Author: myhouseman
Branula Insertion
“Can we remove this branula?” — One of the favourite questions during ward round Types of Branula • Large bore branula = green / grey Common Sites / Veins Equipment Branula 14 G + image16 G + image Steps Branula Insertion in Paeds
Clerking Patients in ED
Important Considerations Population / Age Group Pay more attention to these patients (who are generally more vulnerable):• Children• Elderly (>65 years old) • Pregnant women Patient’s condition on arrival • Came by himself? Brought by car? Brought by ambulance? • Upon arrival, patient was walking? On wheelchair? On stretcher? Timing • Why patient comes to […]
Fall
Introduction • Elderly tends to present ‘fall’ as a consequence of underlying etiology, while healthy and younger age group tend to present with fall/trauma first as the etiology which may later be complicated by stroke e.g. due to intracranial bleed (ICB) Age group Etiology Consequence Younger age group Fall / Trauma Stroke Elderly Stroke Fall […]
Patient Presentation “My father suddenly became aggressive and talking bad words since this morning”“Since discharge from Hospital X yesterday, my wife became more quite and answered incoherently” History Taking Relevant History • Any history of fall? • Any ?• Any weakness / slurred speech / facial asymmetry• Any Investigations Laboratory investigations • Full blood count […]
Approach To Trauma
Background • Premorbid ADL status• • Occupation• • Staying with who? • How patient came? Brought by ambulance? Came alone? Trauma details • Date & time of trauma• Witness• How trauma occurred?• • Was patient under alcohol or illicit drug influence? Motor-vehicle accident• Type of vehicle • Patient was the driver / passenger / rider […]
One Stop Crisis Centre (OSCC)
Introduction • A service provided at all government general hospitals in Malaysia which caters to all cases pertaining to , and exploitation of adults and children Important Points Different approach • Triage counter: victim should be brought to a room with privacy without further history taking at the triaging counter• Soft spoken & rapport building […]
Rib Fracture
Presentation • Patient presented to ED post trauma History Taking Chest pain • Site: at the site of rib fracture post trauma• Onset: post trauma • Severity: pain score Relevant history • Is patient a smoker? Physical Examination • Is patient tachypnoeic? • Chest spring positive at rib fracture site Investigations Blood • ABG Imaging […]
Glasgow Coma Scale (GCS)
Scoring Notes • How to document GCS during daily review?3 separate components documented separately, then total upExample: E4 V 3 M4 (11/15) • SeverityGCS 13 – 15:: mild brain injuryGCS 9 – 12: moderate brain injuryGCS 3 – 8: severe brain injury (impending coma) • GCS <8, especially in trauma, is an indication for intubation […]
Chest X-Rays
Introduction • 12 ribs • Anterior ribs are more diagonally downwards; Posterior ribs are more horizontal Some common indications of doing chest X-rays • TRO lung pathology e.g. pneumonia, TB, , pneumothorax• • , e.g. internal jugular catheter, subclavian catheter Common CXR views/projection Some common abnormalities • Subcutaneous emphysema of chest wall• Rib fracture (trauma […]