Posted by medik-ukm on Friday, February 25, 2011
Introduce yourself
Confirm the patient's name and problem
Inform the patient that it is good to have her husband together during the discussion
Ask patient whether she knows about her condition, any preference in her option
Inform the patient of the options that she has:
vaginal delivery --> Trial of Scar
LSCS
Tell patient that we need to assess the patient condition first whether the condition is favourable for: any short stature -->CPD
pelvic cavity size
exclude placenta previa
exclude other contraindication
Explain that there is risk in every procedurerisk of scar dehiscence 0.5% (if use oxytocin 0.8%, if use prostaglandin 2.45%)--> Therefore need to deliver in tertiary hospital where OT ,NICU and blood bank available
we will monitor her...
Posted by medik-ukm on Friday, February 25, 2011
1. Introduction -To patient and verify patients identity -Include husband if husband is around 1. Ensure privacy 2. Explain current condition and indication -Pre-existing anaemia -Primary PPH -Post-partum Hb 6g/dL -She got symptomatic anaemia 3. Explain procedure - Cross match blood - Infection screening of blood product : HIV, HepB, HepC - Transfuse 2 pints of pack cells - Duration 6 hours/pint - Diuretic in between to prevent fluid overload - Repeat FBC after transfusion 4. Explain complication - acute transfusion reaction -blood-borne disease : HIV, HepB, HepC - ABO incompatibility -volume overload - need for further transfuse if Hb level not satisfy 5. If patient refuse??? - ask the reason why? -re-explain and convince the patient ...
Posted by medik-ukm on Friday, February 25, 2011
1. Introduction 2. Ask patient if she know what we will do 3. Explain indication -screening tool for cervical Ca -yearly for two years,if normal then three yearly - age 20-65 / once sexually active 4. Explain procedure - duration is about 5-10 minutes -no analgesia/ LA/ sedation given - patient will feel uncomfortable during the procedure -this is sterile procedure, wash hand,do aseptic technique, wear sterile gloves - in dorsal position with open leg - clean the perineum first with sterile water - do bimanual palpation to know the position of cervix - insert the Cusco speculum -visualize if there is any lesion or abnormality if vulva/vagina/cervix -use Ayre’s spatula to take sample - rotate the spatula 360⁰ -put the smear on the slide -make sure the...
Posted by medik-ukm on Friday, February 25, 2011
1. Introduction 2. Confirm the diagnosis 3. Tell the patient indication for the procedure – to remove retained POC 4. Explain the procedure - this is aseptic procedure - duration 15-30 minutes - NBM at least 6 hours before procedure (ask last meal) - give patient IV drip - anaesthetist will review patient before operation to choose mode of GA/ regional - done in operation theatre - in lithotomy position - clean and drape - bladder catheterization - vaginal examination to see os open/ close - bimanual examination to know uterus size and position of cervix - insert Sim’s speculum to visualize the cervix -Use vulsellum to grab anterior lip of cervix - insert uterine sound to measure length of uterocervical canal - if os is closed, dilate with Hegar dilator...
Posted by medik-ukm on Friday, February 25, 2011
· Failure to deliver the placenta within 30 minutes after delivery of the fetus · Management : - monitor vital sign -observe if there is sign of placental separation -continue massage uterus -if still no sign of separation , call MO -insert large bore IV access (16-18 gauge) -take blood and send for FBC & GXM -do catheterization - attempt control cord traction, if still failed, take verbal consent for MRP · Preparation: 1. Give IV antibiotic Flagyl 500mg stat and 400mg TDS + Ampicillin 1 gm stat and 500mg QID for 1 day 2. Ensure adequate analgesia ( GA, epidural ,spinal) 3. If patient already on epidural, procedure can be carried out in LR · Procedure: 1. Put patient in lithotomy position 2. Clean and drape 3....
Posted by medik-ukm on Friday, February 25, 2011
1. Explain to the patient wait and see - spontaneous conception can occur after – 1 year 85% 2 years 90 % 3 years 92-95%2. Lifestyle modification - no smoking - reduced alcohol consumption – female 1-2 units/week - male 2-3 units/week3. Avoid stressful condition - spacing sexual intercourse 2-3days to make sure increase sperm count and quality of sperm4. Advice husband - not taking hot bath or frequent sauna because this can reduced the sperm count - do not wear tight underwear -->wear boxer5. Advice wife on cleanliness and hygiene - if having vaginal...
Posted by medik-ukm on Thursday, February 24, 2011
1. Introduction 2. Explain indication - 3 scar -age more than 35 and completed family 3. Ask husband to join discussion if he is there 4. Ask patient what she knows regarding BTL 5. First of all, explain that this is permanent and irreversible procedure 6. If she understood and still want to proceed, continue to explain to her 7. If she did not agree,stop the discussion 8. Usually this procedure done together during LSCS, if done in daycare usually laparoscopic 9. Under GA/ CSE / epidural – anaest will review 10. Failure rate of BTL is 1 in 200 people (0.05%) 11. There is many type of BTL - pomeroy method -filshie clip/ hulka clip - ring -electocauterize 12. Advantage of doing this BTL -no compliance issues anymore for contraception...
Posted by medik-ukm on Thursday, February 24, 2011
1. Introduction 2. Explain indication - breech presentation -previous scar -placenta previa major -macrosomic baby -unstable lie -fibroid / cyst obstructing the lower segment 3. Explain on procedure - we will give admission form to admit to ward one day prior to operation - ELSCS at 38 weeks -fasting start at 12MN -blood taking for FBC and GXM 2 pints pack cells -also take consent for blood transfusion and hysterectomy in case anything happened -CBD will be inserted in the morning before operation -prophylaxis antibiotic will be given - operation done by epidural/ CSE – anaest will review before operation -duration 30-45 minutes - lower abdomen will be cut for 10cm, baby out, placenta out, sutured 4. Explain complication Early - anaesthetic complication...
Posted by FaDhLi on Tuesday, February 08, 2011
COMMON CAUSES OF CEREBELLAR SYNDROMESAcute (hours to days)Cerebellar infarcts (Wallenberg / PICA syndrome)Cerebellar hemorrhageEncephalitisPhenytoin toxicitySubacute (weeks to month)Alcohol abuseMetastasesParaneoplastic syndromesMultiple sclerosisChronic (months to years)Hereditary cerebellar degenaration (spinocerebellar ataxia)=================SHORTCASE=================UPPER LIMB (4)1. arms outstretched and eyes closed --> limb of affected side DRIFT AWAY2. arms outstretched, same level, quick push downward --> affected side REBOUND3. finger-nose test --> INTENTIONAL TREMOR + DYSMETRIA4. rapid alternating movement --> DYSDIADOCHOKINESIAHEAD (3)1. Eye --> HORIZONTAL NYSTAGMUS (> when look toward affected side)2. Speech --> SCANNING/STACCATO3. Head --> TITUBATIONTRUNK...
Posted by medik-ukm on Tuesday, February 08, 2011
MnemonicFALTERF - feverA - autonomic instabilityL - leucocytosisT - tremorE - elevated CPKR - rigiditymedical emergency!!!but rareand NOT an allergic reaction those who take HIGH POTENCY antipsychotic (eg: Haloperidol, Fluphenazine, Pimozide)How to manage? 1. DISCONTINUE treatment2. Supportive therapy3. Pharmocotherapy - Benzodiazepines - Bromocriptine - Dantrolene - Amantad...
Posted by FaDhLi on Tuesday, February 08, 2011
if 1 findings abnormal : probability having stroke >72%if 3 findings abnormal : probability having stroke >85%this scale usually use in prehospital setting.Once the diagnosis of stroke is suspected, time in the field must be minimized.The presence of a patient with acute stroke is a “load and go”.A more extensive examination or initiation of supportive therapies should be accomplished en route to the hospital.another similar name :FAST (facial, arm, speech test) p/s : doctor in emergency department apply this scale during patient's arrival to ED during my oncall shift in Red Box. So i think we can also use this scale to quickly assess probability...
Posted by FaDhLi on Monday, February 07, 2011
reversible causes associated with cardiac arrest6HHypoxiaHypovolemiaHypothermiaHypo/HyperglycemiaHypo/HyperkalemiaH2 (acidosis)5TTension pneumothoraxTamponade (cardiac tamponade)Thrombosis (pulmonary embolism / MI)TraumaTo...
Posted by FaDhLi on Friday, February 04, 2011
Seven Primary Masquerades (John Murthagh)1. Depression2. Diabetis Mellitus3. Drugs - iatrogenic - self abuse (alcohol, narcotics, nicotine, others)4. Anaemia5. Thyroid and other endocrine disorders - hyperthyroidism - hypothyroidism6. Spinal dysfunction7. Urinary Tract Infection (U...
Posted by FaDhLi on Wednesday, February 02, 2011
Score >7 = high suicide risk--------------------MANNED OSCE--------------------1. Have you attempted suicide?# A : No --> low risk# B : Yes --> higher risk2. Have you thought about dead?3. Have you thought about suicidal (suicidal ideation)? # No : lower risk# Yes : higher risk4. If yes to questions (3) :# what kind of thought?# method? (> serious/dangerous method, > higher risk)# how often you thought of it?# any specific plan?# have you told others about the plan?# have you actually ever attempted? (to reconfirm back with patient)# what stop you from attempt suicide? (protective factors)# have you make any suicidal note?# have...
Posted by FaDhLi on Wednesday, February 02, 2011
Keep diabetis under good control and do not smoke.Check your feet daily. Report any sores, infection, or unusual signs.Wash your feet daily.Use lukewarm water (beware of scalds)Dry thoroughly, especially between toessoften dry skin, especially around the heels, with ?lanolineapply methylated spirits between toes to help stop dampnessattend to toenails regularlyclip them straight crossdo not cut them deep into the corners or too short acrosswear clean cotton or wool socks daily; avoid socks with tight elastic topsexercise the feet each day to help the circulation in themavoid injury to the footwear good-fitting, comfortable leather shoesshoes must not be too tightdo not walk barefoot, especially ot of doorsdo not cut your own toenails if you have difficulty reaching them or have poor eyesightavoid...
Posted by medik-ukm on Tuesday, February 01, 2011
Causes of unilateral leg swelling:Vessel - Artery - acute limb ischemia Vein - Chronic venous insufficiency (varicose vein), DVT, post-phlebitic leg synd Lymph - lymphedema (non pitting)Bone - # , tibia osteomyelitisSoft tissue - swelling (post-trauma - knee sprain/injury, gastrocnemius muscle tear/haematoma, cruciate knee ligament tear)Skin - cellulitisTumor - osteosarcoma (compression of large veins by tumor)infection eg filariasisothers:necrotising fascitiscompartment syndRuptured baker's cystfind it easier to rmb based on the anatomical structure thr:)Hope it helps:)Posted by CP,feel free to comment if i am wrong and if thr's any additional info pls feel free to add:) ...
