Monday, January 30, 2012

why a doctor?

tgk 2 patient meninggal dpn mata berturut2 dlm masa 2 hari agak menguji kekuatan. both cases sudden cardiac arrest. tp case semalam lg more affected because i involve with the pt.

case smlm. kt icu. male pt 41y. sudden cardiac arrest, dt hypoventilation and hyperkalemia. start cpr and dr ask me to ambu the pt. 3 org dr gilir2 buat cpr. cpr kn memang guna sepenuh tenaga nk tekan chest, massage the heart, memang penat. ecg machine just beside the pt and repeated ecg has done. all ecg reading only shows pulseless rhythm. nothing change though after loads of drugs. stat bicarb, Ca, insulin & glucose n errr lg tk igt. then after 30min still no cardiac activity on ecg. then resident decide, ok stop cpr. ecg flat. pt death but continue ambu for few more minutes for medicolegal issue.

and today almost the same case. male pt kt emergency int med. nampak muda lg. end stage renal disease. on hemodialysis. cardiac arrest dt hyperkalemia. tk pay attention sgt kt pt tu sbb mula2 masuk terus attach dgn dr masukkn nasogastric tube kt pt hematemasis & melena, my 1st NGT insertion, by my own and alhmdulillah pt very cooperate and it went very well. back to the renal pt, perasan mula2 masuk nmpk pt tu conscious. memang sudden. dr dx cardiac arrest, order abg, ecg, n masukkn ETT utk resuscitate. same scene mcm semalam. pt has metabolic acidosis. loads of drugs stat with continuously cpr & ambu. i just watching at the side and couldn't give more hand because already 6 doctor attend this case. at least pt smlm ade jgk pulseless rhythm. tp pt yg ni cuma 1st ecg je contraction. the rest 20min of cpr, repeat buat ecg memang da flat. then dr pun ok decide, ok last cycle of cpr then let go the pt.

tahu tak perasaan tu.. rase mcm penat je bersusah payah hbs byk tenaga. (continuous ambu pt for 30min while standing penat tau) end up bad prognosis. tk dpt nk selamatkn pt. pt meninggal jg. rase mcm.. kecewa. mcm segala usaha sia2. of course la tk kn, because we put an effort try to save the pt. tp.. hmm dpt bygkn tk perasaan tu? sedih pt meninggal on our hand. org cuma ambu je pun. dr lain yg buat continous cpr, yg buat keputusan, yg handle case, lg la. nyawa org tau.

pt dtg hosp because they seek for the doctor. they seek for our help. derg mengharap pd kte. kuasa semua kt tangan Allah. kte cume beri jalan bantu supaya sembuh. tp ape nk ckp kt sini, they trust us. thats why they come to us. so byk mana kte punya effort & kesungguhan utk berikn khidmat yg terbaik utk rawat pt. walaupun bad prognosis. at least kte da cuba yg terbaik. tp sedih ble bad prognosis. :( memang kena strong utk hadapi semua ni. huhh. kena train emosi lg supaya lebih kuat.

setiap usaha tu iA ada ganjarannya. pk positive, kalau pt tu sihat boleh beramal & buat ibadat kpd tuhan kte secara tk lansung menyumbang utk tu kn.


2 weeks hols. alhmdulillah. tp tk rase mcm cuti. lots of thing to do. hr ni da hari ke 4 cuti, tp not a single task done in my list. penat. tk larat. demam. selsema. homesick. :( stress tau ramai org blk msia. how i missed my family so much! alahai~ try utk tabah. da final year da pun. nanti tahun dpn da tkde kt alex lg da.

tak larat, sgt. siapa nk masakkn porridge utk sy? and i crave for sushi so badly. 

Friday, January 20, 2012


arterial blood gas. 2 common site: radial & femoral artery. femoral selalu kanak2 kot. n main fx: measure O2 saturation, lain2 measure bicarb, carbon dioxide n pH. dx metabolic/respiratory acidosis/alkalosis. lg.. hurm technique. on radial a, find 2 line at radial part, just below the line feel the most high force of pulse. artery is better felt than seen. then felt the exact spot, insert needle 45 degree, n rapid gush of blood will come. if no blood, try to move the needle in all direction without pulling it out. kalau femoral, site: medial 1/3 midway between ASIS n symphsis pubis, 4cm below mid inguinal point. same technique, try to feel the highest force of pulse then insert the needle 90 degree. radial technique is more painful than femoral because may hit the periosteum. but either way, it is still painful procedure.

normal values:
PaO2: 80-100mmHg
PaCO2: 35-45mmHg
HCO3: 22-28mEq/L
pH: 7.35-7.45

semlm, for the 1st time, i did ABG by my own. alone. without assist. on fully conscious pt. and it was very successful. i got it in 1st try and less than 30seconds. tahu tk, perasaan tu, priceless. that was my very 1st time to do ABG here in egypt. n lg best, i send the sample to the lab and perform the test by myself. huhh dlm hati joget2 sepanjang hari. good start isn't.?

n td, hr ni. i got the chance to do it again. went to ICU. female pt, c/o of dizziness and palpitation. ecg revealed supraventricular tachycardia. semiconcious. and dr perform electrocardioversion to her. twice. then alhmdulillah pt da stabil the resident ask 1 of the dr? to do ABG. im not sure he is a Dr or med student. too old to be a student but he's not act like a dr. watch him do the procedure and he got only few drops of blood and didn't get more after few trials. then surprisingly, he ask me to do it.

da confident kn smlm berjaya dgn jayanya, so i try. i hit the right spot. but only drops of blood come out. try to maintain the -ve pressure but still didnt get much. then move the needle to all direction. i can feel i hit the periosteum few times. rase die, ngilu sgtttttt.! terus rase palpitation and i can see my hand is shaking while try to pull the syringe. ya Allah. seriously. terus menggeletar. at the end dpt la dlm 1ml arterial blood. tk byk. cukup2 je kot. lps la nk buat lab test.

huhh da blk rumah. rase menggeletar & palpitation lg. terasa lg cucuk periosteum. pt mesti sgt sakit, tp mujur pt semiconscious. alahai.

btw hr ni best. kebetulan jumpe ramai dr yg kenal. not in their rotation but they volunteer to work at er today. dpt belajar byk and did a lot of practical things. do and interpret ECG, ABG, measure BP, insert NGT and discuss a lot of cases. seronok. tp palpitation & ngilu lg rase periosteum. urgh.

i need more practice.

>> the guy who ask me to do ABG, he just finished med school and waiting to start housemanship. yup so he neither dr nor student. and  i dont like his judgement. 

Saturday, January 14, 2012

kita yang menentukan.

stop whining and complaining.
enjoy every single minute of life.
stay focus.
do not distract with simple things.
control ur emotion & expression.
always positive.
think positive.
act positive.

kelas hari2 start lambat.
kte as student, ok me myself la kn memang la ade rase cm geram.
dtg awl2 buang masa kelas start 45min-1jam lewat.
then fikir tk nk dtg awl lg da. kalau lg nk emo menangis sbb tunggu dr. HA HA.
solution die kt sini senang je. pk 2 bende.
1. kte fikir-ve dr memang saje dtg lmbt nk buang masa kte.
2. dr da ade, dr tahu masa dgn kte tp dr sibuk sgt dgn emergency case, kurg dr lain yg boleh ajar utk start kelas on the time.
ni cth situasi, i think byk lg hal lain rasenya yg bg org la senang utk distract. so org rase apa2 pun cuba utk fikirkn positive. walaupun somehow nampak reason utk bende tu memang obviously negative; memang nmpk kte on the right side, kte diabaikn, teraniaya or ape2 la bende lain yg rasenya boleh effect emotional. tp kt sini, kte yg menentukn. kte nk terus argue, distract n put blames on others ataupun kte boleh je ignore or accept benda tu n think positive about it. kn..? :)

im glad i hv a very good friend who always remind me with all these things. thank you.!


round int med skrg. 2nd part int med i think more hands on pt, skill & management. clerk pt, full PE, venous sampling, measure BP, temp, glucose. ECG. and i did a lot of ECG, tp tk reti2 nk interpret lg. tgk a lot of cases, procedure n mcm2 lg. seronok. setiap hari belaja benda br.

da 3 minggu. 3 minggu yg sempurna. :P seriously almost collapse da. ade remaining 10 minggu lagi. lama tau. 1st week cm biasa ok lagi. 2nd week pack gle2, or mayb i pushed myself too hard and currently 3rd week ni da bkurg momentum. mcm perlukn momentum semangat yg tinggi suruh pergi kelas. bgn pg rase tk nk pergi kelas. tp kalau tk dtg rase rugi sbb hari2 terase berharga rase syg nk skip. 

tkpela, ni practice hadapi masa kerja nanti same je lg penat. oh hari jumaat yg berharga. next week/esok start round br, hopefully dpt semngat blk. next week exam! oh.!

a quote i found in fb. i think it is very nice. kn..? haha.

'If you are working for a living, why do you kill yourself working?'

Saturday, January 7, 2012

Kidney Protection Program of Alexandria

The Kidney Protection Program of Alexandria is a clinico-epidemiological study conducted by the house officers and students of the Alexandria Faculty of Medicine. It is basically a screening program for chronic kidney disease (CKD), hypertension, diabetes mellitus and dyslipidemia. It has three principal objectives:
1. Promoting the basis of preventive medicine among young doctors.
2. Detection of the target non-communicable diseases (NCDs) at early stages.
3. Conducting a cross-sectional study using the gathered data.

a fruitful friday. :) kami; beberapa org doctor pelatih, pelajar perubatan dan nurse berkumpul dpn pintu kuliah perubatan n pkl 1145 bergerak menuju ke destinasi- mina basal, mitras. 6-7km drpd manshiah.
mcm kaw the other side of alex, kaw sgt kampung. lalu port alex. pkl 1215 berhenti skjp utk solat jumaat kt max?. 1st time solat jumaat kt mesir. huhu. masa masuk masjid nmpk most of the women wearing niqab & all black. terasa mcm kt saudi. boleh kira beberapa org je yg pakai selendang mcm typical arab mesir. kitorg cuma pkai jeans n blouse. mase nk solat ade org hulurkn suruh pakai telekung. dr kate, ni kampung yg low education & kaw salafi.
suq jum'ah? mcm garage sale jual brg2 terpakai. mcm2 ade2 sepanjang2 jalan.
finished solat jum'ah at 1pm, and we continue heading to the destination. i really hv no idea where are we and how long we'll be arrive to destination. after about 15min ble pkck tramco masuk satu lorong. nmpk ramai gle org. jln memang da kena block siap ade org utk kawal lalu lintas. n derg suruh u-turn tk boleh lalu. then pkck tu ckp, ni doctor. they allowed us to pass n da nmpk ramai gle org queue. *speechless*. tk sangka seramai ni. terasa mcm doctor2 masuk kaw kampung pedalaman.
org kampung da tunggu kedatangan kami. kami dpt layanan yg baik. upon arrival they serve us with tea. and before back we got a pack of lunch? & al-quran as a gift. and they keep asking us if we need anything else. another 1 houseofficer & medical student come join us there.
ppl know that we're coming. they already fasting 8hours for FBS. memang ramai! in this screening program we took blood & urine test, check for BP, BMI & family history of polycystic kidney and any other risk factors.
a lot of ppl coming to do screening test.
5 stations. 1. hx taking. 2. weight & height. 3. BP. 4. blood. 5. urine. and i did some blood sampling & urine dip test.
sebahagian hasil hr ni.
we didn't put a name in samples. they are anonymous. only after key in the data, we know the identity. so all blood tube & urine sample are labelled by code.
after collecting all the personal data, blood & urine; the samples will bring back to the university lab. and after 4days, doctors will come here again to deliver the test result. ppl with disease will be follow up to get proper mx at hosp university.
wakil rakyat turun sekali. *kempen pilihan raya.* kami masuk tv :P
the ppl really in low-socioeconomic & not really high educational ppl. i did try my best to explain in my broken arabic what actually we're doing and answering their question. how i wish i can speak arabic fluently.
hala. also 6th year med student & madam ni'mah, the nurse.
 around 430, no of ppl start to decrease. we start to pack. and taking pictures. :P
me- dr omnia- hala - dr basma- dr sara- madam ni'mah :)
oh my. dr sara just remind me of hazem. they're very look alike.! the face, the way of talking. i cant keep myself not to look at her most of the time. hahah.
545pm. siap kemas2 n bergerak blk ke kuliah.
around 630pm, arrived at kuliah. and hala's brother already waiting and they insist to sent us home. and dr kareem also offer to give a ride. they're very nice & kind & gentleman. when they hv conversation, they translate again words i might not understand what they're saying even the sidetalk. and during solat jum'ah this afternoon, there are a lot of ppl and they keep looking for us every time make sure we're with them. i really enjoy the day.

i only know about the program this morning. and during that time im cycling from mandarah to bibliotheca. finished cycling, rushing return home and heading to kuliah. what a day! huhhh totally exhausted n fun! giving health education to low-social class ppl. tell all about preventive measure and promote health life style to ppl. ni memang sungguh application of family med. :P