Dr Iliana9

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Download Ampang HO guide for FREE here; https://t.me/nota_perubatan/164

🤰Intrapartum management
(during 1st stage of labour)

🌟according to VenOMMS 🌟


1️⃣ Plot #partogram & T/O LR

[Ventilation]


[Oral intake] 🔽🔽🔽

2️⃣ Allow sips of CF (clear fluids)

3️⃣ 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] 🔽🔽🔽

4️⃣ V/S monitoring hourly

✔️If PIH in crisis, every 15-30 mins
✔️add on GM monitoring in GDM patients


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

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

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

8️⃣ 1 to 1 care (if enough LR personnel)

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


[Medication] 🔽🔽🔽

🔟 #Analgesia if strong contraction

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

1️⃣2️⃣ DIK regime (for GDM patients)


[Special Order] 🔽🔽🔽

1️⃣3️⃣ Amniotomy ie #ARM (if membrane intact)

Source;  ❤️ Medicorp’s O&G #online course❗️local LR protocol varies

So today we'll focus on management of 1st stage of labour ie intrapartum management;

All these plan are HO #responsibilities at PAC, antenatal wards & LR (labour room)

⬆️ Normal labour & #management of each stages

Ref; Kedah O&G protocol

Let's start our #revision on common topics in Obstetrics 🤱

‼️ Stages of Labour,
& definition of each stages

Wajib hafal ‼️

Compulsory #cases ie topics that HO need to know in O&G posting.
.

As medical grads waiting for HOship, focus on the 🟣 highlighted topics as your #preparation for O&G posting soon ‼️
.

You can refer each topic in any of the O&G #protocols earlier 😉

Get HO #logbook_compilations here to get to know #compulsory procedures & topics for other postings as HO;

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

https://t.me/driliana9/6552

Compulsory #procedures for HOs in O&G posting - based on KKM logbook‼️
.

We will practice most of the compulsory performed procedures (highlighted 🟣) at Clinical Skills #workshop by Medicorp.

Register here for the workshop ✅

InsyaAllah minggu ni kita akan revise important #topics in Obstetrics that HO need to know ✅

Stay tuned & turn on #notifications for this channel now ‼️

🔼 few O&G #protocols you can download for FREE 🆓

Kalau dah start HOs, boleh download/ask from seniors HOs your own state/dept punya O&G protocol.

Kalau masih menunggu HO posting, saya recommend focus baca Kedah state protocol (sbb very concise & HO friendly).

Siap ada color2 & very neat, so boleh print & baca semua common topics according to O&G HO logbooks sementara tgg masuk HO ni ❤️

Kedah O&G protocol

Sabah O&G protocol

But we recommend you to join #early after graduation, as you can join again FOC later as facilitator just before you start #tagging 😇

Why just join & practice once,
If you can attend twice & FREE for the second time? 😎

More session available for those expecting 1st HO intake in 2025;

✅ E-HO opening 20th January,
✅ PTM 3-7th March

(Next session will be in April for those expecting 2nd HO intake)

🔼 A concise video on conducting SVD (spontaneous vaginal delivery) - how we do it in Malaysian hospital setting😇
.

Must know for all HOs,
sebab klu nak OFFTAG in O&G kena conduct at least 5 SVD ⚠️
.

Let's practice together at Clinical Skills #workshop Medicorp;

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

"HO kena tahu conduct delivery ke?"

Iya, nak offtag di O&G patutnya kena tahu;

✅ Clerk patients & pink 🩷 book (include CTG interpretation, plot #partogram, blood taking, branula insertion)
.

✅ #Present ie discuss new cases from PAC with MO

✅ Do transfer in #review when patient arrive to LR, update LR board,

Then subsequently do NRVE as needed - update partogram & inform MO if ada issues or EMLSCS is indicated


✅ Present cases to #specialist during LR review
.

✅ Assist & conduct deliveries, including performing #episiotomy & the repair as indicated
.

✅ Review & assess post partum mother, do new born examination - include #referral to Paeds team when necessary
.

Yg expecting HO intake soon, dah ready nak buat semua ni waktu #tagging nanti? 🤔

Shortlist of common disease & #emergencies you need to as HO;


👉🏻 All posting (esp medicine, surgical & ortho)

- hypertensive urgency & emergency
- hyper & hypoglycaemia
- hyper & hypokalaemia
- fluid resuscitation in unstable/patient with shock


💉💊 medicine; AEBA (asthma), COPD, dengue, ACS


✂️ surgery; acute abdomen (appendicitis, choledocholithiasis, PGU),  sepsis, UGIB, LGIB


🦴🦴 ortho; open fracture, DFU, fat embolism, compartment sindrom


🤰 O&G; intarpartum management & complications (1st, 2nd & 3rd phase of labour), GDM, PIH


👧🏻👦🏻 gen paeds; AEBA, dengue, AGE, febrile fit


👶👶🏼 neonatology; NNJ, neonatal sepsis, IDM & hypoglycaemia, respiratory distress in newborn


#Reference; 📚any book you already have, yang penting baca 😂

Must know #normal values for HOs;

🔼 [FBC - Full Blood Count 🩸 ]

WBC - white blood cell
Hb - Hemoglobin
HCT - haematocrit
PLT - platelet

🔽 [RP - renal profile]
Aka [BUSE - blood urea serum electrolytes]

Urea, Creat, Na+, K+

🔽 [LFT - liver function test]

Alb - albumin
Bil - bilirubin
ALP - alkaline phosphatase
ALT - alanine transaminase

Kenapa HO kena #hafal normal value?

Cause the reference range is only available in the computer system & if you get the printed copy as above.

But as a HO, we will usually copy the result into flow chart or patient BHT - so when you review case/ie see the BHT alone - you won’t know whether the result is normal or NOT, unless you remember the normal value ie the reference range ⚠️
.

Ini list lab values yg HO wajib tahu sebelum start #tagging dalam wad 🔼

🔼 A concise video on conducting SVD (spontaneous vaginal delivery) - how we do it in Malaysian hospital setting😇

Must know for all HOs,
sebab klu nak OFFTAG in O&G kena conduct 5-10 SVD ⚠️

InsyaAllah nanti saya share few O&G protocols pula ❤️

Mentorship Revision for #final HO intake Bil 6/2024 has just started 💪

For O&G, your offtag requirement will usually cover the department’s CPP as well (see yellow arrow).

Great news; we cover all these during the Clinical Skills #workshop 👍🏻

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

10 general clinical #procedures for all posting;

These are part of your #offtag requirement & assessment 😇

Blood C&S (culture & sensitivity) or blood taking in aseptic ie sterile technique.

This in 1 out of 10 general compulsory procedures for HOs;

that you need to be competent in doing in before you can #offtag in any posting.

Attention to all HOs included in #final HO Intake Bil 6/2024, if you wish to;

👉 get access to senior HOs WA #group of your hosp

👉 join FREE online Mentorship revision with Dr Iliana,
.

Register for #free here;
https://medicorp.onpay.my/order/form/mentorshiprevision0924


& join live Mentorship revision #briefing on Friday, 13th Sept at 9.15 PM 😇

How to read ie interprete CT 🧠 brain?

“Dr saya nak tanya apa tugas HO dalam #OT (operation theatre)? Contohnya, apa yg HO boleh buat utk assist #LSCS?”

Learn what you need to know in this FREE online course;

https://medicorp-class.teachable.com/courses/ho-role-in-ot-0822

👉🏻 HO role in assisting surgery; what to do before, during & after surgery?

👉🏻 common mistakes to avoid while assisting operation

👉🏻 Modified ISBAR formula to book case for operation from anaest team (with practice)

All the best 💪🏻

All these modules are very #important for your surgical based posting;

✅ Obs & Gynae
✅ Orthopaedic
✅ Surgery

Please go through the modules now, & revise again later during your #preTAG before each surgical-based posting 👌🏻

Just graduated?

Already choose your hosp via E-HO?

Finishing your current posting & will transfer out to new department soon?


But unsure what to #expect & prepare for the next posting, or HOship as general?


Enroll for #Departmental Welcoming session NOW at Medicorp’s Teachable school; https://medicorp-class.teachable.com

You will learn;

✅ HO role in each posting,

✅ must-know #diseases for each posting; the common cases & #emergencies

✅ few case discussions as kickstart #revision for each posting!
.

It’s FREE with unlimited access so that you can learn whenever you want!

Dahulu semasa masih houseman, saya anggap bila kita dapat intubate dengan baik, kita telah dikira berjaya menyelamatkan pesakit.

Rupanya tidak.

Tidak cukup sekadar berjaya memasukkan ETT ke glottis.

Seni resuscitasi semasa peri-intubation (pre, during & post) itulah sebenarnya yang perlu diberi lebih perhatian.

Apabila anda dapat stabilkan pesakit sebaiknya untuk prosedur intubation dan dapat mengekalkan kestabilan patient's hemodynamic post intubation, barulah boleh dianggap intubation itu berjaya.

Nak fahami apa yang kita maksudkan resus sequence intubation? Nah, https://m.facebook.com/story.php?story_fbid=7089168847794050&id=100001030165376&mibextid=Nif5oz

Kredit to Dr Ilman Razak, Master trainee in Emergency Medicine

Let’s learn all these at #online ⚡️Flash HO Induction this Friday😇

Register for FREE here;
https://medicorp.onpay.my/order/form/flashinduction0724