Thank you for following our blog. As you all know, I will be leaving for Sarawak to continue my service as a medical officer there.
I’ve been working on the ED guide, however I had to put it on hiatus as I was trying to appeal my posting, which in the end was not so fruitful.
Well, so far I have done some short notes for Triage, Trauma, Basic USG, log roll…
Ofcourse there’s so much more to write but as I am leaving for Sarawak tmr, I hope this first few chapters will help you adapt in your new posting.
Don’t count so much on this version, it’s INCOMPLETE, will finish the guide once I have settled down in Sarawak.
All the best, dear new HOs, have a great service.
I have completed my latest peds HO Guide. Again, it is an early version which requires proof reading. Kindly assist me in this and correct me if I am wrong.
May this collection help you in your pediatrics posting. Will add on more topics when time permits in the near future. Right now, I’m off to A and E! Cheers
Additional notes by Dr Goh Kiam Seong
Dear friends and fellow colleagues,
I compiled a new surgical guide, however it is not as complete as I like it to be as Surgical was quite an eventful posting, I was rather busy till the end. I have now moved on to my 5th posting…hence I doubt I’ d have any time to check and update it anytime soon. Nevertheless, I’m sharing it and hopefully it may be of some help. Will update it again once I’m free. Do let me know if there are any mistakes or things to add on. Thanks!
The “gangnam” cartoon is in celebration of the Surgical Night, memories which will remain with me for a long time to come. Not to forget the lion dance. Thank you General Surgery Hospital Ampang! My favourite posting so far.
Gong Xi Fa Chai!
I have completed the compilation of my medical HO guide. However, in view that Medical is such a wide field, I have not included quite a number of topics as yet.
Hopefully, in the near future, I will be able to add on to the list of topics, including procedures.
This compilation is not yet reviewed by any Medical officers or specialists and may contain unavoidable errors.
For now, I hope this compilation will be able to assist you in your daily work as a medical HO.
Dedicated to all my mentors and staff at Hospital Ampang.
The O & G HO guide is now available for download!
This compilation is just a quick reference, more coverage in HOW O & G guide part 1.
Special thanks to Dr Liew Nyan Chin for helping me with this book.
Hopefully this book will help you in your early days as an O&G Houseman. Do let me know if there are any mistakes or if you have any additional input to share. I will then upload an updated 2nd version in the near future.
Good Luck! O&G was indeed a fun posting with lots of practical work. Enjoy!
Click on image to download book.
The orthopedics guide is now available for download.
UPDATED VERSION APRIL 2012
However, most of the notes are based on my experience while working in Ampang Hospital, and may vary in your own healthcare centre.
Hopefully it may serve as a guide for your Orthopedic posting!
Good Luck for your next posting!
An ankle block is essentially a block of the terminal branches of the sciatic nerve. It is useful to think of the ankle block as the block of
two deep nerves
1. posterior tibial and
2. deep peroneal nerves
three superficial nerves
3. superficial peroneal
This concept is crucial for the success of the block, because the two deep nerves are anesthetized by injecting local anesthetic underneath the superficial fascia, whereas the three superficial nerves are anesthetized by a simple subcutaneous injection of local anesthetic.
1. Deep peroneal block
The finger of the palpating hand is positioned in the groove just lateral to the extensor hallucis longus. The needle is inserted under the skin and advanced until stopped by the bone. At this point, the needle is withdrawn back 1-2 mm and 2-3 mL of local anesthetic is injected. A “fan” technique is recommended to increase the success rate.
2. Post tibial block
Posterior tibial nerve is anesthetized by injecting local anesthetic just behind the medial malleolus.
Facing the medial aspect of the foot, the needle is introduced in the groove behind the medial malleolus and advanced until contact with the bone is felt. At this point, the needle is withdrawn back 1-2 mm and 2-3 mL of local anesthetic is injected.
1. Spf peroneal nerves
Superficial peroneal nerve is blocked by subcutaneous infiltration of local anesthetic over the lateral aspect of the foot.
3 Saphenous nerve
Saphenous nerve is blocked by subcutaneous infiltration of local anesthetic over the medial as pect of the foot.
It’s your first posting…you’re in the procedure room assisting your MO for the 1st time..
suddenly she yells..
MO: “Get me some orthoban, 3 rolls of POP…and some crepe bandage “
You: OMG..What buns? pee…and what crap??
To prevent such encounters, pls take some time to learn some basic apparatus used in Orthopaedics!
2. Crepe bandage
3. Plaster of paris
4. Plaster saw (aint no vacuum cleaner)
4. Zimmer splint
5. Thomas splint (lateral traction)
6. Plaster spreader
cutter (stout scissors)
CMR and POP
CMR under sedation (prepare in 5cc syringe)
* request drugs from sister or staff nurse, return ampule to sister!
1) Midazolam 1ml + 4ml H20 (1cc=1mg)
Adults give 2.5cc (half ampule/2mins) Peds : 0.1mg/kg
(antidote = flumazenil 0.02mg/kg) 1 amp
2) Pethidine 1ml + 4ml H2O (1cc=10mg)
Adults give ½ dose 2.5cc over 2 mins Peds: 1mg/kg
(antidote = naloxone: 0.01mg/kg) 1 amp
20kg = 1 cc
30kg = 1.5cc
40kg = 2cc
50kg = 2.5cc
max 2.5 cc in 2 minutes
Post POP xray
1. Radial height = 10-13mm
2. Radial tilt 11 (2-20)
3. Volar tilt 10 degrees
4. Radial Inclination = 21 -25 degrees
1. prepare 2-3 rolls POP, orthoban, prepare bucket of warm water
2. apply orthoban around hand starting distal to proximal
3. dip plaster in water until bubbles disappear
4. apply POP, starting from distal to proximal (max around hand 2 layers only)
5. smoothen the plaster and press on affected part to fix plaster (moulding)
6. make sure 90degrees (AEPOP)
7. Perform post POP Xray!!!
1. Take plaster and measure length required (from below MCPJ to cubital fossa)
2. Place orthoban, slightly longer than plaster (for folding)
3. Start layering plaster (up to 15 layers)
4. Prepare a pail of water, fold and dip plaster in water, going in at angle of 45 degrees, until bubbles disappear
5. Remove from water and squeeze lightly excess water from plaster using 2 fingers
6. Place plaster on orthoban, smoothen the plaster and fold edges of orthoban on to the plaster (sandwich)
7. Place this sandwich with orthoban contacting skin
8. Smoothen the plaster to fit limb
9. Wrap with Crepe bandage starting from proximal end to distal.
10. Secure with tape and allow to dry
1. Position patient’s hand with wrist extended 45 degrees and fingers pointing at 90 degrees
2. Measure length from DIPJ to cubital fossa
3. Layer up to 15 layers of plaster and place on slight longer orthoban
4. Submerse in water at a 45 degree angle until bubbles disappear, squeeze and place on orthoban
5. Sandwich the plaster and orthoban
6. Place sandwich, hand first, making sure the angles are kept
7. Wrap with crepe bandage
1. Start by bandaging with Orthoban, from distal to proximal, overlapping 1/3
2. Hold on to one end of plaster and Submerse whole roll of plaster in water, squeeze slightly
3. Start bandaging plaster over the orthoban from wrist to hand, then to proximal, overlapping 1/3
4. Smoothen the plaster and apply next roll. The wrist should be square shaped, and the proximal end spherical
1. Do not wet, draw, spoil POP
2. Do not put long objects inside/scratch
3. TCA stat if pain/numbness/blue