Bismillah
Popular mnemonic used to remember the Alvarado score factors is MANTRELS - Migration to the right iliac fossa, Anorexia, Nausea/Vomiting, Tenderness in the right iliac fossa,Rebound pain, Elevated temperature (fever), Leukocytosis, and Shift of leukocytes to the left (factors listed in the same order as presented above). Due to the popularity of this mnemonic, the Alvarado score is sometimes referred to as the MANTRELS score.
Signs and symptoms lead to the diagnosis of different health conditions. Similarly, the following signs lead to the diagnosis of appendicitis.
General signs:
(1) Pyrexia
(2) Tachycardia
(3) White or furred tongue
(4) Fetor oris (an offensive odor)
Local Signs:
(1) Pointing sign: Patient precisely localise the pain where it started and where to moved.
(2) Cough sign: Patient feels pain in right iliac fossa with cough impulse.
(3) Localized tenderness: When pain has been shifted to right iliac fossa it becomes localized at McBurney’s point.
(4) Muscle guarding and rigidity: Doctor can feel guarding and rigidity in right iliac fossa on palpation.
(5) Rebound tenderness: When hand is pressed and then released in right ilaic fossa the patient complains of pain.
(6) Rovsing’s sign: When left iliac fossa is pressed in patient with appendicitis, the patient feels pain in right iliac fossa.
(7) Psoas sign: In case of retrocaecal appendix, hyperextension of right hip causes pain in right iliac fossa. This is due to irritation of psoas muscle.
(8) Obturator sign: In case of pelvic appendix, the internal rotation of right hip causes pain in right iliac fossa. It is due to irritation of obturator muscle. (Last month, my friend suffered from appendicitis at night and passed the whole night in the emergency. However, he recovered his inflamed appendix and saved himself from undergoing operation of the inflamed appendix).
Bismillah
onset of labour
-true labor pain
*rule of thumb 411*
-the show ( dishacre of blood stained mucus )
-dilatation of internal os
-formation bag of waters
Bismillah, Assalamualaikum wbt.
Well, hari ni excited sikit sebab berjaya mendapatkan risalah eh,majalah al-ustaz edisi ke 9.kenapa excited sangat? haha...
Sebab saya excited sebabnyeee... ok sebelum tu saya nak cerita dulu.Sebagai seorang bekas pelajar perubatan di sebuah universitas terkemuka di Ejip (
So, apa masalahnya dengan belajar paediatric????
Nampak tak apa masalah dia? Pembaca-pembaca blog saya mesti bijak dan budiman, mesti tau kan apa kekurangan dia.hehe.
Tapi takpe, saya nak jugak cakap. Sebenarnye ni baru satu sheet, ada satu sheet lagi tu physical development, tapi tak jmpe dalam laptop usang saya ni.mungkin dalam PC rumah,
Jadi, dalam majalah alustaz ni ada dikepilkan carta aliran tu. Ana fikir amatlah berguna untuk diri ana sendiri mungkin juga family2 ana atau sesiapa saja = )
Assalamualaikum and hello guys. Since i didn't know all of my viewers, it lil bit awkward for me to keep this blog 'alive'. Hehe. By the way, its ok then. This is my blog and this blog is not for "tatapan umum" =p
Well, being graduated from abroad medical school is not as proud as u graduated from local medical school. Really! Since our most beloved country is very tough and strict in documentation compared to abroad especially the country that i have learnt too much medical knowledge. After reading some experiences,heard some rumors and glimpsed at others fb comment, i think as oversea medical graduated we need to be more tougher than a stone. =). After having some discussion with some friend, it is worrisome that i didn't knpw so much about how to write discharge summary, referral report and etc.
So, to ease some burden in the future, it is better to have some idea about discharge summary and referral report before i'm starting to be hospital-servant :) .
Reference: http://mrpalsmy.wordpress.com/tag/discharge-summary/
10 contents of a discharge summary documents the patient’s hospitalisation which includes:
- the reason(s) for admission
- significant physical and other findings(e.g. brief clinical statement of chief complaint and history of present illness)
- significant diagnoses and co-morbidities(example, Principal diagnosis: Cellulitis and gangrene, left foot and lower leg. Comorbidities: Diabetes mellitus, insulin dependent, controlled. Staphylococcus aureus coagulase positive septicemia. Urinary retention)
- diagnostic and therapeutic procedures(example, Principal procedure: Amputation, left leg, above knee. Secondary procedures: Suprapubic cystostomy with permanent suprapubic drainage)
- significant medication and treatments(medical and surgical) and patient’s response to treatment, including any complications and consultations
- patient’s condition/status at discharge
- discharge medications and all medications to be taken at home
- follow-up instructions(patient education when applicable), to patient and/or family (relative to physical activity, medication, diet, and follow-up care) including instructions for self-care, and that the patient/responsible party demonstrated an understanding of the self-care regimen
- unless contrary to policy, laws, or culture, patients are given a copy
- a copy is provided to the practitioner responsible for patient’s continuing or follow-up care
What do I think are the important aspects of a hospital discharge summary?Reference: http://thehappyhospitalist.blogspot.com/2010/04/my-shortest-hospital-discharge-summary.htmlIn the last year or so we have been asked by our hospital transcription service to also dictate the patient's condition on discharge. I've often wondered why. Well, it seems like the Joint Commission has mandated that six components be present for a discharge from an acute to a subacute care facility. What are the six mandated Joint Commission components for a hospital discharge summary?
- Include the main diagnoses during the hospital stay
- Include a description of the surgeries and procedures during the stay.
- Include relevant radiology and blood work results.
- Include a list of the consultants and their subspecialty involvement.
- Include a brief (that's key) summary of the complicating conditions and hospital events.
- Include an accurate list of the medications on discharge, including as needed medications.
- Include a list of pending labs or studies and recommendations for further outpatient studies or labs.
- Strive for one page or less.
Interesting. I never knew one could regulate a discharge summary. It's hard to imagine how one could define each component. Is there a multiple choice we can click on? It all seems so silly. First of all, do they mean stable vs unstable? Or are we supposed to document how badly they smell? Or that they look especially ugly on discharge day. Or perhaps the Joint Commission wants to make sure they are financially secure on discharge. Or perhaps they mean IQ status. Maybe they want us to document how good a father the patient is. It just seems so confusing.
- Reason for hospitalization
- Significant findings
- Procedures and treatments provided
- Patient's discharge condition
- Patient and family instructions (as appropriate)
- Attending physician's signature
Here are the real problems with the hospital discharge summary process.
- Failure to dictate in a timely manner. This is most commonly a problem with subspecialty services who take weeks upon weeks to dictate their discharge summary while the hospitalist has admitted and discharged the patient three times since their sentinel subspecialist admission.
- Failure to include any relevant information. When a physician assistant on the orthopaedic service dictates a hospital discharge summary on an 85 year old who spent 12 days in the hospital with a heart attack, acute renal failure and two cardiac resuscitations and dictates nothing more than the procedure name and random thoughts of the day, you know that no thought was put into the process. But then again, nobody gets paid less for a poor job, so why bother putting any effort into it?
- Using English as your second language. If your transcriptionist can't understand you, you have a problem. Speak slowly so you don't get back a hospital discharge summary filled with medical transcription errors.
- Dictations that are way too long. This is a discharge summary of the hospital stay, not a minute by minute, hour by hour, day by day account. If you are too wordy in your discharge summaries you need to know that everyone hates you. Nobody reads them except you. Nobody thinks they are a masterpiece except you. A summary is meant to be brief. Make it brief. Whenever I admit someone, I pull up old records. What are the only things I look at on the DC summary? Diagnoses and discharge medications. Everything else is noise. Plus, it's expensive to pay someone to transcribe all that nonsense. If someone really wants to get to the fine details, they can pull up the EMR comparisonrecords.
- Failure to carbon copy the hospital discharge summary to the primary care physician AND other subspecialists taking care of the patient. If they don't get your records, why bother with the summary at all?
Bismillah..
Penyakit influenza sangat mudah menular krn ia disebarkan melalui udara. Meskipun rehat yang cukup dan minum air secukupnya terapi berkesan untuk penyakit ini,namun pencegahan masih merupakan kaedah tetap yang terbaik," prevention is better than cure".
Melatih kekebalan tubuh akan membantu tubuh melawan virus influenza.Caranya ialah dengan:
1) Tambahkan potongan bawang putuh yang segar ke dalam sup. Kajian mendapati bawang putih akan meningkatkan sistem imun selain itu kandungan allicin dalam bawang putih mengandungi kompenan antivirus.
2) Penggunaan makanan yang kaya dengan vit C seperti kiwi, strawberi, oren,nanas, atau anggur.Vit C akan
meningkatkan fungsi sistem
imun dan melindungi tubuh dalam melawan jangkitan.Vitamin ini juga memberi perlindungan daripada kerosaka. radikal bebas* ( * free radical )
3) Bila anda menggunakan supplement secara rutin, cubalah memilih yang mengandungi 'Gingko Biloba'.Herba yang berasal dari China ini diketahui meningkatkan pengaliran darah dalam tubuh.Perjalanan darah yang lancar akam membantu penghantaran vitamin & mineral yang diperlukan.
4) Lindungi tubuh daripada serangan virua dengan menganbil tiram. Kandungan mineral zink dalam makanan laut identik dengan afrodisiak ini juga memiliki efek antivirus.
5) Salah satu sayuran yang disyorkan untuk meningkatkan kekebalan tubuh adalah bayam. Kandungan asid
foliknya akan memicu produksi sel sel baru dan memperbaiki DNA.Sayuran hijau ini juga kaya vit C ,serat dan antioksida.Cuma elakkan memasak bayam terlalu lama untuk mendapatkan manfaat yang optimum.
Bismillah
- Surah Al-Fatihah- Untuk menerangkan hati dan menguatkan ingatan
- Surah Maryam- Bagi memudahkan ibu bersalin dan memperolehi anak yang sabar dan taat
- Surah Luqman- Bagi memperolehi anak cerdik akal dan cerdik jiwa
- Surah Yusuf- Bagi memperolehi anak cantik rupa dan cantik akhlak
- Surah Hujurat- Bagi memperbanyakkan air susu ibu dan anak bersifat berhati-hati
- Surah Yasin- Bagi menenangkan hati dan anak tidak terpengaruh dengan godaan syaitan yang mengajak kepada maksiat
- Surah At-Taubah-Bagi membersihkan jiwa dan terpelihara dari maksiat
- Surah An-Nahl- Untuk melahirkan anak yang berdisiplin
assalamualaikum wbt,
"Doktor,saya takut jarum!"
Tajuk buku yang saya teruja terus membaca. Buku ini sesuai untuk bacaan umum malah amat sesuai untuk bakal-bakal doktor mahupun junior doktor. Buku ini banyak mengupas isu-isu semasa, bagaimana cara pemikiran masyarakat sekarang mengenai perubatan moden. Sekarang di Malaysia ada pelbagai lapisan masyarakat,bermula dari yang muda hingga ke generasi tua. Sememangnya generasi tua malah ada segelintir generasi muda ini menolak dan kurang mempercayai perubatan moden. Saya sendiri pernah mendengar cerita-cerita,riwayat-riwayat ganjil yang saya sendiri pun susah nak percaya tapi itu semua kuasa Allah. Ada pesakit yang sudah mendapat breast cancer tahap 4 dah metastasis tapi dengan perubatan tersebut mampu menyembuhkan. Saya sendiri tak tau nk komen mcam mana.Tapi apa-apa pun kita berubat haruslah berubat dengan cara betul.Kalau lapar ikhtiarnya makan makanan yang mengenyangkan.Bolehkah kita makan pasir? Andai seseorang itu percaya yang pasir mampu mengenyangkan maka itu adalah tahyul juga termasuk dalam syirik dan kurang cerdik. Dalam buku karangan Dr.Zubaidi ni, beliau ada mengupas mengenai bagaimana cara berubat dengan betul apa itu tahyul apa itu khurafat. Saya memetik dari bukunya,
"secara mudah, khurafat dan tahyul adalah suatu perbuatan yang tidak berasaskan fakta dan dalil yang benar.Tiada bukti saintifik yang mengatakan perubatan yang dilakukan berkesan dan tiada juga dalam nas al-Quran dan hadis"
Banyak lagi yang beliau kupas dalam buku tersebut,dari permasalahan perempuan contohnya,penghasilan breast milk fron non-pregnant woman, bahaya maggie,kesihatan anak kecil sampailah kepada permasalahan trypanophobia iaitu takut kepada jarum yang ketara. Selain itu beliau juga mengupas masalah rawatan lintah. Sedikit info yang ingin saya kongsi melalui pembacaan saya.Lintah mampu menghilangkan hemoglobin (Hb) sebanyak 0.7g/dl. Biasanya rawatan lintah ni 4-5ekor. Jadi secara kasar seseorang yang menjalani rawatan lintah ni kemungkinan besar akan kehilangan sebanyak 3.0-3.5g/dl. Cuba bayangkan seorang pesakit anemia* yang menjalani rawatan tersebut,sudah tentu merbahaya.
*Anemia is defined as a low Hb concentration which is less than 13.5g/dL for men and less than 11.5g/dL for female.
Pesakit anemia akan mengalami simptom-simptom seperti keletihan, sukar bernafas, mungkin pitam, degupan jantung yang kuat,pening, mungkin akan mengalami sakit dada.
Yang paling saya tertarik mengenai Dr.Zubaidi ni adalah kata-kata penutupnya.
"Di celah-celah masa yang terluang setelah selesai merawat pesakit,saya mengorbankan waktu rehat dengan menjawab pertanyaan emel dan melayani pelbagai pertanyaan kesihatan di ruangan chatting sebuah laman web sosial.
Semua ini saya lakukan dengan harapan, ALLAH memandang usaha saya sebagai suata ketaatan kepada-Nya.Harapan saya agar ALLAH menjadikan perkongsian pengetahuan dan pengalaman saya sebagai satu amalan jariah yang berkekalan.Semoga kita sampai di destinasi yang sama walaupun jalan kita agak berbeza.Aminn"
Bismillah.
That date will never be forgotten.The date where it will be the last night for me in Alexandria,Egp. The night where it will reminisce all of my 6 years journey, long journey. The night where i write this post for the last time in Alexandria, Egp.The day where it will be the last day for me in 'bumi tarbiyah'. banyak 1001 kenangan, pahit jerih, manis,tawar,PediH..bumi yang banyak mengajar tentang kehidupan.Bumi yang mengajar untuk menjadi seorang doktor mahupun dai'e/ =..( ( xnangis ye! )
Teringat post mase tahun berapa ye..agak mentah masa itu. Post on July,14,2010. http://zkwan.blogspot.com/2010/07/if-im-not-mistaken.html
Post ni berkenaan dengan perjalan/peristiwa/fenomena yang berlaku kat Egypt bersama kawan2.Bila selak2 balik, what happened on 5th year?
2010/2011 a.k.a 5th year:
- prev. post i left it with wondering....
- this year, shock! sebab jadi SR = student rep.. banyak mengajar how to deal with person esp. arabs. Oh my... not easy as chewing gum lah deal ngn arab. BUT sedikit sebanyak it make me stronger than before. Sometimes u need to higher ur voice, sometimes u just need to nod ur head. Thats how to deal wif them. These year i don't remember so much.But i guess, this year ramai baby2 Alex yang lahir. Now we have Sarah,widad,urmmm sape lagi ye..sorry coz sy rapat ngn dua budak comel tu aja esp. Sarah. Comel! hehe
- 25 Jan, tarikh keramat.everyone yg blaja even stay kat egypt know about 'thaurah' kan..atau revolusi. That day, even my coolest dad pon risau. tibe2 call around 3am in the morning, even my childhood fren pon sanggup bagi ID internet ntah mane2 anak polis la tu bagi. Fuh terharu~... But nothing serious actually. Tapi apakan daya, parent risau..siap2 masuk duit bagai suh carik tiket balik awal2 maka Royal Jordanian jadi pilihan mengatasi Charlie. Rugi pule.Tapi takpe, at least balik awal boleh settle masalah ngn Uni. awal2. Ramai yang menyangka kami balik awal n lupakan kawan2. Sebenarnya bukan mcm gitu, kalau kami tak deal awal2 ngn Uni., exam final sudah tentu 2 or 3 weeks after 25 Jan. Tp semua tu kuasa ALLAH S.W.T. Segala pergerakan kita mengikut apa yang dicatatkan olehNya. Alhamdulillah kita dapat cuti panjang sikit. Dalam cuti panjang tu lah, sempat nk buat jadual semua balik, deal ngn Prof nk bt kelas revisi sblm exam. Hasilnya ALHAMDULILLAH, kalau tak silap tahun ni la fes kite satu batch lulus semua except sorang kawan yang sakit.Alhamdulillah dia da sehat rasenye skrg.
-Tak igt bnyk sgt this year, terlalu sibuk dengan SR. kesana kesini, meeting sane sini.
2011/2012 a.k.a 6th year:
- 6th year. this year, tak banyak fenomena baru rasenye. yang penting semua trasa mcm 6 tahun tu cepat kan, sbb da nak habis.
-First sem blaja Comm. Med/ Family Med ngn Forensic n Toxi. Relax skit kot
-in between 1st n 2nd sem, dpt cuti. Alhamdulillah trmakbul doa utk mejejak kaki di Tanah Suci. Sungguh benar, sekali pergi terasa rindu disana membuak2. Teringin nak pergi lagi. Sungguh Aku Rindu!.
-2nd Sem, fuhhh blaja subjek yg killer Int Med 2nd part n Surgery 2nd Part. Risau juge tambah2 Doktor int med strict2 n doktor surgery pon mmg style mcm tu.
-Tahun ni bab2 kawen xsemeriah tahun 4 atau 5.Mungkin masing2 fokus untuk stdy kan. Ada yang dapat cahaya mata juga. Tahniah Mabruk semoga jadi anak soleh solehah.
-Tahun ni tahun agak sedey sepanjang 6 tahun disini. hehe.plus farewell lagi.
-Grad jugak tahun ni. tak leh nk gambarkan ngn kata2 dah. ..... ..
-Haa, tahun ni juga ramai yg ckp jmpe arab yg perangai mcm2.hehe. Nk buat suit pun kene prank dua tiga 4 hari baru dapat. sabar je la. Sometimes itulah salah satu pengalaman manis berada di bumi Mesir ini.
- Yang paling terasa/tersentuh, tahun ni la tahun last kita jumpe member2. Yang dekat2 pantai timur, insyaAllah akan jumpe lagi, yang pantai2 barat, bilakah mungkin kita akan ketemu lagi. Andai diberi waktu dan masa, pertemuan kita tidak lagi seindah dibumi Mesir. Suasana pun sudah lain, bukan lagi suasana bekejar-kejaran ke kelas, bertemu di kedai2 arab untuk lunch, suasana berlari2 mengejar 'taram', suasana berebut untuk mendapatkan 'tramco' =)...apetah lagi diindahkan dengan macik2 glamour atas taram..... banyak kalau cerita mmg xckup page.
HO
- wondering again... mcm mne agak2nye life nnt. =). I pray for the best. moga2 apa yang saya,anda dan kita semua inginkn tercapai.Ameen.
---------
- packing for good ni tak pernah sama ngn packing balik summer biasa. Oh!
Bismillah
Hari ini Hari Jumaat 5 oct 2012/19zulkaedah1433
Salah satu dari sunnah nabi yang dianjurkan pada hari Jumaat ialah membaca surah Kahfi.
Disunnahkan membaca surat al-Kahfi pada hari Jumaat sebagaimana hadits Abu Sa’id al-Khudri Radhiyallahu ‘anhu beliau berkata : Rasulullah sallAllahu ‘alaihi wasallam bersabda :
“Barangsiapa membaca surat al-Kahfi pada hari Jumaat, maka Allah terangi ia dengan cahaya diantara dua jumaat.” [HR al-Hakim dan Baihaqi, dishahihkan oleh al-Albani].
After reciting Al-Kahfi, I just explore the net, see the recent news, check dozen of mails, keep update on whats going on in my country by reading both side paper;government and opposition party. Then i stumbled with Aiman azlan blog. I thought he is only knew how to V-Log, well he is good in poem too!. Just for the clarification, its nothing to do with me, i just feel its beautiful poem especially the following poem. Sometimes you can feel it not only watch N enjoy the beauty. = )
Waiting
| Category: Poems
Photo by Umar Mita
So powerful is this memory,
Keeping you so close to me,
My heart flees to you in a hurry,
Struggling I am to keep it steady.
She's not mine! She's not mine!
What is she doing in my mind?
I shall not cross that Divine line,
I'll stand waiting, tortured by time.
O Allah, my heart is aching!
Pounding on the bars it's kept in,
The leash is nothing but a string,
Hands are bloody but still holding.
You know how much I want to let go,
Unleash this flesh to the one it misses so,
But this heart of mine I worship not, no!
I bow to the One who turns it - my Lord
p/s:
-before this,i though hwaiting in korean is same in english..waiting.But after hearing my he-friend pronounce 'fighting'
" 화이팅 hwaiting is a commonly used word of encouragement, as well as a cheer.like Fighting!"
Bismillah...
Oh,lame sudah tidak bergiat dalam bidang multimedia.Memandangkan orang kuat persatuan tersebut sudah kahwin, jadi ana lah kena buat benda alah 'backdrop' ni. Tak reti sebenarnye. & xde mood sangat. huk3 but I try to do my best plus kalau kita tolong ringankan beban orang lain,insyaAllah masalah2 kita akan dibantuNya juga nanti. Kesian juga tengok member2 batch buat kerja siang malam.
Summer has come and passed
The innocent can never last
wake me up when September ends
Six years has gone so fast
wake me up when September ends
ps:/ xlame da nk sireh pulang ke ganggang... =(
Bismillah...
Hurmm... The Shaken Heart.
..... سبحان الله ....
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