Denggi???

Assalammualaikum wbt....

salam sayang bt sume...dh ddk kt ktdi ni, sehari xtulis blog mcm xsah je...anyway, semlm post kal...so tired, jd ummi xsmptla menulis...menaip actually...rabu msk 8am...onkal till kamis 5pm..blk...tdo...so, jumaatla baru sempat...

anyway, during my onkal, got 5 new cases msk...2 from hdu and 3 from ed...ummi cover 2, looi cover 2. 1 more pt come in at 6am, kami dh tdo kepenatan...huhu...

ummi case kawasaki ds n viral AGE, tp ap yg ummi nk cite is about looi's pt...dengue case...

pt ni dtg ed sbb demam...prolong high grade fever with vomiting...ad petechie skt2 tp hess test negative...however dia pny platelet dh low (thrombocytopenia)...t ummi smbg psl denggi...

sbb hjn tgh lebat ni n ummi nk blk johor ambk mak n aishah humaira'...doakan pjlnan ummi selamat..ahad onkal, so, we'll meet again selasala klw xpenat..k, bye...

salam sayang,

ummuhumaira'

Fluid correction and maintainence

salam penuh rahmat dan semangat dari ummi utk sume...

sekarang ummi nk cite psl correction n maintainance plk...mklmla baru ULANG belajar bende yg dh lupa, jadi kenelah abadikan kt sini supaya xlupa....dan org lain boleh baca jgk...

ok, mula2 utk tau mcmn nk correct, kene tau dl percentage of dehydration (cara nk tau t ummi cite dlm entri lain)....

ok, ap yg penting ad 3 kategori dehydration : 5%, 5%-10% and >10%

ok cth pt 5 % dehydrated, body weight 20 kg,

so, cara nk kira 5/100 x 20 x 1000 = 1000 ml...kt darab 1000 sbb nk amount in ml

then, utk maintainance plk...kt guna method .....(xingatla plk)

tp caranya camni---
-----1st 10 kg : 100 ml
-----2nd 10 kg : 50 ml
-----3rd 10 kg : 20 ml

cthnya : BW 20 kg, so maintainance dia

(10 x 100 )+ (10 x 50 ) = 1500 ml/day

pastu divide la by 24, dptla per hour pny rate...ok??

ckp sampai sini dl ya...ops last...in 1 l of normal saline ad 154 mmol sodium...normal range 135-145....n body requirement for sodium per day is just 2 mmol /day...k?

salam sayang,

ummuhumaira'

2nd day in paed ; blood transfusion....

Assalammualaikum wbt.....

hari ni second day ummi kt paed postg...suka sgt utk ummi kongsi dgn sahabat2 pembaca setia blog ummi tntg sikit2 ilmu perubatan ni...anyhow, klw ad yg xfhm...blhla bertanya pd ummi ya...

ok, hr ni pg2 lg ummi dh kene present case, takutla jgk sbb hari kedua dh present case kt specialist, anyhiw, ummi got same finding as the specialist because the mo n ho did not report about the crepitation...then, ummi go to interview an ambigous pt (aka khunsa) which got CAH (congenital adrenal hyperplasia), play DA with tom n short case respiratory with aii ye...

then, we got student round at 11 am till 1pm...out for lunch n solat....

at 2pm--go to observe and assist blood transfusion and consent taking...

here we go...1st ummi nk cite about blood transfusion...

all 3 of my pt had beta thalassemia major and having a regular monthly blood transfusion...so, the step is...

first--set line la kn, baby branula got 2 color--yellow and pink; pink is bigger than yellow...it is a small thing, so we need to 'sambung' dgn t-jx wire b4 smbg dgn blood line...

then, check the blood, the consent paper and the pt form...make sure the name, ic no, blood no, type of blood is same and make sure that the pt line is not bump....

actually, the blood had been filtered twice b4 masuk badan pt...filtered mean all the leukocyte had been removed from the blood, so then, blood transfusion reaction will be less and it also can reduce the CMV ix becuse usually CMV is carried out by leukocyte aka white blood cell...

then, waktu nk mskkn blood 2 dr line ke bdn pt, make sure no bubbles...because it can be air emboli...n many cx can arrised from the emboli...

em, before that kita kene tau bape byk titisan darah per minit yg akn msk ke dlm bdn pt...

so, cara nk kira dia amount of blood req by dr/ time in minit then darab 20 (infusion filtered pny rate)...so, dptla kadar titisan drh per mnt...so, double checkla...kira manually...but ad jgk faktor2 lain yg mempengaruhi such as ketinggian tmpt gantung darah, kelebaran line etc...

n klw kanak2 plk,,,maksimum darah atau fluid blh msk dlm bdn adalah 20ml/kg/day....so kiralah...n biasanya dr akn infuse blood in 4 hours....

ok, enough with the blood transfusion....c u soon dear...

salam sayang,

ummuhumaira'

cystic fibrosis...in ummi view...

Assalammualaikum wbt...

hari ni hr 1st ummi as PRHO (pre reistered houseman) kt wad paed...best, excited but penat sikit sbb dh almost 4 month just bt kje2 lab...ssm...zaman 2 dh berlalu dh, so, skrg fokus...

sbb hr ni ad mcm2 perkara kene bt, dgn orientasinya, jd ummi just sempat clerk 1 case...

12 y/o, malay boy, k/c/o cystic fibrosis with bronciectasis since 9 years old...electively admitted for intensive physiotx and iv antibiotic...hx taken from his mother...

oklah, xnk cite byk psl pt ni sbb xhbs clerk lg sbb dia g bt physio...so, nk cite basic about cystic fibrosis biar sume org faham n ummi pun sng je revise melalui pembacaan blog sendiri...

cystic fibrosis is a lethal autosomic recessive ds. it is a ds of exocrine gland that involve multiple organ.

usually the main complain is chronic resp ix (90%), pancreatic enzyme insufficiency (PI), and its cx...usually the cause of death is end stage lung ds..

actually the pathophysio is like this....

there is defect in CFTR (cystic fibrosis tranmembrance conductance regulator). its encode for a protein that fx as a chloride channel n is reg by cAMP...abN of CFTR will result in reduction of cl secretion and increase reabsorption of na and water across the epi cell....will later result in decrease hydration of mucus---and stickier mucus for bacteria---result in ix n inflammation...

it can be at lung, intestine, oancreas and liver...all start from CFTR defect...so, the result come about d same...later on we discuss about d cx n mx ok....

cukup smpai sini dl utk hari ni...

salam sayang,

ummuhumaira'

CTG MADE EASY....

Assalammualaikum wbt bt sume....esp 2 aishah humaira' n all my beloved friends and followers...
now, ummi have entered final year in my medical scholl...really need to start with gear 5...ummi currently in paediatric posting but thanks a lot to all my housema6e which in surgery (mama kema), o&g (mama nora) and family med (cik jah)....to teach each other what we had learnt and share to complete each other to become a compatible doctor....

today, ummi learn about CTG from mama nora...d easy 1...easy to revise anyway by put it here...

first, there is 3 type of CTG---normal, suspicious and pathological

and it based on 4 things---fetal heart rate, fetal heart variability, acceleration and deceleration...

for fetal heart rate :
-----normal is between 110-160 beats per min
-----suspicious is between 100-110 and 160-180 bpm
-----pathological is less than 100 bpm @ >180 bpm

for fetal heart variability---its mean the difference of the amplitude btwn the highest and d lowest one...taken 1 min in a part that there is no acceleration and deceleration..
----normal is more than 5
----suspicious is more less than 5 for 40-90 min
----pathological is less than 5 for more than 90 min
( am i right nora??)

for acceleration---mean the acceleration for more than 15 bpm of more than 15 second each
----normal : present
----suspicious/pathological : absent
~acceleration mean there is tachycardia...its good as an indication that the baby heart is responded to maternal contraction..

decelaration is the deceleration for more than 15 bpm for at least 15 second
----normal : no deceleration
----suspicious / pathological : present
~ deceleration mean the baby heart is bradycardia..not good as d baby is not response to maternal contrction...
~ 2 type:
----type 1 : the deceleration is a mirror with maternal contraction : fetal head compromise etc
----type 2 : the deceleration is a bit late @ after maternal contraction : fetal decompromise...

cukup dulu smpai sini... t ummi update, mamanora xd nk bantu ummi fill in d blank...k, c u later with ummi pny learning issue plk...

salam sayang,

ummuhumaira'