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MVA
May 13, 2019
My oncall last night was calm, alhamdulillah.... until 5am. I received an update from my colleague that he was going to ED for a new referral - intraabdominal injury, a condition in which I feel challenging to attend other than brain injury.
MVA - motor vehicle accident.
I am not sure about the exact history, but this patient, Uncle L was riding a motorcycle and accidentally hit the tree. We are not sure about the mechanism much but it must be a very serious accident as the patient came to ED unconsciously. Blood pressure started to drop, which may indicate some bleeding was going on.
He successfully underwent emergency operation (exploratory laparotomy + splenectomy) which mean, we cut open the abdomen to find out what was going on inside. There was at least a kidney dish filled with blood clot and approximately more than 3L of blood loss. And the spleen was totally injured and need to be removed. Few segments of liver were contused as well.
Anyway, do you guys know how much blood the heart pumps out every minute? 5L/min!
And he lost more than half of blood in the body. So many blood transfusions going on this morning, my friend became runner to fetch blood between blood bank and operation theater. At least 3 large bore branula were in situ - one for packed cells, one for cryoprecipitate & fresh frozen plasma, one for IV drip.
He was still in critical phase and admitted to ICU post operation.
And actually there was another patient at the red zone this morning, he was also unconscious, lying flat just beside the patient we were preparing to transfer to operation theater just now.
Informed by my friend, he already passed away this morning, in his baju melayu and kain pelekat after finishing his Subuh prayer and he was being hit and run. Arrived in ED with no pulse, cardiac monitor showed asytole (no heart rhythm), I've been told CPR was commenced and the team was unable to revive the patient.
May Allah bless you pakcik T_T
MVA of Uncle L and pakcik was not related, anyway.
Becoming numb and numb T_T
SS, Perak, Malaysia
190512
Evanescent Life
May 4, 2019
"Everything in this universe is evanescent.
Because it is evanescent, it is also precious.
Spend this precious moment wisely and beautifully."
- The Things You Can See Only When You Slow Down
This view is enough to make me smile to the ears :D
Wonder if there are people who're still blogging their heart out? :)
SM, Perak, Malaysia
190504
C.O.D
April 9, 2019
"COD is no longer 'cash on delivery' when I become a houseman...
May Allah bless and grant you Jannah, ameen." - Hanis, 5th April 2019
Basically, death is not uncommon in Surgical department as well.
Most of them are patients with advanced cancer that already metastasis to vital organs especially lungs. Not to forget, victims of MVA (motor vehicle accident) with ICB (intracranial bleeding) - bleeding in brain. I witnessed a lot of cases in which we ended up issuing Death-In-Line (DIL) and Do-No-Resuscitate (DNR) after discussing with the family members regarding poor prognosis or deterioration of patients.
To those who are clueless what is actually COD in medical line - it is a short form of cause of death. It is not easy to come out with diagnosis for a living patient and to be honest, it is even difficult to come out with cause of death as well. Superiors always remind us, be careful with what we are dealing with, document everything we have done and do everything that we have documented.
There are few criteria before we can pronounce the death of patient.
- check the vital signs - usually heart rate, blood pressure, SpO2 will be unrecordable - means cannot be detected anymore
- check the glucometer (level of glucose in blood) - if too low, can be the cause of death as well
- check the pupils - usually fixed, dilated
- check lungs and heart sound - none... a bit tricky with patient supported with ventilator and we can still see lung expanding with transmitted sound on stethoscope
- check cardiac monitor - usually it will show a straight line (asystole) - print it out.
Usually if CPR is commenced to save patients life, it is only be done for up to 30 minutes. After prolonged shortage of oxygen, most of organs will slowly shutting down, especially brain. It is uncommon to go beyond that, taking note of resuscitators conditions as well. Commencing CPR is very tiring, pregnant lady should never do that. 15minutes of CPR = at least 165kcal of energy.
Ya Allah, guide me to Your light, ameen!
SM, Perak, Malaysia
190409
The Baju Kurung Girl
March 24, 2019
I adore girls with baju kurung in the hospitals, as I can't tolerate the heat much to wear baju kurung at work. The only time I wear baju kurung is when I have the shortest working hours which is normal shift (7am - 5pm), otherwise I will wear trousers with blouses instead :)
One of the thing I wish not to happen on the day I wear baju kurung is "dr, patient bed xx collapse / asystole" (in which I hope will not occur on any day pun actually)
Because it seems so hard to climb up patients' beds to do chest compression. ??
Doing CPR can drain much energy and I pray patients will have fast recovery and discharge very soon. Ameen!
Tempting Veins
March 23, 2019
I am currently in my 4th posting, to be specific I am now in Surgical department. Wahh, time surely flies very fast. It was just a year ago when I started my housemanship and now it is already my 2nd year. I've been trying to update my experiences here, but after quite a while not updating stuffs in my own blog, it feels awkward. Haha.
But, I planned to update a glimpse of my daily life in short posts regularly. I don't have much time to really make posts with something like "3 life lessons I learned from...." T_T in which the one I really miss to create.
Honestly, working as a house officer need energy - mentally and physically. I am sure being medical officers and specialists require more energy, just... being a house officer is my level for now.
Why the bulging veins?
I don't realized I have them actually. But, whenever I encountered patients with difficult blood taking, I automatically look at my own hands, only then I realized them. Suddenly I wish all patients have these bulging veins, just to avoid the need to prick the patients more than once just because it is hard to do so.
And actually, after working for more than a year, I can say that blood taking needs experiences, good instinct and sensation from our fingers. Sometimes, doctors can't really see the veins but we can feel them with fingers.
Such veins are more visible in people with less fat, patients who are not edematous (no water retention in body) and people who workout a lot.
And most doctors have bulging veins, thanks to frequent CPR we need to do, maybe some retraction done during operation... ohh, maybe fundal pressure to help delivering the baby in C-section? Hehe
-_-'
Just a random post, I guess?
I miss blogging, but I think I lost that magical blogging touch. T_T
2018 Best Nine
February 11, 2019
I was scrolling my own blog and suddenly my eyes found my featured post - 2017 Best Nine. Maybe it is too late to share my 2018 Best Nine now, but who cares though. :)
I didn't expect I only posted 13 pictures in 2018. Such a drop in number.
Sunset is always one of the thing I will look for especially after I went through any interesting oncall. And the beach with sunset are the best pair to enjoy myself with.
Somewhere in Pos Kuala Mu.
This place is actually in Sungai Siput, but not that close to my house though. If I am not mistaken, we took at least 1 hour plus to get there and it is actually quite close to the border of Perak - Kelantan. The place is getting famous but not that mainstream yet. :)
Somehow, I am glad that I didn't take any part time job during the phase of waiting for job. I did some online stuffs to get money too, but most of my expenses that time were from the saving I had while in Czech.
So, I was unemployed at that time and I must say I had the best few months of my life, exploring Malaysia with my parents. Not just that, I am thankful to have that chance to appreciate meeting and gathering with my relatives in which I don't have the privilege and opportunity much to do so now.
Umrah with my parents.
My favourite flower - tulips :)
This is the background picture of my Whatsapp chat anyway.
The day I requested to go to this viewpoint and for the first time in my life I saw the scared face of Emak. -_-' hehe, kesian mak kena layan anak buat benda2 gayat macam ni. Still remember when I said to her I would love to visit Macau Tower later and to see Macau for the highest point, she agreed even though she mentioned in the first place that she will only stay around the lift. But to my surprise, she accompanied me around the tower anyway.
Emak is always the best!
I didn't expect I only posted 13 pictures in 2018. Such a drop in number.
Completed my tour in Malaysia with Sabah as the last state I went to. Alhamdulillah, finally in February 2018, I managed to go to every state in Malaysia. I always love road trip, although seems like I can't help to sleep in the car nowadays... I can't imagine how my next road trip will be, in view of I haven't drive long distance for quite some time.
But, let's embrace the uncertainty. Too many places in my head, I will catch up on them when the time comes :) with the plus one too, ameen.
Not many people know about this, but I actually went to Macau last year, during my end of posting leave. It was a last minute plan obviously, bought the tickets maybe 2-3 weeks before departure. Don't care much about the price as I need to appreciate the short holidays that I have and spend them with my parents.
Macau is a beautiful, small city. Not sure to call it a country or not. Is it belong to China or is it independent? Some said the first one, some other said the latter. Can't afford to write entries on the trip though. I wish I could.
But Macau is lovely to check it out :D
And I miss hiking now. Hehe.
Towards many more memories in this 2019. And surprisingly I started to snap more random pictures lately. Hope I can share more stuffs in the blog too. :)
SM, Perak, Malaysia
190211
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