Palmo Anest: May 2007

Poor quality devices III

The NEJM posted a complication of central venous catheterization on the 24th May.

I almost had a retained guide wire the other day when I was pulling out the guide wire of a triple lumen I inserted on one of my new case during my last call.

The outer coiled part of the guide wire detatched from the inner core of the guide wire as I was pulling it out. Luckily I notice the difference and stop pulling the softer part and use a needle holding forcep to clamp on both the core and the coil at the hub of the triple lumen to pull it out.

Imegine if I continue to pull on the detatched coiled end, it may detatch completely from the core wire and left the core wire in the cetral vain!

Here's the picture of the soften distal end of the guide wire. See how easy I made 2 loops from the soften wire (the detatched coiled part).

Atypical anaesthetist

They said anaesthtists have OCD (Obcessive Compulsive Disorder). I always consider myself atypical in this case coz I am much relax and less organised.

This is my GA trolly when I started a day.

Anfter an emergency paeds surgery, this is how it usually looks like. Messy.

Lo and hebold, the other day I met my match! Look at his trolly after an elective case!

Welcome to the club! Dr G :) Hope you enjoy your stay in this department.

Doing some good to the Earth

There's a lot of Negative energy in the ortho OT yesterday! The ortho surgeons already over worked, post called, was hand picked by their boss to perform a difficult elective trauma case. The wound is bad. The whole process was quite bad so there's a lot of shouting, to the scrub nurses, circulating and MOs and HOs who assisted the surgery.

I decided to do some good for our earth to balance up the negative energy in the OT.

There's a lot of plastic and papers involved in wrapping up instruments. this is how they look like, wrap and sterile with autoclave.

Although we do have a dedicated bin for recycle in every OR (Operation Room), the nurses usually open up an instrument a just throw the plastic and papers all together into the normal waste basket in OT.

When I'm free, I usually seperate the plastics from the papers and keep the papers in the paper recycle bin. This is the messes I created on the OR floor while I seperate the papers from the plastics.

Now, there's only plastic in the waste basket and all the papers go into recycle bin at the other end of OR.

We do created a lot of waste in the hospital. f everybody do their parts in recycling, I'm sure we will do a lot of good to the earth.

The hospital which I did my elective in Taiwan many years ago has very good recycle culture. Everybody in the hospital do their parts in recycles. They have recycle bins almost everywhere and the staffs from the doctors to the helpers all automatically seperate their waste into proper bins. Things as small as opening up a needle, they will seperate the paper from the plastic package and throw them into proper bins.

Our people, dispite of constant reminders, still throw everything (non-clinical waste) into the common waste bin.

Poor quality devices II

I wrote about poor quality medical supplies we got in MOH's Hospitals nowadays. This is the other products which bugs me all the time.

The three ways connectors.

So someone decided to change to the above sets reacently. The problems? It doesn't connect well, the luer locks doesn't lock properly so it leaks very offen.

So what we did? We complained and someone up there decided to give it a try on another vender...

Japanese company but made in PRC. The out come? Still leak leak leak like our buildings in putrajaya!

Seems like poor quality medical products are not our boleh land problem alone but quite global when ppl what to cut cost and sacrifies the qualities.

Problem solved - ePOCRATE

I'm impressed with ePOCRATES support team! Erica from ePOCRATES emailed me the 2nd day after I write to them regarding my problem with the product. I'm impressed, even though I'm using the free version, their response is fast.

Here is what she said:

I spoke with customer support and they said you most likely have "Scrabbled data".
You just need to delete one file, then sync again.
The file is called "OnBoardAU.prc" on your device that needs to be removed.

Let me know how that works for you. Are you aware of our free drug search option that you could add to your blog? It's at www.epocrates.com/medsearch and allows you to have a widget on your site to search the Epocrates drug database. Might be a nice little addition if you are interested.

However, I've tried deleting only the 'OnBoardAU.prc' but it doesn't help. I ended up delete the whole programme on my Palm T5 then downloaded and reinstalled the ePOCRATES Rx version 8.10.

This is how it looks like on my PC during the sync process.

After the re-installation and sync, I have a functional ePOCRATES on my Palm T5 again.

I've also added a widget on top of this blog that can perform a search on ePOCRATES Online. Thanks Erica for the info.

Having problem with epocrates

I use MedCal and ePocrates very offen during my ICU rounds. Recently, the data in my palm epocrates seems to gone bizarre. This is one of the example:

When I look for renal dose of Cefepime, this is what came out: