tak sampai hati...tapi kena kuatkan semangat!

salam semua!!

minggu ni klinikal asas posting internal medicine

so far posting ni best sbb jumpe byk jenis diseases and blh apply most yg kami blaja mase pre-klinikal dulu

hari ni (25/5/2011) byk benda yg berlaku

sy n kwn2 dtg awl sbb nak amik pluang blaja venepuncture and practice sesame sendiri

kami g wad med 2..mase dtg tu ade sorg patient cina br je meninggal..

mmg x dinafikan semua HO kat sini baik2...lbh2 lg kelahiran hospital tu sendiri(i mean hukm hehe)

after tgk HO buat n blaja sket2 perkare yg berkaitan dgn venepuncture,kami pun g amik brg2 n g bilik tutor utk practice sendiri

alhamdulillah ok..harap2 esok dpt peluang buat kat patient betul plak

then g breakfast..pastu ward round cari mangse! hehe(patient la)

kebetulan hari ni rmi plak discharge and rmi plak kena guna ventilator

pas abis round dua wad akhirnya dpt la sorg patient perempuan kat wad med 5 bed 14 diagnosed with TB

kami buat PE respi..alhamdulillah dpt apply ape yg dah blaja mase teaching smlm

brief positive finding :- 

- reduced chest wall expansion on the right side

- tactile fremitus and vocal resonance is increased on the right side

- dull on percussion on the right side

- crepitation is heard on the middle zone of the right lung
(kwn2 blh cube buat..klu finding lain bgtau ye)

then, kami g wad med 2 nak cari patient utk test PE cranial nerve

kebetulan ade procedure yg sdg berjalan iaitu CVP ( central venous pressure line)
ade dua org doktor, sorg laki sorg perempuan
kalau xsilap dua2 MO
diorg mintak kami tolong kawal patient tu drpd mengganggu p'jalanan procedure
patient was diagnosed to have SIADH with underlying meningioma
mula2 doktor laki yg buat..
target vein is IJV
doktor tu agk kasar n kurg tolerate ngan patient
byk kali dia cube puncture, semua xjd
patient dah t'ketar2 n mengerang kesakitan
doktor perempuan tu yang byk tenangkan patient
bile smpi satu thp doktor laki tu agk lemah smgt sbb xdpt vein
then diorg exchange
dgn mudah dan dgn ucapan kalimah bismillah yg sayup2 kedengaran dibibir doktor ditambah dgn sdikit kata2 lembut utk menenangkan patient
akhirnya vein berjaya di puncture dgn 2 cubaan shj
procedure slps puncture juga agk menyakitkan
kami yg berada di tepi katil sayu melihat patient perempuan tua itu menahan kesakitan dari awal hingga akhir  n ngeri bila tgk procedure yg invasive mcm tu, especially bile masukkan wayar, then tube utk dilatekan vein (kena basarkan ngan pisau before msuk tube), and lastly catheter (kena jahit plak kat tengkuk utk elak catheter move)
slps tamat procedure, kami b'kemas utk pulang
sbb penat n kesian kat patient -.-
pasni kena biasakan diri dan kuatkan smgt utk melalui saat2 mcm ni
sbb kemungkinan besar kami akn berada di tempat doktor2 tu satu hari nanti

byk perkara yg sy bljr dari situasi ni
harap sy dpt mengambil iktibar bagi setiap detik yg berlaku
semoga Allah mempermudahkan segala urusan doktor2 dan patient tu

a bit about CVP:-

A CVP line is a special intravenous (IV) line. The line may have 1, 2, or 3 parts
that can be connected to tubing or needle free adapters. CVP lines are frequently inserted in critically ill infants and children for hemodynamic monitoring, delivery of intravenous fluids and medications, blood
products, TPN, and fat emulsion.  They may also be used for drawing blood samples.
Hemodynamic monitoring of central venous pressure reflects intravascular volume status
and RV function. The doctor inserts the line into a large vein in the neck (IJV) or upper
chest (subclavian vein). Sometimes the doctor may need to place the line into a vein in
the groin or arm (at cubital fossa).
*for further information u can ask mr.google ;)