step by step of inserting a triple lumen CVL

i got this from icu file

but maximal upload can only 5 pic

tracheostomy- to do or not to do

a case report, 18 years old girl
ASA 2 premorbidly
ventilated for 2 weeks, for severe drug poisoning
that drug does not have anti-dote
with inotropic support near maximum
and maximal ventilatory support
endotracheal tube in place, which makes her lips eroded and ulcerated
her vital signs parameters were near normal only
so what to do next?

here tracheostomy whether mandatory?
p/s she has a short neck and is kinda obese..
if yes, who should do it? anaesth? surgical? ENT?
where should it be done? ICU? OT?
what method should be used? percutaneous? open method?

medical should not have heroic thing to be done
and that has been done should be beneficial to patient...

finally a tracheostomy was done, but patient deteriorating..

i like this software

yeah wat an interesting software
once u started, there is no way u can stop it
OMG, it really kills too much of my time...

progression of interest..

photo editor

see the different btw two pic?
is amazing, isn't it..


portrait drawing

extension from yesterday, my technique is improving
i think soon i can open my stall for portrait..hahaha...
and actually this is just shock sendiri only..

the tiny little line remained cos i do not have eraser here,and also the mouth is bit sengek.. haha cos not erasing before enhanced the drawing

portrait drawing

during the conference, there are some drug company hire ppl to draw our face
so i sat down there for 10 min for him to draw me
body is already pre-fixed.

then i just stood behind him, to see how he drew..
finally gone bac home and try it myself..
hehe... outcome?

1st is a random drawing of ppl face, then take my own face to draw...
just put up for ppl to laugh..

first attempt: random face

then i drew myself, like the post during last blog.. hehe..
more like me?

urology conference at klcc

nice conference, nice hall, nice talk
even have robotic surgery..
and live transmission from hkl to klcc
(by tv3, but charge expensively)

the only not nice thing is the lunch
lousy food in box, and no place to sit and eat...

photo editor

before

after

a nice software to use
u can see the different of before and after

i found this website

some funny website
funny photo! create funny pic

i found this in icu

look what i found in icu..
these 2 books are on the table of the on call room
such books placed simply on table
for a transformer fans like me, surely will make them mine.. hehe

"whose books are these?" i shouted
YSS came near and whispered: "ooi, dun shout ler, u wanna let everybody know ar?"
"this is not some illegal thing, and good stuff should be shared right." i replied
"you wait lar," he shouted, "this is not medical books u know, nobody can touch!!"

now you see, movie is better appreciated than medicine

or you can interprate it differently: medical knowledge should be shared, but useless comics should not spread around..

digestion notes from anaesthesiology

no words, just some notes

central venous line

triple lumen CVL at subclavian vein

double lumen CVL at femoral vein

set of double lumen (left) and triple lumen (right)

how many central line that u know of?
how many method that a central line can be inserted?
that would be too many?

well that could be divided grossly
- into subclavian vein, internal jugular vein, femoral vein, basillic vein etc etc..
- long line, short line
- single lumen, double lumen, triple lumen...
- the usage??

a day in ICU, i was going to re-route a triple lumen, and Dr YSS would insert a femoral line for dialysis...

YSS walked near and leaned at the couch: hey SS, i dun know how to re-route a CVL, can i observe?"
"oh ya," i replied :"me too dun know how a femoral line being inserted, can u show me?"
" of course... but let us close the curtain first, dun let others see.." YSS said, followed by a chicky smile.

thus, we pulled the curtain to cover us, with the patient within.. but it so sound like we were doing something bad.. hehe..

then, suddenly a head tucked in, "hooi.. what both of you doing here, GAY is it?" Dr TT with a weird smile: "talk softly but laugh loudly, you two hah..."
"ya ya, u know la." YSS said: "keep quiet and dun tell others ok.."
i added: "or u want to join, then we can play threesome"

opps... that is not for child, if u are below 13, please close this page ya..

working on sunday morning

this sunday i have to work in clinic from 9am onward
traffic is good, no jam is this early time on sunday
so i reached clinic early
able to get a breakfast..
my favourite "chee cheong fan"
look not that interesting
and yet is bit salty

but nevermind la,
with a cup of nescafe, still making it to be an awesome breakfast..

haze haze, hate haze

i drive to work early in the morning everyday
leaving by 6.40 am daily
and will reach hospital by 7.30am
this mean that i can avoid traffic jam..

this morning is a special morning because i noticed that the environment is different
just like i am in cameron highland
the highway is blurr, which cannot see too far away..

well in the pj area, this should not happen
hmmm it is not mist..
but is haze.. covering entire scene.. make vision bad

gosh, please stop pollute our mother earth
she is just too ill..
reserve some green for our children

icu

my hospital icu has 12 beds, 10 normal beds, with 2 isolation room
full monitoring to each and every patient, with connection to the counter monitor
it also have a online program of icu bed watcher

it seem to be perfect, like the picture shown
but... but...

there is under stuff, the nursing is not up to 1-to-1 care
and also only with 1 medical officer and 1 specialist.. for entire icu..

sigh..

luckily my specialist is very experienced, dedicated and efficient
so we still have kind of good time in the stress work place
and learn a lots from her..

thanks you so much