Are you burned out yet, DOC?

WSJ blog listed some causes of burnout among surgeons and other physicians:

• Length of training and delayed “gratification”
• Long working hours and enormous workloads
• Imbalance between career and family
• Feeling isolated / not enough time to connect with colleagues
• Financial issues (salary, budgets, insurance issues)
• Grief and guilt about patient death or unsatisfactory outcome
• Insufficient protected research time and funding
• Sex- and age-related issues
• Inefficient and/or hostile work environment
• Setting unrealistic goals or having them imposed on oneself

Reference:

http://blogs.wsj.com/health/2009/04/20/10-reasons-doctors-get-burned-out/

HOUSEMAN GUIDE

Going through house officer period may be one of the toughest part of a medical officer job in terms of massive physical demands & mental stress induced by patients as well as your superior (MO, Specialist, consultant and so forth). This is because, doctoring job is dealing with human lives and this leave no room for negligence or mistakes. Therefore our Medical Council, MMC came out with a guidelines for house officer. This guide explains on goals of intership in Malaysia, getting full registration, annual practicing certificate (APC), locums, fitness to practise, work and conduct.

reference:

http://mmc.gov.my/v1/docs/A%20Guidebook.pdf

Evidence-based management of CHF

when heart is failing its role

Evidence-based management of CHF

View more presentations from mauron.

Exploring A Medical Career

self evaluation before joining medical school & not after joinning medical school :-p

Exploring A Medical Career

View more presentations from LeslieHutchinsMD.

revised Chain of Survival

CPR meant to provide layperson as well as healthcare staff with the necessary skills to be the first responder in any case of collapsed patient.

*making sure you and patient not in danger zone

therefore DR should be added as suffix to ABC

D: danger

R: response

if everything alright, proceed with conventional

Airway : head tilt chin lift / jaw trust / oropharyngeal airway / making sure no foreign body

Breathing : rise and fall of the chest wall

Circulation : feeling / palpating the major vessel pulse ie carotid pulse

Defibrillation: Automated External Defibrillator

previously chest compression : breathing ratio was 15:2

latest changes in CPR guidelines is 100 chest compressions per minute. When doing rescue breaths, you should breathe into the victim for about one second, until the chest clearly rises. The current ratio is 30 compressions to 2 breaths.

Reference:

Personal Training

American Red Cross, CPR/AED tor the Professional Rescuer, 2007

p/s: (primary vs secondary survey)

1) identify whether this is shockable wave (VT/VF) or not (PEA)

2) remember your 6Hs & 5Ts for PEA.

3) after 1st shock continue with CPR, after 2nd shock give 1mg of iv adrenaline and continue with CPR. If still not reverted and shockable wave, shock and then give iv amiodarone 300mg bolus or lignocaine 1%. If torsades de pointes, give iv MgSO4.

4) maximum iv atropine can be given is 3mg.

heart pain

Acute Coronary Syndrome or better known as ACS consist of a spectrum of thrombotic coronary artery disease ranging from unstable angina to both STEMI and nonSTEMI.

ECG: T wave tenting or inversion, ST elevation or depression (including Jpoint elevation in multiple leads) and pathologic Q waves. 

Troponin I or T is the most sensitive determinant of ACS

Marriott's Criteria

Epicardial injury is diagnosed when Jpoint elevated by 1 mm or more in two or more limb leads or precordial leads v4 to v6 or by 2mm or more in two or more precordial leads v1 to v3. Serial cardiac marker determines confirm myocardial injury or infarction in more than 90% of patient with Jpoint elevation in the limb leads.

Significant Q wave = > 0.04 sec in duration & at least 1/4 of the corresponding R wave height.

Isolated small Q wave II, III and aVF & lead I and aVL frequently normal (these small Q waves are known as septal Q waves because of the origin of the initial vector in ventricular depolarization)

from 1 - 4% patients ultimately proven to have ACS are sent home from ED.

serotonergic disorder? a type of headache

MIGRAINE WITHOUT AURA

-Recurrent headache 

-Manifesting in attacks lasting 4–72 hours

-Characteristics:-

1) unilateral location, 

2) pulsating quality, 

3) moderate or severe intensity, 

4) aggravation by routine physical activity 

5) nausea 

6) photophobia /phonophobia.

Diagnostic criteria:

A. At least five attacks fulfilling criteria B-D

B. Headache attacks lasting 4-72 hours [when untreated]

C. Headache has at least two of the following characteristics:

1. unilateral location

2. pulsating quality

3. moderate or severe pain intensity

4. aggravation by or causing avoidance of routine physical activity...

D. During the headache at least one of the following:

1. Nausea and/or vomiting

2. Photophobia and phonophobia

E. Not attributed to another disorder

Signs & symptoms vary from one patient to another.

It is divided into 4 phases : - 

1) Prodromal  phase 

2) May be associated with aura

3) PAINFUL phase

4) Postdromal phase

reference:-

Headache Classification Subcommittee of the International Headache Society (2004). "The International Classification of Headache Disorders: 2nd edition". Cephalalgia : an international journal of headache 24 Suppl 1: 9–160.