The Synapse Connections of a lifetime

Hi everyone,

It has been a very long time since my last post.
I would like to share a link to my new website, intended for anaesthetic trainees.

Please have a look and let me know how you feel about it!

https://sites.google.com/view/anaestheticstrainingkit/home

Alex Koh

Term one has just ended for me two days ago, and surgical nights is officially over for me. It has been quite a journey, some great experiences and some not. Next up is Emergency, which should be fun, but from what I can tell with my experiences with the emergency people during nights, it's not that great a term, at least in this hospital. I won't get into the details of the politics, but I'll just have to see what's in store.

What I realised after going through the term is how much technology has helped me with my work. Despite hating Apple and the so called fanbois, I have purchased myself an iphone4. This phone has helped me quite a lot during the course of my work.

For start, there's calculators that allowed me to quickly add up severity scores, like Well's score and Ranson's scores. Then there's this app that quickly displays all the differentials to consider with a given clinical symptom. Add that to the army of books available and you can see how much power you can have in your fingertips to support your decision making process. This is especially important at nights, as many times you are the only one there to make the call and everyone else just looks at you, waiting for you to make the decision and assessment.

One day I had to insert an IV cannula into a Russian patient who just recently pulled out her old one. She was a non-english speaker and no one could convince her to get another one. Getting intepreters was out of the question at 3 am in the morning, and the patient was getting increasingly agitated since we can't understand each other. I took out my phone, launched the google translate app, typed in the things i wanted to say and it reads it out aloud in russian! Problem solved, patient finally settled down and IV line inserted. hehe!

Soon I will get myself iMIMS, which would allow me to quickly look up medications and its interactions. It does cost a bomb though.

Technology has changed how we do things and personally it has improved my working experience. What about you?

What i'm going through now is probably old news for many of my friends, I'm starting work as an intern! It has been a long journey of hurdles and reflection, now here I am on the edge of my new life. The room was filled with many eager faces, some of them familiar since we ate from the same uni. What followed was orientation that lasted for three days. It was something we needed. Friendly faces thats there to support us and some time to come to terms with our new responsibilities. Yes, no longer can we hide behind the "I'm a student" phrase when faced with a difficult situation. We are now in a privileged position as doctors and we have responsibilities toward the safety and wellbeing of our patients. I started my first term as a surgical night intern. My job is to take care of surgical patients and to make sure they went through the night smoothly. A week after orientation I find myself alone at night in the wards. There was support by the hdu rmo for high level though which I really need. My first job was a request for fluids.. A simple task that took me quite some time to decide, much because it was the first time I'm the sole decision maker and also because if done wrongly it could really mess up the patient. The confidence increases steadily by the week, and I find myself increasingly able to make critical decisions quicker. The vivas that we went through for the exam was invaluable, kudos to the viva study group, whom without I would be so much more lost. All is not smooth though. On the second day one patient developed severe abdominal pains and needed emergency surgery for perforated bowel. It bugged me for a few days whether I did everything right, and if theres anything that I could have done differently. I'm not sure if the man survived; the last time I heard he was in icu post op, I never see him ever again since. Now I'm in my week off, and it's going to be annoying coz I'm starting work on the first day of cny! And such is my life so far, I wonder what's next..

It has been so long since I’ve updated this place. Seems like this is going to be the trend. We had our last tutorial today. In a couple of weeks I would be starting my internship! Feels like not long ago we were still preparing for the final exams and now everything’s finished!

We’re just doing our PRINT term now. It stands for Pre-internship and it’s basically just an excuse to work us out without pay, haha! But seriously, it’s just to make the transition to working life smoother, with all the discharge letters and stuff.

I’m doing Orthopedics term now and it has been quite interesting so far. My team isn’t that demanding in terms of attendance so I’m taking it slow as well. Went to surgery the other day, did'n’t get to do more high tech stuff yet but I got to remove a screw from a leg! It’s weird coz it felt EXACTLY like unscrewing a furniture. Orthopedics seemed to be quite fun. They are the carpenters in medicine. Hopefully next week i’ll get to wear the space suit!

Still have some stuff to arrange before i leave for good. Just another ten days left. IH seemed very empty at this time, since most residents have left for their holidays. Strangely enough, I don’t think I’ll miss this place that much.. Maybe the food. hehe!

We just finished gradball last week as well and it was a blast! It was the first ball I’ve been to since Uni began. The whole event gave our graduation a feeling of closure. And of course there’s the graduation ceremony which is coming up on the 14th of December. If you know me, please drop by for a photo!

Check this out!

Working in medicine carries a very strong responsibility. We all know that even before beginnning our studies.

Yesterday I had a taste of what decision making in a real clinical setting felt like.

Saw a patient who presents with symptoms of vertigo, did a hallpike manoeuvre which was positive and immediately came about with my diagnosis of BPPV.

Under normal circumstances, I would usually present my findings to a resident or a registrar and then make a decision on clinical management together. That way, I feel safe and well supervised. Most importantly, I feel assured that whatever decision we make is correct in terms of best patient outcomes.

The situation was slightly different for that case yesterday. The resident I presented to didn't know about the Hallpike nor much about the management of BPPV. Based on my convincing presentation that it was BPPV and a short presentation during the ward round, the diagnosis was set and we can safely discharge the patient home.

Everything was fine, I was quite confident of my final diagnosis and the managment plan was safe (we ensured the patient gets followed up by a GP within a week).

I thought nothing of it until last night when I was writing up the case. I felt burdened. What if I was wrong? Did I just send someone home in error? Did I consider all the possible differentials, did I get the history right, did I exclude critical diagnoses?

In another year, this would be routine. I need to buck up to make sure I don't mess up.

Saw this in the command and conquer forums, made me laugh for a few mins. Back to work!

Was gonna post pictures of Brisbane's fireworks in new year's eve 2009 but I procastinated.. yes yes.. haha! That's only one of the many things I've procastinated.. Assignments, study, among other things.

Without further bs i present you my fireworks pictures of NYE 2009.









The nights were lit with colours and light. Thanks for reading!

Haha, i LOL-ed

Went to seaworld last month, it's one of the many theme parks in Gold coast. The park itself isn't much to talk about, its probably more geared towards kids to be honest. There isn't even any thrill rides, except one which is quite fun. :P

It started with this guy on a motor boat coming in with the dolphin jumping in front.



Then suddenly three dolphins leaped from behind.

Grilled salmon for the first time today. Followed the instructions from someone online. I had no expectations.. haha!


The marinade used for this salmon was teriyaki, which is essentially a combination of sugar, soy sauce and sake (or water).

After addind the marinade, the fish was left for about an hour, with occasional turning. Then it was put into the oven to grill for exactly 9 minutes.


After that, it's done! The marinade used earlier was pan cooked until boil then popured over the grilled salmon and its ready to serve.


Again, it doesn't look like much but it tasted great (better than initial expectations at least, haha). The meat wasn't too dry and it wasn't raw. I was happy :P

NYE 2009 pictures from Brisbane coming up next, but it wasn't that good.. the experience in Sydney 2008 was much better.

I baked some scones today, all by myself! This is how it looked like..


Not bad for first time right? I know it doesn't look like scones.. but it tasted close enough.. haha!

New Years Eve tonight, hope fireworks 2009 in Brisbane would be awesome. :)

In Brisbane now for summer holidays. Currently doing my electives term in Princess Alexandra Hospital. Respiratory team there is the best team I've ever been attached to, they were really friendly and helpful! Thanks guys! Will move on to Emergency next Monday, no idea how's that going to turn out at all.. hope it'll be a good term.

Just came back from Wet & Wild, watched a movie until about 8.00pm inside! It was an outdoor movie screening and it was cool coz it's by the pool and people can actually swim and watch the movie at the same time! Astroboy was being screened, which was cool since it was a new movie and all. Never really liked the manga/anime character coz IMO he looks gay.. haha but the movie turned out well. Maybe its coz most of the time he actually wore clothes instead of the gay red shorts in the anime :P The ending was quite heart warming as well.

On another note, I'm starting up a photography tutorial site call lightcrafters. Do pop in and have a look if you are interested and if possible, contribute an article!

Looking forward to NYE 2009 in Brisbane, hope the fireworks here will be as good as Sydney!

I also took some really bizzare pictures like this one, which looked like hairy trees in the sky.

And this one, which looked like an alien invasion.

Brisbane Festival - Fireriver: Dump and burn
Originally uploaded by WaySiong

Brisbane festival's fireworks was the bomb! With a duration of 30 mins it actually felt more intense than the Sydney NYE 2008 fireworks. Great choreography, great variations and great music.

Seen here is the 'dump and burn' thingy, where an F-111 jet flies by and dump fuel then igniting it with its afterburner. More pictures to be processed but the thing I learn is to get a much higher tripod.. there's this SOB blocking all my shots with his head!!

After a harsh experience at Sydney airport, I'm not in Brisbane. Think i only have 2 mins of internet left, waiting for the train to leave the station and leaching off the free wifi :P

Looking forward to meet my gf again :) and also the supposedly awesome Brisbane festival.

More updates later.

I'm sick! runny nose, sore throat.. sigh.. must be one of the kids in Campbelltown with RSV :P On that note, I've completed my 4 week term in Campbelltown hospital, no more travelling 43km one way!

Campbelltown is a nice place to do paeds though, no other students, all the patients for yourself, all the registrars for yourself, hehe!

Anyway, just in between studying i decided to have a look at apple's site and came across the new Mac OS called the Snow Leopard.

Scrolled down a whole page that says how good and fast it is and at the end I saw this:
Good job apple! :P


The guys at apple marketing is probably the best of the best in the world.

Take this ad for example:


The most powerful iPhone yet! A bit duh rite? its comparing to itself.. of course the new one is more powerful than the old one la.. duh!

Voice control? even my old phone has it.. But i guess using voice to control music is something new. Now on the bus you will hear this:

"shuffle"

"next"

"increase volume"

"play"

Haha!

It might be a good thing though, if someone on the train blast his music and you don't like you can shout "off!" to stop it. :P

And compass.. really dunno what to say about it.. :P

Seriously though, at the rate apple is releasing their products, It would suck to buy something only to realise a few months later ur apple is rotten apple already. Slow down laa!

Oh well, that's my little thoughts on the new phenomenon.

Disclaimer:
I have nothing against apple, if you would give me a free apple product I would use it :P

Went as a student volunteer in this year's GP conference and exhibition today. It is a yearly thing held in Sydney olympic park but it was my first time attending. Supposed to be the biggest event for GPs in the Southern Hemisphere.. The thing about Australia, everything you do has the potential to be the best in the southern hemisphere, since there isn't many other people in the southern hemisphere itself with the same demographics :P

Anyway, to be honest, my main objective to attend this thing is to get free stuff. Drug reps are a medical students' best friend. U have things like pens, notepads up til really random stuff like BMI calculators, stress balls, and random junk. Best thing today was probably a 1GB thumb drive, although these things are dirt cheap now. : P


Day was tiring though, was asked to do stupid things like preparing pig throtters for the suturing sessions. Got a suturing kit for free at the end though, but i'll need some meat and some sutures to do anything!

But to be serious, the event itself can be quite a good learning experience since volunteers are allowed to sit in on most of the talks and workshops. Was too tired to do anything though.

Time to pack up the pens! :)



PS: what do you do when a guy who threthens to suicide on a bridge obstructs traffic for 4 hours? You push him down :P . The 'victim' survived at the end.

Saw a classic case of superior vena cava obstruction today. Patient had every single symptom and signs associated with the problem, including +ve pemberton's sign, distended veins, etc. 

Just thought I should share this information. Its rather informative and useful.

Adapted from theStar.

What is swine influenza?

It is a respiratory disease of pigs caused by type A strains of the influenza virus. It regularly causes high flu outbreaks in pigs but with low death rates. There are four main sub-types of the virus, but the most recent isolated influenza viruses from pigs have been H1N1 viruses.

How does it spread?

Swine flu viruses do not typically infect humans though they do occur through close proximity or contact with infected pigs or contaminated areas. Cases of human-to-human spread have been documented.

What are the symptoms?

The symptoms are similar to those of regular flu:
- Fever
- Lethargy
- Runny nose
- Cough
- Sore throat
- Lack of appetite
- Vomiting and diarrhoea in some cases.

How common is swine flu infection in humans?

In the past reports of about one human swine flu virus infection had been received every one to two years in the United States. From December 2005 till February 2009, 12 cases have been reported.

Has this strain of flu been seen before?

No. Flu mutates constantly, so it is common for new strains to emerge. Pigs can also be infected with both human and avian influenza, and the current circulating swine flu strain appears to contain genetic elements from all three.

Can swine flu be treated with antiviral drugs and flu vaccine?

The swine flu is resistant to two common drugs – Amantadine and Rimantadine. The H1N1 swine flu viruses are very different from human H1N1 viruses. Therefore, vaccines for human seasonal flu would not provide protection. However, a “seed vaccine” has been specifically tailored to this swine flu and will be manufactured if officials deem it necessary.

Can people catch swine flu by eating pork?

No. Swine influenza viruses are not transmitted by food. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 70ºC and above kills the swine flu virus.

How long is someone with swine flu considered contagious?

People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic; possibly for up to seven days following the onset of the illness. Children, especially younger children, might potentially be contagious for longer periods.

What can I do to protect myself from the swine flu?

There is no vaccine available right now to protect against the swine flu.

However, you can help prevent the spread of germs that cause respiratory illnesses like influenza by:

- Covering your nose and mouth with a disposable tissue or handkerchief when you cough or sneeze. Throw the tissue in the waste basket after you use it.

- Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also helpful

- Try to avoid close contact with sick people. - If you get sick with influenza, stay at home and limit contact with others to keep from infecting them.

- Avoid touching your eyes, nose or mouth.

- Consult your nearest healthcare facility if you think you have any of the symptoms.

Which countries have had cases of the swine flu?

The World Health Organisation (WHO) has confirmed human cases of swine flu in Mexico, the United States, Canada and Spain. Only Mexico has reported deaths from the new strain.

Are there any travel restrictions or advisories for Malaysians?

The Health Ministry on April 27 advised Malaysians against travelling to certain places in the United States, Mexico and Canada which have been affected by the swine flu.

What precautions are in place in Malaysia?

- The Health Ministry’s operations room in Putrajaya has started a 24-hour monitoring of the situation. The public can call 03-8881 0200/300 for enquiries.

- Those returning from Latin American countries and found to have flu-like symptoms will be quarantined.

- Health Ministry officials are conducting health screenings on passengers arriving from the United States.

- Thermal scanners will be placed at international airports to speed up the screening process for swine flu.

- Public and private medical practitioners have been instructed to report to the district health office any patient with influenza-like illnesses or severe pneumonia symptoms and who had travelled to the affected countries after April 17.

- Owners of the 797 pig farms nationwide have been ordered to immediately contact the nearest Veterinary Services Department office or the Animal Disease Control Centre if their workers or animals show symptoms linked to the swine flu.

Where can I get more information?

For more information, go to the Health Ministry (www.moh.gov.my) or call the Ministry's hotline at (03) 8881-0200/300.

Useful Links:
World Health Organization: www.who.int
Centers for Disease Control and Prevention: www.cdc.gov
Homeland Security Department: www.dhs.gov
WHO swine flu page: http://www.who.int/csr/disease/swineflu/en/index.html

Currently the situation is still under control with border controls well in place in many countries. I guess H5N1 taught everyone a good lesson on pandemic control and reaction.

Seek medical assistance ASAP if you have any flu-like symptoms.