Palmo Anest

Happy Chinese New Year

Gong Xi Fa Chai!

posted by LT @ 10:48 PM 0 comments

Wistleblowing?

Read this post in Waking Up Costs.

In advocating for patient safety, be forceful but not 'disruptive'

together with this article 'Is whistleblowing worth it?' from Medical Economics.

What would you do if you discovered that conditions at your hospital posed a threat to patient safety? Let's say you reported the problem to your supervisor, and got no response. Would you then go to the hospital's administrator or CEO? Say you do, but he also refuses to deal with the problem. Then what? Would you file a formal report, or contact state or federal health officials?

If you do decide to blow the whistle, chances are you won't be rewarded for your efforts. In fact, you're more likely to be labeled a troublemaker or "disruptive physician." And if you persist in pursuing your cause, you could risk losing your staff privileges or your job.

In our pathetic bolehland, it will cost one more then losing job. So you can't even 'be forceful', what can you do? I suggest you write anonymously to people like Teresa Kok, hopefully she will bring it to parliament as for our bolehland, every sensative issue seems to be needed PM's intervention before the authorities can act on it. Probably because if the issue get over heated, with PM's intervention, it would be the wistleblower (yes, you again, the investigation will start from who is the wistleblower!) and PM's problem, the authorities won't want to step on the tail of something big. Kita orng cari maken je!

posted by LT @ 8:20 AM 1 comments

New Year, new post.

Well, it has been very long while I didn't post.

I think I need to clarify sometime here to do some justice to govt medical service. Those of you who are not 'insider' in medical services might get very anxious as peppermint energy posted here. But I'm not telling the truth and the whole truth...

Basically, things that creat much emotional stress that I need to vent out are usually some negative stuffs. However there are actually a lot of good stuffs happening in govt hosp in daily basis. Probably as a chinese, I'm not so used to express possitive feelings... maybe. :)

Anyway, let me illustrate 2 recent cases that happened in one of my oncall days that actually make us feel good and these are part of the reasons that keep us in the service.

Mr S, a 23 y.o. young man riding his motorbike back from work like any other days. Like many young motorist in Penang, he was riding his bike at high speed, going back home. Somehow, for some unknown reason, he lost control of his bike and crashed onto the divider. Brought to hospital A&E department by ambulance service.

On arrival, he is conscious (GCS 15/15), in severe pain especially over his abdomen and hip. His initial BP is normal but getting worst minutes by minutes. Both Surgical and Orthopaedic team was consulted. He has and intra abdominal injury and a pelvic fracture.

I (Anest team)was informed by surgical colleague and went to A&E to assist in resuscitation and prepare the patient for immediate operation. By the time we bring him to OT, he was bearly conscious and was very pale (due to the massive blood lost)but BP holding (due to the fluid resuscitation done in A&E). Surgical team went in 1st and he had multiple intestinal laceration, messentric artery tear, splenic rupture which was corrected on table and severe retroperitoneal haematoma which we can't do much. Itraabdominally packed with abdominal packs. Ortho team then went in for some debridement, T&S and skeletal traction.

He was transfused 7 pints of blood and 1 set of DIVC regime intra operatively. He is still in DIVC when we transfer him to ICU post op. Ventilated and continue post op care in ICU and we removed his abdominal pack 2nd day post op. At that time he is still in coagulopathy and ventilated with high PEEP due to ARDS caused by massive blood transfution. We manage to bring him to OT with ICU ventilator which support him with high PEEP. 4 hours after the 2nd surgery, he bleeds intra-abdominally again and needed a 3rd laparotomy. Again we rushed him to OT with the same ICU ventilator, ligated the bleeder and came out confidently that this time there won't be any more bleeder if we corrected the DIVC.

He finally was discharged from ICU after some 3 weeks+ stays and has been discharged well from the ward. A young life was saved and back to his love ones.

The 2nd incident, Mr F, a 22 y.o man again riding motorbike back from work met with an accident with a trailer truck. When the ambulance went to pick him up, he was still stuck under the traler's wheel. Rushed to A&E and was immediately resuscitated, and refered for immediate operation. He has sever crushed injury to his left lower limb and hip fracture. Degloving injury of his entier perinium including his genital organs. Intra abdominal injury, retroperitonial bleeds and some lung contusion.

To cut long story short, it was very chalanging to keep him alive on table itself but we manage to mantain him and surgical team packed his abodomen. He went in for 2nd laparotomy and repacked the abdomen together with amputation of his left lower limb (high AKA). He was subsiquently went for 3nd laparotomy and debridement of his wounds few days later with an ileostomy done on him. Over the course in our ICU, his DIVC was eventually corrected, ALI resolved, septic shock resolved but unfortunately his wound still very bad and get MRSA infection, there's almost no healthy skin left below the unbilicus.

He was already extubated and breading on his own that time. Lucky for him plastic surgery take over his care and his wound is healing well now after they did full thickness skin grafting on him. He was another 'long time resident' in our ICU who survived and cheated the death.

So, it is not always the bad things. There are many goods in public hospital too... probably more goods then bads, open our eyes and we will see the goods! (and try to eleminate the bads).

This is LT, reporting from Malaysia Public Hospital.

Cheers.

posted by LT @ 11:36 PM 3 comments

Update: ICUmath for PalmOS

This handy PalmOS freeware created by Terry Fagan has been updated on January 7, 2006. Can download from Palmgear at this link.

posted by LT @ 1:06 AM 2 comments

Finally, online again.

Hi friends, I've been offline for about 2 weeks since the Christmas.
So, Happy New Year to all of u out there.
My network card got rosted somehow and my Palm T5 also 'kaputed' so I have no online access till today. Get myself a new network card from PCDepot for rm16. Palm's support is still very good. Called them up, told them the problem and they allow me for a swap, drop my unit at High Point in dato keramat the day before and when I came back last night, my new palm is already on my table delivered by DHL.
That's all for the moment. Have a great New Year!

posted by LT @ 10:35 PM 0 comments