Prehouseman Attachement at USM (Day 11)

Assalamualaikum dan semoga kita sentiasa berada dibawah lindunganNya amin:)

1) Clerking case on my own with my friend.

2)Dr Julia taught us the way to proper clerking the Obstetric cases, how to read antenatal book (pink book)  and extracting history from the ante natal book .

Template ong clerking 1

Template ong clerking 2

3) Dr Julia taught us how to do vaginal examination (V/E) , antiseptic technique before doing the examination and point need to document (write in BSH patient) when do V/E and PSE (perspeculum examination) .

4) Followed Dr Julia [HO] and MO [Dr Chan] into Bilik Rawatan to do PSE & VE on patient and observed MO expressed the findings into the word and HO interpret the findings to the BSH.

5) Observe HO [ Dr Hazrin ] to do branula insertion.

6)Followed morning ward round with HO & MO .
-Observe MO reviewing the cases , make physical examinatiom on pt (P/A)
-MO give the instructions to the HO to formulate or add new plan after the round and HO will carry out all the plans after the morning round.

7) Dr Julia taught to palpate the abdomen .

Point need to find during examinations:
-Fundus length
-Fetal parts and fetal head
-Gestational age
-Head to abdomen
-Lies

8) First time doing the vaginal examination.
Os : 2cm.

Prehouseman Attachment at USM (Day 8)

Assalamualaikum dan semoga kita sentiasa berada dibawah lindunganNya:)

1)Join bed side teaching with year 5 USM students at Wad 2 Akik.

Topics:Gestational Diabetes Mellitus on Insulin.
-one student presented the cases (Complete clerking until physical examination)
-After finished presenting the cases, Dr Haji discussed with the students about the important points regarding the disease in which the patient had.
-noted with HO Ampang Guide.

2) Follow one dearest MO .
-She taught us about how to plot partogram (what details need to be write in the partogram chart) and how to read CTG.
-She explained to us about the ward work.
-Must study MgSO4 preparation (different hospital, different MgSo4 preparation)
-Told us to observe delivery first then try to conduct the delivery.
-Her advise : "Learn as many as possible during Hoship. It is okay to feel "bodoh" as long as we are always willing to learn. Management can learn later when we are treating the cases".

Partogram

3)In labor room:
-Observe Dr do the episiotomy and vaginal examination to detect opening of the Os.
-Helping Dr and fellow nurses to prepare pt after delivery.
: putting pad on the patient, tie the pad.
:check the placenta before putting into the paper bag to bring back home.

4) Join medical ward oncall at 7 Utara ward with my secondary school senior Dr Afham .
-He taught us about how to put on branula and taking blood (VBG & ABG)
-Managed to draw blood on 2 patients on myself.
-He guided us on how to proper clerking pt in medical department. ( must tally and make reference on doctor in ED clerking the cases because most patient come to Medical ward are from ED) .
-Another Ho, Dr Farhana taught us how to key in data about blood investigation  to send to the laboratory after filling the blood into the respective blood tubes.

[TAKE HOME MESSAGE DURING ONCALL MEDICAL WARD]

a) First call ward round malam untuk patient ada issues sahaja

b) MO di ED clerk case yang sampai ke ED terlebih dahulu then HO Medical clerk once again when patient entering the medical ward.

c) Common reason for haemodialysis in medical ward are:
- metabolic acidosis
-hyperkalaemia
-uremic symptom
-infection

d) When HO clerks the cases from ED :
- refer kertas kuning dan merah (clerking sheets) from ED
- Ix yang dah dibuat, refer and trace the result into observation charts.

e) For ABG result , important markers to be noted are ph , pCo2, lactate and bicarbonate.

f) Tips for blood taking (Branula insertion, ABG, VBG)

-Bila ambil darah, jangan inject di tempat yang ada edema or swelling.

-In ABG procedure,ambil dekat radial artery. Elakkan ambil di branchial artery sebab that area cuma ada satu artery.

-After done taking ABG, must compress at least 1min at injection site to avoid haematoma. (if any problem when doing ABG, might be a reason for extension in medical ward for 1 month)

-In CKD patient, usually difficult to take blood because most veins are collapsed.

-Tips inserting branula, masukkan only 1/4 of length of needle and adjust the needle tilll succeed.

Trolley for blood taking

 Each blood taken must put in the respective plastic with label with corrrect patients' name. 

Key in data for blood taking to be sent to each related laboratory.

3.30 am after night oncall at medical ward. 

Prehouseman Attachment at USM (Day 7)

Assalamualaikum semoga kita sentiasa berada dibawah lindunganNya :)

FIRST DAY ELECTIVE POSTING AT  "OBSTETRIC AND GYNAECOLOGY"

My target to achieve during this posting are:
1)clerk cases
2)study the Ong clerking form
3)Join morning ward round
4)Learn to apply and read CTG
5)Familirize common abbreviation for Ong cases
6)know common cases
7)observe VD & LSCS
8)know how to document post and pre op review
9) observe common procedure as CBD, PV etc
10) Do or observe physical examination
11)Join USM students' classes

1) Went to ONG department to meet secretary ONG department. Want to meet HOD Ong but he didnt present at his office at that time.

2)Followed Nurse in charge for orientation. She explained to us about the ONG ward.

-Room for labor.
-Room for premature cases
-Room for HDU (high risk cases)
-Room for pre eclampsia
-Room for epidural
-Labour room (Cs) must wear scrub, shoes, and different scarf)
-Ante natal clinic at ground floor
-Antenatal & postnatal ward. (3 ward)

*we can help nurses to detect BP and call the husband.

3) Join MEDICAL Ho teaching with fellow HOs and one specialist

-They presented about communication skills that involve consultations, breaking bad news, communication while clerking, cultural sensitivity.

-Specialist, Dr Abu added the informations about:

A ho must master 3 languages :
*BI to communicate with colleagues, consultant, registrar
*BM (community language :dialect: to talk with patients

Must always introduce ourself before examine or do procedure to patients

Practice RAPPORT when clerking the patient

Learn when clerking, try not to write while clerking.

Paternalism : Inform choice
                       : Decision making
                       : explain to patient what he need to know and deserve to know
                       : doctor act as agent to deliver the information
 

My partner whatspp status about what Dr Abu said during HO teaching ;)

4) At evening, go to labor room for the
 first day:

-observe dr do vaginal examination before delivery to detect the opening of OS (how many cm)
-observe nurse perfomed CTG
-observe and assist Dr do episiotomy
-observe MO do CBD before labor to fasten delivery because full bladder  that compress the uterus will lengthen the delivery process.
-A pt asked me for a small bottle to fill her 'air selusuh' (she claimed it) but doctor didnt give her permission to drink that because fluid can make the pt to choke and enter the lung.

5) Study how to clerk ONG cses and study common abbreviations.

Post operation review

Template ong clerking page 1

Template ONG clerking page 2

Memory of 1st day ONG elective attachment

**ops today baru dapat nametag after one week here hehe. 

Prehouseman Attachment at USM (Day 6)

Assalamualaikum semoga kita sentiasa berada dibawah lindunganNya :)

Day 6 ( 7/10)

1)clerk one case with general examination and half physical examination (sebab tak sempat)

Pt U/L with:
-spina bifida since congenital
-regular haemodialysis since diagnose with CKD at age of 13years old.
-Bilateral hydronephrosis

2)Perform ECG with ECG machine with staff nurse

3)Meet my highschool senior, Dr Afham. Observed him doing ABG.
He told me to go oncall with him this Wednesday to learn how to do branula insertion and clerk cases.

4)Join EBM (evidence based medicine ) class with year 5 USM students.
-2 students present the slides and 1 student present the case.

-Topic : Uses of ACEI in chronic heart failure.

Prehouseman Attachment at USM (Day 5)

Assalamualaikum semoga kita sentiasa berada dibawah lindunganNya Amin:)

Day 5 (6/10)

1) Take a look with details pt 55years old underlying with
-DM since few years ago
-spondylitheasis
-obstructive jaundice to rule out malignancy

I paid attention on how the Dr clerks the cases through clerking sheet, review forms, results, forms that need to be filled and drug prescription.

2nd patient present with End stage renal failure (ESRF), tertiary hyper Paratyhroidism, Multinodular goiter with retrosternal extension, Hpt on T.felodipine, ch lung disease with pulmonary HTN, B/l renal parenchyma disease and degenerative spine disease.

2) Done observe and do short case on female pt ( I act as chaperone) from general examination and physical examination.

-Hand: detect water hammer pulse, pulse, pallor of hand, clubbing of hand, peripheral pulse.
-eye for jaundice
-mouth for cyanosis
-JVP raised
-palpate abdomen
-CVS: apex beat pulsation
-Resp: movement of chest, auscultate chest sound
-leg: pedal edema
-examine JVP while auscultate the lung usng small cone stethoscope
-apex beat displaced at 6th intercostal space ant axillary line.
-auscultate heart at tricsupid, mitral, pulmonary, aortic area to hear the murmur.

3)  observe eye dressing for corneal ulcer

4) observe MO and HO do peritoneal tapping.

Summary of procedure:
-Inject anesthesia first
-IV Line to draw ascitic fluid -> put into specimen urine container 100ml & collect urine in urine bag (3000ml) .
*if ascitic fluid not flow automatically, drain manually using syringe.

Prehouseman Attachment at USM (Day 3 & 4)

Assalamualaikum dan semoga kita sentiasa berada dibawah lindunganNya Amin:)

Day 3 Attachment 3/10

-Join ward round with senior Ho and Mo
-clerk patient CKD . First time smell pt with CKD Halitosis
-observe 3 MO do femoral cathether vein for haemodialysis.

1) must know the anatomy of femoral vein
2)technique of insertion
3)complication

Day 4 Attachment 5/10

-at 1pm join war round at ward 7S
-Meet with senior Zagazig Dr Amirah & Dr Alifah

-Dr Alifah explain about:

1) simple procedure in ward (Bilik Rawatan), 

2) how to do branula insertion (VBG, ABG)

3)explain about different blood tube

4)explain about common form used in USM Hosp

5)explain about tools and different oxygen mask

Variable of forms.

Trolley tray for branula insertion

Basket that Dr must fill will blood tube and others tools for the next Dr to do branula insertion.

Prehouseman Attachment at USM (Day 2)

Assalamualaikum semoga kita sentiasa berada dibawah lindunganNya.

Things done:

1)Meet and greet with Sister Wahidah
-she explained to us about ISBAR when meet everyone in ward.
I: INTRODUCTION
S: explain the SITUATION
B: BACKGROUND
A: ASSESSMENT
R: RECOMMENDATION

*ISBAR was taught detail during medicorp preho course.

-always do hand hygiene/ hand scrub when entering the ward.
-we are restricted to do procedure unless with permission


2) Morning ward round with specialists,registrar, Mo, Ho and USM students

Points taken during morning round:
-see seniors Dr present the cases
-know what finding that present in pt (do physical examination)
-during clerking must ask detail on every point to reach diagnosis.
-know important and common cases
-interpret and read ecg , know most common questions about ecg

3)clerk one case with acute tonsillitis case

-know the template of clerking
-familirize the abbreaviation
-take a look at patient's file, result and forms.

4)Meet my high school senior, Dr Afham (Ho) & Dr Adilah (Mo)
-observe Dr Afham do am review.
-Dr Afham explain the ward system,  what to do during medical attchment, common disease in medical

5) Take home message for today 2/10
-read management based on CPG (must read once before entering HOship)