Health Revisited

Wedding Bells

noreply@blogger.com (Jhun) — Tue, 21 Feb 2012 06:44:00 +0000

A couple of days back, I attended the wedding of one of my college buddies. It was held at the other side of Metro Manila, but the trip is worth it. After being engaged for nearly a year, he was finally married to his long time girlfriend of 7 years. Saw some old faces but unfortunately some buddies weren't able to make it to the wedding day. It was a garden ceremony held in a resort in Bulacan. It was quite gloomy that day and rain eventually fell, even so the ceremony still proceeded although it started quite late. The reception was held on the same venue and food was serve after taking pictures with the couple was done. All in all it was a good ceremony celebrating their love through marriage in this heart month. To my good friend Rhekz, congratulations and best wishes.

Dead on Arrival

noreply@blogger.com (Jhun) — Sat, 18 Feb 2012 16:13:00 +0000

We will be having an audit for our charity cases for the month of January in a couple of days, and Ill be assigned to ICU admissions for the said month. Sometime in the middle of last month, a 42 year old male, who was a hospital personnel, admitted to the ICU and came in due to unresponsiveness. It was noted that a couple of minutes prior to arrival at the emergency room, the patient was doing moaning sounds and was noted lying on the floor. Suddenly one of his roommates stood up, and called for help to bring the patient to the hospital. It only took the patient's group of roommates around 5-6 minutes to reach the emergency room but upon arrival, patient was noted to have no heart rate and no blood pressure. He was declared dead on arrival.

Upon arrival, resuscitation was immediately done, CPR was done, epinephrine given, intubation was done and eventually after 10 minutes, patient responded and eventually was revived. On work-up it was noted that he suffered from an acute myocardial infarction, hence myocardial infarction regimen was started and patient was admitted to the ICU. Upon arrival at the ICU, he was noted to be with stable vital signs, but seizure episodes were noted to be starting. Seizure were attributed to hypoxic encephalopathy since a patient was noted to be asystole (no heartbeat) for some minutes. Anti-seizure medications were added to his treatment regimen. I endorsed the ICU to the incoming resident knowing that this patient won't make it to next day.

Next day came, I went to the ICU to put my things and upon seeing him the next day, I big smile formed in my face, he was awake, although a little bit disoriented, he has stable vital signs and no seizure recurrence was noted. Patient was eventually extubated and transferred out of the ICU in the next days and eventually discharged. When I asked him if he remembered anything, he told me the last thing he heard were people screaming to bring him to the hospital. A second chance of life happened infront of me, hope he could nurture and take care of it.

An Old Patient's Demise

noreply@blogger.com (Jhun) — Mon, 13 Feb 2012 15:37:00 +0000

It’s been a gloomy and rainy Monday; the rain drizzled since late last night and continued until morning which somehow made me late in coming to the hospital. The early hospital atmosphere was filled with cold air ushered by the water drops from outside. Upon arrival at the office, loud chattering about yesterday’s events were heard all over, then the outgoing ICU resident entered and directly held my shoulder and told me news that somehow coincided with the gloomy weather outside. The patient situated on ICU bed no. 2 just died early today. She recounts that the nurses called her attention, a sudden change in cardiac rate, from tachycardia to bradycardia, was noted and eventually the patient went into cardiac arrest. Resuscitation was initiated, CPR done, epinephrine given, ambubagging and fluids adjusted were done. A couple of minutes later, inspite efforts to revive his heart, it did not respond and he was eventually declared dead.

Looking back 3 months ago, when I was still the IM resident assigned to the ER, the above patient was brought to the ER due to unconsciousness. On history and examination, the initial impression back then was that the patient suffered from a stroke. A CT scan was done which revealed a massive infarct on his left cranial hemisphere causing him to be down to GCS 3. A neurosurgery referral was made which booked the patient to a stat craniotomy to relieved the elevated intracranial pressure. He survived the first few critical days in the ICU. His sensorium eventually increased, bit by bit in the next days but a persistent fever caught him. Possible causes entertained were ventilation acquired pneumonia or a possible abscess formation on his surgical site. Diagnostic measures were planned however, due to financial compromised a repeat CT scan, blood, sputum and urine cultures were not done. In the next days, inspite of the occasional spiking fever, patient was noted with eye opening and occasional spontaneous movement. He was fighting the disease that’s been tormenting his body, but unfortunately the financial aspect didn’t give him a good fighting chance. During those days, how I wish for a better health care system here in the Philippines, for better health insurance that could cover all of a patient’s expenses form day 1 to the day of discharge. A health system that won’t inhibit a patient from seeking medical consult because of financial reasons. It might not be happening now, but how I wish it would be a reality in the coming months or in the coming years.

It his last few days, he was noted to have much improved sensorium with spontaneous eye opening. But the financial aspect of the family leads him to his untimely demise.

Rest Day Sunday

noreply@blogger.com (Jhun) — Sun, 12 Feb 2012 03:34:00 +0000

After a grueling week being at the hospital, I finally got may first Sunday off for the month of February. A woke up pretty late, doing some stretches and finally hitting the television. Plan to be do some non-hospital stuff this afternoon, probably play some computer games and head to church later. I have to refill my batteries for tomorrow another day at the hospital awaits. Im actually yawning doing this post... my much needed rest...

Uncontrolled Diabetes

noreply@blogger.com (Jhun) — Sat, 11 Feb 2012 06:34:00 +0000

A 69 year old male, diabetic and hypertensive, sought ER consult last night due to sudden vomiting of 3 episodes associated with crampy abdominal pain. His initial symptoms just started a couple of minutes before going to the emergency room. At the ER, patient's blood glucose was taken and the CBG machine read it as "HI". An intial dose of bolus insulin was given via intravenous route and his blood sugar levels were monitored.

Diabetes mellitus or commonly termed as diabetes is a chronic metabolic disease that gives a person a high sugar level. This is caused by decreased or no insulin production or resistance to insulin or a combination of both. Diabetes could also occur in pregnant patients which termed as Gestational Diabetes. Other patients could also develop diabetes when thay have had surgical procedures involving the pancreas. There are also diabetic emergencies like your diabetic ketoacidosis and your hyperglycemic hyperosmolar crisis.

A patient with an uncontrolled elevated blood sugar could have target organ damage. Diabetes can give you kidney damage, neuropathies, blindness, a risk factor for stroke and heart disease and many more. Studies have shown that for diabetic patients who have controlled blood sugar levels,end organ damage can be prevented or delayed. Its highly advisable for patient with diabetes to seek physcision consult, be vigilant in controlling their appetite, and be compliant with their medications as to prevent morbidity and even life threatening complications.

Run Run Run

noreply@blogger.com (Jhun) — Thu, 09 Feb 2012 13:06:00 +0000

I spend my afternoon running in a nearby village park. I gain quite some weight during the past 2 years so its high time to lose them before I finished my residency training. When I started running at first I was doing ok, then after a couple of minutes after I felt the burden of carrying my whole weight.. I really need to trim down.

Studies have shown that exercise could prevent chronic disease like diabetes, cardiovascular diseases, obesity,and many more. Getting in shape is no easy task, but it is a task one overweight person should undergo to stay healthy. Looking to lose weight soon :)

Tumor Seizure

noreply@blogger.com (Jhun) — Wed, 08 Feb 2012 04:49:00 +0000

A 24 year old female presenting with seizure was admitted to the ICU yesteday. She was diagnosed with anaplastic astrocytoma last 2008 and underwent craniectomy for removal of her tumor. She was doing ok from 2008 up to late last year, she even went into college and graduated from engineering. She started to feel some back pains late last year and was diagnosed to have lumbar spine metastasis and eventually underwent radiotherapy. Hours prior to admission she was noted to have upward rolling of eyeballs which prompted consult.

Astrocytomas are brain tumors coming from brain cells called astrocytes. They could occur in any part of the brain but most commonly occurring in the cerebrum. They could occur in any age group but the said tumor is more prevalent among adults particularly the middle-aged group. Symptoms include headaches, double or blurred vision, vomiting, changes in mental status, seizure episodes, and difficulty in speech. Main treatment options include surgery, radiotherapy, and chemotherapy. For our patient, she initially underwent cranial surgery, unfortunately for her there was note of seeding of the primary tumor in her lumbar spine which is currently being treated with radiotherapy. Patient is currently maintained on anti-seizure medications and hopefully improvement will come in the coming days.

Your Common Diarrhea

noreply@blogger.com (Jhun) — Tue, 07 Feb 2012 03:20:00 +0000

A couple of months back, I was assigned to report on a common topic which is diarrhea. I was informed by my infectious disease consultant to find common and some rare causes of diarrhea. So I did some research for my report about the common disease diarrhea.

Diarrhea is defined as passage of stools of >200g/d and is categorized to acute, persistent and chronic. Diarrhea affects million of people around the world annually and is a major cause of mortality worldwide. I dealt with the infectious causes of diarrhea which are usually common among acute diarrhea. Chronic diarrhea have a wide range of causes aside from infectious causes. Viruses like your rotavirus and adenovirus, bacterias like your campylobacter and salmonella, Protozoans like your amoeba and giardia are just some of infectious causes of your common diarrhea.

The corner stone of treatment for diarrhea is still fluid replacement. Fluid replacement with water plus your oral hydration salts are indicated on patients with diarrhea. Antibiotics to cover for your common bacterial and protozoal causes are given if they are indicated. Antimotility agents could also be given in adjunct to your oral hyrdration and antibiotics.

Diarrhea might not be an easy disease after all.

Will Try to Blog Again

noreply@blogger.com (Jhun) — Mon, 06 Feb 2012 05:12:00 +0000

Its been months since I have last posted on this blog, been quite busy with hospital staffs and some year end festivities. For this year, I'll be assigned to the ICU area and will find time to do some blogging. Hopefully I could do entries everyday for my blog. Looking forward to a bright blogging year for me.

Finding Air

noreply@blogger.com (Jhun) — Wed, 31 Aug 2011 12:10:00 +0000

Prior to ending my duty this morning, a patient suddenly complains of difficulty in breathing. Nebulization and IV steroids were rendered but still his difficulty in breathing was not relieved. Wheezes were noted in both of his lung fields. Arterial blood gas was requested and revealed respiratory acidosis. Patient eventually improved with intermittent ambubagging. He is a diagnosed case of chronic obstructive disease but with poor compliance to his medications. Patient was eventually admitted due to worsening dyspnea which started 3 weeks ago.

Chronic obstructive pulmonary disease (COPD)is a progressive disease which makes one hard to breathe. The most common cause of COPD is smoking, usually higher among chronic smokers. Symptoms usually include chronic cough, difficulty in breathing (dyspnea), tachypnea, labored breathing, etc. Diagnosis is done with taking a lung function test. Management strategies include smoking cessation, use of B2 agonist inhalers and nebulizers, vaccinations, and for some patients they would need long term oxygen therapy even at home and for some, lung transplantation.

Long Weekend

noreply@blogger.com (Jhun) — Mon, 29 Aug 2011 04:54:00 +0000

Aside from the weekend, Monday and Tuesday are declared holiday in our country due to National Heroes Day and the end of Ramadan respectively. A much needed rest from Saturday's hectic duty which a lot of patient's came for ER consult most of them due to fever. Will be on duty again tomorrow, planning to sleep the whole day. Zzzzzzz

Blood in the Brain

noreply@blogger.com (Jhun) — Sat, 27 Aug 2011 23:14:00 +0000

Before ending my duty today, a 34 year old male was brought to the ER unresponsive. Patient was seen approximately an hour before lying on the floor and noted to have drooling of saliva. Upon arrival at the ER, patient was noted at GCS 4 with anisicoria. A cranial ct scan revealed an intraventricular bleed with an amount roughly reaching 100cc. Patient was intubated, hook to mechanical ventilator and admitted under neurosurgery service.

CVD bleed or hemorrhagic stroke occurs when a blood vessel in the brain ruptures and spills blood causing in compression to the other brain structures. They are more likely to have headache, altered mental status, seizures, nausea and vomiting, and/or marked hypertension, however this mentioned symptoms could also be seen on ischemic stroke cases. It can be cause by hypertension, an aneurysm or less common from an AV malformation. The amount of blood/bleeding determines the severity of the disease and the possible prognosis of the patient.

Pulmonology Lecture

noreply@blogger.com (Jhun) — Fri, 26 Aug 2011 14:42:00 +0000

Today I attended a pulmonology lecture at a prestigious hotel in one of the cities here in Metro Manila. The topics included ventilator acquired pneumonia, a case of viral pneumonia with neurologic complications was presented, recent super bugs in community acquired pneumonia and many more. Aside from the learning experience, the food served was great. Even though it was a tiring day, the lecture was worth it. I ended the day eating pizza in front of the hospital.

TIA vs Stroke in Evolution

noreply@blogger.com (Jhun) — Thu, 25 Aug 2011 14:59:00 +0000

Last night I came across a 36 year old male Japanese, who consulted the emergency room due to left sided numbness. It came suddenly while the patient is drinking coffee, no headache nor dizziness were associated with the numbness. At the emergency room, patient was then noted wit slurring of speech, facial asymmetry and eventually left sided weakness. A couple of hours after the above events, I went back to the patient to see how he is doing and it surprised me that the above symptoms were gone. Left sided weakness was not appreciated, slurring of speech and facial asymmetry were also not noted. It came to me that this might be a case of transient ischemic attack or maybe its a beginning stroke.

TIA or transient ischemic attack is defined as a neurologic deficit like weakness or numbness which usually resolves within 24 hours. Usually having a TIA is a sign that the patient is in impending stroke or might proceed to stroke. As with stroke, TIA also shares the same etiology which is disruption of blood flow to the brain. Early detection is important.

For the patient last night, hopefully he could recover from his neurologic deficit and be back to his normal life after his hospital stay.

Dengue Explosion

noreply@blogger.com (Jhun) — Wed, 24 Aug 2011 11:35:00 +0000

Dengue fever cases are soaring in the country. Numerous outbreaks have been reported in different parts of the nation and several mortalities were also noted. Currently at the hospital, the number of cases are also on the rise especially in the pediatric service. Lucky for us, most if not all cases of dengue in the hospital do not need any blood transfusion.

Dengue fever is a viral disease transmitted usually by the dreaded Aedes mosquito. Symptoms usually include fever, headache, body malaise, joint points and some would present with a skin rash. Symptoms usually appear 3-14 days after a bite from an infected mosquito,. There are severe forms of dengue, which usually has bleeding, thrombocytopenia and hypotension.

Treatment of dengue fever is usually supportive, IV or oral hydration, anti pyretics for fever, and usually for the severe forms transfusion might be necessary. Currently there are no vaccines for dengue, but we can do preventive measures to avoid the disease. Prevention is done by emptying water containers, cleaning canals, wearing protective gears to avoid mosquito bites, etc.

Dengue fever may be lethal if left untreated, early recognition is important together with preventive measures to avoid its spread.

noreply@blogger.com (Jhun) — Tue, 23 Aug 2011 17:56:00 +0000

Powered byEMF Contact Form

Report Abuse

Blog Roll

noreply@blogger.com (Jhun) — Tue, 23 Aug 2011 17:41:00 +0000

Leave a Message to Link with Me

Health Revisited

A Night of Referrals

noreply@blogger.com (Jhun) — Tue, 23 Aug 2011 02:58:00 +0000

Last night saw the skies drip with rain which started strong but ended quickly. The hospital was filled with a sudden cold breeze and referrals from different services poured like the rain outside. Referrals from the Surgery and OB service poured like the rain outside, but gladly it stopped with the rain going to a halt. One referral was for hematology co-management and clearance, two were for cardio-pulmonary clearance prior to surgery, another one was for diabetes management in a pregnant patient. Good thing, they stopped by the time the rain pour ended.

Multiple specialties handling the case could further improve the management and treatment of the patient. The strength of one might complement the strength of the other. Viewing things from difference perspectives may further enhance the outcome of the patient. Two heads are better than one as they say.

Health 101

noreply@blogger.com (Jhun) — Sun, 21 Aug 2011 17:25:00 +0000

As the saying goes "Health is Wealth", staying healthy is one though priority for everyone of us. Even economists would agree that a healthy population would increase the economy. I'm a doctor in the middle of my residency, and would like to share some views, points and experiences regarding the word "Health"

Contact Form
Name *

Email *

Subject *

Message *
<br />