being useful

lately at OS, me got more than 2 patients per day. its an improvement ppl!!!!
not that i hope people get sick, but please attract more people, than letting small clinic getting crowded. right? hurrrmmmm!!!!

hokkay...updating infossss...

1) we wait until patient got 8 g/dL hemoglobin for extractions. (but for hemodyalisis patients, they mioghbt always got low hemoglobin level because of no erythropoietin that is responsible for rbc production. erythropoietin is produced in kidney. renal failure patients have low erythropietin or none at all.)

2) withdrawing blood. usually for admitting patients, we fill up for FBC, coag and buse. fill up the blue bottle first, then purple then yellow.

3) during admittance, patients aged 40 years old and above plus smoking habits, will need an ecg and chest xray before, fear of any heart problem. and this is to be reviewed by anaesth clinic.

tiada tajuk

feel like dont have goals at all.

dont wanna be a chicken who go out in the morning, found cacing then balik rumah to feed children and repeat the same thing tomorrow. likewise, human, go out kerja kerja kerja, balik makan, tomorrow wake up and repeat the same thing. sometimes go out have fun with friends. if friends like lagha things, we'll do lagha too.

i'm at oral surgery department, in a day, i do 1-2 patients ONLYYYYY......aarrrrrr....bosannnnnn....

waiting for january to come, i'll go to ipoh. will be missing OS badly coz they said resto is very busy, half an hour for any procedure - working length, crown prep, etc..

then febuary i'll be campak-ed anywhere tpkn g wants.

i hate lame days

i missed thrills.

but i want an easy life, happy times.

i am never grateful right?

pity me, doakan aku.

getting back to Him

sesungguhnya Engkau tahu
bahawa hati-hati ini telah berpadu
berhimpun dalam naungan cintamu
bertemu dalam ketaatan
bersatu dalam perjuangan
menegakkan syariat dalam kehidupan

kuatkanlah ikatannya
kekalkanlah cintanya
tunjukilah jalan-jalannya
terangilah dengan cahayamu yang tiada pernah padam
ya Rabbi bimbinglah kami

lapangkanlah dada kami
dengan karunia iman
dan indahnya tawakkal padamu
hidupkan dengan makrifatmu
matikan dalam syahid di jalanmu
engkaulah pelindung dan pembela

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~)