Archive for the ‘Uncategorized’ Category

KKIA Guide

Posted: September 4, 2018 by gerardloh in Primary Care, Uncategorized

Dear friends,

I have left the government service.  I was serving in the KKIA (mother and child clinic) before resigning and here are some notes that I wish to share. I made a check list to summarize the main points to look out for during antenatal follow up visits.

MCH notes 2017
-compiled by my colleagues at KKIA MIRI
Many thanks to Dr Jody Yii, Dr Wong Wang Ming, Dr Fatimah Azmi

– compiled by yours truly, Dr Gerard

I have truly enjoyed my 5 years stint as a Primary Care Medical Officer and will always miss the lovely town Miri.

Coming soon: Quit Smoking Guide


Especially for those who missed this, Download me =)

Key Summary – Saturday Teach-in Difficult Dengue



(i)     ABG interpretation


pH 7.35-7.45

pO2 80-100 mmHg

pCO­2 35-45 mmHg

HCO3 22-26

*To convert mmHg to kPa divide 7.5

(ii)    If pH>7.45

pCO2 < 35

HCO3 >26

Respiratory Alkalosis

Metabolic Alkalosis








-salicylates poisoning

-profuse vomiting



(iii)  If pH<7.35

pCO2 > 45

HCO3 <22

Respiratory Acidosis

Metabolic Acidosis

         NAGMA                          HAGMA

Respiratory failure -RTA


-Addison ds

-Pancreatic fistula

-NH­4 ingestion


Increase in organic acid production

-lactoacidosis-shock, sepsis,hypoxia

-uric acid

-ketone-DM, alcohol

-drug – metformin, metanol

*anion gap = [ Na + K ]– [ Cl + HCO3 ]

(iv)  Oxygen dissociation curve

Left side of curve – ­pH ¯T ¯DPG (2,3 dephosphoglycerate)
Right side of curve – ¯pH ­T ­DPG (2,3 dephosphoglycerate)

p50 – point where saturation of Hb reaches 50% (at pO2=26.6)

ICU point (PaO2, SaO2) = (60mmHg, 91%) = lowest acceptable paO2 in ICU patient because further drop beyond this point lead to drastic drop in SaO2

Mixed venous point at SaO2 = 75%

(v)   Indication for intubation

ü  To deliver positive pressure ventilation

ü  Airway protection from aspiration

ü  During surgical procedures involving neck and head in non-supine position

ü  Neuromuscular paresis

ü  Procedures increases intracranial pressure

ü  Profound disturbance n consciousness

ü  Severe pulmonary and multi-systemic injury

Respiratory Distress in Newborn

Posted: January 2, 2012 by kiamseong in Paediatrics, Uncategorized

The followings are the slides prepared by us for HO teaching presentation in HTAR, Klang. (Links for download)

Enjoy! =)

Part 1

Part 2

Part 3

The journey continues

Posted: September 13, 2011 by gerardloh in Uncategorized

Congratulations fresh graduates of medical schools who will now enter the working field of medicine.

We have battled for years, had endless sleepless nights studying for those exams, and finally we may put on the famous black robe….soon to be replaced by a clean white coat..

But how many of us are truly ready to face the difficult task of being a competent house man and doctor? How many of us will actually know how to do everything without a single mistake and escape the hair dryer by our medical officers and specialists?

Much have been read in the news about incompetent house officers from ru or ua. Refering to the blog by Dr. Pagalavan, doctors graduating from these universities usually go to classes waiting for hours, only to find that the lecturer was absent. And that bribes are given to pass exams easily and finally graduating by merely attending classes without tutors.

I’m glad to say, during my time in CSMU, lecturers were usually present and grilling us with questions, tests and situational tasks everytime!  I have not paid a single kopek (cent) to pass my exams, and although sometimes I hope for that strict tutor to be absent (due to overwhelming stress and fear), they always seem to turn up to kill you for hours.

Ofcourse there are also occasions when professors are busy and send their assistants. Lazy teachers exist everywhere. But as as medical student, you do not just rely on your teachers in class. We are usually given a list of topics to prepare for classes the following day so it’s really up to you whether to relax or hit the books. Lazy students exist too.

In CSMU, we go to practical classes, having prepared the night before (usually few chapters at a go!), and are asked questions, definitions, etiology, symptoms, management, which you have to answer or face the consequence of having to rework the class. Points are given for each practical class, which decide whether students are eligible to sit for final module exams. So it is vital to prepare and answer the tutors satisfactorily. After the Q & A, we are then usually given patients to clerk, and the diagnosis discussed with the tutors. Depending on the subject, we are taken to ward rounds or surgeries. Your performance during the whole 5 hour class will decide your marks for the day including some multiple choice and situational tasks. And there are no guarantees of passes. Many have been expelled for failing to pass their module exams after 3 attempts. Module exams are conducted after a module of for example Gastrointestinal diseases.

Contrary to the reports, we  at CSMU certainly had to work hard to get by. However, this system is different from Malaysia, and although we have a good theoretical base, clinical skills are often lacking. Ukrainian methods are not used in Malaysia.

So we at House Officers Workshop, established in CSMU, are continuously educating ourselves. Sharing elective posting experiences in Malaysia over the summer, and trying to study the Malaysian way. Because sometimes, overseas hospitals have different systems of clerking, with different terms and even methods, it is important for us “overseas students” to identify these differences and adapt to them quickly, to avoid being called a “bad apple”.

These videos are part of a 1 month workshop stint conducted by members of HOW and also volunteers who were referred to as “mentors”. Our mentors were trained during workshops like these, who then started training other participants of a second workshop opened to all students of CSMU. The response was good. Upon completion of the workshop, participants were then tested on knowledge and skills acquired during the 2 months training.

This mentor system, developed by President Dr. Goh and his central committee, was different from the previous years, where lectures and seminars were conducted once a week instead. Previously, demonstrations were conducted, and guides issued to participants. Lectures and workshops sometimes lasted a whole day.

Goh decided that as most of the major topics were discussed before, this year’s the goal was to focus on clinical examination and clerking skills.

All the examinations were derived from videos from local Malaysian medical schools, international videos on youtube, and guides from previous elective postings of CSMU students. So it’s safe to say, they will provide the basic examination skills a houseman requires, if mastered.

The last batch of CSMU students have graduated, but HOW will continue to deliver information and guides on our blog.

We would like to welcome any house men, medical officers or specialists to contribute and comment on our entries and guides. Hopefully, this project will reduce the number of incompetent doctors in the future as claimed.

The journey continues…