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Tuesday, August 23

Gerak Khas Attachment: Day 12

Salam people!

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

Actually, today is a long day but there's nothing much to write. I started my day like days before. Came a bit late then go o the ward. I'm intending to follow HO rounds but that friendly HO said that he will not be there for the rest of the day because he need to go to the clinic. Anyway, I saw a patient with empty blood specimen bottle.

I told the USIM student that we still could have the opportunity to do blood sampling. She asked from the HO in charge of the night shift to do blood sampling. After that, I approached the same HO to do blood taking. Luckily, he still not take any blood in acute female cubicle. All of them need ABG except this one 'nenek' that only need FBC and RP. So I tried to take blood from this nenek la. It was quite hard actually to take blood from elderly since their skin is wrinkled and make the vein searching a bit difficult. Luckily, I got to feel the vein. I prick her skin but there is no blood getting in the needle. I tried to adjust it a little bit but to no avail.

I pull off the needle and reinsert the needle after search for the vein for the second time. Alhamdulillah, this attempt is a success. It is quite hard at the beginning but practice make perfect people! After doing that, I thanked the HO and go to the USIM girls to see what happened. There's two of them but they do it together, so as I come there they just completed one patient. They tried to withdraw blood from the second patient but to no avail although they tried it twice. I take a chances to withdraw the blood and praise to God, I can withdraw 3 cc of blood.

But when filling the specimen tube, I notice that the syringe is quite hard to push. Maybe there's clot in that and I was right as soon as I remove the needle. Don't tell sister (head nurse) about this haa? I removed it by using gloves what? It was so dangerous for me actually but I cant think of another maneuver. We just fill the two serology tube but leave the FBC tube empty because the specimen is clotted. Then, after that I followed MO rounds until the specialist come. Today the specialist in charge for this ward before is back from her holiday.

She asked a HO why we can not bring down the BP quickly following ischaemic stroke. The answer: to prevent further stroke to ischaemic penumbra. And the doctor should not hesitating to give aspirin in such patient unlike the patient with hemorrhagic stroke. Also, we were asked about the feature of peritonitis in patient with PD. It is among others, abdominal pain, cloudy dialysis fluid and diarrhea. But the patient got DM also, so gastropathy is more likely since the peritoneal fluid is clear. It is caused by the autonomic dysfunction along the GIT. There is a patient with newly diagnosed PTB. The specialist prescribe INH, rifampicin, ethambutol and pyrazinamide but didn't asked the patient to go the nearest KK or KD for taking the medication as obliged by the DOTS strategy. She said, the DOTS therapy is needed for patient with suspected non-compliance in taking medication e.g. RVD pt, ex-IVDU etc.

After rounds with specialist, I went to the library and took a nap (a 2hour one). When I came up, I was joining the USIM student to search for cases and all of a sudden a chinese elderly pt have asystole. CPR is indicated but was delay due to dispute in NAR status. As usual, we joined the CPR session again this time. Too bad the patient LO already. After that, we observe a PD installing procedure. The tube was inserted to the peritoneal and drained from the same hole. The fluid inserted is the peritoneal dialysis fluid 1.5% dextrose. After that procedure, we continue our observation in IJC procedure. It took a little bit longer time due to patient in-cooperation and ?abnormal vein structure. After that I excuse to go back and that's all for today folks!

Glossary

ABG- arterial blood gas
FBC- full blood count
RP- renal profile
BP- blood pressure
PD- peritoneal dialysis
DM- Diabetes mellitus
GIT- gastrointestinal tract
PTB-pulmonary tuberculosis
INH- isoniazid
KK- klinik kesihatan
KD- klinik desa
DOTS- direcly observed therapy-short course
RVD-retro-venereal disease
IVDU- intra-venous drug user
CPR- cardiopulmonary resuscitation
LO- a term for passed away
IJC- internal jugular catheter
?- query, put in front of a fact that is not confirmed/unknown


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