My CPR experiences

Another 4 months before my final exam. As usual, we were trained and taught with the Basic Life Support. 2 years in clinical years and I had just did 5 CPR (Cardiopulmonary Resuscitation). Out of my limited experience, 2 manage to survive meanwhile another 3 cannot be safe. Those cannot be save were happened within the recent week. One of them was an Indian during Deepavali.

This man was brought into Emergency Department at the evening of Deepavali. At that time, I was happened to be in Emergency Department during my surgery on call. We started Cardiopulmonary Resuscitation but the patient was unable to go through it. What make me feel sad was the moment when the doctor in-charged breaking bad news to the family members. The Emergency Department was crowded with 20 to 30 friends and relatives of this Indian Man. The moment when the doctor inform the family and relatives, I felt that it was really quiet with that slow running time at that moment. Break of the silence started with tears which floaded the Emergency Department.

It was an Deepavali for Indians. No body will ever wish their family members to leave them behind especially in a big celebration like this. For them, a happy celebration ended up with tears.

Another limited experience of mine was a Chinese Man brought in with Acute Myocardial Infarction (Heart Attack). Patient was cyanosed when he arrived in Emergency Department. We started with CPR and the patient was survive with the CPR. This make me feel great as I was able to help the patient.

CPR is something can be performed by any individual provided they know what they are doing. Taking a course and having a proper training will make you understand the CPR better and perform better.

Before we conduct a CPR, remember DR. ABC!!!
D = Danger. Make sure that the place and condition is safe for you to conduct the CPR.
R = Response. Tap or shake his or her shoulder and ask loudly, "Are you OK?" Proceed if the patient is not responding.
. = Stopped! Call for help. Ask someone nearby to call 999 (In Malaysia)
A = Airway. Make sure the airway is patent. AIRWAY: Clear the airway
Put the person on his or her back on a firm surface.
Kneel next to the person's neck and shoulders.
Open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway. If there is foreign body, evacuated it out.
B = Breathing. Use 5 seconds to check for normal breathing. Look for chest motion, listen for breath sounds, and feel for the person's breath on your cheek and ear. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. Pinch the nose for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal. Then give 2 rescue breath. Make sure the chest rises during each breath.
If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth rescue breathing and proceed directly to chest compressions to restore circulation.
C = Circulation. Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 2 inches (approximately 5 centimeters). Do it fast and hard. After 30 compression, repeat with "B" statement with 2 breaths. Then repeat "C" and "B". You may check the pulse again in every 5 cycles of "B" and "C". Do it until there is sign of movement or Ambulance arrive.

Please always refer to the standard guide of CPR and go through a proper training course. It is a life saving procedure. By the way, the method mention above is only applicable to adult. Children would need another method. I had come across with the website of The Heart Foundation of Malaysaia (Yayasan Jantung Malaysia) and I believe they can provide a training to you. If free, please have a look on what they do in there.
* Any mistake, please inform me.
* Always refer to the proper guide and update yourself with the newest CPR method.

Be brave.. Face it..

Was having a student ward round few days ago and there, i met a patient with breast cancer which is ulcerating. After some history taking and I realise that the patient has been hiding from the family for quite a long time. None of the family members are aware of it. It is really sad to say that these does occur quite often in our community. A lot of patient are afraid of disease and they choose to avoid it. Probably they wish to try traditional medication or they just don't bother about it and hopefully it will get better by itself.

According to my lecturer, most of these cases can be seen among those who stay in rural area. When they came to us, the cancer had become an advanced disease. I think that education does play an important role. It is so important that every one know that early detected breast cancer can be treated well. To all my friends out there, please do not hesitate to see a doctor if you feel that something is wrong. Don't hide. Be brave enough to face it so that we can help you. Another lecturer of mine always tell us that: "there is always something we can do about it. Even with an end stage disease, we still can offer palliation to reduce the suffers."

Screening test for breast cancer is available. For those with strong family history of breast cancer, please screen yourself from time to time so that early treatment can be done if you have it. If you are busy with works and always say that you have no time to go to clinic/hospital, please do a self breast examination. Learn the proper technique for self breast examination and if you find a breast lump, go to the nearby clinic immediately. Most of the breast cancer presented with painless lump. This make self breast examination become more important as it can be asymptomatic in the early stage.

Last but not least, it is your own decision whether you want to seek any medical treatment or not. But I seriously hope that every one will take it seriously. Just like what the advertisement always say : "Ingatlah orang yang tersayang." Remember their loves to you and be brave...

Great effect of each words..

Since the first day i stepped into medical school, i was told that medical profession is always in the professional group in any of the community hierarchy. That's why a lot of people always ask for opinions from doctors as they always respect doctors. Of cause, the medical advice from doctors always have a great value and great impact towards a patient's life.
At first, I don't really understand how powerful a word can be. But slowly, I realize that words from a doctor can be very influencial. Let say if you SUSPECT a patient to have a cancer and you are just about to tell her that i am suspecting a cancer. Do you know how much this will affect the patient?
Once ago, a patient's relative told me how much he is disappointed with a doctor because of what the doctor had said. Even i myself also feel sad when i heard about those words used by the doctor. Doctors were given a trust, a respect by patient that they will act the best on behalf of patient. With this, doctors are given the power to break bad news which can be very cruel to the patient or patient's relative. Imagine that you need to tell patient that "Sir, I am sorry to tell you that you are having cancer", or "Sirs and Madams, I am sorry that we had tried our best and the patient cannot make it". Seriously, I feel that I am not ready for that stage yet. Not ready to break this type of news to patient or patient's relative.
I was impressed by a surgeon when i was posted in Klang hospital last year. There was a patient with Upper Gastrointestinal bleeding. Lying on the bed and not really responsive. He was taken care by a 15 years old son who is having a national PMR exam in 2 months time. This boy skipped his classes just to take care of his father in the hospital and this was realized by this surgeon. And she make such a comment to his medical officers and house officers: "We must do something and help them. We cannot let the situation like this and we must save them". I was really happy and amaze with this comment just like i felt a wave of bright light shinning out from her.
In hospital, simple word like how are you does means a lot to the patient. Same thing to a medical students like me. A simple word from us like how are you can guarantee a smiling face from patients and relatives.
Getting closer and closer to my final exam. Really wish that i can be a good and caring doctor and be aware of every words that i use as it really affects a patient's life a lot.