Gerak Khas Attachment: Day 10

*As usual, refer glossary or Prof. Google in case of any difficulties*

Ok. Sorry for the late update. Some familial emergency does take my precious time. Anyway, I had a rather short day today. I went to the ward as usual every morning. I got to be on the same lift with the specialist. She said, "Today we got hospital CME from 8-9am. You can join it and I'll do rounds afterwards". I said ok and thanked her. I went to the ward, putting on my coat, and preparing to do rounds.

I joined on of the HO for morning rounds. She asked me about lots of thing. And we were joined by the USIM student.

First question, in what condition is subclavian lymph node is enlarged?

The answer: gastric CA, which also you may be asked about the pathway of lymph drainage.

Second question, What will we see in Grave's disease patient's eye?

The answer: Exophthalmus, Lid lag, Lid retraction, Ophthalmoplegia

Tricks to see fine tremors better, put a piece of paper on the extended upper limb! Easy! Thyroidism is a fairly frequent case in Malaysia. So you just need to study both hypo- and hyper-.

Come to the most exciting moment of the day. Well, we sort of having this patient suffering for CCF, also some AF but he was not on Warfarin so we were all suspecting the patient have cardio-embolic stroke. He was planned to do plain CT scan for brain and to put on ventilator. Unfortunately, before the Anesthesiology

team install the ventilator, he develop ventricular fibrillation and needs CPR. We were all asked to be ready for any consequences. Initially just the MO and HO doing the cardiac compression. But after a while, the specialist asked me to wear on the rubber gloves and be ready to do the chest compression.

How to do chest compression

I was shaking when putting on the gloves, and the specialist told me to relax and don't panic. That's the key, people! I put my hands on the sternum 2" below the upper border and 1" above the end of xiphoid. And start to push my hand on the patient's chest, I sort of hesitating but nevertheless we need to push 2" deep. While doing compression, we must see the cardiac monitor. That's all I think for CPR today. Also, the specialist asked for the homework she gave yesterday. Thank god, I searched for it and share with you guys!

Glossary

CA- cancer

CCF- congestive cardiac failure

AF-atrial fibrillation

CT-computerized tomography

CPR- cardio-pulmonary resuscitation