I am super tired today....u know why? because I woke up at 5.30am, then just sleep back for a while (not really sleep) and get up at 6.10am to prepare. Today there will be a surgery at 7.30am. My dad fetched us to Normah this morning, and we were not late for the surgery! This time is Cystoscopy for ureterocele + vesico-litho-tripsy (urinary bladder-stone-cut off). The cystoscopy went through the urethra into the urinary bladder showed that there is a elevated mucosal surface containing stone, at the right ureter orifice, the stone had partially blocked the orifice and causing pain, so it needed to be removed. The operation was very short and fast. Just break the mucosal surface and suck out the stone..well, the stone is quite small compared to gallstone. If a young patient comes with dysuria, pain when passing urine,it's probably because of blocking of the orifice by the stone. If the patient has repeated UTI, just do ultrasound to investigate! And 2day I saw 3 more operations. Amazing huh? Haha, Faye, Natasha and Gaik Si they all saw 6 operations le.I missed those 2 operations including spinal surgery(cut open vertebrae segment disc) and AVF.
Btw, the second operation I saw today was take out foreign bodies + suturing. The wound is quite huge and open and the surgeon can't really seal it up completely as there is lost skin, moreover can drain the pus if left open 1 small hole. Dressings need to be changed often. H2O2 (antiseptic) was used to wash the wound before the suturing was done. Straight after the 2nd surgery, Doc proceeded to do the 3rd surgery for me of the day-appendicectomy. Where's the Mc. Burney's Point? It's 2/3 medial from the line from the umbilicus to the ASIS. It's the place to cut open the skin. We could see different layers before reaching the appendix...from skin, then superficial fascia, external oblique, tranverse abdominis, internal oblique,transversalis fascia, extraperitoneal fat. The appendix was cut off and suturing was done using absorbable type.
The appendix appeared to be quite normal 
but it's causing pain to the young man. The last surgery of the day for me to see was stenting to dilate the ureter so that the stone in the calyx can flow out when passing urine. This case was the same as the case which the woman wants to do ESWL but failed. This operation finished very soon too. O ya, we need to go out for a while the X-ray was taken after the contrast was pumped in, if not our balls will be cooked, lol!!! There was a brain surgery-Craniotomy + Excision of Left Meningioma which require 8 hours long operation by expert doc, we followed Doc to go in but the neurosurgeon said to the doc if you don't mind I don't want to see them here, he is a fierce doc who don't like medical students, I wondered why? Natasha, faye and gaik Si were shouted and scolded by him today. Smart people really weird la...Hmm...other interesting things are Me and Matt followed Dr. Teo to visit patients at ward. I like the way he explained to patients,he explained clearly and makes patient satisfy,although sometimes he used too much medical jargons, haha! He alao asked us what we think about H1N1 and discuss the different views/perspective between politicians and medical doctors. He taught us about the basic of medicine, how to think as a medical doctor, hmm..that's very good. The cases at the ward including Polyarteritis Nodosa, SLE likely, renal failure, hepatitis A suspect,multiple myeloma related, diabetic patients, acute dengue fever + breast cancer. Why we need to change normal saline drop to dextran sugar to diabetic patient who is fasting? It's so that they will not use up amino acid which will cause diabetic acidosis. O ya, today 1pm we also went into the conference room and sat at the side to listen to various surgeons, radiographer to discuss about the cases and X-ray slides, although we still not understand completely what were they saying, but it's kind of cool!!!Lesson of the day:
Dr. Gabriel Teo (Physician) said:
What is the Basic of Medicine? It's....(9 letter words)..DIAGNOSIS!
Without diagnosis we cannot really do anything.For example in the case of H1N1, the hospital just always reject the cases and push them all to GH becasue they don't have a test to do and confirm DIAGNOSIS...H1N1 needs laboratory diagnosis, but not clinical diagnosis. Hence, the test is really very important. With diagnosis, everything becomes so easy in medicine because it's all written down. The books teach us management and treatment but not diagnosis, we have to learn it!!!! So do diagnose Correctly wor!!!!! But there is exception too, when we fall into situations where diagnosis cannot be made and patient's life is in danger, then we have to guess the diagnosis according to experience so that to save patient's life.
Stages of anesthesia on patient
Stage 1---Conscious
Stage 2---Stage of excitement, inhibits thoughts, will cause laryngeal spasm, usually want to skip this stage
Stage 3---Unconscious
stage 4---Patients die
3 components of anesthesia
1. Conscious
2. Lack of pain
3. Muscle relax
p/s: Canteen's food sucks, lol, I accidentally ate chicken's butt, swt!
Went for fish spa today!
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