DrKlinik 2

 Assalamualaikum...

I hope everything just fine. Have been in KK Permaisuri, Setiu for 1 year. Gained a lot of precious experience here. I was assigned incharge zone A together with super osem Zie, Idura and Muiz. Got a lot of love reminder from Dr Kasma FMS regarding my substandard management especially NCD patient. Finally she confronted with me and patiently teach me how to manage NCD patient (what medication should i start or change when according to case). Thanks to her, now i got more cofidence to start and change medication.

Muiz commuted from Kota Bharu to Setiu. He was promoted to UD48, then he always tell me to take over his clinic portfolio- CDC including TB and HIV. I start learning slowly from him, but still he attend all ACD and meeting. Towards the end of 2020, COVID 19 case start increasing in trend. We have rotation for sampling and ILI/fever counter. Its really stress out when you have ILI patient. Because its can be as simple as URTI up to case needed to be referred and you have to refer the case from ILI counter. I have referred case infected AGE in compensated shock, DF with warning sign and lastly I refer her as SARI, the latter 60 years old malay lady, NKMI presented with h/o fever for 5 days with chills last PCM taken that morning, h/o non productive cough, worsening lethargy for 2 days, no SOB, no loose stool, no vomiting, no UTI symptoms, no PTB contact. On examination, pt alert but drowsy, lethargic, not septic looking, pulse volume fair, dehydrated and talk in full sentence. BP 61-75/50-60, PR 103-120bpm, RR 20, SPO2 92-94 under RA, RBS 5.4. Upon auscaltation of lungs, clear and equal air entry. Hb 11.2/ TWC 5.4/PLT 120. Really I dont know what going on to her. So I put NPO2 2L/min, give her IVD run fast, then refer her to nearest hospital as SARI (in view of SPO2) with hypotensive episode possible 2ry to poor oral intake with ddx of TRO electrolyte imbalance. RTK Ag was taken at my clinic and it turns out negative. I really hope she will have speedy recovery and well.

Have been go to Ketengah Jaya for COVID 19 mobilization, but not getting 600 ringgit pun. Me so sad. Whatever laa. 

It took 3 months for me to adapt with KK surrounding. To familiarize antenatal scan, confidence with my finding and management. By the way, there was 1 patient came with agony chest pain and was brought to ED straight away. ECG was done and damn En Saidi, our ED MA show that ECG to me and asked is it ST elevation. When look at that ECG, half confident i said its not ST elevation. Then I double confirm with my senior collegue and alhamdulillah all said so. But this gentleman has typical left sided chest pain radiated to left shoulder, no SOB, no palpitation. H/o smoking 20 years ago and he has underlying HPT on multiple medication. He was alert, conscious, in pain, GCS full. BP 198/110, PR 98, RR 20, SPO2 97% under RA. Lungs bilaterally clear and equal air entry, CVS DRNM. 1st ECG show SR with deep Q wave V1-V4. So I gave him T. Captopril 25 mg stat and S/L GTN 1/1 stat. Then repeat ECG after 20 min. 2nd ECG has no evolving changes, but patient still in pain and his BP slightly reduce to 160/93. So I treat him as ACS and gave T. Aspirin 300mg and T. Clopidogrel 300mg stat. Referred to district hospital, and 1 week later, he has follow up at our clinic to review his BP. he was treated as NSTEMI with acute LV failure. He developed hypotensive event in ward but his EF still good, 63%. 

This just few isolated interesting cases. Otherwise cases at KK quite boring and repititive. Seeing DM/HPT patient, if uncontrolled finding its cause, giving endless lecture regarding dietition, what complication they might face etc. Facing MC seekers is the most tiresome. They will give you so mmuch complaints and sometimes its look real. Toward end of consultation they will ask for MC not 1 or 2 days sometimes up to 1 week. *sigh* .

However I like when its antenatal time. Scan for RME 1, RME 2, baseline scan and even when ut>POA or excessive weight gain. Do RME 1/12 for babies, poking for prolong w/out. I like light handson.

Okay laa, till the next time.

"not everyone has access to me because I want peace, not attention"