Okay..harini kita blogging dari Hospital Parit Buntar ye... Maklumlah ade broadband celcom : internet everywhere, kaedahnye...
Alhamdulillah today selesai la Neonatal Resuscitation Program... Mula-mula sekali harini kena test lah kan. Alhamdulillah I passed bahagian teori. Lepas tu ada practice session, nak prepare for megacode.
My Pneumothorax newborn
memandangkan my group adalah bersama kumpulan sokongan, so the main assessment adelah in assisting. Tengok akak-akak misi semua macam pro je anchor endotracheal tube kat baby, I think I should try as well, nanti dah kerja takkan dokter pun tak reti nak anchor kan, semate-mate sebab mase belajar dulu ingatkan benda ni misi yang kena buat. no no no... so this morning, tried la assist, lepas kite assist, kita pulak yang kena conduct resuscitation ni.
So, instructor pun bagi scenario... baby full term, amniotic fluid clear, doesn't cry or breathe, no muscle tone. ok, ak pun dry kan baby, suction sket mulut pastu hidung, stimulate breathing. breathing, tp central cyanosis pulak dah... ok, bg supplementary oxygen... still cyanosis, bagi positive pressure ventilation.. cyanosis lagi, intubate la ape lagi...bagi oxygen...assess lagi, heart rate pulak jatuh...Ok, buat chest compression, still low, bagi epinephrine pulak.. heart rate dah stabil, tp baby still cyanosis, chest movement sebelah je, right lung dah tak naik.
Dr. Maizura : kenapa chest rise on left side only?
Me : Maybe ETT tadi termasuk ke dalam sangat.
Dr. Maizura : Tapi dah auscultate tadi, betul kan ETT masuk?
Me : haah. (sambil memikirkan ape sebenanye instructor plan ni..maybe pneumothorax, tp takkan nak tanye tu kot)
Dr. Maizura : Ok, selain tu?
Me : Congenital diaphragmatic hernia
I swear she didn't see that coming, sebab semalam Dr.Saiful dah ckp it was VERY RARE, and kalau ada pun mesti kita dah tahu awal, area sini kalau expected baby ade diaphragmatic hernia kena hantar Alor Setar - ade pediatric surgeon. I was panic, jadi I thought dy memang nak bg yg susah2 je.
Dr.Maizura : No bowel sound on right chest. Bukan diapragmatic hernia, lain?
Me : Pneumothorax?
Dr. Maizura : Yes, so kalau penumothorax you nak buat ape?
Me : guna syringe and stab ....
Dr. Maizura : Kat mana nak buat tu?
(assitant pun dah panic same)
Me : (playing safe) margin of 4th ribs
Dr. Maizura : Yelah, kat mana? (sambil tgk aku tak tau).. dekat safety triangle, axillary line, below pectoralis, dekat situ...
Assistant & kawan-kawan : oh kite tak payah tahu...kite tak payah... (menarik nafas lega)
aiyo...never expected my assessment will get that complicated. but i know then to expect anything on my megacode.
Megacode : the too good to be true newborn
wah, start-start je : baby term, clear amniotic fluid, crying and good muscle tone? macam tak payah buat ape-ape pulak kan. hehe. kering-keringkan baby terus stimulate, terlupa nak suction mouth and nose. aaaaaaa... mula panic sekejap, baby cyanose, bagi supplementary oxygen pun still no improvement. buat PPV also no improvement. Bila PPV also no improvement, kena check secretion kat mulut, and peralatan, mase tu dah perasan dah, tadi mula-mula tak suction...ha..padan muka... dah ade sikit chest rise, HR drop.. standard lah, dia mesti nak tgk kita buat chest compression punye.
Dr. Maizura : HR 70, baby slightly pink, ada respiratory effort.
Me : Ok, continue PPV, send patient for post-resuscitation care.
Dr. Maizura : HR 70?? terus nak hantar post-resusc?
Me : Ha, yelah.
(teammates kat belakang geleng-geleng buat gaye pam PPV)
Me : continue PPV for another 30 second, assess colour, HR and respiration.
adelah 2-3 kali kena ulang sebab HR tak naik-naik to above 100. lastly dah habis tu, Dr tanye, dah tahu dah ape silap awak buat tadi?
Me : Ye, saye tak buat suction mula-mula tadi.
dan akhirnya berjaye lah saye menghabiskan megacode saye, dengan 0 markah untuk initial steps sebab tak buat suction. ape-ape pun, alhamdulillah I made it, layak dapat lesen for 2 years. :-) certificate coming in 3-4 months.
too bad tak ada peluang nak duduk labor room lagi. hihi.
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