Menjelajah ke 7E Cafe
8 hours ago
MOship
Pasar Presint 8
October 20, 2020
Finally I found a place that I can do groceries shopping without having to worry about the price. Thanks Kak Mulan :)
For the early 2 weeks of my stay in Cyberjaya, I kept on buying stuffs from Grocers (name it - Village Grocer, Jaya Grocer, Star Grocer yada-yada), so I posted Instagram stories asking for help and opinions. A lot of information came into my message box.
One of them is Pasar P8. It is actually very close to Hospital Putrajaya.
So, I went there on Saturday with Haziq and haha of course I love the place!
It is a market in a neighbourhood surrounded by apartments, a school, a food court, a local library in Presint 8.
The price of vegetables, fruits, fishes, meats, chickens etc are affordable. I can say, it is almost similar as in Mydin etc.
The market will be the place for me to get my groceries on regular occasions :)
Here is the map. Luckily it opens daily.
These Tiny Tubes
October 18, 2020
Poking babies for some blood investigations is not that easy. First, we need to decide if poking them / to insert IV line (branula) is really needed. Then, of course we need to explain to mothers why we need to do that.
I always tell my patients (since housemanship phase) that our blood is like our identity. I think I have mentioned this in previous post too. We can check many things from few drops of blood. :) And I love the facts that we can do so.
In paeds, blood taking procedures are RARELY be done bedside (means most of the time, we will take the babies / kids to the procedure room) and we will ask the parents to stay outside of the procedure room, or simply stay in the patient's room. Why? I don't think people loves to see their kids crying with the pain initiated with poking them. Right? I have witnessed lots of mothers (usually) have tears flowing on their cheeks every time they hear their children crying in procedure room.
And to be honest, kids have really good memories - name it from their eyes and even from their body memories. Huhu. Every time we just hold to check their hands & foots for any possible veins, they usually will start crying. But some others are cool haha. Some will only cry once the needle is inside.
From left: EDTA tube for adults - EDTA tube for paeds - plain tube for adult - plain tube for paeds
EDTA tube - usually for full blood count, full blood picture
Plain tube - for renal profile, liver function test, serology etc.
Tricking the children with some videos are helpful to be honest. It helps to distract the kids. For babies, I discovered that playing some sleep lullaby can help to calm the babies. :)
I always asked my husband why on earth would he prefer Paediatrics compared to Medical Department. He said that both are busy departments, one handling general medicine for babies & children while the other one for adults. But, at least seeing cute babies sooth his mind to continue working. Lol. He handles kids better than me though we both are the youngest in the family.
And now, both of us are Paediatrics MO. Haha. Life is very funny sometimes.
Anyway, please pray together with us to be blessed with kids ya :)
I still remember I will ask your prayers when I was in medical school & housemanship. Hopefully, you will not mind to keep praying for me too.
May Allah bless your day :)
Cyberjaya
20201018
Open the Book, Seek Help.
October 11, 2020
Have you seen this book before? Hehe
This is a famous book in medical setting, especially in Paediatric Department. It is available in PDF form but most superiors prefer the juniors to have this book in pocket.
It is called Frank Shann.
A book consists of name of drugs and doses used. In Paediatrics, the dosages depend on the weight of the baby / children, hence you can see doctors start to open this book every time endorsing medications. Plus using calculator too.
For example, the most common drug used for fever / pain relief in kids.
Syrup Paracetamol 15mg/kg/dose 4-6H (max 4g/day)
Which means,
- the name of the drug: syrup Paracetamol (brand name can be like Panadol)
- the dose: 15mg/kg/dose. For example: a kid with weight 10kg, the dosage for him is 150mg.
- maximum dose if 4000mg/day
- 4-6H: means taken every 4-6hourly
- if taken every 6 hourly: the kid will consume 150mg x 4 times = 600mg (still below the maximum dose)
There are too much of information that health care workers need to remember. And again, it is really hard to know every single doses for every drugs in this world. So, this book makes it easier. Of course, it is helpful apart from calling the pharmacists and double confirm the dosage hehe.
Same goes in life.
Have we ever feel we had too much of things happening in our life?
We are human beings. We are not robots.
Even robots have the guidebook, so do we.
And what do humans have?
Yes.
Al-Quran.
Open the book, seek help. :)
Don't be ashamed.
This is simply a reminder for myself. Huhu.
Cyberjaya
201011
New Life, New Adventure
September 26, 2020
Assalamualaikum, hello guysss!
Hehe actually I am not really sure who's still reading this blog, but whoever you are, thank you for dropping by.
So, where should I start?
First and foremost, I just moved to Cyberjaya and work in a hospital in this area. I can say, it is so-called 'first class' hospital as it does not provide 3rd class beds so far that I know. Still struggling to adapt here though I have been working in this hospital for a month.
The environment is different.
The colleagues are different.
The system is totally different.
The approach is different.
The working 'politic' is different
Well, different hospitals have different styles. That is common.
I only know one person who used to work together with me in my previous hospital. And to be honest, the main reason I choose this hospital is because of the location - in between Perak & Johor so that we can take turn to go visit our family. Oh yaa, my husband is originally from Johor.
Luckily I choose to rent a unit of 2 bedrooms quite close to the hospital. About 10minutes journey. Quite a number of people suggested for me to rent around Seri Kembangan, Dengkil, Bangi, Puchong etc for a cheaper rent. But, I am from Perak, I am not used to drive 30-40minutes just to go to work, passing through highway with tolls and facing traffic jams.
"Dah kerja kat sini, kena la lalui. Itu lumrah."
Well, yeah I understand.
I tried to look for alternatives. It was either I spend money for lower rent (which was RM100 lower?) for cheaper place to stay but need to face those journeys... or I spend higher amount for somewhere closer.
I chose the latter.
But, I totally respect those who choose the former. :)
During the first few days, I can already feel the differences in living cost - where it was not easy to find a small kedai runcit, simple kedai makan etc. So I initially doubted my decision. However, after I went through my first oncall which was working at 8am today only to punch out at 5pm the next day... I finally relieved with my decision. Having microsleep while driving was totally not good. I was glad that my unit was not that far.
I honestly dislike oncall system. I had experienced oncall system when I was at early phase of housemanship (where the system was changed to shift system later). Staying awake for 36hours from 5-6am till at least 6pm the next day... I hate it. -_-' Some people maybe don't really mind oncall system but my body actually cannot take it.
I didn't get the department I choose. So that's another challenge. To make decisions for managements on something I don't have passion about... is really a challenge. People always say 'just try first, maybe you will develop your interest.' I tried. A month passed, still the feeling is not there. Haha.
Why are you pushing someone to do something they don't like?
But again, people will say, 'bersyukur lah kau masih ada kerja.'
Hahaha okay then, I rest my case.
Don't worry, I will still do my best. I will always try to do my best within my limit. :)
“Dan boleh jadi kamu tidak menyukai kepada sesuatu padahal ia baik bagi kamu, dan boleh jadi kamu menyukai sesuatu padahal ia buruk bagi kamu. Dan Allah mengetahui sedang kamu tidak mengetahui.” Al-Baqarah ayat 216
Last few days, I had a talk with a colleague who is currently in the same boat.
S: Perasan tak, Allah uji kita benda yang kita tak suka.
H: Kan... Lagi kita tak suka, lagi Allah bagi. Memang nak ajar kita kesabaran. Mungkin nak kita overcome perasaan tak suka tu.
And yeah, we are the chosen one to join the Covid team at quarantine centers in November-December. Alhamdulillah tak kena deployed ke Sabah. T_T
Doakan yaaa.
p/s: anyway, sorry for the negative vibe post. Haha I just need to rant it out first then I will be cool insyAllah.
Cyberjaya
200926
I was scrolling my Quora and came across this question. It is an interesting question if we are trying to answer it from perspective of healthcare workers like me vs riders.
To be honest, I don't have motorcycle license and have no skill to ride it as well. Haha.
And after working in the hospital,
I WILL THINK TWICE BEFORE RIDING ANY MOTORCYCLES. T___T
 |
| https://www.quora.com/Why-do-people-not-wear-a-helmet-while-riding-a-motorcycle |
-----------------------------------
**WARNING - THIS POST CONTAINS WOUND IMAGES**
Let me share with you a recent case I attended in the Emergency Department.
It was the morning of last day of Ramadhan, maybe around 4am. The patient was a 16-year-old boy, if I am not mistaken. He was referred from a klinik kesihatan that was 40km away, with the impression of: To Rule Out Skull Fracture.
Resources in Klinik Kesihatan can be limited, they can do chest xray, but not others. I've experienced a lot of referral to rule fractures from KK and to be honest, skills of doctors and medical assistants in KK are amazing. They are usually the primary team to stabilize patient in areas without hospital.
So, back to this case, he was brought in on a wheelchair, with lots of gauzes covering different parts of all four limbs. He could even walk from the wheelchair to the bed.
Usually, when we attend trauma cases, we use ATLS as guidance.
ATLS - advanced trauma life support.
The PDF itself is almost 500 pages! -_-'
Starting with A - airway + cervical
- Patient able to speak in full sentences, no gurgling or stridor, no foreign bodies in the mouth/ nose, not on cervical collar, range of movement of neck was full.
Proceed with B - breathing + ventilation
- Here, we usually use the acronym IPPA - which means Inspection, Percussion, Palpation, Auscultation
- I - breath spontaneous, not tachypneic, chest rise was equal bilaterally, no chest wound
- P - resonant percussion bilaterally
- P - no clavicle tenderness, no chest tenderness, chest spring negative, no subcutaneous emphysema / crepitus
- A - lung was clear, equal air entry
- Don't forget to check the oxygen saturation too (SpO2)
Then, C - circulation
- check other vital signs - blood pressure, pulse rate
- CCTVR - Color of skin, Capillary refill time (CRT), Temperature of extremities (is it warm/cold), pulse Volume, pulse Rate
- for this patient, it was all normal - pink, CRT <2s, warm peripheries, good pulse volume, pulse rate around 60-70.
- then, we checked the abdomen - soft, non tender, not distended, no abdominal wound.
After that, D - disability
- GCS was full E4 V5 M6, pupils 3mm/3mm equal reactive
Finally E - exposure / environment
- Here, we inspected the whole body from top to bottom, from front to the back.
- This boy has abrasion wound everywhere - shoulder, elbow, hand, shin, foot. But there was no swelling, no limb deformity, no limb tenderness, no limited range of joint movement (means, he can bend all joints normally) - so we don't expect any fractures here.
- There was no spinal tenderness / step deformity during log roll
- But the head was covered with bandage and we could see some blood stain. When we open the bandage, fuhhhhh there was jagged wound, quite big one! the skull was exposed. And there was no skin flap to cover back the skull.
- We gave him antibiotics and painkiller too.
- FAST scan done, no free fluid.
Something like this but smaller around 6cmx6cm size.
 |
| https://www.slideshare.net/vipinvenugopalnair/free-ld-flap-for-scalp-reconstruction-dr-vipin-v-nair |
Okayy, I know there are LOTS OF MEDICAL TERMS here haha. It is okayyyy, you don't have to understand everything. :D
To make it easy, generally we can say that this patient was stable clinically, vital signs was okay. Just, if there was no jagged wound on his scalp, he didn't even need to be referred to tertiary hospital.
Biasalah orang accident mesti akan calar balar sana-sini. Takde patah, kira alhamdulillah sangat dah. Tapi untuk dia ni, kulit kepala dah terbukak, tengkorak terdedah camtu. Nak jahit kulit kepala pun tak boleh.
We managed to request CT brain in view of the wound was big and skull was exposed - just to rule out any skull fracture or any possible bleeding in the brain (ICB - intracranial bleeding).
Alhamdulillah, turned out CT brain was okay - no ICB, no skull fracture.
So, what we did for his jagged wound - we referred him to Surgical Team so that they can refer the patient to Plastic Team. In big hospital, you can see lots of sub-specialty for Surgery - neurosurgery, plastic surgery, ear-nose-throat, hepatobiliary team etc. But, we don't have such sub-specialties here. There nearest one for that is HRPBI - Hospital Ipoh.
If the wound was a simple laceration like the one below, usually we can suture it ourselves..
| https://www.medicalimages.com/stock-photo-image-image9257585.html |
I feel sad for his father, he looked very tired and when the surgical team informed him that the patient will be transferred to Ipoh, we could see his 'pasrah' face. I believe the importance of parenting, but kids nowadays can be beyond control.
This is one kind of accident that actually can be avoided.
Why?
The boy is underage, without licence, without helmet, went out riding motorcycle with his friends around 12am, speed at least 80km/hour and the mechanism of accident was as I expected - he said "kawan main motor himpit-himpit, saya tak boleh control motor tu yang terbabas"
Rasa sedih bila jumpa kes macam ni.
And there were countless cases like this EVERY SINGLE DAY.
So, if you guys or your family members are motorcycle riders, do remind each other kay.
Always wear helmet.
200530
SM, Perak, Malaysia
Day 10 of May Photo Challenge - Self Care
I Miss...
May 15, 2020
I miss travelling actually, walking around the airport to catch flights.
I miss sitting by the window and watch the beautiful scenery from the top.
I miss the feeling to pass the security control and to have another stamp on my passport.
:)
I was actually planning to have a trip back to Czech after completing my housemanship hehe :D. Usually, after housemanship, we are allowed to use the remaining annual leaves and take a long holiday up to 27 days (if I am not mistaken). But my husband was still working at that time, so I decided to wait for him first to go later together. I went to the office to inform that I would be starting my floating (junior medical officer) soon.
Due to Covid19 outbreak, my friends who decided to take that long holidays were called to start working and our leaves were apparently have been frozen since March.
Ouch.
And I think travelling abroad is going to be tricky after this pandemic, right?
Maybe travelers need to provide supporting documents, health reports - new norms maybe?
Day 9 of May Photo A Day - I Miss...
SM, Perak, Malaysia
200515
I Made This PPE :)
May 10, 2020
On last Wesak day, I had this opportunity to learn and watch the staff nurses making our own Personal Protective Equipment (PPE) in our observation ward, this ward was closed due to rearrangement of our Emergency Department into Respiratory area & Non-Respiratory area and has become our 'store' and staff area.
- Respiratory area - attending patients with any complaints of SARI (severe acute respiratory infection) symptoms like fever / shortness of breath / cough / runny nose / sore throat / any history of Covid contact. Sometimes, the patients may come with other main complaints like infected wound over foot but just because he/she have any of these SARI symptoms, the patient will be attended in Respiratory area.
- Non-Respiratory area - attending patient with any complaints without SARI symptoms
Me: kak, nak try buat satu bolehh?
SN: haa, nah try jahit bahagian lengan ni dulu.
At first I just need to sew the stretchy area over the end of the sleeves. Then, slowly and patiently, Kak Daini & Kak Atun taught me how to sew the whole PPE. Since I have no skills of using the sewing machine, my product was not that neat. Terlebih sana, terkurang ni. Hahaha. Nasib baik laa PPE ni pakai buang. If you compared to their products, fuhh, dah macam baju raya, kemas sangat!
 |
| My first PPE everrrr. |
Honestly I only have the most basic skill for sewing, which means, I can only do hand sew like picture attached below.
 |
| Source - https://www.apartmenttherapy.com/how-to-sew-basic-stitches-221433 |
Though my mum is literally good in this, I guess I don't inherited the skill haha. For every Eid celebration, my mum will usually send some plain cloth to her favourite tailor and then she will make her own decoration on the dress with all those beads, labuci etc. For mine, my mum will 'encourage+force' me to the same so that I can survive with hand sew haha.
But, my skills of using the sewing machine - NIL
-------------
After completed one and a half of PPE suit, we heard the bell informing there were new cases in the respiratory area. So, that marks the end of my PPE sewing journey. Lol, when I returned to the sewing area later, seems like they already finished sewing. :D
It was honestly a nice experience.
Thank you akak-akak sabar mengajar!
p/s - my mother-in-law has awesome sewing skill too! :D
Day 6 of May Photo A Day - I Made This
SM, Perak, Malaysia
200510
I am Dreaming of...
May 5, 2020
... this pandemic to be over.
I am sure everyone hope for the same too.
It was a hard year, I can say. Beginning from end of January, when the team was given a briefing about the potential spread of Covid19 in Malaysia, then we were taught on how to properly don and doff our PPE. At that time, the cases were still low, there was no social distancing even in the hospital. When the cases increased in number, almost all seminars / teaching sessions / CME have been cancelled. In the middle of March, healthcare workers' leaves were freeze and most of us need to work and go to the health care center as usual.
It is already 2 months since I last met my parents too. I miss hugging them.
I miss the beach, so close yet so far.
I miss travelling.
I miss freedom of playing badminton at the courts with friends.
I miss going to body massage (which my body need it right now).
I miss eating out.
But, I believe everything surely happens for reasons.
I hope by the time this pandemic is over, we already learnt how to appreciate the health more. Always continue all the proper hygiene we have learnt through out the MCO. We will appreciate the moments we can spend with the families too. InsyAllah :)
Day 3 of May Photo A Day - Dreaming of...
SM, Perak, Malaysia
200505
Dalgona Coffee's Impact
May 2, 2020
I was working morning shift that day when my colleague passed over a pending night case. I That was my earliest day of returning to work after 2 weeks of quarantine as I became close contact to 2 positive Covid19 colleagues. Alhamdulillah my swabs turned out to be negative and I need to be non-symptomatic and complete 2 weeks of quarantine.
So, this young lady (Miss A) was in her 20s, with no underlying diseases, presented to us with palpitation and no other symptoms. Basically palpitation is an uncomfortable feeling that the heart is racing or the heart beats too fast. Same feeling when you are about to receive your exam results, or maybe when you see your crush walking around. :)
This same feeling is normal to me ever since I started working too. Haha. Nak masuk kerja selalu nervous sebab tak boleh nak expect much apa akan jadi sepanjang shift. So, I will always expect the worst situation so that I can get more prepared.
Okay, back to the patient.
Palpitation is normal is you feel it after a sprint or physical activities
It is also normal if you are stressed or anxious about anything.
Not to forget, if you drink alcohol or caffeine.
Why? your heart is pumping blood more frequently to the rest of the body to support it. :)
However, if you came to the hospital because of this, the health care staff will definitely need to rule out the emergency causes especially the heart problem. Along with palpitation, you definitely need to visit your doctor if you ALSO feel difficulty to breath / dizziness / collapse / fainting.
For this patient, some blood investigations will be taken - usually:
- full blood count (FBC) - we can see if there is any low hemoglobin, so it can be a sign that your body does not receive enough oygen.
- renal profile (RP) - to check your baseline for kidney function
- cardiac marker (in my hospital setting, we will take troponin I) - here, it can show if there is any problem with your cardiac (heart) muscles, maybe the muscles also do not receive enough oxygen and start to break down.
- electrocardiogram (ECG) is a must - this can show the rhythm of your heart, is the conduction of impulse okay or not
For Miss A, the blood results turned out to be normal and serial ECG was normal (improving sinus tachycardia, without ischemic changes going on)
Back to the history that we already taken at the beginning, she admitted that she drank lots of coffee during this Movement Control Order (MCO). She claimed that prior to this, she drink a cup of coffee as usual and she denied having this symptom.
To my surprise, during MCO, her caffeine intake was 4 TIMES DALGONA COFFEE A DAY!
If I use the viral Dalgona Coffee's recipe, it mentioned to use 2 sachet of Nescafe for one drink. So can you imagine how much sachets she drank a day? T_T
Diagnosis: Palpitation secondary to Caffeine
We re-accessed her after a while and decided to discharge her after she claimed her symptom is much improving and she looked very comfortable. We as well advised her to reduce caffeine intake and to come to ED urgently if she developed any other symptoms (especially chest pain / shortness of breath etc)
---------
I know that we are encouraged to give all out in everything we do, but please do not jeopardize our health. Okay?
SM, Perak, Malaysia
200502
Terima Kasih, Nak.
April 30, 2020
Today morning, just before Subuh prayer, a patient came with complaint of generalised itchiness with periorbital edema (means - bengkak di sekitar mata) that made his eyes become so small, I barely can see.
HCW : dah berapa lama dah jadi macam ni pakcik?
Pakcik : masuk hari keempat ni, pakcik pun taktaw kat mana silapnya. Bangun-bangun tidur, terus jadi camtu, pastu pakcik pergi klinik, dia bagi ubat gatal, ubat allergik, ubat sapu. Tapi makin teruk pulak bengkak kat mata ni.
 |
| If you received medications like these (only tablets with label of symptoms), please kindly ask the clinic to write down the name at least. Is it piriton, prednisolone? It is tricky even for us to know the names of medications just from the tablets. |
 |
| Something like this. Wikipedia |
Maybe there was some allergens on his bed, maybe some insects, or maybe some food he ate before. The patient denied any history of food allergy. Though he had some allergic to an analgesics - pain killer (unsure name), he denied any history of taking analgesics prior to symptoms.
At first I got confused if this is allergic reaction OR anaphylactic reaction (which the latter is worse), I quickly read back the notes shared by one of my favourite medical officer and found this.
Going through by systems:
Skin - yeah, pakcik got some itchiness all over body with periorbital edema.
Respiratory - he denied any problem with breathing - no shortness of breath / chest pain / wheezing etc. And the lung was okay, no wheezing (wheezing ni selalu jadi bila saluran nafas jadi sempit, macam orang kena serangan asma.
Gastrointestinal - he also denied any abdominal pain / vomit / diarrhea
Cardiovascular - no history of dizziness / shock / fainted
Neurological - none as well.
Diagnosis:
Allergic reaction secondary to ? cause.
Intravenous cannulation done, we decided to give these medications given:
- IV hydrocortisone 200mg stat
- IV piriton 10mg stat
- IV ranitidine 50mg stat
After discussing with senior about IM adrenaline, there is less harm than benefits to give... though this is allergic reaction (not anaphylactic) - so, IM adrenaline 0.5mg stat.
We reaccessed patient about 30minutes later, the first thing he said "Nak, pakcik dah boleh nampak, terima kasih, nak." We can see the swelling around his eyes already improved much! He claimed the itchiness also had improved, hence we decided to allow him to go home with some medications.
A thing about this pakcik was he kept on smiling through out his visit in ED, soft spoken as well. Dah la mata tengah sepet, senyum senyum lagi la sepet pakcikkk.
--------------
I always feel anxious to work night shift in Emergency Department. With this current Covid situation, staffs are distributed to many teams, hence, I need to survive on my own feet managing the Non Respiratory cases (green zone, yellow zone and red zone). Every single night shift, I will always pray for smooth shifts and the senior MOs working on respi team will not be annoyed to share their opinions for management. Alhamdulillah. the senior MOs, staff nurses, medical assistants are helping a lot and HO colleagues are good as well :)
Till next story :)
Salam Ramadhan semua.
SM, Perak, Malaysia
200430
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