✅Attend patient STAT.
✅ to look for DDX/life threatening condition. E.g. ACS, PE, pneumothorax, aortic dissection, acute HF, cardiac arrest

✅ assess the patient's well-being and look at the vital signs to ensure whether the patient is stable or not, conscious or not. Vital signs (BP, PR, RR, T, pain score)

In concious patient:
✅ proceed asking further history (SOCRATES) about the chest pain. And apply ECG.

Socrates:
Site: central, retrosternal pain

Onset: sudden or progressive. Any previous episode of chest pain?

Character: pressing, squeezing, heaviness, tearing pain

Radiation: to the left arm, jaws

Associated sx: profuse sweating, palpitation, NnV, dyspnoea, syncope, calf pain

Time

Exacerbating/releaving factors: exertional pain, worsen upon lying/respiration. Relieved by leaning forward, rest

Score: pain score


✅ quick physical examination
🫀 cardiovascular examination
-CABG scar, implantable defibrillator
- auscultation: murmur, gallop rhythm
- look for signs of HF

🫁 lung examination
- breath sounds ( absent/reduced: pneumothorax), additional lung sounds ( crep, rhonchi)

Abdomen: AAA

✅ IX
📌 ECG stat ( identify STEMI, any cardiac causes)
📌 take cardiac biomarkers (troponin, CKMB) if suggestive of ACS
📌 order CXR if we suspect lung causes

✅Mx
📌secure ABC
AIRWAY & BREATHING: give O2 supplimentation if spo2 <95%
CIRCULATION : blood ix as above and trace. Must have IV access.

📌 Medications:
- if STEMI s/l GTN 0.5mg STAT, if pain not resolve repeat up to 3x. Can give if SBP >90mmHg, inferior MI and aortic dissection have been excluded. Aspirin and clopidogrel STAT.
- if fluid overload ( sign and sx of congested) give frusemide

If pneumothorax, call for help. Ready with equipment. If tension pneumothorax( needle thoracocentesis - temporary measure, chest tube-definitive)


However, I need to call MO and discuss mx before executing the plans.

If unconscious pt:
- check pulse and breathing if absent call for help and start ACLS.
-Identify either it is a shockable rhythm or unshockable rhythm
-if shockable ( VF/pVT)
- non shockable (asystole/PEA)

Shockable rhythm ▶️ give shock ▶️ CPR 2 min (+ IV access) ▶️ still shockable rhythm give shock ▶️ CPR 2 min, epinephrine every alternate cycle ▶️ still shockable rhythm, give shock ▶️ CPR 2 min, amiodarone, treat reversible cause

Non shockable rhythm ▶️ CPR 2 min, epinephrine every alternate cycle ▶️ still non shockable rhythm, CPR 2 min. If shockable ▶️ follow shockable rhythm algorithm

#Department mana bagus utk 1st poster HO? 🤔

#wiseseniorHOadvise

#Tagging usually for the first posting is 14 days (2 out of the 14 days is your offday),

but it will vary with manpower required and if the superiors find us safe and independent to #offtag, it will be earlier.


Tips to #survive tagging,

👉🏻 always volunteer to do something (with supervision is even better) to learn faster like admission clerking, discharge, blood taking, branula, referrals, imaging requests, procedures etc


👉🏻 ask if you are not sure/dont know,


👉🏻 bring smol snacks if it helps and please drink some water from the pantry of each ward, ada cuckoo/coway usually, pls do grab a cup and have a drink at least🙏,


👉🏻 try to learn to #prioritise which is urgent and stat. For Muslims, work in a way that we will always try to be able to solat on time regardless of the workload.


Usually, first posting tagging, tak rasa sangat, cause banyak nak belajar, tgk2 dah habis dah the tagging 😂, 2nd posting onwards, duration will vary with different posting.


Division will be done by the team leader (TL) of the posting. Each posting will have different ways of working, for further details boleh tanya your TL when you know your posting nanti.


All the best 😊


#wiseseniorHOadvise

Satu HO jaga berapa patients? 👨‍⚕️

#wiseseniorHOadvise

Tips utk senang / kenal case 👩‍⚕️👨‍⚕️

- jaga same cubicle for 1 week or more ( jgn tukar cubicle daily)
- so bila dh jaga same cubicle for one week or more, usually first day je akn bit difficult sbb nk faham kan semua case dkt cubicle tu kan.
- tp usually by next day tu dh bole tau case ape, so bila round dgn pakar bole trus bgtau progress patient.

👉🏻 tips amik daily blood dkt medical 💉🩸

> mlm before balik rumah siap2 isi borang patient, ltk dlm plastic specimen sekali dgn botol yg kite nk guna ( tp jgn label botol dulu)

> besok pagi2 masa amik drh patient, tnye nama patient make sure tally dgn borang dan masa tu bru amik drh dan label botol ( make sure semua bedside)

Lebih mudah mcm ni, kire mcm kite buat blood taking kit for every patient. More easier dan lebih pantas.

😇 Another tips for better ward round with pakar

- always ask yourself why this patient cannot be discharge yet?

> any pending op ke, pending blood ix ke, pending social issue ke, any recent infection ke.

- so by mcm ni baru kite tau reason pt tu still kt ward. Kenapa pt still x bole discharge. That is the current issue.

"I had to spell the #antibiotic name for them during rounds" 😒


Read more here;

https://m.facebook.com/story.php?story_fbid=2147735758570154&id=100000012518463&sfnsn=mo&mibextid=6aamW6

Final session for workshops in March ❤️

#clinical_skills 💉🩸
#episiotomy_repair&suturing ✂️

(No session in Ramadhan, we will resume in mid May- hopefully before the next PTM 😇)


So join #early if you are expecting next HO intake in May- you can rejoin again FOC as facilitator later 😇

FREE suturing kit (worth RM 129) when you join #episiotomy_repair workshop! ✂️


So you can #practice more & brush up your surgical #skills at home after the workshop ❤️


Register #now here;

https://medicorp.onpay.my/order/form/clinicalskill_suturingworkshop

‼️ Limited seats available ‼️

HO logbooks for each department.

#Pandemic version.
Download here; https://t.me/driliana9/4280

#Normal version (will be used again once pandemic ends- these version are more comprehensive)

Download from the list down here;