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Archive for the ‘Strictly Medical’ Category

What is an aphorism?

According to Wikipedia,

The word aphorism (literally “distinction” or “definition”, from the Greek: ἀφορισμός, aphorismós ap–horizein “from-to bound”) denotes an original thought, spoken or written in a laconic and easily memorable form.

Well, I spotted some of these in a cute book called “How to survive in anaesthesia: A guide for trainees” by Neville Robinson and George Hall. These are my favourite words of wisdom as well as those that appealed to my funny bone..

Never start an anaesthetic until you have seen the whites of the surgeon’s eyes.

Always pee before starting a list.

ABC of anaesthesia: always be cool, always be cocky!

Anaesthesia is ‘awfully simple’ but when it goes wrong is ‘simply awful’.

If in doubt, ask for help. There is no place for arrogance in anaesthesia. (Kinda contradicts the ABC one)

First rule of anaesthesia, if there’s a chair in theatre, sit on it.

Never panic. This applies particularly when the patient is trying to die and you have no idea why.

If in doubt, take it out. This applies to tracheal tubes and many other things in life!

There are three things to respect in anaesthesia: the airway, the airway and the airway.

When all else fails, disconnect the catheter mount and blow down the tracheal tube.

The laryngoscope is a tongue retractor, not a tooth extractor.

Never say to the patient ‘just a little prick’ before inserting a cannula, you are likely to the told that is exactly what you are!

Make sure that you are not the only sucker in the anaesthetic room/theatre.

All 1 ml ampoules look the same – check very carefully.

For a rapid sequence induction, always have two doses of suxamethonium ready in case once goes over the floor/ceiling etc.

Be professional. Humprey Bogart’s definition of a professional – somebody who can still give their best performance when they feel least like it.

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Full Name: Big Black Monokoru Boo

Age: Less than 1 year old

History: Patient initially presented with mild loss of weight with incontinence of stuffing. Previously noted to have a perforation at the dorsal surface of his body causing continuous leakage of stuffing. T+S done under local about 2 month ago. However, in the past 2 weeks, noted that patient persisted to have weight loss and a flattened look. On examination, patient looked ill, spiking fever from wound dehiscence and hemodynamically unstable due to hypostuffinaemia. Patient was then fasted and posted for emergency surgery.

Diagnosis:

1. Cachexia and sagging due to severe hypostuffinaemia

2. Sepsis secondary to wound dehiscence

Surgery: Wound debridement, body lift and re-stuffing

Surgeon: Jellio’ MD

Date of surgery: 26/05/2009

Duration of surgery: 1840 H – 1945 H

Procedure:

1. STO done on old wound.

2. Skin cleaned and drapped.

3. Lignocaine 2% infiltrated at proposed op site.

4. Wound incision extended and edges trimmed.

5. Wound irrigated with saline and hydrogen peroxide.

6. Stuffing consisting of 2 rolls of Otoban shredded, fluffed and optimised.

7. Stuffing inserted into all four quadrants under aseptic technique.

8. Skin closed with interrupted sutures using Silk 3/0.

Post-op orders:

1. Continue IV antibiotics.

2. Strictly light duty for 6 weeks.

3. Not to be squashed or sat on by humans in the near future.

4. Wound inspection Day 3, no need STO.

before

after

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Banana bag

I heard bout this banana bag thingy in both Grey’s Anatomy and House MD. Curiosity got the better of me. Interesting…

From Wikipedia

A banana bag (or rally pack) is a bag of IV fluids containing vitamins and minerals. The bags typically contain thiamine, folic acid, and 3 grams of magnesium sulfate, and are usually used to replenish nutritional deficiencies or correct a chemical imbalance in the human body. Most often they are used in ICUs and CCUs to correct acute magnesium deficiencies. They are extremely beneficial for the sick and dying (cancer, etc.) because magnesium mitigates nerve pain and muscle pain/cramps and helps detoxify the liver and kidneys (increasing drug benefits and reducing drug adverse effects). They are commonly used for alcoholics who need thiamine to prevent Wernicke-Korsakoff syndrome and magnesium to reverse dementia symptoms.[1][2]

Folic acid is yellow in color — this ingredient makes the fluid yellow, hence the term “banana bag”.[1]

The typical composition of a banana bag is Thiamine 100 mg + Folic acid 1 mg + MVI 1 amp to 1 Liter of Dextrose 5% and Normal Saline + three grams of Magnesium Sulfate. The solution is typically infused over four to eight hours.

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Med Degree Acronyms

I always wondered what was the difference between MBBS, MD, MB ChB, MB BCh, MB BCh BAO and all those acronyms. I asked Cindy, who then told me to google it. Turns out that they are almost the same thing.

MBBS – Bachelor of Medicine, Bachelor of Surgery

MB BCh/ChB – Medicinae Baccalaureus, Chirugiae Baccalaureus (which is latin for bachelor of medicine and bachelor of surgery)

MB BCh BAO – the BAO being Baccalaureus in Arte Obstetricia (Bachelor of Obstetrics), a degree unique to Irish universities.

MD – Doctor of Medicine, based on the North American model and style, which usually requires entrants to have a four-year bachelor degree before entry into a professional medical degree

There you go, mystery solved.

Dr. Jellio. UPSR. PMR. SPM. STPM. MBBS. MSlth.

(MSlth – Masters in Slothness)

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I am currently watching TVB’s “The Last Breakthrough”. This show, about a bunch of doctors who do charity work via Life Force was shown on Tv sometime early this year. Somehow I watched snippets of it, but since my friend gave me a copy of the whole series, I decided to watch it at my own pace…which is why I still haven’t finished watching it after so long.

Anyway, since it’s in Cantonese with Chinese subtitles, I find it hard to follow some of the medical stuff they talk about, in which case I would draw my own conclusions or simply ignore it. Nevertheless, one of the cases struck my curiosity. A guy was on the cellphone in the hospital when he suddenly collapsed while walking. They found him pulseless and in ventricular fibrillation (VF). They managed to defib him and was he was later diagnosed to have Brugada Syndrome.

Basicly the Brugada Syndrome is a genetic disease inherited in an autosomal dominant pattern. It is characterised by abnormal ECG findings (coved/saddle shaped ST elevations in V1-V3, RBBB and T wave inversions) and an increased risk of sudden cardiac death. It’s also known as the sudden unexpected death syndrome (SUDS). Due to mutations in gene SCN5A, some epicardial areas of the right ventricle have abnormal repolarization causing reentry tachycardia and/or fibrillation, thus leading to sudden cardiac death.

The cause of death is ventricular fibrillation, and since there is no treatment modality to prevent VF, the principle of treatment lies in termination of VF before it causes death. Implantation of an implantable cardioverter-defibrillator (ICD) will enable the heart rhythm to be monitored continuously and will defibrillate the individual when VF is noted.

In the show, the patient was adviced to undergo this procedure but was told that it would cause 20K, and that the device would need revision every 3-4 years. The patient refused the option, saying that he could not afford it, and later died of VF when he collapsed again, this time by the roadside…

There you go. Must make a mental note to tell my dad that I’ve actually learnt something from watching canto serials. Hah.

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