Epocrates Online

Sunday, April 16, 2006

Medical Acupuncture

Attended a one day Workshop On Medical Acupuncture organised by Penang Medical Practitioners' Society today.

Kind of interesting on how much it can help/compliment the 'modern' medical practice. Would like to take a full course of medical acupuncture or even the TCM's acupucture course one day.

Did a google search and these are the 2 institute found locally:
1. Research Institute Of Medical Acupuncture
2. The Tole Institute of Acupuncture and Herbal Medicine in Malaysia

I don't know their credential. This is what I found on google. Anybody has any other info?

Thursday, April 13, 2006

Long crazy day

I was oncall the other day, it was a public holiday. When I arrived in OT at 7:55am, there's already a patient waiting to be pushed into OR for ortho surgery. So I started the case with my post-call colleague passing over in OR and then do a quick ICU passing over rounds with him and the rest of the on-call/post-call team.

My OT has been going on and on case after case non stop till about 9:40pm. That's when I finally took my dinner. After my dinner, when I was explaning the progress of one of my 'ICU permenant resident' to his relative, I got a call from surgical that we have a case of stab wound in A&E who needs immediate operation.

I went STAT to A&E with 2 14G branular with me. Went there secured extra IV access while arrange for Intra abdominal and possible intra thorasic surgery. The victim were stabbed twice on the back and the fatal one on the lower right thorax which lacerate 2 segments of his liver, transected the right kidney, perforated his duodenal and cut some of the unidentified larger vessels.

We transfused 4 unit of blood in A&E while waiting for transfer to OT. On arrival in OT, we set an arterial line for invasive monitoring and the Hb after 4 units of blood before the surgeon opening up the abdomen was 5g%. He continued to bleeds on table and by the time we finished the laparotomy, we'd transfused 14 units of bloods and 2 courses of DIVC regime. He was on both Dopamine and Noradrenaline intraoperatively.

HB on arrival in ICU was about 3g%. Chest tube drained 4400ml of frank blood. BP even lower, added dobutamine and later adrenaline infusion. Continue to pour fluids and blood and blood prodcts. Seems getting no where... Pupils became fixed and dilated.

I finally touch my bed at 4+am. Just before 6am, a MI patient with APO admitted CCU and was reffered for ventilation support. I called up the experienced CCU staff to ask for patients condition, was reported to be better after lasix. I didn't see the patient untill I wake up in the morning! (Guitly! but i just can't drag myself out of the bed till my morning shift colleague came into the call room!) Luckily the patient is really ok and doesn't needs ventilation...

OTOH the surgical patient continue to be very bad and we giving up on him after the morning round after reviewed by the surgical team.

We play GOD but we ain't GOD!

Sunday, April 09, 2006

House Call

I'm locuming today. Just attended a house call to certified death of an old lady who had just AOR discharged from a private hospital in town.

I wonder what is the going standard of attending house call by local GP nowadays... Any official/unofficial guideline? (will google for it later at home) What's the going rate I or the clinic should charge the party?

Any input from our colleague out there is very much welcome!

Thank you.

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