NOTA MEDIK KITA

Be mindful. Peritoneal tap is not risk free. Sekarang ni pula kes saman banyak.

Semakin distended ascites semakin tak legit anatomical marking. Why? Sbb epigastric vessel distended along too

https://twitter.com/i/spaces/1eaKbaQXNQRxX

To compensate for the technical issues. Malam ni saya santai sharing di X

9.45pm 🙌

Sesi malam ni dibatalkan. Maaf 🙏🏻

Link will be shared shortly..

💿 INVESTING 101 MASTERCLASS 💿

Lama rasanya tak buat webinar.
Kalini saya cuba guide khas untuk kawan-kawan yang:

🤧pergi kelas saham dah 10x tapi takut juga nak mula
(risk aversed & analysis paralysis)

🥲Yang modal kecik
(Kurang RM10,000)
🫠 Busy tak cukup 24 jam sehari
🤕 Dah banyak melebur coba coba melabur sendiri
☠️ Dilema nak park modal dekat mana
👶🏻 Simpan di ASB/TH je

Link akan dikongsikan bila dah hampir dengan sesi nanti.
Buka kuorum kecil sahaja kot, santai santai.

See ya🤓

p/s: purely educational purpose. Please do not join if you expect buycall

Climbing mountain for a view? Not always worthy. That’s why you need to be very careful when setting goals and having aspirations.

You’re signing up for a suffering.
You’re signing up to climb a mountain.

Make sure you’re not climbing a mountain that doesn’t actually mean anything to you.

Or worse, climbing a mountain someone else told you to climb.

Effort without purpose is exhaustion.
Purpose without effort is delusion.

Sama mcm investment..
Data says 93% rugi dalam stock market.
90% dana unit amanah merugikan.
Averaging down on wrong funds, just deepening your capital loss. Sometimes all you need is a hand and a brain which is better than yourself.

Just like a wrong partner and wrong employer.
Forgiving them despite being abusive, is leaving you hurtful day by day. You need a counseller or close friend for a wake up call and leave that environment.

Selective perseverance is the key. Choose your battle ⚔️

Mesenteric ischemia ni organ threatening tau. Don’t ever miss it!

Amanah dan amanah bukan sekadar lelah.

Documentation matters 💪

Sometimes patients know what is best for them. Can also write

“I explained the risks, benefits, and alternatives of X. Patient declined X because (reason goes here) and had the decisional capacity to do so.”

Semalam ternampak dkt X orang upload video seorang ibu berbasikal ke arah ambulans sebab anak sawan.

Dah tiba masanya untuk kita gesa kerajaan mewujudkan cycle/bike emergency responder.

1.Lebih praktikal untuk hard terrains yang tak celuih ambulans nak masuk. Shopping mall, tanah estet

2.Lebih laju reach tempat kejadian dkt bandar.. dapat pulak driver selfish tak nak beri laluan. 1 minute delay can increase mortality

3. Ubat bantu hentikan sawan boleh diberi hanya beberapa saat melalui lubang dubur (suppository)

Time is LIFE

Especially dalam kes ni kalau sawan berpanjangan (status epilepticus) ada kemungkinan membawa maut sebab oxygen tak sampai. I know it’s sentimental but please be practical. The video saddens me. Kita sembang nak jadi negara maju. Kita sembang Forest city, data center.

Semalam juga 700 diberhentikan kerja ByteDance.

Negara boleh mula fikirkan untuk bantu sara mereka dengan tawar mereka as volunteer paramedic bike response. Give them a bike. Ramai sebenarnya nak bantu orang tapi tak cukup ilmu atau tak berani.

But our healthcare masih purba.
Gunalah ambulans kokak tu yang bergoyang masuk parit.

Pre hospital care is utmost priority especially yang jauh lebih 15 minit ke hospital. Treatment or stabilisation at least reach these people rather than transportation.

Kemudian ternampak statistik every day hampir 20 kematian kemalangan di Malaysia. It’s a silent pandemic. I wonder berapa % yang mati accident tu sebab bleeding lambat dikawal. Berapa % yang mati sebab pneumothorax.
Berapa % yang mati sebab burn dehydration.

Semua ni can be sorted if only we reach to the scene quicker.

I am hopeful to see this change to our healthcare

Channel photo updated

Reference: Rosen Emergency Medicine

harini nak share.. patient palestinian , 48, datang dgn loin to groin pain. Urine dipstick clear. My guts rasa x sedap hati. Sent him for CT KUB.

4mm multiple renal calculi.

Key takeaways
1. Blood in urine dipstick hanya seen in 85% cases. No blood in urine does not rule out renal calculi

2. ⁠Importantly, hematuria can represent injury at any level of the genitourinary system and does not localize to the kidneys.

Gynae protocol for HTF,

but applicable for other Hospital too as the principle of management is the same ✅

A very good read before starting HOship soon 😎

I’ll be migrating abroad next week.
I am letting go off my beloved books to help ease my living there.
Grab while it’s last!


Whatsapp: +60199993017

How to remember causes of pneumothorax? 🤔

- Mnemonic - I LIKE MY Birg SCARF 🧣
- Infection: TB, PCP, necrotising pneumonia 🦠
- LCH, Lung cancer🦀, LAM
- Infarction (pulmonary)
- Katamenial* pneumothorax
- Ehler Danlos
- Marfan
- Young, thin, slender 👦
- Birt Hogg Dube
- Smoking 🚬
- COPD
- Asthma
- Rupture (esophageal)
- Fibrosis - cystic fibrosis, ILD

*it is supposed to be spelled catamenial

https://www.emra.org/emresident/article/deep-dive-tpe/

PEAPETT study

SPARCL study

https://www.nejm.org/doi/full/10.1056/nejmoa061894

https://www.aliem.com/trick-trade-ultrasound-cord-peripheral-iv-access/

https://www.aliem.com/trick-of-trade-external-jugular/

https://www.aliem.com/trick-epistaxis-merocel-nasal-packing-angiocatheter/

https://www.aliem.com/trick-of-trade-speed-up-ecg-paper-rate/

https://www.aliem.com/trick-of-trade-winging-it-external-jugular-cannulation/

https://litfl.com/crochetage-sign-ecg-library/

Renungan doktor muda.

Bila hari-hari lihat berbagai penyakit. Barisan pesakit yg menunggu rawatan menjadi hanyalah himpunan outpatient card yg perlu diisi.

Perlahan-lahan kita jadi bebal dalam berempati.

Kita kata; "Alah, biasa je ni pakcik"

"Ok je result darah & xray"

Sedangkan sakit itu benar.

Untuk kita, mereka hanyalah satu dari beratus pesakit yg kita akan temui setiap hari.

Untuk mereka, kitalah antara doktor yg mereka beranikan diri untuk bertemu dengan pengharapan. Harapan untuk dptkan jawapan dan rawatan.

Untuk kita, ia hanyalah hari-hari biasa berkerja. Kematian. Tenat. Berdarah. Ataupun hanyalah merisik surat MC.

Untuk mereka, walau luka itu hanyalah terpotong sedikit kulit luar. Tetap baginya itulah paling kritikal pernah dirasainya.Tetap sakit itu benar. Walau org kata "alah tak ada apa-apa la ni"

Kita boleh terus dgn penilaian yg objektif dlm merawat pesakit. Kritikal. Semi kritikal. Tidak kritikal. Tetapi apabila berbicara dengan setiap mereka, laraskan bahasa dengan empati.

https://www.facebook.com/100001030165376/posts/pfbid04vVzAaWpBrSeQBT2FtwfJNe6KRFhaHttT8LrrKujbx4pUc6KLERrtPeUuXe3R8tzl/

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The ones that we clerk / examine / take blood / treat every day are somebody's loved ones — husband / wife / father / mother / daughter / son / grandchild / sibling / boyfriend / girlfriend / grandparent / relative etc.