Hari ini,17/3/2011 dalam sejarah.hehe~~
*giggles*
BEFORE I PROCEED ANY FURTHER,ALLOW ME TO story pasal apa yang berlaku pada PLEURAL TAPPING
haritu yang asik dok X JADI je.tapping dah wat tapi bukan continuous drainage.tapping just untuk aspirate cecair keluar je.MAYBE DOCTOR JUST BUAT IN-OUT je kot...by right,ada 2 pressured bottle utk tampung fluid yang keluar.and 1 vacuum maschine utk bantu suck out fluid dalam paru2.anyway,aku sebenarnya dah X INGAT SANGAT pasal chest management ni...belajar masa semester dua dulu...so bila dah join ortho,jarang gila la nak jumpa this kinda event.huhu....x pe,dengan cara ni,i am able to recall what i had learnt 4 years ago....
when it comes to the topic of CHEST TUBE INSERTION,ada 3 jenis bottle drainage system..tapi yang biasa aku jumpa kat wad respiratory dulu,2 BOTTLE DRAINAGE SYSTEM.
here's the description :
How should the drainage system of a chest tube be managed?
· After insertion, the chest tube should be connected to an underwater seal drainage system. Three types of underwater seal drainage systems are available: the 1-bottle, the 2-bottle, and the 3-bottle system.
o In the 1-bottle system the chest drain is connected by collecting tubing to a tube approximately 3 cm under water (the seal) in the underwater-seal bottle while another vent tube is open to atmosphere. In this system pleural pressure greater than 3 cm water will force air or fluid from the pleural space into the bottle while negative pressure in the pleural space will suck fluid up the tube. As long as the underwater-seal bottle is well below the patient (e.g., on the floor beside the patient), the hydrostatic pressure of the fluid column in the tube will counterbalance the negative pleural pressure and prevent water from being sucked into the pleural space.
It should be remembered that hydrostatic pressure is proportional to the height of the fluid column. As the level of the underwater-seal bottle is raised, it will become easier for fluid to be sucked into the pleural space. Therefore it is mandatory that the bottle be kept well below the patient at all times. A disadvantage of this single bottle system is that, as liquid contents (blood, pus, effusion fluid) is expelled from the pleural space and collects in the underwater-seal bottle, the seal tube becomes immersed deeper under water and the pressure required to force more contents into the bottle increases. A 2-bottle system can alleviate this problem.
o The working principle of the 2-bottle system is the same as the 1-bottle system except a trap bottle is interposed between the drain tube and the underwater-seal bottle.
o In both the 1-bottle and the 2-bottle system, the vent tube may be connected to a high- volume/low-pressure suction system (e.g., the Vernon-Thompson pump) set at a level of -10 to -20 cm H2O. A low-volume pump (e.g., the Roberts pump) is inappropriate.
Since i am a TRUTH-TELLER,haha...truth la sangat yer....aku MEMANG LEMAH GILER la bila talk about PHYSICS....hampeh result aku masa SPM dulu...tapi aku tau fungsi botol ni dalam men-SUCK-ing keluar fluid inside the pleural cavity....
balik pada cite tadi,tapping tu dah buat 2 hari lepas.aku baru naik keje smlm petang (17/3/2011).so yang 1st daughter tu bgtau,
"doctor ada tebuk dada makcik kelmarin.air yang keluar dalam 700-900mls.kan before this,kaki and tangan makcik bengkak.so once the thing is done,tangan kaki makcik kecut.tapi bila diorang cabut,jadi bengkak balik."
tu yang aku pelik bila makcik cakap dah wat tapping.tapi bottle n maschine x de.rupanya wat sekali je.not continuous.
memang bengkak pun kaki n tangan makcik.tapi asal macam btambah je besarnya?hmmmm......CONFIRM PLEURAL EFFUSION MAKCIK X RESOLVED LAGI.
severe heart failure can cause edema of lungs (pulmonary edema, pleural effusions and peripheral edema.The hydrostatic pressure within blood vessels tends to cause water to filter out into the tissue leading to a difference in protein concentration
Read more: http://healthmad.com/conditions-and-diseases/effective-treatment-of-edema-oedema-with-furosamide/#ixzz1IfjYVzW9
regarding her infected AKA stump haritu,after for so may days dok dressing (cuci luka),so surgeon decided utk buat SECONDARY SUTURING.dah buat dah.
Tapi kali ni,bila aku yang transfered out makcik ke PP1 (wad PERUBATAN PEREMPUAN 1),aku ada RASA...i mean MOST PROBABLY LA,yang makcik AKAN STAY DI SANA.but still,aku takutkan satu benda sebenarnya.
alamak,MOOD DAH berubah..jadi DOWN AND HAMPA lak....
HISYYY...APA LAGI KALI NI,CIK AIN OIII???!!
"I AM AFRAID OF HER SACRAL PRESSURE SORE."
pressure sore means luka yang disebabkan oleh tekanan pada tilam di kulitnya.
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| this is sacral sore |
Ripple matress tu ialah sejenis device yang menyerupai tilam,dan disertai dengan satu mesin utk supply udara ke dalamnya (floatable).
so,mattress ni akan mengembung.bila nak pakai,we'll place it on top of tilam biasa kat katil.with this application method,it helps to reduce the pressure onto skin,and thus the risk of patients getting pressure sore can be reduced.
Duoderm Patch is a piece of thick patch which is light brown in colour.it has similar function of the skin.
so when we apply it onto the skin yang dah melecet,it'll protect and avoid the pressure sore from worsening.bukan apa,yang aku cakap AFRAID tadi tu,aku takut bila dia masuk medical wad PP1,takut pressure sore akan jadi lagi TERUK.aku dah X RISAU pasal AKA stump makcik.even though wad aku ni basically ortho case e.g :
- diabetic patients for ray's amputations (potong jari),major amputations (potong kaki/tangan)...nak potong kepala pun boleh...haha!
- various bone fractures due to home/vehicle accidents e.g tibia/fibula/pelvic/femur/shoulder/humerus/radius/ulnar etc.
- elective admissions for major operations of TOTAL HIP/KNEE REPLACEMENT
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| cellulitis |
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| necrotizing fasciatis |
This bacterial infection has the ability to destroy skin, fat, and connective tissues which cover the muscles. You get Necrotizing Fasciitis by coming in contact somebody or something which already has it. Usually, people with compromised immune systems or people with open wounds get the infection. It is unlikely to get it if you are a healthy, cut and bruise free individual. The disease is fatal in 30 - 40% of its victims.The bacterium which causes Necrotizing Fasciitis is a member of the same group of bacteria which cause toxic shock syndrome,and strep throat.Symptoms of the infection are usually normal flu like symptoms, and may include pain at a cut or bruise which seems more severe than would be expected from the appearance of the wound. Treatment must start a soon as possible for the best possible outcome, and treatment includes antibiotics, surgical removal of the infected skin, and a stay in the intensive care unit. Medications usually need to be administered for shock and other complication associated with the infection. WANNA SEE FEW MORE EERIE AND SCREAMING-LIKE PICTURES...????hehehe!!!
BUT see these first lahh...(^^,)v
OKAY,SOL (SCREAM OUT LOUD) !!!!
macam ni punye kes,kena suggest HSAJB bukak wad untuk pesakit kulit!
tapi,nak wat camner...bila cakap pasal kulit,understood already.memang dekat dengan BONE sebab anatominya begitu....kalau x de kulit,tulang dan otot akan infected akibat dijangkiti KUMAN surrounding kita.that's why Tuhan created the skin sbg THE FIRST PROTECTIVE LAYER/SHIELD AGAINST INFECTION.kalau you rasa musykil,go revise form 4 biology subject.aku pun ingat2 lupa.tapi aku ingat macam ni la...
aku takut kalau pressure makcik INFECTED.aku risau...48x risau.tapi aku leh wat early conclusions.MO aku mesti akan REFUSE PUNYE nak amik makcik ni masuk wad.biar MEDICAL HANDLE EVERYTHING.tapi aku x tau la assumption REFUSE tu leh PAKAI KE TAK.sebab MO aku yang 3-4 orang tu kenal makcik ni since mula2 admission.tapi aku x leh nak JAMIN bila tiba MO aku yang BAKI lagi 3-4 orang tu ONCALL,99-1%,BUKAN 50-50 lagi dah.99-1% MO yang saki baki tu AKAN ALLOW TO TRANSFER OUT TO ORTHO WARD
masa tu,aku dah TAK TAU NAK KATA APA LAGI.....
dah arr...i think i should STOP THIS HORRIBLE KIND OF THINKING.
SEKARANG BACK TO THE HARI INI DALAM SEJARAH~
setelah keadaan makcik yang almost DETERIORATED last week kemudian dah discharged ICU (Intensive Care Unit),
akhirnya......................................................................................................................................................
MAKCIK DAH DISCHARGED ORTHO AND TRANSFERED OUT TO WAD PERUBATAN PEREMPUAN (PP1).
lagipun,plan surgeon aku pagi tadi,DISCHARGE ORTHO AND FOR MEDICAL TO REVIEW~~~
so,bila staff pagi passed over report petang tadi,dia soh aku confirm balik dengan MO petang nanti masa diorang wat PM rounds.sebab anak perempuan makcik,ala...yang 1st daughter tu requested nak AOR (At Own Risk) discharge before MO datang rounds.Houseman aku yang Dr.T---ingat lg kan?....consult 1st daughter tu HABIS-HABISAN la agaknya....sampai mula2 tadi requested nak AOR discharge,alih2 X JADI.sebelum 1st daughter decided x jadi,dia ada bgtau aku yang dia dah x larat nak tengok makcik pindah-keluar-masuk wad..kalau APA2 PUN,baik dekat rumah je..tengok makcik pun dah lemah.
then aku tanya Dr.T,
"Doc,anak makcik s yang tadi tu cakap nak AOR discharge.so macamana?"
Dr.T jawab,
"x jadi.anak dia agreed utk proceed dengan plan kita.lagipun,i x sedap hati la...i takut kalau i bagi makcik AOR,takut dia akan MATI di rumah.ain,u tolong i k,i nak masuk CVL"
Aku x yah prepare set coz staff pagi dah prepared..so aku just add some more barang2 yang kureng....Dr.T insert CVL first time,x berjaya.2nd time,baru successful.then Dr.S...ni bukan S yang haritu...tu S lelaki.ni S perempuan.Dr.S siap2 dah isikan form untuk buat chest X-ray portable.aku tanye Dr.T,
"nak wat kat sini gak ke?"
then dia cakap,
"x yah,buat kat PP1 je."
Lepas dah baca 1st reading post insertion,aku pun prepare la sume dokumen yang nak di bawa masa transfer.and then dah siap sume,aku prepare patient lak especially NAK MENGANGKUT TONG OXYGEN.last2,sister soh sorang student ikut skali,just untuk tolong tarik troli dengan tong oxygen.kecik je tong tu.sebab stretcher ambulan x de kmudahan utk letakkan tong oxygen....NGOK NGEK ek.....kalau camtu,bek pkai stretcher wad aku je.LAGI BAGUS!
YA AMPUN......punya la hampir setengah jam dok waiting for ambulance to arrive....bila aku call for the 2nd time,baru la nak gerak...driver tu cakap,
"BARU NAK START ENJIN"
BULLSHIT la!dah called and booked ambulance since dari wad lagi!
masa call kat wad,soh anta cepat sebab driver yang aku spoken to tu cakap,
"kalau x anta skrg,kena tunggu la kul 7 mlm,sebab nak anta patient ke HSI ngn hosp.permai."
A'AH,BANYAK LA DIA PUNYA ANTA....okay fine,unit pengangkutan dah ANTA AMBULAN KAT LOBBY utk attendant aku amik stretcher.PATUTNYA TUNGGU LA SAMPAI KAMI SAMPAI DI LOBBY DENGAN PATIENT SKALI....ni TAK!sampai je aku,attendant dengan patient atas stretcher,tengok2 ambulan dah TAK DE.nasib baik dekat dengan bahagian daftar masuk..leh gak la nak call pengangkutan tanya APA CER..call skali,aku soh anta ambulan SEKARANG,sampai 15 minit pun TAK SAMPAI2.call 2nd time tu la,baru nak gerak....START ENJIN KATANYA...hmmmmmm!
ambulan dah datang and dah selamat transfered out makcik ke PP1.makcik dok katil 12.okay la...x yah pakai oxygen dengan tong.just guna WALL OXYGEN SUPPLY.lagi senang.kalau wad aku kena wat MANUALLY..kena TANG-TANG-TANG-TONGGGG!!!!
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| NI LA RUPA BENTUK TONG OXYGEN YANG HAMPIR SAMA DENGAN WAD AKU PUNYE....TAPI GAUGE YANG DISPLAYED KAT DALAM GAMBAR NI X SAMA. KURANG LEBIH,SAMA JE..HUHU |
just kidding..ketuk tong oxygen dulu,pasang sparepart dia,connect tubing and then baru supply oxygen ke patient.
ortho review PRN...PRN means BILA PERLU SAHAJA.
okay la,sampai di sini sahaja cerita I'VE NEVER FEEL FREE.harap makcik tabah dan kuat DITEMPAT BARU.mudah-mudahan kalau makcik dipanjangkan umur oleh TUHAN,makcik dapat pulang ke rumah.
AMEEN~~
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