this eye opening experience. This will be my 1st regional congress. Before this all the conference and congress I attended were national levels. What is more excited is all the 3 papers we submitted for free paper/poster presentation had been accepted for oral presentation! I'll be the presenting author for a paper with the title:"
Continuous Spinal Anaesthesia for Palliative Surgery in Carcinoma Colon: An Initial Experience".
Acctually we didn't expect all the 3 papers we submitted would be accepted for oral presentation. It comes as a surprise. One of my boss and supervisor in this project will be going with me and he will present the other 2 papers.
Hmm.. Vietnam... Any advice out there for travelling to Vietnam?
Laparotomy day
Was on call yesterday. Very bad day indeed. Early in the morning at 8am soon after taking over from post call colleagues, we have the 1st emergency,
A young lady with 2 previous LSCS 36 weeks pregnancy. Coming in for bleeding placenta previa type 4 accreta.
She bleds ~4000ml of blood intra operatively. Was in DIVC, we ventilate her in ICU post op but able to correct her DIVC very soon with transfusion of blood and blood products. I extubate her in the afternoon and she is out from the ICU this morning.
Before this case could ended in the OT, we get a call from another hospital that they are sending in a road traffic accident case with open book pelvic fracture and intra abdominal injury. GCS 10/15 and BP very low at 50/30mmHg in the refering hospital. After the initial fluid resuscitation, patient's SBP picking up to arround 90mmHg,they packed and sent the case to us.
When I saw him in our A&E, whihc is actually 59 minutes after they sent the patient (pt), his GCS dropped to 7/15 and SBP hangging around 60-70mmHg. I intubated him and get 2 14G branulars on him then sent him up to OT.
This pt had a few parts of his intestine (both small and large) perforated and rupture mesentric artery. He also had lots of retro-peritonium bleed with the unstable pelvic fracture.
Surgical team repaired the ruptured & tears. Ortho team came in later to ext. fix & stabilised the pelvic fractures.
The pt bled 10L of blood. We massively transfused him with blood & blood products. On doable inotropes support on table & post op. We lost the pt @ about 17:30hr.
While the surgical team closing the abdoment, we get a call from anothe hospital that they will send in a case of stab wound. 6 inches deep ?Kidney injury, unable to control bleeds with packing in A&E.
Again we get all 'excited', prepare for another 'blood sucker'. Luckily on the table we found out that no major organ was injured & the surgical team did a good job to secure the bleeding. The pt was discharged well to general ward.
The 4th Laparotomy of the day was actually booked with me early in the morning when we are doing the 1st LSCS. However, we had to operate on the trauma cases 1st. Now, this is a 70 yr old gentleman with Ischemic Heart Disease and Atrial Fibrilation, on Warfarin and digoxin! Came in with sepsis secondary to Perforated bowel. He actually admitted the night before I on call but the surgical team was trying to correct the coagulation profile. In the morning when they book the case with me the INR is 2.7. Intra-operatively uneventful but he developed fast AF post op with BP chrushing. When I left this morning, he was on Dobutamine, NorAdrenaline, Digoxin.
Ad my 5th laparotomy, it's 6 or 7 pm by that time. Is a teenage young lady with an gynaecogical mass, stable, not rupture or twisted or anything emergency about it... But have a 'very demanding' parents. So the case was booked with me as emergency due to a 'very angry' father has been pestering the gynae consultant to op on the poor girl...
Being a 'very considerate' doctor.. (ahem, ahem.... ) we finally agree upon using our emergency resources (emergency OT) to operate on this not-so-emergency case of laparotomy. She is now recovering in gynae ward.
After that it was all other common day-to-day cases going on and on till 3 something in the morning...
What a day man! I had a bad day, but hope you all will have a great day!
Kedah Govt Hospitals To Set Up Complaints Bureau - Another knee jerk raction??
Kedah Govt Hospitals To Set Up Complaints Bureau.
I'm glad that Kedah Health Department has finally being serious about the public complaints. this was reported by Bernama in
this report.
Kedah Deputy Director of Health Dr Hasnah Ismail said: "We will try to solve any complaints of cases or problems faced by customers and patients within three days and if we fail to do so, customers can make public their complaints to the media."
I don't know how many issues they can solve within 3 days of an incidence but it is a start. I just hope that this is not another knee-jerk reaction by our administrators following recent highlight of HSP in the media.
However, I seriously think it is just another knee-jerk reaction which is so very common in our boleh land. Look at what he said in another statement: "...apart from the counter (Complaints Bureau), hospitals were required to display the list of contact numbers of directors, medical officers and staff nurses at all wards." This is unthinkable!!
If all the hospital staffs are attentive to patients' complaints and their reasonable needs, I'm sure there will be less complaints on the press. The nurses and the doctors play an important roles, but if they are just plain ignorant and sometimes lazy, at times rude, all of these negative attitues will be a time boom when a near miss or a horrible incidence happen.
Simply rambling...
The other day,
Uncle Lim bloged: "
...that the national integrity campaign launched by Pak Lah is being used to waste more public funds, making a complete mockery of the national integrity plan with no impact whatsoever in creating a new culture of zero-tolerance for corruption in the public service."
Indeed, can anyone help me to recall any campaign launch by BN which is a real success and have a positive impact on the rakyat?
On another note, today, when I was on my way to work, I saw a policeman carrying a school boy to school on his motorbike without wearing a helmet! How are we expect the road users to obey traffic rules when a policeman himself cannot do the right way?
Probably it's deep in our Malaysian culture that everthing should be taken a tidak apa attitute? Laws are ment to be broken. I don't know, u tell me.
2 singaporean doctors
Added two Singaporean doctors' blogs into my link.
Angry Doctor and
A Doc's Life.
Enjoy and Happy reading!
Airway emergency
The other day my friend
Chen had a
Bleeding day in their OT, today, I have an airway day. 1st of all, the Capnograph not working on our philip monitor, had to change to an old side stream capnograph.
I'm running Dental/Maxillofacial OT. My 1st patient is an obese lady with BMI of 40. Well, I was anticipating some problem but it was a smooth take off and landing (induction and extubation). I've planned to blind nasal intubate all my today's patients so that I'd master this technique. However seeing my patient's size, I give up on trying blind nasal intubation. In fact her saturation droped very fast, before the suxamethonium works, while her feet was still fasciculate, her saturation already starts to drop. I didn't wait untill she finished fasciculate, intubate her with a Nasal RAE tube, her saturation never fell below 94% during intubation.
Another case, a young man coming in for dental clearance under GA, had receding chin with Thyro-Mental-Distance about 2.5 cm; limited mouth opening of less then 3 cm. So I wouldn't try blind nasal intubation on him also. I was telling the 3 student MA about how to assess the airway and anticipate problem intubation for this case, what's our options etc etc... Guess what I got? A Cormack-Lehane class 4 laryngoscopy! Goodness, that is the most difficult airway, together with his limited mouth opening making it worst. Luckily I can mantain the airway with simple bag and mask!
I tried to push the nasal tube into the trachel with Mcgill forcep but can't. CHange to a Oral ETT, twice I pushed it into oesophagus. This guy is really a classic, with strong cricoid pressure still unable to visualised the vocal cord... not even 0part of the damn hold.
Called my consultant, called surgeon to stand-by for tracheostomy. Luckily God is with us that I can ventilate him very well with the bag and mask. My consultant anaesthetist took over the intubation part and he also struggled a lot. Finally he get him intubated with a much smaller size ETT, size 7. If we couldn't maintain his airway, by the time the surgeon arrived, my boss might probably poke a
QuickTrach down his troat already...
The dental surgeon is a sprot. he kept remind us that not to worry, he can cancell the case, no problem.. :)
National Health Financing Scheme (NHFS)
How much do you guys/gals know about this NHFS thingy which suppose to take over the current health financing scheme (which is just minimal token fees in the government clinics/hospitals for all Malaysian) from year 2006? A major change which will affact almost all Malaysian.
Untill now, Sept. 2005, we are all still in the dark. There are a few articles regarding this which may shown some light: bring to you by
The Star, by
Aliran I,
II and
Citizens' Health Initiative.
The Coalition Against Health Care Privatisation (Gabungan Membantah Pengswastaan Perkhidmatan Kesihatan or GMPPK), A coalition form by 81 NGOs, trade unions and political parties to oppose further privatisation of the health care system and to insist on democratic accountabilty from the government on whatever new health care system that it plans to introduce. The coalition has set up an
online petition to the Prime Minister urging him to make no further move towards the implementation of a compulsory health insurance scheme
until there has been a full explanation of the details to the people and an open discussion with all interested groups.
Take a look at the petition by clicking
here. Please endorse it if you agree with it. Try to let as many caring Malaysian know about this petition as you can.
Cheers and God bless.
Great help for Penang Bridge user - Live cam feeding.
Well, while I was browsing thru
Malaysian Medical Blog Aggregator, I went to
Dr. Liew's blog, and after a few links, came across
this on mybabybay.com.
Wow, I think it's a great discovery and sharing of resources. I wouldn't have gone to
UEM's website to search for the cam feed (both still and vedio feeds) if not because of this post. :) Thank you, whoever you are for the pointer.
New fans?
There has been quite a number of spams in the comments lately..
Just received this one:
" Hi, you have a great blog here! I'm definitely going to bookmark you!"
Wah.. I thought I've got a fan! But wait a minute! Here's how it goes...
"I have a make money online site/blog. It pretty much covers make money online related stuff.
Come and check it out if you get time :-) "
Aiks... it's a spam!! Damn!
I'm going to activate the 'Show word verification for comments' thingy!
1st Call of the month.
I was oncall on the 3rd of Sept. This is the 1st time in 2-3 months that I actually see empty beds (2 of it!) in our 7 beds ICU. However after my colleague passing to me, I know it was not as relieving as it seems to be.
We have 3 very very ill patients in the ICU which is enough to torture me till next morning. One of the patient, Mr. T an old man who had just transfered into our ICU erly in the wee hour from a near by hospital. He has been in their ortho ward for 1 month, treated for cellulitis and necrotising fasciatis. However like many other old man with prolonged stay in general wards, he developed Broncho Pneumonia and the lungs getting worst. What irritates me most is the referring ortho MO dare to told us that they had been managing this case without medical involement since in their hospital, ortho and medical not getting along well! WTF?? Because of that si-tiu-pid reason the poor ahpek developed respirator distress and their anaest intubated the ahpek however their ICU was full, thus sent him to us!
On arrival, the ahpek is in severe sepsis, ARDS, needed double inotropes and high ventilator setting! What a bunch of irresponsible orthopods! (well, I used to like the job, glorified carpenters, just bang and screw everyday... chuck all the medical problem to physician and anaest!)
The 2nd ill patient is a maternal case. Post Caesarean day 30, came in with sever sepsis ?source and Acute renal Failure. Showed CNS symptoms with sudden dropsand fluctuate of GCS. Family refused CSF tapping (as usual with most malay family). CT sacn showed an hypodense area at left parietal area reported as ?infarc/abcess, sent the film to Neuro Surgeon for opinion and was reported as infarc again. We intubatedand ventilated her to protect her airway and she has been with us in ICU for 10 days. May problem had been her renal failure. However 2 days ago she started to develop fits.. and getting increasing in frequency and duration, yesterday, on top of her phenytoin, and midazolam infution, we had to add Sodium Thiopentone infusion to arrest the seizure. She still having breakthru fits with all of these. I'd think its intra cranial pathology coz she was not hypoxic, metabolyte and electrolytes are within normal range... God help us...
Hmm.. been whining too much. I wouldn't want to talk about the 3rd patent now. Am just letting go of my frustration.. you guys don't have to read these..
I felt better now! Cheers! :)
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