Thursday, October 21, 2010

Patch Adams is Coming to KL!

No not Robin Williams. I mean the "real" Patch Adams.

Read this from MMR - that he's coming to KL on 26th Nov.

But 26th Nov is a Friday...why?! Too bad I'm just gonna miss this annual leaves are finished! I think it'll be great to see him in person, and share his concept of "joy and laughter are an integral part of healing process"...just like magic? XD

But I also found out something interesting in Wikipedia - that he actually doesn't like the movie "Patch Adams" so much. According to Wiki -

"Adams has criticized the film made about him, saying it sacrificed a lot of his message in order to make a movie that would sell. He said that out of all aspects of his life and activism, the film portrayed him merely as a funny doctor. Patch Adams also said of Robin Williams in an interview 'He made 21 million dollars for four months of pretending to be me, in a very simplistic version, and did not give $10 to my free hospital. Patch Adams, the person, would have, if I had Robin's money, given all 21 million dollars to a free hospital in a country where 80 million cannot get care.'"

Well, I didn't know that!

Wednesday, October 20, 2010

CPR Guidelines 2010 (NEW)

AHA (American Heart Association) has just released the latest CPR guidelines on 18th Oct. This is undoubtedly something very essential in our daily working life - so make sure you are aware of the new changes.

Some of the highlights in the guidelines:

* "Look, listen, and feel for breathing" has been removed from the algorithm.

* A change in the recommended sequence for the lone rescuer to initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C). The lone rescuer should begin CPR with 30 compressions rather than 2 ventilations to reduce delay to first compression. (Evidence: Improved outcome and survival with early chest compressions)

* Compression rate should be at least 100/min (rather than 'approximately' 100/min - Evidence: more compressions are associated with higher survival rates)

* Compression depth for adults has been changed from the range of 1.5 to 2 inches to at least 2 inches. (Evidence: Compressions of at least 2 inches were shown to be more effective in generating critical blood flow and oxygen)

* Routine use of cricoid pressure in cardiac arrest is not recommended.

* The recommended initial biphasic dose for cardioversion of AF is 120-200J, and 200J if monophasic. (Old guidelines recommended 100J starting dose for monophasic)

* Atropine is no longer recommended for routine use in management of PEA/ asystole and has been removed from the algorithm. (Evidence: Use of atropine is unlikely to have a therapeutic benefit)

There are many more key changes.
You can access the full guidelines here.

Read it today!

Tuesday, October 19, 2010

Cause of Ascites?

Think this is an interesting CT scan of abdomen.

A lady was admitted to medical for "Ascites for invesigation" - as usual, everything under the sun will be "for medical to find out". She complained of progressive abdominal distension and discomfort, and there was a vague mass felt on abdominal palpation.

What do you think the CT (circled area) shows? (You can click to enlarge)

Wednesday, October 13, 2010

Interesting ECG (5)

You were asked to examine this gentleman's cardiovascular system. By only inspection, you should have gathered two possible diagnoses in mind.

Got it? If not, then have a look at the ECG (not his but just to give you a hint):

(ECG from

Now shout out the answer! ;)

Thursday, October 07, 2010

A Simple Thought?

Recently there's a case of severe anaphylactic shock requiring intubation for respiratory distress. It was secondary to severe allergic reaction to honey consumption. Surprisingly, according to family members, the patient is fully aware of the fact that he's allergic to honey, and would develop allergic reaction (pruritic urticaria and wheezing) each time he takes it. However, he still continues to take it, despite repeatedly advised by family members against it, and for this time, he took extra amount just because "he feel like eating it".

Why would anyone insist on doing something that actually risking his/ her own life?

Come to think of it, similar stories often occur. It's not something uncommon at all.

Have you seen patients with advanced COPD (Chronic obstructive pulmonary disease) but still smoking? I'm sure you do, don't you?

Or patients with congestive cardiac failure/ renal failure but still never compliant to fluid restriction? - common cause for the recurrent admissions.

What about diabetic patients who are still taking high sugar diet? - Extremely common, needless to say.

And those who's already having severe deforming gouty arthritis, but still continue drinking beer? Same for those with advanced alcoholic liver disease? Plenty, too.

The common answer is always, "Ya I know..but I just can't resist it..."

Can't resist a simple thought. But think carefully, this is a thought which may lead you to a life-threatening complication, irreversible outcome, or even, death.

Still think it's a simple thought? I'd say it's an irresponsible thought, to self, to the people around you. Please think again.

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