Gerak Khas Attachment: Day 13

Salam people!

*MO in charge, Mdm. Glossary, Specialist in charge Dr. Google*

Well today I came as usual. Doing rounds with the same friendly HO, finishing all his 4 patients. There is some issue with the patients' insulin. There is some misunderstanding in off-ing some medication. I asked him to consult MO regarding the medication. He consulted the MO after that while I was joining the specialist doing rounds. We were joined by a group of dentistry student from USIM. I asked a HO about persistent hyperkalaemia, which is one of indication of PD/HD. He said, after 2-3 times hyperkalaemia in BUSE result, we consider the patient have persistent hyperkalaemia.

The specialist also do a lot of teachings today, since dentistry student is in their first day posting to this ward. She taught us about things to ponder in CT brain namely; ischaemic changes, ICB, cerebral edema, coning/herniation. So this is what you want to see in CVA patient. You may want to see other lesions in other cases e.g. SOL, psychosis etc. So, as you guys knows eh, brain is divided into 3 different circulation that interconnecting each other.

Posterior infarct may likely to come with cerebellar sign (ataxic gait, incoordination, dysdiodokinesia) and giddiness. While in middle cerebral artery infarct may manifest with hemiparesis and poor GCS. If GCS is dropping, it is indicated to repeat the CT brain to see any bleeding, extension of infarct to penumbra and cerebral edema. We were also asked about DM complication and its' classification.

- Macrovascular

* CVA/TIA

* MI

- Microvascular

* Nephropathy

* Neuropathy

* Retinopathy

Also, in AIDS patient there is defining illness to diagnose that RVD patient had advanced to AIDS stage.

* Cerebral toxoplasmosis

* Cryptococcal meningitis

* Cerebral lymphoma

* Kaposi sarcoma

* Oral-esophageal candidiasis

* Pulmonary Aspergillosis and/or PCP

* TB (not specific to the AIDS stage)

In clerking a patient with RVD, identify his risk factor so that control can be done. They are sex promiscuity, drug usage (esp IV usage), frequent blood transfusion, needle prick in health worker.

Back to the case of misunderstanding in off-ing the medication. The specialist asked why the HO off the drug but the HO remains silent. I don't know what is in his mind but he desperately in need of good reasoning and diplomacy. Anyway, the specialist asked me about AF type which I read few weeks ago but forgot it already. There are 3 types of AF i.e. paroxysmal, persistent, permanent. There is a long list of condition that can cause AF. Among others, they are

* HPT

* MI

* persistent pneumonia

* thyrotoxicosis

* PE

* MS

* alcohol consumption

* heart failure

* Hypo K+

(caffeine can only precipitate the present AF)

While doing rounds, I noticed one of the most crucial preclinical subject; PHARMACOLOGY! There's a lot of situation where your basic pharmacological knowledge is applied. After finished the morning rounds with specialist, I come to the library to read newspaper and read a little bit. Half an hour before 3pm, I came up to the ward ready to join CME. Then I met that friendly HO clerking a dengue patient. As FBC in dengue is needed TDS, I'm quite lucky that the HO allow me to take the blood from the patient. I withdraw the blood and the HO put it in each tube. Then, we intend to do BFMP which I tried to do but failed it. I put 2 drops for the thick smear which is enormous! Then the HO take over and do a proper blood film.

At 3, I followed the specialist to attend CME. While walking there, she showed me a good book to read for better understanding ECG named Making Sense of ECG, A Hands-on Guide. It is available at Sykt Kamal, KL for RM 65.00 only. Before the CME started, I heard about some drama which a HO leaving a comment in a blog bad-mouthing about the hospital administration. Then the 'pengarah' got so angry that he passed a memo on every HOD to find the truth about what that fella said. Dramatic enough huh?

Glossary

PD- peritoneal dialysis

HD- hemodialysis

BUSE- blood urea serum electrolyte

CT- computed tomography

ICB- intra-cranial bleeding

CVA- cerebro-vascular accident

SOL- space occupying lesion

GCS- Glasgow Coma Scale

DM- Diabetes Mellitus

TIA- transient ischaemic attack (an ischaemic attack that last less than 24h)

MI- myocardial infarction

IV- intra venous

AF- atrial fibrillation

PE- pulmonary edema

MS- mitral stenosis

CME- continuous medical education (a class presented by HO in front specialist, MO & HO)

FBC- full blood count

TDS- ter die semendie (latin thrice daily)

BFMP- blood film for malarial parasite

ECG- electrocardiography

HOD- head of department