Friday, July 16, 2010
Choices and Decisions
YES or NO.. TRUE or FALSE.. RIGHT or WRONG.... these statements bother us most of the time.. which is which.. who to believe... which one to follow... what is the best choice....
Most of the time, we do things base on our instincts. Every times we decide on something, it is a balance between id, ego and superego. In layman term per say, there will be mixture of your common sense, wisdom, personality and emotional intelligence. However, everyone has different thinking and opinion. So, they decide differently although they are dealing with the same issue. To correlate it in my daily life, i have many collegues, many ppl under me and above me. There is a network connection between those working under the same roof. And the fact is everyone has their own frequency and channels in the sense of thinking and preference. This creates a complex human behaviour.
To be frank, ego put a larger percentage when it comes to making decision. The ego is a component of personality especially when dealing with reality.And talking about personality, it builds up from your background moulding you into a human with unique characteristic. Hence, what is in the outside will be the reflections from the inside. Your inner self or personality will be acting like a preset mind which will makes u act/ behave according to what you learn. So, our so called ' fight and flight' responses are different in the sense of how we react when dealing with hardships, obstacles or problems. And this preset mind has ego moulding inside . That make things complicated.
To cut the crap, i will apply it to my current bleeding issues which blunted my decision making ability. As i mentioned, everyone has their own thoughts. So, trouble happens when you have many bosses in queue.. this one order A, that one order B, and the other ones order you to do C.. So, at the end of the day, confusion happens. What should be done? A , B or C ? or A+B+C? or dont do anything at all.. which is which.. Can we do half and dont do the other half?? If i dint do the other half, i will be blamed for not following the orders. Standing in the heats, you will lost your decisive ability as those things are related to human life and undeniably are serious matters. Acting according to our instincts might be wrong at times. And the point is there is no room for mistakes. So, i am carrying a big stones behind my back which is to do everything ordered and confirm i will work until i wear and tear. But if i miss something relevant by doing things selectively, i dont really trust my instincts.
Blunted.......
I cant blame anybody as we all are complex human beings. And according to my bosses experiences and skills with all the hardships that they had been through, they can decide things which they think will be the best for the particular patient. As quoted from our rule of thumb ~ DO NO HARM. But leaving the middle man bleeding without active management is kinda cruel i guess ... Which one is the most accurate ones? who has the right to decide everything..
One more bleeding issues arise from here. Is there any right or wrong in life? How to define right and how to define wrong... which is true and which is false... Guess there wont be any answer for that forever. Safe your breath from asking those questions. There are points to and points against in each statement. It depends on how you analyse and how you see it. If you think its wrong, no one can say its right. Cos these are your assumptions and your own ego. Sometimes, its good to stay in a grey area and stand on the fence. In that way, everything will go smoothly. You wont differentiate hatred or love, basic or complicated, should or shouldnt and do or donts.
But, the problem is staying in a grey zone dont make you a human. It is like a chicken on the fence, that will fall down to either sides when the wind or tornado comes in.
My conclusion is there is no conclusion.. This is just another uninteresting blog written by me after 36 hrs working.. tired, exhausted and GREY...
gonna be black soon as i am gonna sleep edy.. zzZZZZ...
Most of the time, we do things base on our instincts. Every times we decide on something, it is a balance between id, ego and superego. In layman term per say, there will be mixture of your common sense, wisdom, personality and emotional intelligence. However, everyone has different thinking and opinion. So, they decide differently although they are dealing with the same issue. To correlate it in my daily life, i have many collegues, many ppl under me and above me. There is a network connection between those working under the same roof. And the fact is everyone has their own frequency and channels in the sense of thinking and preference. This creates a complex human behaviour.
To be frank, ego put a larger percentage when it comes to making decision. The ego is a component of personality especially when dealing with reality.And talking about personality, it builds up from your background moulding you into a human with unique characteristic. Hence, what is in the outside will be the reflections from the inside. Your inner self or personality will be acting like a preset mind which will makes u act/ behave according to what you learn. So, our so called ' fight and flight' responses are different in the sense of how we react when dealing with hardships, obstacles or problems. And this preset mind has ego moulding inside . That make things complicated.
To cut the crap, i will apply it to my current bleeding issues which blunted my decision making ability. As i mentioned, everyone has their own thoughts. So, trouble happens when you have many bosses in queue.. this one order A, that one order B, and the other ones order you to do C.. So, at the end of the day, confusion happens. What should be done? A , B or C ? or A+B+C? or dont do anything at all.. which is which.. Can we do half and dont do the other half?? If i dint do the other half, i will be blamed for not following the orders. Standing in the heats, you will lost your decisive ability as those things are related to human life and undeniably are serious matters. Acting according to our instincts might be wrong at times. And the point is there is no room for mistakes. So, i am carrying a big stones behind my back which is to do everything ordered and confirm i will work until i wear and tear. But if i miss something relevant by doing things selectively, i dont really trust my instincts.
Blunted.......
I cant blame anybody as we all are complex human beings. And according to my bosses experiences and skills with all the hardships that they had been through, they can decide things which they think will be the best for the particular patient. As quoted from our rule of thumb ~ DO NO HARM. But leaving the middle man bleeding without active management is kinda cruel i guess ... Which one is the most accurate ones? who has the right to decide everything..
One more bleeding issues arise from here. Is there any right or wrong in life? How to define right and how to define wrong... which is true and which is false... Guess there wont be any answer for that forever. Safe your breath from asking those questions. There are points to and points against in each statement. It depends on how you analyse and how you see it. If you think its wrong, no one can say its right. Cos these are your assumptions and your own ego. Sometimes, its good to stay in a grey area and stand on the fence. In that way, everything will go smoothly. You wont differentiate hatred or love, basic or complicated, should or shouldnt and do or donts.
But, the problem is staying in a grey zone dont make you a human. It is like a chicken on the fence, that will fall down to either sides when the wind or tornado comes in.
My conclusion is there is no conclusion.. This is just another uninteresting blog written by me after 36 hrs working.. tired, exhausted and GREY...
gonna be black soon as i am gonna sleep edy.. zzZZZZ...
Thursday, July 15, 2010
unsoundable complaints
When we were asked about the problems we had been facing during housemanship... i think there will be an endless list. And when the next question throwed to u which is.. did seniors do anything bad to u or bully you or taking you for grunted.. the floor turn into silence. Why?? lots of questions will appear in the mind... And before voicing out anything, we need to think, filter and extra filter so that we wont hurt anybody besides getting what we want. However, its kinda hard as these complaints are not general to everyone, but specifically to certain ppl. We cannot make it as a prototype saying that this senior sucks, so everybody who is a so called 'senior' will be grouped in a category or being put in a bucket..
An issue arise when u really wana voice it out but you know u cant. Why?? cos with a mature thinking and good emotional intellligence, u know this matter wont be solved by other ppl but yourself. If u dont make it as an issue, it wont be an issue after all... But if the patience has already offf limits, u have the eagerness and hesitancy to splurt everything out at one time. Nvertheless, your subconscious mind told you not to do so as it wont bring any benefit but to create more chaos to the society or to the other unrelevant ppl.
What is the best way to solve a problem..
1. when you are being bullied blindly as those ppl who is elderly than u jus wan to take advantages on those so called ' stupid' jr by giving wrong information or more towards ignorance.. Is ignorance a bliss in this settings?? of course not..
2. when you know that its not your fault and you are being backstabbed by someone who is a known case of lazy worms, jus to show off during ward rounds to impress bosses. when you are jus doing your job, they will hate you like hell and describe u as a mirror that reflects away their brightness. HOW ON EARTH can they get such an idea while you are doing nothing wrong..
Sometimes, you can just keep quiet after those hard cores and endlesss jobs with 36 hrs staying awake ended up being scolded or criticised that u r blocking the brightness in them (although during daylights). Its a voiceless message that i am trying to convey but a pointless ones.
So, there's no point discussing pointless topic. To end it up... i shall only say to myself. Keep quiet and do your job. thats the best answer after all
An issue arise when u really wana voice it out but you know u cant. Why?? cos with a mature thinking and good emotional intellligence, u know this matter wont be solved by other ppl but yourself. If u dont make it as an issue, it wont be an issue after all... But if the patience has already offf limits, u have the eagerness and hesitancy to splurt everything out at one time. Nvertheless, your subconscious mind told you not to do so as it wont bring any benefit but to create more chaos to the society or to the other unrelevant ppl.
What is the best way to solve a problem..
1. when you are being bullied blindly as those ppl who is elderly than u jus wan to take advantages on those so called ' stupid' jr by giving wrong information or more towards ignorance.. Is ignorance a bliss in this settings?? of course not..
2. when you know that its not your fault and you are being backstabbed by someone who is a known case of lazy worms, jus to show off during ward rounds to impress bosses. when you are jus doing your job, they will hate you like hell and describe u as a mirror that reflects away their brightness. HOW ON EARTH can they get such an idea while you are doing nothing wrong..
Sometimes, you can just keep quiet after those hard cores and endlesss jobs with 36 hrs staying awake ended up being scolded or criticised that u r blocking the brightness in them (although during daylights). Its a voiceless message that i am trying to convey but a pointless ones.
So, there's no point discussing pointless topic. To end it up... i shall only say to myself. Keep quiet and do your job. thats the best answer after all
Tuesday, July 13, 2010
My 1st intervention ~Vacumm assisted dressing
This morning, i finally has a chance to do my very own vaccumm assisted dressing.. As i had learned it weeks earlier, so i might had some ideas how to deal with it.
For this procedure, i am asked to use some cheap stuffs to build a vaccumm assisted dressing with wall suction. And previously, i saw other patients using high tech stuff with an equipment cost about at least few thousands ringgit not including the accesoories...
So now, i am going to use a more economical stuff as we have inadequate machines in the ward.
So, the tressure hunts begin. Equipments needed are basically sponge, gauze, ryles tube, suture, suction tube and a big bottle . Initially i found an RM1 sponge that has been autoclav ~ super sterile.. i grab 2 sponge and put into my trolley. Then its time to find the suction tube.. Searching up and down for the tubes... tiring but interesting. Gauze , suture and ryles tube are easier to find as it is a common stuff used in ward. And lastly, i asked for a big bottle from the staff nurse. After everything done..its time to get myself sterile.
Before starting to do anything, i need to make sure the wall suction is powerful enough to suck the pus and keep the wound in a vacumm state. Luckily i found one but it was being used for a comma patient as he needs regular suction for his tracheostomy. Then, with a bad intention, i stole his suction and exchange a less powerful suction for him (still can be used~ i am still not that bad i think- p/s : i tested it already before i change. it is functional).
After attaching the pot filling with chlorhexidine and suction in situ, i cleaned and drapped the patient under sterile technique. Actually, he has a big cavity wound with big pouches filled with foul smelling psu which is an indication for us to do vacumm assisted dressing. So, i irrigated his wound with povidone iodine mixed with normal saline. Then, after drapping him up,i start to cut small holes along the ryles tube to create more holes so that more suctioning can be done. After that, the ryles tube is wrap with gauze and sutured with dafilon 3/0. And then, the ryles tube is inserted into the pouch and then roll around at the cavity. Next,, the sponge is cut according to the wound size and is covered on top of the ryles tube. FInally, everything is wrapped up with op-site to secure the position and make sure there is no room for air entry.
At last, the ends of the ryles tube is attached to the suction tubing. And suction pressure is turned to 150mmHg. Alas, the wound has turned into a vacumm state. The Vacumm assisted closure (VAC) done..
Pus is drained out immediately. Initially, patient will feel the pressure and tightness but as he get used to it , i can increase the pressure up to 200mmHg. Hence, this is the end of the procedure. This vacumm assisted dressing can last for a week and then if the wound is clean, we can opposed it with secondary suturing with KIV split skin graft or change another VAC until the wound is totally clean with granulation tissues.
I think the total cost price of the whole procedure is 50x cheaper than the high tech machines..
The most economical method i ever done...
SATISFACTORY....
And i keep looking at the patient's leg the whole evening and looking at the successful intervention that i did for the day..
Ohh... goody..
For this procedure, i am asked to use some cheap stuffs to build a vaccumm assisted dressing with wall suction. And previously, i saw other patients using high tech stuff with an equipment cost about at least few thousands ringgit not including the accesoories...
So now, i am going to use a more economical stuff as we have inadequate machines in the ward.
So, the tressure hunts begin. Equipments needed are basically sponge, gauze, ryles tube, suture, suction tube and a big bottle . Initially i found an RM1 sponge that has been autoclav ~ super sterile.. i grab 2 sponge and put into my trolley. Then its time to find the suction tube.. Searching up and down for the tubes... tiring but interesting. Gauze , suture and ryles tube are easier to find as it is a common stuff used in ward. And lastly, i asked for a big bottle from the staff nurse. After everything done..its time to get myself sterile.
Before starting to do anything, i need to make sure the wall suction is powerful enough to suck the pus and keep the wound in a vacumm state. Luckily i found one but it was being used for a comma patient as he needs regular suction for his tracheostomy. Then, with a bad intention, i stole his suction and exchange a less powerful suction for him (still can be used~ i am still not that bad i think- p/s : i tested it already before i change. it is functional).
After attaching the pot filling with chlorhexidine and suction in situ, i cleaned and drapped the patient under sterile technique. Actually, he has a big cavity wound with big pouches filled with foul smelling psu which is an indication for us to do vacumm assisted dressing. So, i irrigated his wound with povidone iodine mixed with normal saline. Then, after drapping him up,i start to cut small holes along the ryles tube to create more holes so that more suctioning can be done. After that, the ryles tube is wrap with gauze and sutured with dafilon 3/0. And then, the ryles tube is inserted into the pouch and then roll around at the cavity. Next,, the sponge is cut according to the wound size and is covered on top of the ryles tube. FInally, everything is wrapped up with op-site to secure the position and make sure there is no room for air entry.
At last, the ends of the ryles tube is attached to the suction tubing. And suction pressure is turned to 150mmHg. Alas, the wound has turned into a vacumm state. The Vacumm assisted closure (VAC) done..
Pus is drained out immediately. Initially, patient will feel the pressure and tightness but as he get used to it , i can increase the pressure up to 200mmHg. Hence, this is the end of the procedure. This vacumm assisted dressing can last for a week and then if the wound is clean, we can opposed it with secondary suturing with KIV split skin graft or change another VAC until the wound is totally clean with granulation tissues.
I think the total cost price of the whole procedure is 50x cheaper than the high tech machines..
The most economical method i ever done...
SATISFACTORY....
And i keep looking at the patient's leg the whole evening and looking at the successful intervention that i did for the day..
Ohh... goody..
Da' drug abuse patient
Funny things do happen in our daily life.. Once, i was attending a patient which was a drug user and retroviral disease. He was isolated at one corner due to unknown hepatitis status and had suspicion of having tuberculosis. Initially, i felt empathy on that patient. He looked so cachexic and had hyperpigmentations all around the body. His leg was ulcerated and necrotic.
I was ordered to take an excisional biopsy from the patient's leg. I spent almost the whole morning calling here and there to get the form and also the sample bottles with formalin just for this particular patient. At last .. everything done. And its time to wear like astronaut for double barrier and universal precaution sake. Spending 10 minutes to put everything on~ apron, goggles, mask and double gloves. Finally, i approached the patient.
On the night itself, i stayed up as i had oncall. At 4am in the morning, as usual, i took blood from patients that need daily electrolytes and coagulation profile monitoring. When i scroll thru the whole ward, i stopped at the corner of the ward. And i double checked the bottle... Oh, it was him again. I was predicting something might happen again.
As predicted, when i entered his boundary, he started to screen for any sharp equipments. He saw me taking a syringe and needle. Voluntarily, he gave me his hand.. Before i sucked his blood, he started to give his lecture. He told me ways to take blood and ordered me to take blood from the particular vein in certain angles and directions. I followed what he said and eventually failed my first attempt. So, he started finding other veins for me and ordered me to take from the site he pointed. ( Hmm.. he do have a more advance knowledge in regards of the anatomy of blood vessels than i am.. ).. He kept babbling and babbling.... giving me his very own lectures.. IT WAS 4AM IN THE MORNING.. (ANd it was the crab teaching the duck how to swim) My patience was then escalating up to the boiling point. Swallowing a gulp of saliva, i finally poke his radial artery. He scolded me for blindly poking his veins without even seeing them. And he reassured that i wont get any blood from him as i didnt listen to his advise. Out of nowhere, blood started gushing into my syringe and i finally took 10cc blood from him.
I exhaled soundly as a sign of relief. At this moment, the environment was as quiet as i could even hear the laughter of the nurses at the counter area. Then i realise that his face turned blue and he finally kept his mouth shut.
-------THE END---------
The lesson for the day is to TRUST YOUR INSTINCT...
I was ordered to take an excisional biopsy from the patient's leg. I spent almost the whole morning calling here and there to get the form and also the sample bottles with formalin just for this particular patient. At last .. everything done. And its time to wear like astronaut for double barrier and universal precaution sake. Spending 10 minutes to put everything on~ apron, goggles, mask and double gloves. Finally, i approached the patient.
So, the procedure had begun. I started irrigating his wound with normal saline and povidone.. Weirdly, when i irrigated his wound on the leg, he shouted for help and crying of pain.. He lifted his leg as high as possible and couldnt let me touch it. He sworn that he rather amputate it than letting me irrigating the wound. I dint even cut a single piece of his flesh, he already yelled like someones going to die.Then , he refused to let me proceed with the procedures. Initially, i felt numbed by his reactions. Of all the preparations i made, he refused to take the sample because i irrigated his wound. And the utmost part was that I HAVENT TAKE OUT THE BLADE...
On the night itself, i stayed up as i had oncall. At 4am in the morning, as usual, i took blood from patients that need daily electrolytes and coagulation profile monitoring. When i scroll thru the whole ward, i stopped at the corner of the ward. And i double checked the bottle... Oh, it was him again. I was predicting something might happen again.
As predicted, when i entered his boundary, he started to screen for any sharp equipments. He saw me taking a syringe and needle. Voluntarily, he gave me his hand.. Before i sucked his blood, he started to give his lecture. He told me ways to take blood and ordered me to take blood from the particular vein in certain angles and directions. I followed what he said and eventually failed my first attempt. So, he started finding other veins for me and ordered me to take from the site he pointed. ( Hmm.. he do have a more advance knowledge in regards of the anatomy of blood vessels than i am.. ).. He kept babbling and babbling.... giving me his very own lectures.. IT WAS 4AM IN THE MORNING.. (ANd it was the crab teaching the duck how to swim) My patience was then escalating up to the boiling point. Swallowing a gulp of saliva, i finally poke his radial artery. He scolded me for blindly poking his veins without even seeing them. And he reassured that i wont get any blood from him as i didnt listen to his advise. Out of nowhere, blood started gushing into my syringe and i finally took 10cc blood from him.
I exhaled soundly as a sign of relief. At this moment, the environment was as quiet as i could even hear the laughter of the nurses at the counter area. Then i realise that his face turned blue and he finally kept his mouth shut.
-------THE END---------
The lesson for the day is to TRUST YOUR INSTINCT...
Sunday, July 11, 2010
Tibial pin traction
Finally i was able to do a proper tibial pin traction after assisting for once. My first impression of tibial pin traction was ~ we were inducing harm to the patient rather than for good. Why i made such impressions were because i was standing in the third person's view.. A doctor is applying pin poking and screwing thru and thru the bones and on the other hand the patient screaming for help echoing around the whole ward due to more pain induced by the doctor besides having a femur fracture above it. But , thru deep considerations and weighing the pros and cons, i think its a doing good procedure than doing harm though we just give local anaesthesia to the patient which only contribute a chicken dose of pain relief effect.
After some deep thoughts , i began to realise the fact that in a patient having long bone fracture over the lower limbs , there will be a muscular spasm going on around the fracture area. The strong musculature will cause more displacement and deformed bone.Besides., any mechanical movement will induce more pain via the friction between the fractured bone with the soft tissues. So, the purpose of doing the tibial pin traction is actually to immobilize the bones, reduce the muscular spasm( by using the bla bla bla law) ,to relief pain and for an easier operative procedure. And thru immobilization , there wont be any mechanical movement which can aggravate more pain.
The day when i oncall where i had an opportunity to apply a tibial pin traction for a patient who alleged domestic injury and sustained fracture over the femur.
What i needed was a blade size 11 or 10, local anaesthesia ~ lignocaine, syringe and needles, povidone iodine and normal saline, tibial pin , T- handle (for screwing purpose) and also a bohler braun frame ( for elevation of leg, padding and a connector to the pulley) , lastly the traction weight which is 10% of the weight of the patient.
Initially, i had to mark the place i need to cut which is first to allocate the location of tibial tuberosity, and go lateral 2FB and inferiorly 2FB. the reason to go laterally was that i was not suppose to hit the common peroneal nerve. So, by going laterally, i could push away the nerve avoid cutting the nerve that night cause foot drop. So , after marking the point of incision, we should test for any pre- procedure foot drop. And to compare with the post-procedure foot drop. To see whether the foot drop were induced by us or it had been originally torn as these are medicolegal stuff that we need to be concerned about.
After getting the skin drapped under sterile technique and areas of incision cleaned with povidone and NS, i started giving LA to the patient on the incisional site. Then to test whether the anaesthesia taken effect or not, i had to pinch the skin with forceps. If the area got numbed, i couls start doing a 1cm longitudinal incision on the marking area. And then using a dilator to open up the fascia. Tibial pin applied and screw from lateral to medial. It shud be crossing thru the metaphyseal area which shud be softer than the cortical region. So, when felt a give way, meaning that it had already poked thru the bone. So, another incisionon on the other site can be done~ also 1cm longitudinal incision. Before that, to give LA for anesthesia. After all and all, apply stirrup and place the leg in a BBF and lastly connect to a tractional weight for ~5kg (standard weight).
Make sure that the ASIS-patella-2nd toe are is aligned.With enough padding on fracture site to prevent presuure between bone and soft tissue causing necrosis. leave ankle free to allow exercise and prevent foot drop. For tibial pin care, flavin dressing daily at the pin tract site is a must. And to watch out for tibial pin infection as it could cause further osteomyelitis to the patient.Make sure the countertraction is there or else the whole procedure serve no purpose.
As the rules of dealing with fracture is to reduce, hold and exercise, we need to permanently hold it via platting or intramedullary nail/ interlocking nails base on specialist preference and which are the best for the patient. After operative procedure, sending for physiotherapy is a must to prevent joint contractures by starting with quadriceps strengthening exercise, buttock lifting and ankle foot pump exercise and lastly for Non weight bearing crutches for at least 12 weeks. So that the bone will unite without causing refracture of bone as the load sharing is there.
After some deep thoughts , i began to realise the fact that in a patient having long bone fracture over the lower limbs , there will be a muscular spasm going on around the fracture area. The strong musculature will cause more displacement and deformed bone.Besides., any mechanical movement will induce more pain via the friction between the fractured bone with the soft tissues. So, the purpose of doing the tibial pin traction is actually to immobilize the bones, reduce the muscular spasm( by using the bla bla bla law) ,to relief pain and for an easier operative procedure. And thru immobilization , there wont be any mechanical movement which can aggravate more pain.
The day when i oncall where i had an opportunity to apply a tibial pin traction for a patient who alleged domestic injury and sustained fracture over the femur.
What i needed was a blade size 11 or 10, local anaesthesia ~ lignocaine, syringe and needles, povidone iodine and normal saline, tibial pin , T- handle (for screwing purpose) and also a bohler braun frame ( for elevation of leg, padding and a connector to the pulley) , lastly the traction weight which is 10% of the weight of the patient.
Initially, i had to mark the place i need to cut which is first to allocate the location of tibial tuberosity, and go lateral 2FB and inferiorly 2FB. the reason to go laterally was that i was not suppose to hit the common peroneal nerve. So, by going laterally, i could push away the nerve avoid cutting the nerve that night cause foot drop. So , after marking the point of incision, we should test for any pre- procedure foot drop. And to compare with the post-procedure foot drop. To see whether the foot drop were induced by us or it had been originally torn as these are medicolegal stuff that we need to be concerned about.
After getting the skin drapped under sterile technique and areas of incision cleaned with povidone and NS, i started giving LA to the patient on the incisional site. Then to test whether the anaesthesia taken effect or not, i had to pinch the skin with forceps. If the area got numbed, i couls start doing a 1cm longitudinal incision on the marking area. And then using a dilator to open up the fascia. Tibial pin applied and screw from lateral to medial. It shud be crossing thru the metaphyseal area which shud be softer than the cortical region. So, when felt a give way, meaning that it had already poked thru the bone. So, another incisionon on the other site can be done~ also 1cm longitudinal incision. Before that, to give LA for anesthesia. After all and all, apply stirrup and place the leg in a BBF and lastly connect to a tractional weight for ~5kg (standard weight).
Make sure that the ASIS-patella-2nd toe are is aligned.With enough padding on fracture site to prevent presuure between bone and soft tissue causing necrosis. leave ankle free to allow exercise and prevent foot drop. For tibial pin care, flavin dressing daily at the pin tract site is a must. And to watch out for tibial pin infection as it could cause further osteomyelitis to the patient.Make sure the countertraction is there or else the whole procedure serve no purpose.
As the rules of dealing with fracture is to reduce, hold and exercise, we need to permanently hold it via platting or intramedullary nail/ interlocking nails base on specialist preference and which are the best for the patient. After operative procedure, sending for physiotherapy is a must to prevent joint contractures by starting with quadriceps strengthening exercise, buttock lifting and ankle foot pump exercise and lastly for Non weight bearing crutches for at least 12 weeks. So that the bone will unite without causing refracture of bone as the load sharing is there.
* image taken from http://wheelessonline.com/tibtrac.jpeg
Saturday, July 10, 2010
Suffocated
In the first few days of life, i was so stressed up and tired with jobs, obligations and the worst part is the cooperations with the staff nurses.. In the first few days, i kept making mistakes. I was scolded no matter what i do.. And i got confuse between right and wrong.. A list of mistakes done... eg. filling up the wrong form, forget to sign, writing wrong thing at the wrong place, taking staff nurse trolley, forgot to clean up after use and the list goes on.. There were tonnes of mistakes that i did in one day and got scolded like hell.. i felt suffocated and started to wonder why i became an FOC punching bag ..haizz..
My goodness, why staff nurses can be so fierce.. i got so phobia to them. Am i too young ? Do i really do that much of mistakes? are there any considerations as i was still a newbees there? i knew that there wont be answers for these questions. I started to find a way to solve it, by learning things faster . But then, i notice that its not abt the mistakes that i did.. at times, i got scolded without reasons and being humiliated by them in front of the patients .I knew there was something wrong somewhere.Things didnt go well as i thought to be.With lots of question mark in mind, i consulted my family members. They taught me some management skills and also ways in handling crisis.. My collegues taught me to be more confident in making decisions and be strict at times so that i wont be bullied blindly.
With their help,i was able to go thru these obstacles without problems..
My goodness, why staff nurses can be so fierce.. i got so phobia to them. Am i too young ? Do i really do that much of mistakes? are there any considerations as i was still a newbees there? i knew that there wont be answers for these questions. I started to find a way to solve it, by learning things faster . But then, i notice that its not abt the mistakes that i did.. at times, i got scolded without reasons and being humiliated by them in front of the patients .I knew there was something wrong somewhere.Things didnt go well as i thought to be.With lots of question mark in mind, i consulted my family members. They taught me some management skills and also ways in handling crisis.. My collegues taught me to be more confident in making decisions and be strict at times so that i wont be bullied blindly.
With their help,i was able to go thru these obstacles without problems..
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