PAKA

Hari ni first day keja di paka. K Kam pergi kursus TBIS di kemaman, so kena handle sorang2 klinik arini. herm.



Pegi belek2 machine scan. Kuno ya rabbi. Tapi takla seteruk machine di kj. Boleh faham la camne nak operate. Ok jom kita start keja. panggil patient masuk. Nice and comfy.

Elok2 pukul 10am dapat call dari M.. Dr ada satu kes pengsan kat rumah. Makcik tu umur 60's ada DM and HPT. BP on arrival 218/100.. alamak.. hypertensive emergency with possibility of stroke. Ok saya datang kejap lagi.. wait me in casualty.

Tiba2 ada sorang akak staffnurse berlari2 datang dari site. Dr Dr ada patient nak deliver. Dah 7 cm . Nak minta tolong dr buatkan ARM ( artificial rupture of membrane -pecahkan air ketuban). ok, nak sambut kat sini ke? ok je dr, lagipun dia dah gravida 3 ( kandungan ke 3).. ok ... saya gi tengok case casualty jap, sikit lagi saya gi sana...

Examine makcik yang tengah terbaring di stretcher. GCS 12/15. Tak bercakap pun..rupanya recurrent stroke. Left CVA with right hemiparesis. and hypertensive emergency. Pupils equal, Buat referral and send patient to hosp.

Pergi pulak attend patient in labour. Dr Dr Air ketuban dia dah pecah dah tadi. Cuba dr check.. saya rasa macam fully. Tapi bukan kepala tu dr.. cam pungggung baby je ..

ah sudah.. breech ke..
ana pun buat VE.. o my god.. buttock presentation.. Breech la oi..

saya rasa macam membrane bulging lagi.. sempat kut kita kejarkan ke hospital dungun. bukannya tak nak sambut kat sini.. tapi better ada paeds standby.

Patient nak push sangat. Alamak. all i can see is a buttock at the vagina. Membrane dah rupture la!

Dah sambut je la kat sini. Ok akak2 .. kita sambut baby ni kat sini!

Ana cakap dengan patient... Ok kak ye.. anak akak ni songsang. Akak kena tolong saya supaya saya boleh tolong akak.. banyak doa moga mudah baby ni nak kuar.

akak2 staffnurse sibuk pakaikan ana gown. I put on sterile gloves.
Ok kak..sakit tak skrang? patient angguk,..ok TERAN!

nampak buttock baby kuar masuk kuar masuk. TERAN KAK kuat2!
ok kak staffnurse. bagi saya gunting epi, kena buat epi ni..

dr dr kita takde epi set!

hah! la.. dah camtu kita guard elok2.

patient teran bersungguh2, good.. buttock bby nak keluar dah. Guard perineum dia. Kang tak pasal2 koyak rabak plak. Ana cari kaki baby. Extended breach. Kuarkan satu kaki kiri pelan2,.pastu kaki kanan baby. Berjaya.

Baby terberak. Agaknya stress kut, ok.. takpe takpe.. tangan baby pulak ana tarik kuar, Satu satu. Ok akhirnya tingggal part kepala tak kuar lagi. Huargh,, ni yang paling takut ni.

ok kak.. badan dah kuar ni.. kepala plak,

Ana buat maneuver badan baby secara tertonggeng. Masukkan jari dalam mulut baby. Support neck dia,.

Lama kepala baby stuck. Kami dah takbir ramai2..dalam lebih kurang 3minit, kepala baby dapat dikeluarkan. ALLAHUAKBAR!

Baby cuba nak nangis. Sikit je,Blue but vigorous. Ana gosok2 belakang dia. Stimulate senses, Suck secretion dia.. baby pun nangis. ALHAMDULILLAH>.

Cucuk syntometrin kat peha patient. Then minta tolong staffnurse tolong kuarkan uri sementara ana dok siapkan referral ke hosp. Check tear patient. Ok. Second degree je,.. boleh jahit kat hosp. Patient dah berjela2 menunggu.. fuh..

lepas ni nak kena minta epi set . tak logik la kat klinik takde epi set.

Am i to take O&G? cam menarik la plak.

what a day! sampai ada staffnurse yang tegur.. baby dr ok ke? nyaris dr sendiri tak terberanak!
hehe.

ALLAHu mustaa'an..

note: External cephalic version boleh dilakukan untuk cuba memusingkan baby sebelum tanda2 bersalin. Syaratnya kena dibuat di hospital yang ada pakar and ada paeds. Sbb risiko utk fail tinggi yang boleh menyebabkan uri lekang ( placenta abruptio) and perlu ada backup ceaserean section. )

Crucial…

Because of recent abductions
In daylight hours, refresh yourself of these things to do
in an emergency situation...
1. Tip from Tae Kwon Do:
The elbow is the strongest point
on your body.
If you are close enough to use it, do it!
2. Learned this from a tourist guide.
If a robber asks for your wallet or purse,
DO NOT HAND IT TO HIM.
Toss it away from you....
Chances are that he is more interested
in your wallet or purse than you & he will go for the wallet/purse.
RUN LIKE MAD IN THE OTHER DIRECTION!
3. If you are ever thrown into the trunk of a car,
kick out the back tail lights and stick your arm out
the hole & start waving like crazy.
The driver won't see you, but everybody else will.
This has saved lives.
4. Women have a tendency to get into their cars
after shopping, eating, working, etc., & just sit
(doing their cheque book, or making a list, etc.
(DON'T DO THIS!)
The predator may be watching you,
& this is the perfect opportunity for him to get in
on the passenger side, put a gun to your head,
and tell you where to go.
AS SOON AS YOU GET INTO YOUR CAR,
LOCK THE DOORS AND LEAVE....

If someone is in the car with a gun to your head
DO NOT DRIVE OFF,
Repeat:
DO NOT DRIVE OFF!
Instead run the engine and speed into anything, wrecking the car.
Your Air Bag will save you.
If the person is in the back seat they will get the worst of it.
As soon as the car crashes bail out and run.
It is better than having your body found in a remote location.
5. A few notes about getting
into your car in a parking lot or parking garage:
A.) Be Aware:
look around you, look into your car,
at the passenger side floor, and in the back seat
B.) If you are parked next to a big van,
enter your car from the passenger door.
Most serial killers attack their female victims
by pulling them into their vans while the women
are attempting to get into their cars.
C.) Look at the car parked on the driver's side of your vehicle,
& on the passenger side.... if a male is sitting alone
in the seat nearest your car, you may want to walk back
into the mall, or work & get a
guard/policeman to walk you back out.
IT IS ALWAYS BETTER TO BE SAFE THAN SORRY.
(And better paranoid than dead.)
6. ALWAYS take the elevator instead of the stairs.
Stairwells are horrible places to be alone,
& the perfect crime spot.
This is especially true at NIGHT!
7. If the predator has a gun & you are not under his control,
ALWAYS RUN!
The predator will only hit you (a running target)
4 in 100 times, & even then, it most likely WILL NOT be a vital organ.
RUN, preferably in a zig -zag pattern!
8. As women, we are always trying
to be sympathetic:
STOP!!
It may get you raped, or killed.
Ted Bundy, the serial killer, was a good-looking,
well educated man,
who ALWAYS played on the sympathies of unsuspecting women.
He walked with a cane, or a limp,
& often asked 'for help' into his vehicle or with his vehicle,
which is when he abducted his next victim.
9. Another Safety Point:
Someone just told me that her friend heard
a crying baby on her porch the night before last
& she called the police because it was late
& she thought it was weird... The police told her
'Whatever you do, DO NOT open the door..'
The lady then said that it sounded like the baby
had crawled near a window & she was worried
that it would crawl to the street & get run over.
The policeman said, 'We already have a unit on the way,
whatever you do, DO NOT open the door.'
He told her that they think a serial killer
has a baby's cry recorded & uses it to coax
women out of their homes, thinking that someone
dropped off a baby. He said they have not verified it,
but have had several calls by women saying that
they hear baby's cries outside their doors
when they're home alone at night.
10. Water Scam!
If you wake up in the middle
of the night to hear all your taps outside running,
or what you think is a burst pipe,
DO NOT GO OUT TO INVESTIGATE!
These people turn on all your outside taps
full bore so that you will go out to investigate
& then they attack.

Stay alert, keep safe, and look out for your neighbours!

Ketengah Jaya

Today i replaced Jason at Kj.. alhamdulillah, abang drove me there. Jauh sey..masuk felda.. huhu.. nasib baik sehari ni je.

Jlan masuk ke dalam memang bersimpang siur..L pernah kata kadang2 motorsikal lalu takde lampu..kereta lain semua laju sbb turun bukit.mmg accident head injury kaw kaw sampai doctor sendiri kena turun ke accident site confirm death.

if duduk kuarters, confirm penduduk kampung datang ketuk pintu rumah malam2 minta tolong tengokkan case.

Ana pusing2 tengok klinik. Ok. Nice setup. Ada klinik ABC (birth center) kat sini. Seronok jap baca pasal exclusive breastfeeding. Tengok Kd pun dah dapat pengiktirifan baby friendly clinic.

kes2 still banyak bertambun2..

Ultrasound memang antik.. yang screen besar tu..berat..terboyot boyot rasanya nak ubah kedudukan ultrasound bagi patient tengok baby yang discan.. puas tekan tekan pusing pusing cursor, baru jumpa fetal measurement. Nasib baik gambar tak kelabu asap. Kalau tak patient kena datang balik la utk confirm REDD and repeat scan.

after quite sometimes in clinic, i realized Public health is quite interesting. Peranan yang dimainkan primary care memang menarik and all out especially dalam bab Pengawalan denggi, vektor surveillance, TB , leptospirosis... u know all these community projects. We were all given abate ( ubat jentik2 ) to be put in our own water tanks /pots masa orientation..turun padang utk bersihkan kawasan hot spot dengue. Kalau ikutkan thermal fogging and semua kempen2 banteras dengue yang kita dah buat, mmg sepatutnya takde dengue dah.. tapi disebabkan community awareness yang kurang.. ( oh.. betapa haritu masa wabak dengue di KTganu, takde orang kampung nak join gotong royong.. tapi sampai hati tunjuk2 kat kami kat mana tempat tong2 yang perlu dibersihkan.. teruk sungguh.. bukannya nak tolong..

Malaysia ku yang kotor dengan penduduknya yang pengotor. Sbb tu nyamuk aedes aegepti betina membiak dengan berjentik2 banyaknya.. dalam air yang bertakung..berterbangan sejauh 200mter utk gigit orang lain pula. Thats why thermal fogging kita target rumah2 yang within 200meters radius.

Tapi masalah iman yang sebenarnya. Kurang iman leads tu kurang taqwA. Kurang taqwa leads to suka buang sampah merata rata. Sbb tak takut ALLAH nampak. Suka buang sampah leads to pengotor. Pengotor leads to dengue..

An nazofatuminal eman..