Thursday, February 13, 2014

GP Attachment in Newmarket Day 3

Assalamualaikum.


Hari ni dapat dengar crackles dekat seorang 5 months baby girl. Alololo cute gila budak ni, suka senyum pulak. Pipi tu rasa nak stretchkan je, HAHA. So, my GP kata, untuk baby, bila kita nak listen to their breathing, tekniknya kena guna bell of the stethoscope sebab bell untuk detect sound yang lebih low.




Next pagi ni, HAHA, asyik kena "buli" oleh GP untuk ambik reading blood pressure. So far so good. Kalau dulu-dulu, rasanya macam cuak and susah gila je nak ambik reading blood pressure, sebab merasakan telinga ni macam tak dapat tangkap bila entah first korotkoff sound and tak tahu bila korotkoff sound tu hilang. So, clinical skills ni semuanya the matter of practise je. Lagi banyak buat, lagi konfiden next time. The moment when GP said, that's perfectly correct, wallaweyh rasa macam dapat award pulak. HAHA. Poyoss. Ambik reading blood pressure je pong~


Kalau pergi klinik kat Malaysia, selalunya nurse yang akan panggil patient masuk bilik consultation kan. Kat GP aku, GP sendiri yang pergi panggil. Memang GP berjiwa patients. Oh ya, dah 3 hari kat sini, aku perasan kebanyakan patient lelaki, diorang semua jenis rangka besar kot. Semuanya tinggi and besarr. Memang baka-baka orang Kanturk ni macam tu kot. 


And then ada seorang makcik ni hari ni dia buat ECG, and then GP pun check dia radial pulse. So yeah memang pulse dia bila palpate irregularly irregular. GP pun ajar laa how to manage makcik ni. First, bagi B-Blocker untuk betulkan cardiac arrythmia dia. Second, check CHAD score dia untuk determine whether kita nak bagi makcik tu anticoagulant drug ke tak. 





So, bila check CHAD score makcik ni, more than 2. Hence, the third step is prescribe for warfarin. Kenapa bagi warfarin? Sebab warfarin ni anticoagulant. So? Sebab bila ada A.Fib, the blood tends to accumulate kat auricle of the atrium, so ada tendency for formation of thrombus and hence emboli and paling terus sekali can lead to embolic stroke. So, untuk prevent this sinister event to happen, kena plan betul-betul. Kalau sampai stage chronic, consider cardioversion and electric shock.


Okey itu cerita A. Fib. Kalau supraventricular tachycardia macamana nak manage? First, kita boleh tekan kat bahagian carotid artery sebab kat situ dekat dengan vagus nerve. So kiranya macam nak stimulate vagus nerve untuk enhance parasympathetic stimulation so boleh slow down heart rate. Takpun, kita jugak boleh suruh patient buat valsava manouvre yang akan increase vagal stimulation of the heart.


Next belajar pasal Upper Respiratory Tract Infection (URTI) and Lower Respiratory Tract Infection (LRTI). So briefly, URTI selalunya disebabkan oleh viral infection and disebabkan dia viral, sebab tu kadang-kadang doktor tak bagi pun antibiotic. Sebab antibiotic is for bacteria. Kalau LRTI, selalunya disebabkan oleh bacteria infection. So antibiotic yang commonly given is Amoxycillin.


What is amoxicillin?
Amoxicillin is a penicillin antibiotic. It fights bacteria in your body.
Amoxicillin is used to treat many different types of infections caused by bacteria, such as ear infections, bladder infections, pneumonia, gonorrhea, and E. coli or salmonella infection. Amoxicillin is also sometimes used together with another antibiotic called clarithromycin (Biaxin) to treat stomach ulcers caused by Helicobacter pylori infection. This combination is sometimes used with a stomach acid reducer called lansoprazole (Prevacid).


Kalau Amoxicillin doesnt work, then doctor might give Macrolide antibiotic.


Macrolides are a class of antibiotics found in streptomycetes. Macrolides bind to the 50S subunit of the bacterial ribosome and inhibit ribosomal translocation, leading to inhibition of bacterial protein synthesis. Their action is primarily bacteriostatic but may be bactericidal at high concentrations, or depending on the type of microorganism. Macrolides mainly affect gram-positive cocci and intracellular pathogens such as mycoplasma, chlamydia, legionella






So, that's all for today. Sekian, wassalam

2 comments:

Yasmin Yahaya said...

ko bagi ubat kat patient.
Aku skrg buat research nak cari new antibiotik untuk drug resistant.

Bagus betul. haha

Norain Ishak said...

Obes minye,,, hahah. Bagusss!