Wednesday, July 20, 2011

Simple Way to Interpreting CXR in Emergency Department


This morning during round, one medical student ask me how to simply read the radiograph in emergency department. Mmmm...i just smile to him, there is no simple way to interpret CXR in ED. I know they are waiting for my mnemonic to share with them. Maybe this mnemonics will help, i found this in the net. RIP ABCDEFG

Rotation: Check to see that the patient is not rotated. You can look at the clavicles and make sure the vertebral processes line up nicely in between them.
Inspiration: Check to see that you can see about 9 ribs on each side. Less than 8? It is likely poor inspiration.
Penetration: You should be able to see lucencies in the middle of the film representing the intervertebral discs. If there are none, the film is over-penetrated; if they are too well-defined, the film is under-penetrated.

Airway: Trace the lucency from the neck down towards the carina. It should be midline and you should be able to see two bronchi splitting from it.
Bones: Look at the shoulder joint and trace out each rib contour to check for fractures or other abnormalities.
Cardiac Silhouette: Check the right and left heart borders.
Diaphragms: These should be well-defined with no obscuration of their margins.
Empty Space =)
Fields: Look at the lung fields bilaterally and compare. Don't forget the apices.
Gastric Bubble: Check for a lucency in the left upper abdominal quadrant.
Hardware: Make sure the placement of any lines or other hardware is appropriate.

Click here for basic interpretation of the CXR

Monday, July 18, 2011

APPROACH IN EMERGENCY MEDICINE


There were many approaches has been taught in dealing with patient presented to ED. Most of the emergency clinicians had their own way to approach certain cases. We have to understand that emergency department has their own environment which different with other disciplines. Some people said we are living in the fast lane...need quick thinking,quick decision & quick intervention within short of time. Here, i just want to share my practice that i got from my "guru" in approaching patient in ED. Only 5 steps...

step 1 : What are the chief complaints
step 2 : What are the life threatening condition
step 3 : What are the common causes
step 4 : Is it patient safe to be discharge or not
step 5 : if discharge need follow up or not

An example if patient come with the chest pain

step 1 : chief complaints chest pain
step 2 : what are the life threatening chest pain eg : AMI, Pulmonary embolism, aortic dissection
step 3 : after rule out life threatening can find the other causes of chest pain
step 4 : safe to be discharge or not
step 5 : need follow up or not.

Some clinicians used mnemonic 4C

1. complaints
2. condition
3. causes
4. complication

You can choose either one that comfortable/easy to use. I hope this sharing knowledge may help us in reducing misdiagnosis in our ED especially for young doctors.

Wednesday, June 15, 2011

Paracetamol is more effective than placebo for migraine, and paracetamol 1000 mg plus metoclopramide 10 mg is similarly effective to oral sumatriptan

Acute migraine is one of the common presentation in ED. Usually we treated patient with NSAID (Voltaren) & Maxolon. However, recent study using systemic review suggest PCM + Maxolon are equally active to Sumatriptan in 2H post attack. Most of the centre do not have Sumatriptan in floor stock. For details can click this link klik.

Sunday, June 5, 2011

APAKAH ILMU YANG BERMANFAAT ?


Assalamualaikum & Salam sejahtera

Dalam kitab
Bidayatul Hidayah, Al-Hujjatul Islam Al-Imam Al-Ghazali rohimahuLlahu Ta'ala menyatakan bahawa terdapat 6 ciri ilmu bermanfaat, ya'ni seperti berikut:

1)Ilmu itu menambahkan takut pada dirimu kepada ALLAH.

2)Ilmu itu menambah penglihatanmu akan keaiban dirimu.

3)Ilmu itu menambah makrifatmu dalam beribadah(kata guru kami,keseronokan dalam beribadah).

4)Ilmu itu menambahkan kecintaanmu terhadap akhirat dan mengurangkan kecintaan kepada dunia.

5)Ilmu itu membukakan pintu hatimu untuk mengenali bermacam-macam penyakit amalmu sehingga engkau dapat menjauhinya.

6)Ilmu itu menambahkn penglihatanmu terhadap tipu helah syaitan dan penipuannya sehingga engkau arif dengan kehalusan tipu helahnya ketika dia menyesatkan ulama' su'.

Thursday, March 31, 2011

Sajak Buat Teman


Teman…

Kalau dulu kita bersemangat waja…

Azamnya tinggi menggunung…

Ingin mencari ilmu menambah pengalaman..

Agar dapat mengenal Tuhan…

Teman…

Kalau dulu niatnya tulus…

Jiwanya kental hatinya mulus…

Merawat pesakit tanpa fikir soal fulus…

Agar menjadi hamba yang lurus…

Teman…

Kini hati terasa gersang…

Bertambah ilmu,bertambah kontang…

Bertambah tahun, bertambah jurang…

Adakah tiada keberkatan atau hilang panduan…

Teman…

Ilmu ini bukan milik kita…

Bukan juga milik sesiapa

Tapi ilmu milik Sang Pencipta

Ilmu bermanfaat kalau dapat mengenal TuhanNYA…

Teman…

Usah resah dengan viva & ujian…

Jawablah dengan ilmu yang matang…

Walau soalan tiada terhidang...

Lihatlah examiner yang handsome didepan…

Teman…

Resahlah pada ujian yang mendatang

Dengan soalan sudah terhidang…

Hanya amalan jadi bekalan…

Ibnu Fauzi 26 Rabiulakhir 1432H

Monday, March 28, 2011

Selamat Hari Lahir Buat MamaTercinta


Mama...
Engkau bagaikan rembulan buat kami...
Menerangi malam dikala sepi...
Sanggup membakar diri mencerahi kami...
Walau diri dihimpit jerih tidak terperi...

Mama...
Titisan airmata mama kami mengerti...
Kekadang kami lupa diri...pentingkan diri...
Namun itu tidak bererti...
Kami tidak menyayangi...

Mama...
Kami tahu...dikala ini...
Mama bersiapsiaga untuk menghadapi ujian...
Ujian dunia yang hanya sementara...
Kami doakan mama berjaya...

Mama...
Dikau tidak berseorangan menempuh ujian
Kami sentiasa disamping mama...
Semangat kami bersama mama...
Doa kami bersama mama...

Ya Allah...
Berilah kesihatan & kesejahteraan buat kami
Duniawi & ukhrawi...
Tunjuki kami jalan kebenaran hakiki...
Agar kami tidak terpesong dalam hidup ini...

Selamat Hari Lahir buat Mama...
Semoga Allah mencintaimu
...
Melebihi luas cinta kami...




Ibnu fauzi, Lutfi, Baihaqi...Rabiulakhir 1432H