Coretan Hari Selasa
8 hours ago
I was scrolling my Quora and came across this question. It is an interesting question if we are trying to answer it from perspective of healthcare workers like me vs riders.
To be honest, I don't have motorcycle license and have no skill to ride it as well. Haha.
And after working in the hospital,
I WILL THINK TWICE BEFORE RIDING ANY MOTORCYCLES. T___T
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| https://www.quora.com/Why-do-people-not-wear-a-helmet-while-riding-a-motorcycle |
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**WARNING - THIS POST CONTAINS WOUND IMAGES**
Let me share with you a recent case I attended in the Emergency Department.
It was the morning of last day of Ramadhan, maybe around 4am. The patient was a 16-year-old boy, if I am not mistaken. He was referred from a klinik kesihatan that was 40km away, with the impression of: To Rule Out Skull Fracture.
Resources in Klinik Kesihatan can be limited, they can do chest xray, but not others. I've experienced a lot of referral to rule fractures from KK and to be honest, skills of doctors and medical assistants in KK are amazing. They are usually the primary team to stabilize patient in areas without hospital.
So, back to this case, he was brought in on a wheelchair, with lots of gauzes covering different parts of all four limbs. He could even walk from the wheelchair to the bed.
Usually, when we attend trauma cases, we use ATLS as guidance.
ATLS - advanced trauma life support.
The PDF itself is almost 500 pages! -_-'
Starting with A - airway + cervical
- Patient able to speak in full sentences, no gurgling or stridor, no foreign bodies in the mouth/ nose, not on cervical collar, range of movement of neck was full.
Proceed with B - breathing + ventilation
- Here, we usually use the acronym IPPA - which means Inspection, Percussion, Palpation, Auscultation
- I - breath spontaneous, not tachypneic, chest rise was equal bilaterally, no chest wound
- P - resonant percussion bilaterally
- P - no clavicle tenderness, no chest tenderness, chest spring negative, no subcutaneous emphysema / crepitus
- A - lung was clear, equal air entry
- Don't forget to check the oxygen saturation too (SpO2)
Then, C - circulation
- check other vital signs - blood pressure, pulse rate
- CCTVR - Color of skin, Capillary refill time (CRT), Temperature of extremities (is it warm/cold), pulse Volume, pulse Rate
- for this patient, it was all normal - pink, CRT <2s, warm peripheries, good pulse volume, pulse rate around 60-70.
- then, we checked the abdomen - soft, non tender, not distended, no abdominal wound.
After that, D - disability
- GCS was full E4 V5 M6, pupils 3mm/3mm equal reactive
Finally E - exposure / environment
- Here, we inspected the whole body from top to bottom, from front to the back.
- This boy has abrasion wound everywhere - shoulder, elbow, hand, shin, foot. But there was no swelling, no limb deformity, no limb tenderness, no limited range of joint movement (means, he can bend all joints normally) - so we don't expect any fractures here.
- There was no spinal tenderness / step deformity during log roll
- But the head was covered with bandage and we could see some blood stain. When we open the bandage, fuhhhhh there was jagged wound, quite big one! the skull was exposed. And there was no skin flap to cover back the skull.
- We gave him antibiotics and painkiller too.
- FAST scan done, no free fluid.
Something like this but smaller around 6cmx6cm size.
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| https://www.slideshare.net/vipinvenugopalnair/free-ld-flap-for-scalp-reconstruction-dr-vipin-v-nair |
Okayy, I know there are LOTS OF MEDICAL TERMS here haha. It is okayyyy, you don't have to understand everything. :D
To make it easy, generally we can say that this patient was stable clinically, vital signs was okay. Just, if there was no jagged wound on his scalp, he didn't even need to be referred to tertiary hospital.
Biasalah orang accident mesti akan calar balar sana-sini. Takde patah, kira alhamdulillah sangat dah. Tapi untuk dia ni, kulit kepala dah terbukak, tengkorak terdedah camtu. Nak jahit kulit kepala pun tak boleh.
We managed to request CT brain in view of the wound was big and skull was exposed - just to rule out any skull fracture or any possible bleeding in the brain (ICB - intracranial bleeding).
Alhamdulillah, turned out CT brain was okay - no ICB, no skull fracture.
So, what we did for his jagged wound - we referred him to Surgical Team so that they can refer the patient to Plastic Team. In big hospital, you can see lots of sub-specialty for Surgery - neurosurgery, plastic surgery, ear-nose-throat, hepatobiliary team etc. But, we don't have such sub-specialties here. There nearest one for that is HRPBI - Hospital Ipoh.
If the wound was a simple laceration like the one below, usually we can suture it ourselves..
| https://www.medicalimages.com/stock-photo-image-image9257585.html |
I feel sad for his father, he looked very tired and when the surgical team informed him that the patient will be transferred to Ipoh, we could see his 'pasrah' face. I believe the importance of parenting, but kids nowadays can be beyond control.
This is one kind of accident that actually can be avoided.
Why?
The boy is underage, without licence, without helmet, went out riding motorcycle with his friends around 12am, speed at least 80km/hour and the mechanism of accident was as I expected - he said "kawan main motor himpit-himpit, saya tak boleh control motor tu yang terbabas"
Rasa sedih bila jumpa kes macam ni.
And there were countless cases like this EVERY SINGLE DAY.
So, if you guys or your family members are motorcycle riders, do remind each other kay.
Always wear helmet.
200530
SM, Perak, Malaysia
Day 10 of May Photo Challenge - Self Care
I Miss...
May 15, 2020
I miss travelling actually, walking around the airport to catch flights.
I miss sitting by the window and watch the beautiful scenery from the top.
I miss the feeling to pass the security control and to have another stamp on my passport.
:)
I was actually planning to have a trip back to Czech after completing my housemanship hehe :D. Usually, after housemanship, we are allowed to use the remaining annual leaves and take a long holiday up to 27 days (if I am not mistaken). But my husband was still working at that time, so I decided to wait for him first to go later together. I went to the office to inform that I would be starting my floating (junior medical officer) soon.
Due to Covid19 outbreak, my friends who decided to take that long holidays were called to start working and our leaves were apparently have been frozen since March.
Ouch.
And I think travelling abroad is going to be tricky after this pandemic, right?
Maybe travelers need to provide supporting documents, health reports - new norms maybe?
Day 9 of May Photo A Day - I Miss...
SM, Perak, Malaysia
200515
The Sky
May 12, 2020
Sunrise from the hospital, to be exact - the Emergency Department. :D
I think this one was taken on my post-night shift around 7am plus.
Sunrise.
Means it is another day.
Another opportunity. Another chance.
For?
Being a better person.
I always wonder, how did I survived housemanship the past 2 years. To be honest, I believe most housemen will have the thought of quitting, but due to every own reasons, most of them survived and still surviving. It was a tough journey. Hanis Amanina who you are seeing now is a lot different than who she was in Czech or before that. Hehe :D
Go with the flow.
Sometimes, I cannot deny that the HOship hurt my heart and feeling a lot. I believe it affects my personality, my attitude and my knowledge. Learning as a medical student is not the same as being a doctor itself. The responsibilities I need to carry every time I do something to the patients, always overwhelm me. Still.
But at the same time, honestly it gave me happiness as well - able to manage patients correctly, able to see patients getting healthy, surrounded with good and helpful colleagues, have the opportunity to say the first Assalamualaikum to newborns. MashaAllah, the feeling was AMAZINGGGG and I will never forget that! :)
I believe the key is not to give up.
Recently I read the The Art of Letting God, at the very first chapter, it shared about the greatest temptation. I agree that the greatest temptation to deal with is the temptation to give up.
"Are these goals truly achievable? Am I being realistic? Am I good enough? Am I worthy of such achievements? Or is it simple better for me to just give up?"
In the book, it mentioned about dealing with it is by asking help from Allah. When we looked back the story of Prophet Moses (peace be upon him), despite only asking for ease, he also asked for strength, wisdom, patience, ability and support.
I have shared a post about DOA PENERANG HATI when I was still a medical student. At that time, I was having difficulties adapting with Czech's exam system where almost all exams were done orally. T_T It was a struggle to speak medical stuffs or answer medical questions confidently in the exam because once you said something wrong, the examiner will directly know you are lacking something there and suddenly he will go deeper on something that you are not confident with.
But Alhamdulillah, that phase has passed. :)
Housemanship tooooo :)
Alhamdulillah alhamdulillah.
Anyway, still remember my collections of sky over 2014? Can't believe 6 years have passed. WOWWW. MashAllah :)
Day 8 of May Photo A Day - The Sky
SM, Perak, Malaysia
200512
I am not sure if you can find people talking about this movie on your Facebook
timeline, but it happened to mine. I was a bit hesitated to watch at first but
subhanAllah it was definitely a great movie to be appreciated! :)
It is actually a Turkish movie and I have no experience watching any before.
Synopsis:
The story played around the Korean War eras which was between 1950-1953,
where United Nations came to help South Korea from being attacked by North
Korea. One of the countries that send a lot of soldiers was Turkey. A
Turkish brigade was sent there, one of the soldiers was Sergeant Süleyman.
While Ayla was a 5 year old Korean girl, lost her parents when their village
was bombed. The name Ayla was given after she was saved by Süleyman from a
frozen night in the moonlight. Two of them developed deep connection as
father-daughter, where Ayla could be seen around Süleyman almost every time
and everywhere. They were together for almost 1.5 years.
Upon completing his task in South Korea, finally it was time for Süleyman to
return to Turkey and he found it difficult to leave Ayla. They were attached
to each other. Süleyman tried to leave Ayla at Ankara School but ended up
trying to bring Ayla back to Turkey in his suitcase - his mission failed.
Süleyman had to leave Ayla alone. Upon arrival to Turkey, he tried his best
to get in touch with the school but the communication was disaster because
of the war. Both of them reunited after almost 60 years. T__T
This is a real-life story where we can watch the documentary Kore Ayla on
MBC in 2010.
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| Sweet! |
2. War Ethics
Ayla was found in the sea of dead bodies.
"Cowards! They slaughtered everyone, even the children."
Somehow, I suddenly recalled the war ethics of Rasulullah - one of them is
don't kill a woman / a child. Ayla witnessed her parents died and refused to
talk, maybe she was traumatized. Süleyman didn't want to leave her anywhere,
he ended up taking her to the base.
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| The very first time Ayla met Süleyman |
After failed his attempt to bring Ayla onto the ship back to
Turkey, Suleyman accepted the fact that he need to return alone. He promised
himself and Ayla that he will return to meet her.
The scene was heart breaking T_T
Can you imagine a small kid who had lost both parents in front of her eyes,
now need to be apart with the one she loved as a father? T_T
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The ending T___T |
I know that we are now in PKPB where almost all local roadblocks have been
lifted. I think there are some at the districts' borders, no idea actually as I
haven't try crossing the district yet.
Lots of time, the scenario was like this:
During the PKPD, I need to pass through 2 roadblocks between my house and the
hospital. It was supposed to be 8 minutes journey, but with roadblocks, I need
to leave the house at least 15 minutes earlier. Less cars actually at the
beginning and the middle of PKPD, but fuhhh the traffic was torturing towards
the end of it, especially when we were entering the PKPB.
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Kad Petugas Kesihatan |
Similar to other health care workers, I received my own card too. Just
sharing this here so that I can read this later. Still not fancy much to
share life journey on Facebook. And I still prefer the blog to elaborate my
stories and experiences than on Instagram.
Police / army: Assalamualaikum Cik/Puan. Nak pergi mana ni?Me: Nak pergi kerja encik.Police / army: Oh, kerja mana?Me: Kat hospital.Me: *I can see they suddenly took a glimpse on the front screen*Police / army: Ohhh, maaf Cik/Puan, tak perasan kad ni. Okay, boleh jalan, lambat pulak sampai nanti.Me: No problem. Terima kasih Encik.
I am not sure if the card is small to be seen, or maybe I put too deep between
the dashboard and the screen so it could be hard to be seen. Haha
But, never mind as the questioning did not take too much time every time I
mentioned about the hospital.
To make it even easier was by hanging my stethoscope around the rear-view
mirror.
Honestly, I think they have a challenging task to check every cars. I felt so
bad seeing them standing in the middle of the road under hot sun, even on
rainy days too. T_T
Police / army: Ohh doktor kee? Boleh check kami tak? *sambil gelak-gelak*
Haha, here I knew they were already tired. You know, sometimes, you can see a
tired face trying to say something funny to cheer themselves. :)
Me: Bolehhhh, nanti saya inject sekali. Nak saya cucuk kat mana?Police / army: *sambung gelak*
Thank you to all frontliners.
Now, everyone need to take care of our own.
- Always think twice before leaving the house especially if we don't have solid reasons.
- Always wear face masks outside especially if we are dealing with people
- Always wash our hands / use sanitizers
- Keep 1 meter distance with each other - social distancing.
- Avoid 3C - closed conversation, confined space, crowded place.
Day 7 of May Photo A Day - A Throwback
SM, Perak, Malaysia
200511
I Made This PPE :)
May 10, 2020
On last Wesak day, I had this opportunity to learn and watch the staff nurses making our own Personal Protective Equipment (PPE) in our observation ward, this ward was closed due to rearrangement of our Emergency Department into Respiratory area & Non-Respiratory area and has become our 'store' and staff area.
- Respiratory area - attending patients with any complaints of SARI (severe acute respiratory infection) symptoms like fever / shortness of breath / cough / runny nose / sore throat / any history of Covid contact. Sometimes, the patients may come with other main complaints like infected wound over foot but just because he/she have any of these SARI symptoms, the patient will be attended in Respiratory area.
- Non-Respiratory area - attending patient with any complaints without SARI symptoms
Me: kak, nak try buat satu bolehh?
SN: haa, nah try jahit bahagian lengan ni dulu.
At first I just need to sew the stretchy area over the end of the sleeves. Then, slowly and patiently, Kak Daini & Kak Atun taught me how to sew the whole PPE. Since I have no skills of using the sewing machine, my product was not that neat. Terlebih sana, terkurang ni. Hahaha. Nasib baik laa PPE ni pakai buang. If you compared to their products, fuhh, dah macam baju raya, kemas sangat!
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| My first PPE everrrr. |
Honestly I only have the most basic skill for sewing, which means, I can only do hand sew like picture attached below.
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| Source - https://www.apartmenttherapy.com/how-to-sew-basic-stitches-221433 |
Though my mum is literally good in this, I guess I don't inherited the skill haha. For every Eid celebration, my mum will usually send some plain cloth to her favourite tailor and then she will make her own decoration on the dress with all those beads, labuci etc. For mine, my mum will 'encourage+force' me to the same so that I can survive with hand sew haha.
But, my skills of using the sewing machine - NIL
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After completed one and a half of PPE suit, we heard the bell informing there were new cases in the respiratory area. So, that marks the end of my PPE sewing journey. Lol, when I returned to the sewing area later, seems like they already finished sewing. :D
It was honestly a nice experience.
Thank you akak-akak sabar mengajar!
p/s - my mother-in-law has awesome sewing skill too! :D
Day 6 of May Photo A Day - I Made This
SM, Perak, Malaysia
200510
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