*you know who is in charge in cases of difficulty, don't you?*
People are waiting for season finale in every single drama series. But for my drama series, I hate the season finale. My season finale means a good bye to a 15 days adventure in this beloved wards.
Anyway people, I came like usual today but looked and felt a bit lethargic. I come and disturb a petite HO doing her work. We chatted about the whole wards and department story, it was fun though to see people in other perspective. She also taught me about ECG.
First thing to see, whose ECG is that. Them move to the rhythm. If the rhythm is regular, count the rate. How? Let's count the big box from Q to next Q, e.g. 5 boxes. Then 300 divide by those boxes e.g. 300/5= 60bpm! Easy huh? Next, see the axis, which if lead I is positive, and AVF is negative, then it is left axis deviation and vice versa. In normal ECG, both leads are positive. After that we need to see any abnormalities in leads.
V1, V2, V3, V4- anterior
I, aVL, V5, V6- lateral
II, III, aVF- inferior
So, see on that leads if there is ST elevation or depression, T inversion, hypertrophy or bundle branch block etc. And uh yes, yesterday the specialist asked about what causes QT elongation. What popped in my mind was erythromycin as the specialist told me last two weeks after CME about CAP. Other causes include MI, myocarditis, head injury, hypothermia, U&E imbalance etc.
Enough about ECG, I was after that was asked to assist a HO to remove the chest tube. That procedure is aseptic one, thus needing me to scrub, wearing apron and put the surgical gloves properly. I gotta help him to pull the chest tube and doing other assistive task. It was not that hard actually but I need to be more alert next time. I was asked why we should ask the patient to inhale first before we pull the chest tube. I answered about lung expansion and pleura come to each other and all. But the answer is about the negative pressure created in case of patient inhale during pulling that tube off. Hahah..I need to read more so that my answer is of medical student standard not a layman one.
Continue to round business, today we were not met by any asystolic neither apnoeic patient so no CPR today! It had been very dramatic today. There is this schizophrenic patient who was left at a hut by her parent to live by herself. It is very sad actually and the specialist add the drama by telling us another story when she was a MO. There is this makcik having CVA, on RTF and have bed sore. Obviously this makcik needs special attention and nursing. She was on first class ward back then and that reflects the children wealthiness. But, when it is time to discharge that makcik, their children refuse to take that makcik back! WTH right (this is not included in glossary)? Then that makcik stayed in the first class ward for like one year until her death. Dramatic enough, right? Another story, a son putting his mom inside a store and give his mom food in a plate that left on the floor of the store. OMG, he did not even invite his mom to eat together? When you were small, your mom wouldn't even care to eat if you don't have enough food but now?
C'est la vie, people! It is very much make me sad to call it an end. Then, I bid farewell to all the doctors there and leave before jumaat prayer. While waiting for my dad to pick me up, I listen to my iPod. Then I accidentally played this song. I was touched. I thank my teacher here in HoSHAS in Medical Department, in ward XX especially. The specialist, Dr S, Dr. H H; the MOs Dr N, Dr. R and Dr. K, Dr. H, Dr. Y; the HO, Dr. M.N, Dr. A, Dr. L, Dr. S, Dr. I, Dr. N, Dr. M, Dr. Iz, Dr. E; the sister and staff nurses. You all had been a very good teacher. Thank you! God bless you all!
CME- continuous medical education
CAP- community acquired pneumonia
MI- myocardial infarction
U&E- urea and electrolyte
CVA- cerebrovascular accident
RTF- Ryle's tube feeding