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Image  —  Posted: March 25, 2013 by kiamseong in Orthopaedics & Traumatology, Uncategorized

Surgical HO Guide

Posted: February 17, 2013 by gerardloh in Surgery

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!

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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.

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Gong Xi Fa Chai!

New medical HO guide (unedited version)

Posted: November 3, 2012 by gerardloh in Medicine

Dear friends,

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.


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Basic things you need to know in surgery department

Posted: October 2, 2012 by kiamseong in Surgery

Things you need to know in surgical dept

(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