Houseman in Sarawak General Hospital (SGH) Vs Hospital Seri Manjung (HSM)

5 things about SGH & another 5 about HSM

1. Working in SGH was super duper hectic and tiring. Never had a chance to watch an English Premier League Match nor Malaysian Super League. At that time I even didn't know at all that my favourite club Chelsea FC buying Demba Ba from Newcastle United.

2. Some if the MOs in SGH like a very BIG BIG BOSS. Even the specialist also were nicer compared to the 'some' MOs. Mind my word; some, not all!

3. In SGH,Off to work at 5.30am and reached home at 9 or 10 at night for almost everyday in a week!

4. Chances of extension was very high in SGH. O&G, Paeds come 1st, followed by Ortho, Surgical and medical. When I was in Paeds, most of my seniors get extended. Higher expectations perhaps. I was lucky enough to complete Paeds Posting without any extensions!

5. In a tertiary center like in SGH, I still can imagine how there was no printer to print all the investigations! Just imagine, I did my oncall alone, need to take blood, then I need to send myself the blood to thw lab, wait another 1 hour, then go back to the lab to trace the results. Sometimes the results still not ready. The Mos will asked this and that. If something happen during my time walking to send and tracing blood/results I would be the one getting the blame. Its somehow very unfair. Hopefully things change nowadays.

6. In HSM, though its not that hectic but the stayback shift makes me feel damne tired. But nevermind, still can go back home to see and sleep with my cuttie little daughter! Yeay!!!

7. MOs here treat the houseman like a colleague. Its because MOs are a senior colleague. Once we completed our HOship well become an MO too...

8. In HSM, went to work at 6.30 or 6.45 and get the chance coming back at 5 or 5.15 almost everyday. But u need to be super duper efficient, and good communication with your colleague.

9. There are still chances of getting extended. But the rate is not sky high. Among all Medical is the highest is HSM. Almost nil in O&G, surgery and ortho (during mr suresh era)

10. Though sometime the PPK quite lame in HSM, but the printer is available! Just need to call the respective lab number, then the results will be printed in front of you! 

Snipper~

Apart from the previous post, it has been almost a year I have  not blogging...

1. Im officially a papa on the 20 September 2013. Yeay!. Love u both..mama and dearie daughter

2. Did aqiqah for my daughter on the 6th of her birthday.

3. Attended almost all the vaccinations for my baby! Yippie. I wondered if I have time to attend it if Im in Kuching. With due respects to SGH, it is dam* unfair asking us to work almost everyday in 4 ******months!!!

4. I am a houseman in Hospital Seri Manjung. Started with ortho (3rd posting). Completed ortho posting uneventfully. Was seen as a regular in OT. Had a couple of  wound debridement done. Had once considered to do ortho as MO ship. We ll see how it goes.

5. O&G was my fourth posting. 2nd in HSM. People said that the most important thing is VE, which totally agreed! All went well except my End Of Posting leave. From 7 days cut down to 2. Missed my chance to went back to Kuching...argh!!!

6. Then my medical posting. Will share  regarding this posting later. Another 1 more week....

7. Although tentatively it is more chillexing from SGH, But the schedule are more packed here in Hospital Seri Manjung. Therevare lots of stayback shift  (6.30am to 10.30 or 11 pm)which require us to work more time in Hospital. Average of 75 hours per week!

8. Anesth vs Casualty.  Im choosing anesth. hopefully I can enter anesth!

9. For the first me in my life fasting in ramadhan as a dad! Though my little cutie  daughter also woke up, but her tok ayah really like her so much in the very early in the morning! !

10. Raya-ing as dad!!! Yahoo....Selamat hari raya!!!

Selamat Hari Raya 2014!

Its been a long year since the last entry...huhu

1. 1st raya in Penang. Brought my wife and daughter to meet with their tok nek jah and tok nek wan.

2. Raya eve, 2nd and 3rd day of raya still working in Hosp Seri Manjung

3. Off to Kuching on the postcall day 3rd Hari Raya.

4. 1st time Hari Raya as a dad. Im very proud of it.

5. Again, people in Kuching wear baju melayu

until more than a week of raya! Raya sakan!. I like the spirit!!!!

6. Happy to see my daughter plays with her cousins- Aziz & Aishah ( little cuttie Aishah daa besar = ) )

7. Feel chillex as Im off from hospital for few days~ yeay...

8. I still vote ketupat palas is the best among all ketupats/lemangs

9. RAYA RAYA RAYA!

10. RAYA RAYA RAYA RAYA RAYA RAYA
X 1000000000. HAHAHA......

Saddest & Happiest Raya

1. I miss my wife, my queen,  my soulmate, my munyi so much. Miss you honey.

2. Many things happen in life. You can be happy the 1st day, then sad on yhe next day.

3. Its hard to take when the love one are taken or being away from you.

4. Really enjoy my raya there in Kuching. People there wear baju melayu for more than a week after raya.

5. Met a lot kinds of people while I am abroad. Most of them only cared about themselves only, only some will think about the others.

6. Soon I will became a pappa. Dear, I really love u so much. Please take care of yourself and our baby. Pappa loves both of you. I feel blessed.

7. Ya Allah, please give us strength in life.

8. All of us do have problems. Iys a matter of how we manage it.

9. Live is simple. Don't make it simpler. I like it.

10. Again, I love you dear, Nur Afiqah Binti Morshidi...

Paediatric Posting in SGH/ Hospital Umum Sarawak

Paediatric is my second and last posting in Sarawak General Hospital. There are lots of ups and downs, but playing with kids somehow make me happy...

1. I am not sure elsewhere, but my tagging time started at 5pm till 11pm (actually it exceeded 11pm, once I went back home almost 1 am, and need to go to work as early ad 6 am the following day). Huh..

2. Houseman here tag for 10 days, which are 5 days in ward and 5 days in nursery. We have our own tagging sheet. Need to do alot of stuff such as clerking 10 general cases, 5 NNJs, 5 blood c&s, 5 participation in resuscitation, 5 interpretation of ABG, and clerking 10 cases in nursery.

3 Started my posting in Paediatric Oncology ward. There I met one of the Giant name in paediatric oncology in Malaysia, Dr Ong Gaik Bee. Struggled for the 1st few days but able to recover in time.

4. Then I went to paed isolation ward. 1st time I was shouted in a ward. The very 1st day. Here I learn a lot of AGE and HFMD cases. Able to met with Dr Ng Hoong Phak. Check his name in the Paediatric Protocol Cover

5. Next, Nursery. The hell among all. The 1st 3 week is very difficult and tough. For most every day I went at 4.30 to 5 am in the morning and went back aeound 8 to 9 pm  Managed to see the rotation of nurses all 3 shifts. Seriously having an OCD mo was very crazy. Once, I need to take full set of blood investigation for 4 babies and another 2 urine in and out cathether for 2 babies in the same SCN. This place really challenge d me to the limit.

6. General Paed 2B. Heaven. As simple as that. 

7. Paed ICU-PICU. Spent 3 weeks there. At this time, I was one of the senior poster already. Bosses and mo's seem to trust us more. So its quite hard hard to repay your bosses trust by not to do any stupid mistakes. I tried to maintain the standard of a senior poster which I could. Its been relaxing for the the entire 3 weeks there, but startedbto get hot on the very last day. Haha.

8. Paed 2B second spell. 4 more days left in paeds. As a senior  poster, I went to home visit to evaluate the condition of child with hime oxygen therapy with Paediatric  Intensivist Dr Chor Yek Kee. We started to go around 10am and we reach ed SGH around 6pm. It was a good experience for me and I learnt alot of stuff.

9. NRP. Neonatal Resuscitation Programme. Failed once but not twice. Haha. If I failed x2, I will be getting extended. 2 values need to remember,  100 & 60. Remeber the basic algorithm too.

10. PALS. Paediatric Advanced Life Support. Im not sure other hospital have it or not. But this tine I passed during my 1st attempt.

Its been a long time 2

1. Barisan Nasional won the election once again.

2. NAJIB is still th PM. Not ANWAR.

3. Manchester United yet again the champion of England.

4. Chelsea? Not bad for becoming Europa League champion.

5. John Cena is a champ once again.

6. ASB loan settled already. Next will be House, then car.

7. A good paediatric intensivist offered me to become his trainee. Hurm...

8. Currently on Cuti Tanpa Gaji.

9. My cargo will be on next Wednesday.

10. Just few more day..August 13...

Its been a long long time

1. My last post was back in 2011???!!??

2. Thank God. Syukur. I passed my MBBS. Automatically I am a doctor now.

3. I am blessed that I married the one that I love. I am blessed too that I am awaiting my 1st child. Yahooooo.. 

4. Working for almost everyday in 8 months time really challenging and take me to the limit. Housemanship in Sarawak is challenging but working for almost everyday is ridiculous.

5. Goverment or ministry of health need to look in depth how to ease the burden of houseman in SGH. I am serious.

6. This year I will be celebrating raya for the 1st time in Sarawak.

7. I had celebrate raya without my parents back in Manipal days. So this is not the 1st time.

8. I will be transferring to Hospital Seri Manjung as a 3rd poster with effective date of 19 August 2013

9. I really hope and pray so that my wife can cope or manage on her own during my absence.

10. May God bless us all.

'3S'

It's Sunday! but need to study for my sessionals, in between, I slept alot also~ huhu

Sunday-Study-Sleep

~~~

X!0M@N!@[$ Prop.

Obstetric Mnemonic

Since I am having a block test tomorrow, here a little bit of mneumonics to share with..p/s thanx to the one that create it!


Oral contraceptive complications: warning signs ACHES:
Abdominal pain
Chest pain
Headache (severe)
Eye (blurred vision)
Sharp leg pain


Abdominal pain: causes during pregnancy LARA CROFT:
Labour
Abruption of placenta
Rupture (eg. ectopic/ uterus)
Abortion
Cholestasis
Rectus sheath haematoma
Ovarian tumour
Fibroids
Torsion of uterus


Post-partum haemorrhage (PPH): causes 4 'T's:
Tissue (retained placenta)
Tone (uterine atony)
Trauma (traumatic delivery, episiotomy)
Thrombin (coagulation disorders, DIC)


Prenatal care questions ABCDE:
Amniotic fluid leakage?
Bleeding vaginally?
Contractions?
Dysuria?
Edema?
Fetal movement?


Asherman syndrome features ASHERMAN:
Acquired Anomaly
Secondary to Surgery
Hysterosalpingography confirms diagnosis
Endometrial damage/ Eugonadotropic
Repeated uterine trauma
Missed Menses
Adhesions
Normal estrogen and progesterone


Gestation period, oocytes, vaginal pH, menstrual cycle: normal numbers 4 is the normal pH of the vagina.
40 weeks is the normal gestation period.
400 oocytes released between menarche and menopause.
400,000 oocytes present at puberty.
28 days in a normal menstrual cycle.
280 days (from last normal menstrual period) in a normal gestation period.


CVS and amniocentesis: when performed "Chorionic" has 9 letters and Chorionic villus sampling performed at 9 weeks gestation.
"AlphaFetoProtein" has 16 letters and it's measured at 16 weeks gestation.


Alpha-fetoprotein: causes for increased maternal serum AFP during pregnancy "Increased Maternal Serum Alpha Feto Protein":
Intestinal obstruction
Multiple gestation/ Miscalculation of gestational age/ Myeloschisis
Spina bifida cystica
Anencephaly/ Abdominal wall defect
Fetal death
Placental abruption


Female pelvis: shapes GAP:
· In order from most to least common:
Gynecoid
Android /Anthropoid
Platypelloid


Pelvic Inflammatory Disease (PID): complications I FACE PID:
Infertility
Fitz-Hugh-Curitis syndrome
Abscesses
Chronic pelvic pain
Ectopic pregnancy
Peritonitis
Intestinal obstruction
Disseminated: sepsis, endocarditis, arthritis, meninigitis


B-agonist tocolytic (C/I or warning) ABCDE:
Angina (Heart disease)
BP high
Chorioamnionitis
Diabetes
Excessive bleeding


Secondary amenorrhea: causes SOAP:
Stress
OCP
Anorexia
Pregnancy


Preeclampsia: classic triad PREeclampsia:
Proteinuria
Rising blood pressure
Edema


Alpha-fetoprotein: some major causes for increased maternal serum AFP during pregnancy TOLD:
Testicular tumours
Obituary (fetal death)
Liver: hepatomas
Defects (neural tube defects)


Dysfunctional uterine bleeding (DUB): 3 major causes DUB:
Don't ovulate (anovulation: 90% of cases)
Unusual corpus leuteum activity (prolonged or insufficient)
Birth control pills (since increases progesterone-estrogen ratio)


IUGR: causes IUGR:
Inherited: chromosomal and genetic disorders
Uterus: placental insufficency
General: maternal malnutrition, smoking
Rubella and other congenital infecton


Early cord clamping: indications RAPID CS:
Rh incompatibility
Asphyxia
Premature delivery
Infections
Diabetic mother
CS (caesarian section) previously, so the funda is RAPID CS


Oral contraceptives: side effects CONTRACEPTIVES:
Cholestatic jaundice
Oedema (corneal)
Nasal congestion
Thyroid dysfunction
Raised BP
Acne/ Alopecia/ Anaemia
Cerebrovascular disease
Elevated blood sugar
Porphyria/ Pigmentation/ Pancreatitis
Thromboembolism
Intracranial hypertension
Vomiting (progesterone only)
Erythema nodosum/ Extrapyramidal effects
Sensitivity to light


Forceps: indications for delivery FORCEPS:
Foetus alive
Os dilated
Ruptured membrane
Cervix taken up
Engagement of head
Presentation suitable
Sagittal suture in AP diameter of inlet


Delivery: instrumental delivery prerequisites AABBCCDDEE:
Analgesia
Antisepsis
Bowel empty
Bladder empty
Cephalic presentation
Consent
Dilated cervix
Disproportion (no CPD)
Engaged
Episiotomy


APGAR score components SHIRT:
Skin color: blue or pink
Heart rate: below 100 or over 100
Irritability (response to stimulation): none, grimace or cry
Respirations: irregular or good
Tone (muscle): some flexion or active


Postpartum collapse: causes HEPARINS:
Hemorrhage
Eclampsia
Pulmonary embolism
Amniotic fluid embolism
Regional anaethetic complications
Infarction (MI)
Neurogenic shock
Septic shock


Multiple pregnancy complications HI, PAPA:
Hydramnios (Poly)
IUGR
Preterm labour
Antepartum haemorrhage
Pre-eclampsia
Abortion


IUD: side effects PAINS:
Period that is late
Abdominal cramps
Increase in body temperature
Noticeable vaginal discharge
Spotting


Labour: preterm labor causes DISEASE:
Dehydration
Infection
Sex
Exercise (strenuous)
Activities
Stress
Environmental factor (job, etc)


Miscarriage: recurrent miscarriage causes RIBCAGE:
Radiation
Immune reaction
Bugs (infection)
Cervical incompetence
Anatomical anomaly (uterine septum etc.)
Genetic (aneuploidy, balanced translocation etc.)
Endocrine


Shoulder dystocia: management HELPER:
Call for Help
Episiotomy
Legs up [McRoberts position]
Pressure subrapubically [not on fundus]
Enter vagina for shoulder rotation
Reach for posterior shoulder and deliver posterior shoulder/ Return head into vagina [Zavanelli maneuver] for C-section/ Rupture clavicle or pubic symphisis


Labour: factors which determine rate and outcome of labour 3 P's:
Power: stength of uterine contractions
Passage: size of the pelvic inlet and outlet
Passenger: the fetus--is it big, small, have anomalies, alive or dead


Post-partum examination simplified checklist BUBBLES:
Breast
Uterus
Bowel
Bladder
Lochia
Episotomy
Surgical site (for Cesarean section


X!0M@N!@[$ Prop.

'Big' day for Manchester!

Though I am a Chelsea fan, but today is absolutely a massive day for Manchester. Both Man U & Man City won the Premier League for 19th time and FA cup respectively~
For Man U, they have surpassed the record held by Liverpool of 18th league title, and for Man City, their huge investment started to paid off! Well, we're looking forward for next season, as it getting tougher and tougher. Believe me! For Chelsea FC, its the 3rd season post-Abramovich era trophyLESS.

X!0M@N!@[$ Prop.