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@faruqzulkafli
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Ditidurkan? Ape tu?Kenape ditidurkan dan apa yang anda kena faham?
Ditidurkan = Sedated & Intubated
Apa indikasi?
Kenapa kebanyakannya berakhir dgn kematian?
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Dpt sorang pesakit,umur 23 tahun,student university local.
Dtg sbb rasa “berdebar/jantung laju”
bile buat ecg - tachyarrythmia/ brugada pattern”
Risk factor :
- family mmber meninggal umur 35-40 tahun.
-Xmerokok
Kes ni special.sbb keturunan.
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Rupanya ramai xthu yang selepas Positive COVID 19, u guys xboleh ambil COVID 19 Vaccines.Must defer for 3 months.
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Kepada yang nk anticipate in volunteer utk bantuan banjir, i strongly suggest u guys to pay visit to clinic and take Tablet doxycyline utk prophylaxis againts Leptospirosis dan any water borne disease.
Jgn self prescrbe. Pay visit to clinic and ask for advice.
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ED RZ***
Suatu malam yg busy pkul 11.43pm
“Doktor,please standby,kita dpt panggilan dari uni kolej nearby pt paracetamol poisoning”! teriakk MA sebelum ambulance call direspon.
“Paracetamol poisoning”?? 😨😨😨😨
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“Doktor Faruq,ada pnggilan dari Hospital G*****”nak bercakap dgn incharge Yellow Zone,ED
Hello Dr,sy Dr ***** Mo dari Hosp G*****
sy nk refer satu kes ke ED YZ. Case referred to Peadiatric Dept already.
4 y old boy,presented to casualty with cough of worms...
wait??What??
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"Anak sy masih budak lg doktor! xkan la sy taktahu kalau dia ada ambil dadah!
baru darjah 5 kot!" bentak ibu Amir,Puan Azi.
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Introduction of Polio
What is Polio? Asal kecoh sgt Polio ni?
Well,since today gempar dan we already being informed by our health minister about re-emerging so call “eradicated disease” from Malaysia since 27years ago, lets us get to know it more.
A thread
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Dapat pesakit 25 tahun,dtg sbb sakit dada.
Bila buat ECG,ada ischemic changes.
Risk factor :
-Smoking/Vaping/Pod for 2years plus.
-Family ade mslh jantung
Xpyh tggu artis meninggal dulu utk sedar.Nyawa muda2 lgi dh terancam.
Xkan nk tggu kena dulu bru nk stop kan?
ACS
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“Hosp *** paggilan dari MECC,sila respon over”. “melaporkan satu kemalangan melibatkan kereta dan motosikal di lebuhraya *** “
“minta ke tempat kejadian dgn kadar segera”
MECC dari Hosp ***,berita terima,roger and out.
*Siren kedengaran disebalik pintu kecemasan utama*
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<STD>
Last few weeks ago
A guy i pronounce - 19years old
student
complained of burning sensation while peeing
Claimed pain was so intense during and after urinate
+ greenish discharge from urethral
(describe as slimy/greenish/fishy odor)
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Saringan untuk Covid-19
1) casual contact
- brief meeting/sekejap - dduk dlm satu kelas but not sit directly front him/her -in crowd large space
-xpernah jmpe tp thu org tu dlm satu community/bgunan - positive covid
2) Close contact
Ahli keluarga kepada confirm case yg...
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< Product of conception >
This thread maybe a bit disturbing to some people.
Please excuse me.
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Tahukah anda utk kelayakam haji tahun ini,
Sesiapa yg ade kencing manis dan TIDAK TERKAWAL dengan bacaan
HBa1C > 8, Tabung Haji xkan benarkan ke Mekah.
Sekiranya parent anda kencing manis, make sure proper control. HBA1C adalah test utk trace kawalan gula 3bulan kebelakang.
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simple hack/parenting advice for those who have 2years old child and below.
Since i got lot of DMs regarding baby with nasal block/cough
Nasal block,coughing,runny nose in child less than 2 years best manage with this thing
Beli simpan dkt rumahlah.xpyh dtg hosp dh lpsni.
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“Ding! 1055 - bilik 6“ -Kedengaran di speaker klinik pesakit luar.
seorang makcik berumur 80tahun berkerusi roda ditolak masuk ke bilik consultation,ditemani oleh anak perempuan berusia 40 -an
Assalaualaikum dik,sapa pesakit.
“W’salam makcik”
Ape cerita ni dtg ni?
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<Extrapulmonary Tuberculosis>
Recall back few month ago in OT
“Faruq, have you ever seen cheesy material made by bacteria?”asked surgeon
Well today is ur lucky day assisting me in here.there you go! Feta cheese!”
This is what we call a caseating material of Tb mucle
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In this case
we treat him with high dose albendazole and IV Cefotaxime for pneumonia part- based on paediatrician.
Moral of story :children above 1 years old and below 5 should be given syrup albendazole at least once in their life.Our Klinik Kesihatan procide this medication.
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Someone over phone : Hello ni emergency hosp ** ke?
Me : Ya,knpe puan?
Pt : Saya ni selsema batuk dh 3 hari.Boleh sy buat sringan covid?
Me : ade pergi ngra China/Italy bla2 atau ada join perhimpnn tabligh or jumpe sape2 yg positive ke?
Pt : xde,sy stay rumah je
Me : 😡
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10.30pm at night
A patient was brought in lying on stretcher by JPAM’s ambulance.
“32 years old,malay gentleman
not working,unknown comorbid
ambulanced call from kg *****
reported by to have fitting episode at home around 9.25pm while was sitting on the stairs at home....
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“MA *****, ni kenape patient umur 27 ni dtg ni?” Xnmpk mcm cemas pon keadaan dia” tanyaku pada MA incharge triage kaunter dpn.
“Owh adik ni datang utk dressing kaki katanya. Klinik swasta mintak dia dtg ED hrini jgk sbb weekend utk dressing”
Pkul 5 ptg dtg utk dressing?
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“Doktor,ada satu patient dtg dkt kaunter saringan dia kata sesak nafas.Bru jadi pagi ni.
Semalam ada batuk mase tdo” kata MA dikaunter saringan.
Ok masukkan dia di cubicle SARI reassest balik dia dlm tu.
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I received lot of questions regarding pre hospital visit.
What to do if infant <2years old having fever at home.
Most basic thing is
1) Paracetamol
-syrup
-suppositories
2) Thermometer
3) Fever care
To prevent unnecessaries visit to AE/ED late at night,should u guys know
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Been working with Dr Benedict Sim before.And i stand with him.
It is not necessary to wear a facemask YET since no human to human transmission IN Malaysia reported yet.
But if u opt for facemask,u can proceed.
It is not necessary to wear a
#facemask
for now since no human-to-human
#transmission
of the novel
#coronavirus
has occurred in
#Malaysia
, says infectious diseases consultant Dr Benedict Sim.
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<Dedication post to all my fellow colleagues(Drs,Nurses,MAs,PPKs) whose help me in resus a baby 3 days old in Redzone>
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So poppyseed in food boleh menyebabkan false positive urine test.
Normally consume dlm kuantiti yg byk.
Based on MRO interviewed and class, a MR Officer need to get proper personal history when encounter such case.
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Terima panggilan telefon dri pusat tahanan sementara berdekatan pkul3 pgi.
MA penjara : Salam Dr,sy MA**** incharge klinik di pusat tahanan
sy ada satu kes utk dptkan opinion dr
Pt sy ni 41 tahun,tiada rekod jenayah,tiada rekod penyakit
Pkul 2 pagi td.Katanya pedih di
.
.
.
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perlu referral ke cardiologist.Muda2 dh kena under cardio follow up.
Sape yg ada risk family meninggal awal kurang 50.Kena thu psal bnda ni.
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"Betul ke makcik xde pegi mana2 seminggu lepas?"
tanyaku disebalik mask N95.Ak kuatkan lg nada utk memastikan suara dan pertanyaanku jelas didengari.
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Since lots of remedies spread dlm wassap group/socmed -
-Air rebusan bwng putih
-Air lemon
-Madu
-cuka
-dll
ada satu case semalam dtg ke hosp.
complained of abdominal discomfort dan pain over pubic area.
history stated that,dia mkn those remedies sbb overthinking
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MCO extended till 14 April.
May those who involve in frontliner (beside medical staff) not exhausted.
Police/Military/Retailer/dll
😪
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Once again i got a patient who was overdosed amphetamine (Pil Kuda) and cannabis (took hashish) and morphine (Heroin)
Aggresive behavior on withdrawal.
What wrong with todays kids ah? 21years old
3 pending court order
4 times masuk “Uniserenti”
Tak insaf2.
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Kelihatan kelibat seorang lelaki masuk ke kawasan yellow zone smbil dipapah oleh seorang lelaki.
Lelaki tersebut mengusap dada smbil mulutnya kumat kamit seakan menyebut sesuatu.tapi tidak kedengaran
PPK : “En Z*** register dkt triage td katanya sakit dada”,katanya pda nurse..
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Dalam kari ade poppyseed. Poppy seed akan menyebabkan urine positive utk morphine. Tp yg part cirit birit menyebabkan garam dia rendah. boleh terjadi. tp sgt jarang disebabkan cirit birit jadi sawan. Kemungkinan ape yg puan nmpk adalah kekejangan otot disebabkan garam rendah!
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30 years old,malay lady
married,nullipara
Underlying diabetes melittus and working as operator in radio factory.
came to hospital last 2 month on the weekend around 3pm complaining of sorethroat,fever reduce oral intake and athralgia for about 1 weeks.
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bknnya pilih untuk "mematikan" sebagaimana yg diclaim oleh org yg xfaham ape itu intubasi.
Saya bosan tgk komen mengatakan intubasi dibuat utk membunuh. Sudahlah anda tidak thu, menambah lg menghasut org utk mengeji kerja2 menyelamatkan org ini.
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Happy new year from ED
Tgh tggu budak2 motor accident dtg dan geng2 mangsa cabul mlm new year di ED utk specimen sampling.
Dh standby clerking OSCC byk2 ni.
Yang mana sambut new year dkt rumah tu,tahniah.Good job.
#penatkenakerjamlmnewyear
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Glove/Sarung tangan
Sekarang nmpk ramai pakai glove kalau pergi runcit acheh/beli tong gas/pgg tombol pintu dll.
Bagusnya ada kesedaran bahaya virus covid MAYBE transmit pada permukaan objek.
TAPI
yang x bgus bile pgg semua tmpt pkai glove sama.
.
.
.
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For those yg selalu inject vitamin C THROUGH BRANULA
done by “beautician” do you know what body only need few mcg of vitamin C daily and will remove it in urine? Xkire u masuk byk mana dlm urat u,at the end it will kluar in urine.
*lots of vit C in system cause renal stone 🤦🏼♂️
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i just used it 2 days ago.
One makcik,62 years old dtg sebab “penat” dan abdominal discomfort utk 3 hari.
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Sadden to hear a news of 1year 3 month old baby positive Covid 19 after incontact with his tabligh father 😭🤣
Our people need to be educate even more.
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Musim batuk kokol raya ni. Tolong
jgn bagi org luar pgg dan cium
baby masing2.
xpasal kena strt azithromycin nt.
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Today i reviewed a 17years old boy in ward with Right Lobar Pneumonia
Futher history taken
Non smoker but “Vaping” since last years
Today admitted for lobar pneumonia and skipped Sejarah’s SPM paper. Asked why,simply said “Cikgu xtanye”
Whyla kids skrg mcmni nowadays?
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Back in 2018
there was one case
“Salam, ni Dr Far** ke,houseman Peadiatrics in-charge ED kan? Haa ni ada satu patient,kami dh refer pada your senior Mo peads oncall dh just now. I think you guys kena dtg ASAP la.This child look stupor and got some abnormal movement.Looks like..
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Ending my call shift with 2 freshly delivered babies.
5babies .Delivery spree 🤪
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Postcall.Otw balik rumah singgah stesen minyak.
akak kaunter : kenape xpakai mask?
me : sy xde gejala kak.Xpe kan?
akak kaunter : Musim covid ni dik.xkena ada gejala pon kau kena pkai.
me : Baik kak.Trima ksih.(tapi dkt hosp facemask satu shari je**stok xde - dlm hati)
😪
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Actual size and length of the “worm”
This sample was plucked from mouth of the patient himself
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@edddddrx
@bellakhann
They need expert in infectious disease(ID)
Both of our national leader not specialised in ID.
Lets not make a joke of it.
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itu adalah contoh dan maybe tidak lengkap. sekiranya ada persoalan boleh DM sy utk penerangan. Sekurang2nya lega la sy dpt explain ape tu intubasi.
Dr Faruq
Juru - intubasi di unit kecemasan suatu ketika dlu.
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This story end up with that boy actually an orang asli boy,4years old
really have poor hygiene and never been deworminization.
Been in environment forest,lack of food hygiene,not wearing shoes/slippers around turn out to be infestation of ascariasis inside his belly.
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RMO - Day 8
So far since rmo only 1 kes accident - tu pon sbb tayar kreta pecah.Bkn car vs car
Tapi yg mkin byk kes jatuh dri pokok plak.Dah 6 org dh.
Yg jatuh pokok ni rumah atas pokok ke? dh boring sgt agaknya 🤣
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case contoh :
Lelaki 45tahun, tiada masalah kesihatan terdahulu. Tiada asthma. Positive covid D4. Kuarantin di rumah. Pergi kecemasan dengan keadaan tercungap2 sebab sesak nafas dan kepenatan selepas 4 hri dirumah.
Oxygen ( 88- 90%)
Kadar pernafasan 30 kali seminit.
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Umur baru 5bulan setengah tapi Hb (haemoglobin) sel darah merah 5!
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No.high dose Vit C not proven to be one of remedies that can prevent u from getting the viral infection such Covid-19
The logic is - It MAYBE works as immune booster.
If u consume high dose Vit C - End up u will suffer diarrhea/Cirit Birit.
Stay healthy during these season.
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Polio case reported in Malaysia – first in 27 years
Welcome back Polio:Thanks antivaxxers.
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@ndrhsuhaimi
Possible.Drug abused boleh buat.atau byk lg jenis2 ubat yg ada.
Bnda pling common dlm daily food/drink adalah caffien.Kandungan dlm coffee.
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I see one case last night
4years old boy being kicked at penis by friend who is a female.Same age
Reason turn out to be because jeles sbb he play and sing with other girls.
Aiyoo dik,ambik kau crik pasal sgt.Nasib x sunatkan je smlm.
Besar nt jgn buat lg klu x senak tau🤭🤭
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Virus : 👀
Dr: Pakcik ada pergi perhimpunan tabligh hari tu?
PC: Tak ada Dr. Pakcik ni masjid pun tak pernah pergi.
Dr: 👀
Nurse: 👀
Meja: 👀
Stetoscope: 👀
Kayu aiskrim: 👀
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Kenape mati? Kenape semua intubate xbgun balik?
Sape ckp semua xbgun. Semua yg buat operation besar2 semua intubated. ELECTIVELY INTUBATE dan sedar je.
Cuma dlm isu covid, paru2 sgtla teruk. fungsi paru2 langsung xdpt support utk masuk oxygen. Even dgn bantuan mesin! J
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@AqmaAizaa
coffee itself contain caffien.Caffien boleh lajukan jantung,kerapkan kencing dan increase concentration.
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"Terus terang sy cakap sy ambil pil kuda 3 bjik, 2 bjik codie** dan 1 antiemetic metoc***** ",kata seorang pemuda 30an yg dtg mndapatkan rawatan selepas terlibat dgn accdnt motor. Dtg ke private clinic c/up
30 years ++ old
working as Mutawif under well known travel company.
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Dah brapa kali dh twitter blocked dri ak sign in account sbb explicit/violent pictures ak dlm ni.Looks like twitter more ok kalau u post nudes than spread medical awareness images.Hahaha.
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prepare yourself and partner with few basic thing regarding pregnancy
1) Please 6 month prior to conception,try to take folic acid/folate.Make it a habit.If u are not yet married no harm if u take it pon.
2) Please be aware of complication traditional/alternative medication.
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Ruptured superficial vessel inside conjuctiva.
and mybe got block nasolacrimal apparatus hence blood drained over his cheek.
#donememe
#dengarcitesemuasukaintelectualguy
#brocube
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I just got this vid from one of my colleagues.
10,000-30,000USD for one delivery? pengsan**
Imagine when all of this medical care being privatize.
Inhaler&epipen 600usd
Epipen di malaysia u guys dpt free.
Kalau ade lg yg marah kna byr singgit i xthula🤦🏽♂️
US im coming 📦 ✈️
Ambulance call out? $2,500. Childbirth? $30,000.
Our NHS is not for sale,
@realDonaldTrump
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Mother consented to not proceed for another cycle of CPR.
Pronounce death to mother.
another episdes of failure for me.
We did what we can.Sometime people need to understand limitation district hosp,we didnt have access to OT,we didnt have proper ventilator,not even ....
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Dont get confuse with URTI (upper respiratory tract infection) symptom vs Covid 19
Both are likely same but different in history (visiting places/contacts)
If its happen to you having runny nose,cough,fever,myalgia these few days WITHOUT
encounter +ve case/visit countries
.
.
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Pagi2 masuk masuk oncall dh dpt incomplete miscarriage dh.
Blood pressure low
Bleed out - 4 pad fully soaked in 3 hours.
Remnant of poc manage to evacuated
Transfer out for futher mx.
#lifethreatening
#kivdnc
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More interesting story i jumpe di hospital yg reluctant for medical treatment.
Pesakit 18tahun, KHUNSA (more to got female genitalia- labia/Clitoris,but got some male (Penile like and corrugated skin?) Refuse for referrel to Urology/Endocrinology
Well built 18yo,guy like
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2) Kadar pernafasan manusia adult normal sptutnya 16-20 seminit. Kenape laju? Sbb reflex oxygen kurang, otak bertindak utk compensate dgn lajukan pernafasan. Side effect? Bdan dan paru2 akan letih.
Nafas laju mnyebabkan pertukaran oxygen xefficient.Co2 washout.
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Pernah jumpe sorang budak perempuan ni range 23-24 cmtu.
Cantik tp sygnya buah pinggang dh xcantik.bacaan.
So ape guna klu muka dh cantik tp hidup sengsara kena dialysis.Korang thu x dialysis ni mcmne ?
Bdan sembap,kaki bengkak dan muka serta kulit appear older than your age!
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Darah nadi (Arterial blood gases)
Partial o2 65%
Saturation o2 88%
Lactate 5
Hco3 18
Jadi ape yg anda faham dari info diatas?
1) oxygen xckup (sptut 96% keatas)
Bacaan di Pulse oximetry tidak setepat ABG tp boleh digunakan dan diterima sbgai saringan awal.
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19 years old,boy came to ED with panic.
“bang2,tlg sy susah nk bernafas”
Me : adik dari mana td? Asal nmpk pucat je ni?
**Spo2 100%
HR 99
Bp normal
Temperature normal 37
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Nati tlg inform Mo incharge klinik dlam tu kes ni can put my name in your record.
Jap, pt ni masuk ke dlm sane atas reason ape yer ??
“Owh dia ni,langgar arahan PKP,ditangkap tgh jogging”
Me : Errrr. Phew xpasal2 dpt gastrik dkt dlm! org ckp xdgr.
.
.
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For me as frontliner,frustrated,sad when we had chance to save patient,we did what we could,treated acute issue,we did correct electrolytes,gave antibiotic,we did all the things but still poor respond,still it is my failure
Another good soul met God today.May his soul rest well.
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Update patient for NF leg from prev posting.
Patient took AOR (at own risk) discharge from ward - want to treat using traditional option. Seek rawatan alternative . So 🤷♂️🤷♂️🤷♂️🤷♂️
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Alfatihah to arwah and takziah utk keluarga.
Rumours said high grade fever? I wonder.Mcm unlikely.
Anyway semoga roh arwah ditempatkan dikalangan solehin.
Pelawak popular Abam Bocey meninggal dunia di kediamannya di Gombak.
.
Abam difahamkan tidak menunjukkan tindak balas sewaktu dikejutkan untuk solat Subuh.
.
Semoga rohnya di tempatkan dalam kalangan para Syuhada. Al-Fatihah.
Berita selanjutnya di
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My day 2 of 2020 turn dark by action of that CPR.
maybe not flying car we should focus.Educate people for cpr is priority.
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Received referral from private clinic a young kids age 3 years old
came to clinic with fever/runny nose/cough.
Did influenza test and turn out positive influenza A
Clinically the baby in good great shape
All clinical examination shows fit for home monitoring
Refer to us ..
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Please guys
Those yg volunteers
-wear proper boots (ada kes terpijak kaca/paku/kayu)
(Kalau berlaku juga-dptkan suntikan ATT untuk elak kancing gigi/tetanus.
-elakkan terminum air dri sources yg tercemar.
volunteerism bukan utk hype. Please take care of yourself juga.
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<Snake Bite>
19 yo,malay boy
no known medical illness
came to casualty hospital complained of allerged unidentified snake bite at home 8.45pm.
upon arrival
Alert
councious
oriented to time place person
pain at 2nd toe
Local examination reveal :
1) dermanecrosis
2) ...
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and the war continues!
*before sampling PUI Group B to contact Positive Covid-19 (HCW)
PPE xckup.we need more PPE.
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Jadi kesudahannya, bantuan yg diberikan dktr melalui mesin pon sudah xdpt ditmpung maka keadaan makin teruk.
utk pengetahuan semua, kalau xtidurkan jangka hayat pesakit mkin singkat. Jadi bantuan diberi adalah untum sokong dan extend lg hayat nyawa. Sebab itulah intubasi dilakukn
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But then still debatable among medical docs if u still nak ambil even sebelum 3 bulan. Ensure no more symptoms and consult doc in charge for further clearance.
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AOR form signed
*At own risk
Cabaran dan mentaliti masyarakat.Dtg hospital dan bile dh thu reason,xnk plak admit.Aduhhh.
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Hye guys
This morning i was quite suprised myDM full of medical consultation questions.
Please all,no such thing as online medical consultation.A consultation must include full medical checkup with blood if necessary.
Kindly seek proper consultation in nearest hosp/clinic.
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So inilah part dimana intubasi diperlukan. Ditidurkan?
Ya. Akan di tidurkan dgn ubt tidur (Sedative) dan disebabkan paru2 tadi penat(Laju nafas) fungsi paru2 dihentikan untuk diberikan kepada mesin supaya dpt rehat dan mesin membantu.
Inilah dimana anesthesia memain peranan.
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<Unit Pesakit Luar,24/10/2019>
61 years old malay pakcik came for blood review.
“Pakcik, bacaan Cholestrol pakcik 7.8 ni.Tinggi sgt ni. Pakcik mkn ubat ke x ni?
‘emmm, haritu 6 bulan lps bacaan 5.1 lgi.Pakcik stop ubat sbb dh rendah bacaan.kdg2 tertggal ubat sbb ttdo..
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Ape jadi slepas tu? PH xbalance. Sbb carbon dioxide terlmpau byk kluar. PCO2 kluar byk menyebabkan HCo3 kena compensate. Makin trun bacaan. Single digit. Lagi xbalance electrolyte.
Pastu ape jadi?
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I agreed for those want to pursue medicine based course,not necessary medical mbbs/mbbch/MD ,nurse also bgus jgk.Ade perkembangan kerjaya post diploma. Post basic in ED mmg lg perform dr doc dh 😎
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~Mentos~
Dktr, meh sni jap!
ajak MA incharge greenzone padaku.
Jam menunjukkan 2 pagi.
"abang ni bgthu td pkul10 mlm dia ada chew 2bji mentos, tp dia rase mcm something melekat dkt blkg leher dia,dia dtg bgthu risau bnda tu melekat dan tkut block dia punye kerongkong"
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Receive a referral from nearby klinik kesihatan for admission yesterday.
Postnatal mother,Para 1 (anak pertama)
baby day3 of life -Visit KK for checkup
Anak kuning dan bila diperiksa oleh pgwai perubatan weight baby loss 10% dlm 3 hari.
IT IS A WARNING SIGN!
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Meanwhile you guys realised kan
UK akan keluar daripada European Union (EU) at 2300 GMT today?
Mark end of 47 years of membership in EU.
#brexit
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So recap balik event,data,
unlikely this case causes by paracetamol poisoning.
More like ongoing sepsis with severe metabolic acidosis,complicated with hyperkalemia and ongoing suspected bleeding from gut somewhere.
Unable to rule out diases as family refuse postmortem
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