Intrapartum management (during 1st stage of labour)- updated

🌟VenOMMS formula🌟

1. Plot partogram & T/O LR

[Ventilation]

[Oral intake]

2. Allow CF (clear fluids)
3. Insert large bore branula & start IVD NS/HM/Dextrose Saline; 125cc/hour

❗️In PIH patient; only 1cc/kg/hr (risk for APO), use only NS

❗️In Diabetic patients; if DXT less than 7mmol/litre, use D5% solution instead of NS

[Monitoring]

4. V/S monitoring hourly
✔️If PIH in crisis, every 15-30 mins
✔️add on GM monitoring in GDM patients

5. CTG monitoring (tracing on admission & post ARM), then to repeat accordingly based on risk factor

6. Time contraction; aim good contraction (4:10 in primid, 3:10 in multipara)

7. NRVE in ? hour (according to current V/E findings)

8. 1 to 1 care (if enough LR personnel)

9. Husband/companion to accompany during labour (not available during pandemic 😷 )

[Medication]

10. Analgesia if strong contraction

11. For Pitocin augmentation 1 or 2 hour post ARM if contraction inadequate ( <4:10 in primid, <3:10 in multipara)

12. DIK regime (for GDM patients)

[Special Order]

13. ARM (if membrane intact)

❗️local LR protocol varies

💊Analgesia options during labour 🌟

🕧during 1st stage;

✅Entonox (inhalation, need to educate patient properly about the technique) ⚠️ not available during COVID -19 pandemic as it is aerosol inducing.

✅Epidural analgesia or CSE (combine spinal epidural anaesthesia)

✅IM Pethidine 50/75/100mg (1mg/kg)
✅IM Nubain
✅IM Tramal

Non pharmacological measures;
-Aromatherapy
-Calming music
-Partner/companion during labour

🕒during 2nd stage;

✅ local anesthesia or pudendal block before episiotomy & instrumental delivery

Ada MOs dekat sini?

Jom start kumpul CPD points untuk 2024!

1st webinar by Salam EduMed & Jardin Pharma;

Practical Approach to Treatment of Atopic #Dermatitis

Register for FREE here;

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UPDATE ON EHO ❗️❗️❗️

So I clarified things yg bercanggah sblum ni , now below adalah yg confirm , staff kata ini adalah keputusan bahagian pengurusan latihan and everything comes from BPL

Saya call bahagian Bahagian Sumber Manusia KKM just now and reconfirmed everything , this is the FINAL saying and everyone should understand this.

1.System will be open in next week , what day? Dont know yet but she dare to say it is next week , so email from KKM will be in this week or even next week. CONFIRMED

2.PTM should be this 27 feb but since everything have delayed, PTM is confirm next month , even if it is fasting month , if they want to conduct it during fasting they will do it .but the best they want it before ramadhan

3.so lapor diri juga will be next month la after ptm, so got enough time to settle things

4.berkenaan bilangan calon akan di ambil this intake, before this they said kump calon dengan no urusan sm 20222074 is the last tapisan in first batch but they received new order now tapisan 29 nov not included for now means 2074 not included, no urusan below 2074 included thanks.



The best thing to do now is just wait,things are about to happpened next week.

The staff said, things can be change mengikut keputusan Badan Pengurusan Latihan,so yang tak included for now doa bnyak2 .

I can sense the staff is already annoyed by this issues , while she has no authority to take us all in , my advice is DONT CALL them again anytime from now on until next week .

❗️❗️❕

Pembetulan SM 20220274 and above not included

Sorry my bad

So most PROBABLE date of E-HO opening; 14 or 15th Feb,

(selalunya E-HO dibuka hari selasa atau rabu - selalunya, tak semestinya ya 🚨. Pernah jugak dibuka hari isnin atau Jumaat, tapi jarang sgt)

& most PROBABLE date for PTM;
13-15th March

(Usually PTM about 3-4 weeks after E-HO, never on Ramadhan or week with public holidays during the weekdays)

So this is just a guide for everyone, not necessarily will be true, but hope it helps 😇

I saw the news here that eHO is opening soon, Housemanship will not be easy in any hospital

However you will learn a lot. Please be proactive during your training. Think beyond just Houseman. Think like an MO.

"If I'm MO standing in front of this patient, how will I manage this case properly?" Then you will slowly progress.

Don't forget your dream too. Few of my friends had set their future early. By the time they finished Housemanship training, they have also completed part 2 MRCP.

Repost in conjunction with E-HO opening soon;

List of Guide on Choosing your hospital 🏥

▶️ 5 factors to #consider when choosing your hospital for HOship training

https://t.me/driliana9/3025


▶️ Banyak hospital #dekat2 dgn rumah saya, nak pilih yg mana satu?

https://t.me/driliana9/3043


▶️ #Hostel/quarters availability for each Hosp 🏥

https://t.me/driliana9/2816


▶️ Is it advisable to do HO at #Sabah/Sarawak?

https://www.facebook.com/100000012518463/posts/5154646941212339/?d=n


▶️ E-HO tips & live E-HO experience

https://t.me/driliana9/3030


▶️ #New hosp for HOship, ok ke?

https://t.me/driliana9/3033


▶️ I have specific #interest in certain field (surgery/O&G/psy etc), which hospital is the best for my HOship training?

https://t.me/driliana9/3038


▶️ #Penangguhan semasa E-HO;

https://t.me/driliana9/5053

👆🏻Yes. Ada yg call KKM last week & diberitahu 2nd intake will only be in May ie no HO intake in March 🚨🚨🚨

(Saya baru terima info ni semalam & since info ni diterima melalui phone call, saya tak pasti sama ada info ni boleh dipercayai atau tak - Dr Iliana, Wednesday, 25th January 2023)

Morning dr, just called PTM staff and they confirmed that PTM will be physical from 13/03 - 17/03🙏🏻

Info from one of med grads - Wednesday, 8th Feb 2023

So important date for HO intake bil 1/2023 will be as above 👆🏻

How to document physical examination findings in patient’s case note? 🧐

1st 👉🏻 General observation & vital signs (compulsory for all patients)