Archive for the ‘Uncategorized’ Category

A plea to my readers

Posted: October 11, 2018 by gerardloh in Uncategorized

Dear friends, this is sort of a medically unrelated post.

I need to make a plea to my followers and readers. Are any of you working in HEMATOLOGY DEPT HOSPITAL AMPANG?

As a former employee and author of these AMPANG HO guides, I need your help!

My father has underlying PCV/myelofibrosis and may soon need treatment with JAKAFI.
I do not know what to do as the drug is very expensive. I’m hoping he can get a follow up at the dept, and perhaps get some funding for treatment. Is there such a programme?

I truly hope out of the thousands of readers of my guides, one of you can help me.

Kindly drop me a message @ gerardloh@hotmail.com or whatsapp 012-6049443

Thank you!

 

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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

1st RME CHECKLIST
– 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

w2

w1

(i)     ABG interpretation

Norms

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

Hyperventilation

-stroke

-SAH

-meningitis

-anxiety

-hyperthermia

-PE

-salicylates poisoning

-profuse vomiting

-hypoK

-burn

(iii)  If pH<7.35

pCO2 > 45

HCO3 <22

Respiratory Acidosis

Metabolic Acidosis

         NAGMA                          HAGMA

Respiratory failure -RTA

-Diarrhoea

-Addison ds

-Pancreatic fistula

-NH­4 ingestion

-Drug-acetazolaminde

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