a traumatized fydo doing examinaion on trauma case

beauty is pain.
no pain no gain.
no gain no knowledge.

me is traumatized but like i told ya, i need to be strong. *crying*.
i was told to manage a trauma case(tiba2 je) so macam oncall sket.
someone didnt have the common sense.
me is small hearted.
male assistants are there. they tend to underestimate a female doctor. i said tend to, not really doing it.
i kesiankan patient tu. dia tua, dia sakit, aku terbayangkan ba. i feel like i'm his daughter, not his doctor. (shouldnt feel like this - should balance it)

so todayyyyyyy, an examination is done under fulllll supervision.

1) c/o - LOC? ent bleeding? retrograde amnesia?
2) hpc - how mva happen, what vs what, when,
3) pmh
4) pdh
5) sh - smoke, drink, work
6) fh
7) eo - check for fracturessss


palpate
face - periorbital, nasal, maxillae, mandible
tmj -

mouth opening
lateral excurion

look for
hematoma (accumulation of blood=swelling)
ecchimosis (bleeding under skin without swelling)
abrasion
laceraion

check
eye - diplopia (ask patient to follow your finger) , blurred vision, subconjunctival haemorrhage

I/O

occlusion deformity
dento-alveolar fractures
crown fractures
tooth mobility

management :

toilette and suturing (this case, l/w at lip) - cari n cantumkan betul2 dekat vermilion border, baru cantik bibir dia.

bagi cloxacillin because its extraoral. if intraoral only, can give ampicillin(x ingt)

later, we ordered omv and opg to rule out infraorbital fracture (Ihe pt have periorbital hematoma)



DONE FOR TODAY. STRESSSSSSEDDD

electrolytes lecture by Dr F

writing this with api membara dalam hati.
but after all, disebabkan aku nak ilmu, semuanya harus ditempuhi dan dilupakan. whatever it is. me have to be kuat.

usually, everyday we'll lose 2500 mililiter of water(urine,sweat,respiration,faeces).
so, for patients who cannot tolerate orally, unconcious, dehydrated, we need to give them water through IV drip(ye kot) around that 2500ml jugak.

Important body electrolytes are sodium and potassium. Daily, we need 1-2 mmol/l perkg, per24hours of sodium and 1 mmol/l perkg per24hours potassium. (mostly potassium is inside cells and sodium is outside cells). Potassium will be lost only if we have trauma, when cells are damaged.

so normally we take standard weight : 70 kg. So what a patient need daily are :

1-2mmol sodium x 70kg = 70-140 mmol sodium
1 mmol potassium x 70 kg = 70 mmol potassium
2500 ml h20

a bottle of normal saline usually used in hospital contains :

150 mmol/l sodium
0 potassium

its content is actually 500ml, so actually it contains

75 mmol sodium

so how do we give patient enough sodium and saline?

if we use only normal saline, we could have give 2500 ml h20 using 5 bottles of ns, but then we will over saturate the patient with a 75x5 mmol of sodium which is (375mmol)- extracellular fluid (intravascular and interstitial) will be hypertonic, and cells (intracellular fluid will be hypotonic)will shrink to achieve osmolarity equlibrium. we dont want this.

how to give normal saline and sodium, perfectly as neede by patient?

we use other solutions, which is dextrose 5%(D5) solution. it contains glucose, no sodium nor potassium.

so, 2 bottles of ns will give :

150 mmol sodium
1000 h20

and plus 2 botlles of D5 will give :

1000 h20

which sums up to be :

150 mmol sodium
2000 h20

nearly what the patient need.

one other solution is ringer's lactate (hartmann) it contains electrolyte nearly the same like in plasma(ye ke???) bacaan dia aku lupa tapi lbh krg 131, 5,...xingt dah.

ok korg..tadi kita bagi 2 bottles of ns and 2 bottles of d5 kan...that makes it 4 bottles in 24 hours. so one bottle is given in 6 hours. we dont wanna give it faster nor slower than it should be, so the drop of water is counted/estimated so it is controlled for 1 bottle=6hours.

for patients with brain injury, to prevent brain edema, we give fluid that is hypertonic to intracellular fluid, to prevent water accumulation in cells.

and in cases of severe trauma/burns(ye ke?) there might be need for potassium.


lastly, i admire you Mr F coz u taught it in a very easy way. u are Dr Y the 2nd.

road tax sticker!

guna road tax sticker utk tampal ropad tax coz gam dia memburukkan cermin keretamu!



http://firestartingautomobil.blogspot.com/2011/02/tip-tanggal-dan-pasang-sticker-road-tax.html

endless house chores

house chores never ends. it will only ends when people die!
we'll continue doing house chores as long as we live.

nobody love doing it.
its only our eyes cannot tahan looking messy things, so we tidy up.
its not an easy job. it uses energy a lot! it also uses brain coz we think on how to put things in the right place, so a small space can look bigger, a buruk thing can look nicer and so on..unless we dont mind looking messy.

there will be no house chores if the house is a dead place : meaning , we dont eat at home, we stayed alone, we like to go out, and we spend weekend at other places! - but still floor should be mopped, toilets should be cleaned, etc...

kalau basuh baju, nanti kena angkat, lepas angkat kena lipat, lepas lipat kena simpan, bila dah cantik susun nak pakai la pulak, then nak basuh, jemur lipat simpan pakai...hahaha..tu baru baju!

nak masak? u think la how kilojoules will be used.

conclusion : do not underestimate a housewife's job.

lesson : a working wife need to get supplement and be strong! (just saying~)

amanura's new world order

I'm thinking of something...

1) people should put knowledge as benchmark on who is better, not the wealth/money. usually when dealing with rich, people will memperhambakan diri to them. And the rich people will act like they are the bosses and treat others like their slave. aku benci melayan orang yang tiada budi bahasa dengan baik. orang tiada akhlak adalah orang yang paling tidak bertamadun. Banyak hadis yang menyebut kepentingan akhlak. manakala orang yang berilmu selalunya berakhlak mulia. itu tanda keberkatan ilmu. kita menghormati orang berilmu kerana ilmunya, bukan kerana dirinya. kerana ilmu yang Allah gunakan dia sebagai perantara untuk disampaikan. Boleh tak fikir macam tu? its simple but most people dont think it that way. most people like to see money, kecantikan dan gaya. lagi satu kemuakan yang berlaku dalam malaysia ni ialah mengagungkan barat. siapa yang dapat speaking english fluently and ada accent british/american macam hot gila. padahal itu sekadar bahasa macam bahasa kita juga.orang yang mengagungkan barat itu tandanya dia sudah tiada rasa agung pada bahasa sendiri. lebih rasa cool bila dapat berbahasa lain. bila hanya tahu bahasa melayu(tak cool lgsg), rasa macam rendah. kalau dapat berpemikiran barat sikit rasa macam modern gila. kalau dapat melancong ke uk rasa gah. kita perlu ada jatidiri bangga dengan diri sendiri, dalam masa sama mencelup kemajuan dari tempat lain untuk memajukan diri.

ni penyakit orang melayu kl/mana2 tmpat konon modern.

2) being a leader (eg : of a country) is about responsibilites, not popularity/money. so normally, people will avoid this(responsibility), but in reality, people is running after a position as a leader, obviously for money n popularity.

@ klinik pakar bedah mulut

me, is Dr F attached.

today i removed old BIPP and replace with new one.

BIPP :

- bismuth iodoform parafin paste
- served in one long,thin gauze
- packed inside cavity and later bone will close the cavity
- example : Dr F did marsupialaization of a cyst. (patient is very old, not worth it to do surgery to remove cyst) . then the cavity filled with BIPP. BIPP is changed every 2/52 and later 3/52. the cavity really shrunken in size. later, maybe we can just suture the cavity opening or let it heal until there's no cavity at all.

CT scan , coronal section.

to determine right or left, imagine we are looking to patient who is lying, from its feet, and the patient

seberat hijab yang menutup kepalamu..

pakai tudung besar sikit je dari orang lain, tapi macam2 expectation orang letak pada kita...bukan sekadar expectation, perlian dan cacian bila expectation tak dipenuhi juga dapat.
tak kurang juga, bila ilmu agama mereka cetek sungguh, diperlekeh pula cara menutup aurat, seakan tiada guna melebihkan menutup aurat itu.

sungguh manusia dalam kerugian.

setiap manusia ada tanggungjawab dakwah, dan sedikit sebanyak aku terasa tanggungjawab dakwah terbeban di bahuku, sebesar tudung yang aku pakai sekarang ni!

that independent woman is crying

when they see i can drive, i can isi petrol by myself, i can drive long distance alone without problem, they think i'm ok. people stop caring about me when i seems independent already.
this is sad
sometimes i wanna be a housewife, someone else should be taking care of sending me to where i work, taking care of the car and safety and all...and having someone to accompany me wherever i go.

but actually this feeling happens SOMETIMES only.

mostly, it is fun being independent. HAHHA

aku menderita bukan sebab aku sedang bersedih, tapi aku menderita kerana tak tahu nak meluahkan kesedihan itu!

Bila aku tidak menangis, bukan bererti hati aku batu. Aku masih seorang perempuan yang penuh dengan perasaan citrawarna itu (hahha aku punya prumpamaan over kan!)

aku takpandai nak marah orang - (akan merosakkan mood aku kalau aku marah) - tapi resultnya, orang suka kacau/buli aku sebab takkan kena marah. - boleh jadi advantage, kurang dosa marah aku.

tapi aku masih tercari2 keikhlasan dalam diri aku agar tabiat aku tidak memarahi orang itu dikira pahala, bukan sekadar angin lalu sahaja.

Tuhan, gimme strength!