Elective Posting: Day 01

Today came back to this hospital again, the same hospital that I did my 3-days attachment 4 years ago when I was applying for JPA scholarship, and I was waiting with JS at the same place I waited 4 years ago, feel kind of nostalgic. 

Spent quite some time for briefing at the auditorium. One thing that I'll not forget, "Everyone come to this world with many blood, shit and urine."  This reminded me what Paul wrote to Timothy. 

For we brought nothing into the world, and we can take nothing out of it.

1 Timothy 6:7

Later assigned to our own department. Spent quite some time finding the medical department, and register at there, and JS and I were assigned to our own ward. Again we spent some time to find our ward. By the time we reach our own ward, we have already miss the morning round. Saw many HOs at my ward, and they look just like students. Out of my surprise, HOs' handwritting looks like typical students' handwriting >.< . 

In beginning kind of bored. Don't really understand what the HOs and specialists talk about (can't that specialist speaks louder a bit?). Somemore I don't understand what are they writing. In Russia the doctors I can't read their super-cursive cyrilic handwriting. In Malaysia I don't understand doctors' short form. IPR, S/B, TRO, UGIB, c/o, o/e, 3/7, 1/52, LOC, LOA, LOW, WD, TRO, K/C/O, and those superscript-ed "+" and "o" in front of those symptoms and signs, etc etc etc @.@.

After have a lunch at cafeteria with JS (food not very nice, but better than those in Russia), I came back to my ward. Out of my surprise again, I met someone graduated from my university. Though not very close with him and he didn't really know me, but after knowing that I amhis junior, he willingly taught something, how to read their 'files' or case histories, their self-created short forms, what to look for, etc. 

But different HOs gave me different advices. One told me to look through those files because in those files can see the condition of the patient and the plan of management. However another HO told me to go do procedures, like withdraw blood and insert vrenula, because these are the basic things that HO should know and next time no need to worry these procedures and can concentrate on other things which can be only learn when become HO. So what I should do? Hmm......

Anyway, got a chance to draw venous blood, but from a HIV+ patient. Got a chance to insert CBD, but need to leave already, some more is in a female ward. Anyway, I am looking forward into the upcoming CME, and here are some interesting patients that I met today.

* * *

Patient 001 Bed 39

C.C.: Fell down on his forehead. Admitted to hospital by ambulance.

HOPI: On 30/07 patient fell down on his forehead at 11pm, family called ambulance, but only analgesic given. Fell down second time on his forehead at 5am.

Past Hx: Fell down many times last year.
Pneumonia 2 years ago, with cough.
Not oriented since many years.
Taking sedative/anxiolytic for many years (about 10 years).
Difficulty in walking, no able to walk far.
Multiple brain infarct: left posterior, right middle.

Co-morbidity: HPT, on nifedipine, prozasin, atenolol.

O/E: Demented, confused, conscious, cannot walk, want to 'cabut' from hospital.

Dx: Multiple infarct?

Plan: Trace for CT result.
Off anti-HPT drugs.

* * *

Patient 002 Bed ?

Dx: Necrotizing fascitis on left UL.
Co-morbidity: DM, HPT, CRF stage III, TRO psoas abscess
Plan: WD of UL until patient agree.

* * *

Patient 003 Bed ?

HOPI: Admitted on 31/07.
GCS full. Able to lift up LL only after 15sec.

Fever 3/7, LL weakness 2/7

K/C/O: HPT, IHD

O/E: Progressive worsening of GCS and LL weakness.
UL: hypertonia, power 3, biceps jerk ?+, supinator jerk 3+ (brisk), triceps jerk 2+
LL: normal tone, power 2, 0 clonus, knee and ankle jerk ?+, plantar upward, flexion of toe  upon pressure on nail bed

GCS 11/15: E3, V2, M5-6
Open and close eye by command (obey command) - E3, M6
Localizing pain upon sternal pressure - M5
Moaning, no understandable words - V2

Eye examination:
Reactive pupils.
Arcus senilis.
Right INO: left nystagmus, no right adduction when look left.
Fundoscopy: cataract

Lung: left crepts, left consolidation
CXR: left pleural effusion

BUSE: hypokalemia

CT: whiter at left posterior occipital lobe or brainstem (pontine part?) --> bleed/infarct?
*Fresh blood is of higher attenuation, but reduces as Hb breakdown

Plan: Order urgent CT
MRI, MRV, MRA + contrast
look for meningeal or tumor enhancement, to exclude meningoencephalitis (gradual onset of disease with fever)
Maintain BP at 170/120

* * *

Lesson of the day

1. Be initiative, don't expect people to spoon-feed.
2. Protect yourself. Mask, gloves, coat.
3. Is okay to make mistake, but don't let your mistake compromises patient.

P/S: Do feel free to ask any question, either the meaning of those short forms, or the patients, or other things. But I think there are hardly anyone else still follow my blog here >.<