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Wednesday, August 17

Gerak Khas Attachment: Day 8

*The title should be 7 1/2 because today is holiday*
*Also, in case of any short form toxicity, please consult the glossary*

Well people, today is Nuzul Quran public holiday in Pahang. I went to the hospital with all the spirit (medical student spirit la konon). So today is considered weekend round which means specialist less likely to come. Nevertheless, I still come early in the morning, hoping to get any blood sampling job but to no avail. So, the JMO in charge taking blood this morning is very much efficient lah! Good for him, but pity me lol.

Then I went to see one of the HO, which is friendly enough to get along with. He is medical graduate from Medan, Indonesia. Actually I'll meet him every morning because now he's undergoing his 'denda'. He was amerced like that because he don't show up to work one morning without valid reason. The result, he need to do every morning shift, in addition to other round he may have. Pity him, but this is HOD decision. Well, we were going through some cases and also talked about our past. Yeah, he's actually brilliant just maybe lack of skill (he is first poster, what do you expect?). Otherwise he is a very good, friendly, emotionally tough doctor.

Then there comes the time for MO round. Same round everyday, but today I learn something about swallowing test. It is a test where we assess the ability to swallow for CVA patient. We give the patient ten spoon of water. The patient fail the test if;

i) Cough after giving water
ii) Drooling
iii) Voice changes after few spoon

If patient fail the test, consult patient's/relatives' consent to install Ryle's tube. If Ryle's tube is not installed, patient may have aspiration pneumonia as complication.

Also, we saw a patient with pleural effusion. He was transferred in from CCU. The pleural fluid is exudative. It is known by calculating the fluid over serum. If more than 0.6, then it is exudative while lower ratio shows transudate. Then, there's this one patient which have malarial disease. His BFMP show 400+ asexual stage but there is new appearance of sexual stage. Thus, this patient should be kept in the bed net most of the time since his blood is ready for transmission by mosquito bite.

After that we saw a CKD patient with fluid overload. Likely to be, she don't follow the ROF given. She developed APO with loud crept after sharp rise of BP. All doctors are working on giving her IV Lasix but her peripheral line is hard to find. Finally, the MO set up a central line in her femoral and give her lasix 120mg stat. She improved and after that, the PD machine and ventilator came. Then she is short of relieved. Also, HO insert CBD in her urethra and that is my first time seeing a doctor inserting CBD to a patient. After that, I sort of tired and excuse from the ward since there is no CME today. I need half day off, I'm not yet a HO (they have 10 days off in 4 month posting!).

Glossary

JMO- Junior medical officer (senior HO, 4th poster above)
HOD- Head of Department
Ryle's tube- a nasogastric tube (inserted in mouth till stomach)
CKD- chronic kidney disease
ROF- restriction of fluid
APO- acute pulmonary oedema
CBD- continuous bladder draining
CME- continuous medical education
Lasix- furosemide (a diuretic)



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