Crosmed Ambulance Klang

04/11/2024

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06/06/2024

"Dr Afifa, tengok pakcik Samad ni sat. Time saya nak ambil BP, dia senyap je. Takde
respon." Staff nurse inform pada houseman in charge apa yang berlaku pada patient semasa
check vital sign sebentar tadi.
"Kak, GCS drop ni. Boleh tolong saya inform Dr Leong." SN pun terus call Dr Leong, manakala Afifa terus mulakan proses resusitasi.

'Pukul 7.30 pagi jugak patient collapse ni' bisik hati Dr Leong.

Apa yang perlu kita buat jika ada patient collapse di wad?
✅ DXT - Check blood glucose patient. Kadang2 patient cuma mengalami hypoglycemia & boleh terus recover lepas kita bagi D50.

✅ Pulse - Jika ada pulse, tak perlu terus naik atas katil & buat CPR. Jangan lupa attach cardiac monitor dahulu & check heart rate.Tapi kalau patient takde pulse, on the spot kena CPR.
✅ Cardiac monitor - Minta nurse attach cardiac monitor untuk tengok heart ryhtm. Ada kemungkinan patient collapse sebab heart attack seperti tachyarrythmia, bradyarrythmia, pulseless VT, VF. So kita boleh detect awal melalui cardiac monitor

✅ Blood pressure - Check BP patient. Jika BP high hingga 200/120, kita boleh suspect patient ada intracranial bleed atau ischemic stroke. Jika BP low p**a, benda yang kita suspect ialah shock. Tak kira lah hypovolemic, cardiogenic atau septicemick shock. Semua boleh jadi. Resus dengan fluid & standby IVI noradrenaline

✅ GCS - Examine & conclude berapa GCS patient. E (eye) V (Verbal) M (Motor). Biasanya jika GCS 95%, boleh asses dulu patient & cari cause kenapa GCS drop & lain2. Tapi jika

23/04/2024

Crosmed Ambulance
0189804784


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23/04/2024

[AMBULANCE🚑SERVICES]
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2️⃣4️⃣H
☎️Hotline;0189804784
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http://www.wasap.my/60189804784/ambulanceserviceklang
http://www.wasap.mambulanceserviceklang
🕹️ base In Klang Valley area
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26/03/2024

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2️⃣4️⃣H
☎️Hotline;0189804784
📞 01169872302
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10/03/2024

"Doctor Mas, patient bed 8 BP very low 83/47. I've given 1L NS still haven't picked up" Dr Farahin informs MO oncall. Done with patient reasses, immediately informed the nurse staff to prepare Norad.

Riddle of the day. What inotrope options can we use for shock patients?

Types of inotrope/vasopressor

✅ Noradrenaline
➡️ Act in Alpha-1, Beta-1 receptor
▶️ Initial vasopressor of choice in septic, cardiogenic, and hypovolemic shock
➡️ Initial dose : 5 to 15 mcg/minute (0.05 to 0.15 mcg/kg/minute)

✅ Adrenaline
➡️ Act in Beta-1, Beta-2 & Alpha-1 receptor
▶️ Initial vasopressor of choice in anaphylactic shock.
▶️ Typically an add-on agent to norepinephrine in septic shock when an additional agent is required to raise MAP to target
➡️ 1 to 15 mcg/minute (0.01 to 0.2 mcg/kg/minute)

✅ Dobutamine
➡️ Act on Beta-1 receptor
▶️ Initial agent of choice in cardiogenic shock with low cardiac output and maintained blood pressure.
▶️ Add-on to norepinephrine for cardiac output augmentation in septic shock with myocardial dysfunction
➡️ Initial dose : 2 to 5 mcg/kg/minute (range: 0.5 to 5 mcg/kg/minute;

✅ Dopamine
➡️ Depend on dose
🔷 0.5-2mcg/kg per min -> Dopamine receptor
🔷 5-10mcg/kg per min -> Beta 1,Dopamine
🔷 >10mcg/kg per min -> Alpha 1,Beta 1, Dopamine
▶️ May use as second line after Noradrenaline but only in certain condition for example bradycardia. It will improve cardiac output and improve perfusion and diuresis

✅ Vasopressor
➡️ Antidiuretic hormone
▶️ Effective as second line in refractory vasodilatory shock (septic or anaphylaxis)
➡️ Initial dose : 0.03 units/minute

Point2 close to the top I got from the update. Apologies if there are insufficient points because I'm afraid that the post will be longer.

Is there any patient with 6 infusion pump near general ward?

Dr Hanif Arshad

21/02/2024

in coming soon. 20?? 😂

22/01/2024

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📍Discharge/AOR
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2️⃣4️⃣H
☎️Hotline;0189804784
📞 01169872302
http://www.wasap.my/60189804784/ambulanceserviceklang
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🕹️ base In Klang Valley area
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13/01/2024

13/01/24 @ 0730

0189804784 Ambulance service

chinese/female/60+

c/o sob since last night
urti x4/7 with yellowish phlegm
h/o NSCLS (f/u with IKN, putrajaya)

on arrival pt alert and concious.
complain chess tightness.
gasping motion seen.
swelling both lower limb.

vital sign:-
temp: 36.7
bp: 135/78
pr: 113
spo2: 86 on air
dxt: 11.3
gcs: 15

O2 8L given via face mask
pt able to move with assistant
request to go to IKN for further management.

11/01/2024

"Staff nurse, minta tolong prepare ubat. Saya nak bagi lytic cocktail kat pakcik Ahmad"
Doktor Syazwan selepas clerking new case yang baru sampai daripada ED.

Siapa yang tak pernah dengar 'lytic cocktail'?
Aku rasa semua houseman mesti pernah bagi ubat lytic cocktail. Selalunya kita akan bagi kepada patient nephro yang ada CKD atau ESRF with hyperkalemia sambil patient attach dengan cardiac monitor.

Apakah ubat dalam lytic cocktail?
➡️ IV Calcium gluconate 10% 10cc in 10min
➡️ IV D50% 50cc
➡️ IV Actrapid 10U

Kita akan bagi jika patient ada hyperkalemia >5.5 atau ECG nampak tall tented T wave.
Kalau dibiarkan : tall T wave ▶️ longer PR interval ▶️ widen QRS complex ▶️ sine wave ▶️ Asystole

Apa function setiap ubat ni?
✅ Calcium gluconate : For cardio protection by stabilize cardiac cell membrane against undesirable depolarization

✅ D50% (Air gula) : Counteract effect of insulin

✅ Insulin : Reduce potasium level by drive potassium into the cell

Apa ubat lain untuk turunkan potassium?
- Neb Salbutamol
- Oral Kalimate 10g TDS
- IV Frusemide 40mg TDS
- Low potassium diet

Kalau boleh, cuba turunkan potassium melalui medical therapy. Jangan lah terus refer nephro untuk dialysis kerana nak insert catheter tu invasive process. Patient sendiri tak mahu cuci darah sebab depa tak ada apa2 symptom.

Aku cuma share balik post aku yang dulu. Kot2 ada HO yang belum familiar dengan lytic cocktail ni lagi.

Apa nama yang hospital korang guna selain lytic cocktail?

Dr Hani
MO Nephro

08/01/2024

TCA
TEMU JANJI HOSPITAL
0189804784