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Friday, August 12

Gerak Khas Attachment: Day 5


So, today I started my day by going to pasar pagi to pick up ikan patin. Wearing full formal cloth and shoes is so overdressed for going to market. But I miss going to market in the morning (buat-buat rajin pulak nak pergi pasar).

Ok. Back to attachment story eh. I came this mo
rning and seeing the HO which I did round with her yesterday. I was noted that a patient in our cubicle LO last night. Also a critical patient that has long been there after referral from CCU. Then I meet one of male HO. He is very friendly and I

was with him until the specialist came. Then I follow the specialist on her rounds. She taught me about patient with CBD, after CBD off we need to make sure normal PU because of weak bladder after CBD (especially long CBD usage).

She also ask me to see a tonsilitis patient tonsils. It is very much enlarged, almost at the midline but no kissing (meeting of two tonsils by huge enlargement). And there's this one patient which have eosinophilia, which DDx for eosinophilia include allergic reaction, parasitic infestation, Wegener's syndrome. For high eosinophilic count + mouth ulcer + hepato-splenomegaly, consider HES. Also, she told all of us that in Master program unlike undergraduate degree, you are fail until proven otherwise. New fact huh?

kissing of the tonsils

Also we meet a pt with rather distended abdomen. 5F for causes of distended abdomen is
i) Fat
ii) Faeces
iii) Fetus
iv) Fluid
v) Flatus

One of the most important thing you need to know is how to evaluate GCS. Quarter of the ward need to be GCS evaluated. Then I clerk a pt of new admission. He is suspected from dengue fever. P/W fever day 4, thrombocytopenia, high hematocrit, also from dengue prone area and fogging history. I clerk him, with another HO. She was showing me how to clerk the pt. Last few days she also asked me to clerk an anemic pt. I got this one scheme for clerking the pt.

1) Demographic detail (age, sex, work, where he live etc.
2) Complaining Of (C/O)
3) History of Present Illness
4) Severity Rate
5) Past Medical & Surgery Hx
6) Medication Hx
7) Allergy
8) Family Hx
9) Social Hx
10) Summary

That patient on examination both lung clear, CVS DRNM S1S2, Pulse Rate 78. My impression is dengue fever, because of fever, thrombocytopenia and from dengue prone area. And Dengue (IgM) Rapid Test is pending. After those clerking, I went to jumaat prayer with one of senior HO. After got back from the prayer, I go and check the dengue pt and make sure he is comfortable. After assessing the pt, I was asked if I wanna try to do venepuncture on a patient. I did it half way. I wrongly inserted the needle subdermal, which it should be in side the vein. KANTOI!!! (Malu gile! Kesian patient). Then the HO did it. It is easy actually when you know how (Tak serik, nak buat lagi tuh). Then at 3, we all went to HO presentation CME. It was about CAP, sign symptom, Mx and Tx. It was a long topic. It took hour and half to be finished.

After CME presentation, we all went up to the ward and do ward round. The specialist is teaching me about reading ECG which I consider difficult. So, when you see an ECG, there is a long lead II wave called rhythm strip or long II strip. It is used to see sinus rhythm which is defined as a cardiac rhythm started with P followed by QRS complex and T (occasionally U). I never think a lot about ECG before, but she said ECG is made of 3-D 'imaging'.

Lead V1, V2 is for anterior region, V3,V4 is for septum area, V5 , V6, I, aVL is showing lateral region while II and III and aVF is for inferior region. While aVR is only to see whether ECG is properly measured because the wave should be positive, if negative it should be repeated. Then we met a pt, which is non-responsive on we waking him up. The special way to know whether it is true LOC or the pt just made it up is to induce pain or to lift his arm on his face. If his arm hit his face, then it is true LOC but if he avoided the face, the pt is likely to see for extra attention.

Glossary

LO-a hospital way to say passed away. (abbrev. of ?)
CCU- cardiac care unit (unit rawatan jantung)
CBD- continuous bladder draining (insert catheter in urethra)
PU- pass urine
HES- hyper-eosinophilic syndrome
GCS- Glasgow Coma Scale
P/W- presented with
Hx- history
CVS- cardiovascular system
DRNM- dual rhythm no murmur (normal heart sound)
S1S2- heart sound heard
CAP- community acquired pneumonia
Mx-management
Tx/Rx- treatment (Rx is specifically for medication)
ECG- electrocardiogram
LOC- loss of conciousness

*other abbreviation see below eh? (malas nak tulih laa hahahah)

see you again on monday!