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Clinical Placement D4

Day 4 : 19th May 2016

My colleague (Fatin) and I listened and involved in the passing report. So we only had one patient which was admitted in the afternoon of 18th May 2016.

This patient has Supra Ventricular Tachycardia (SVT). The SVT is an abnormally fast heart rate of more than 60 beats per minute. This patient has around 115 beats per minute.

So during the doctors' round, the patient has questions and answers session with the doctors. The doctors explained to him what should be done to reduce the heart rate per minute. The doctor gave opinion of first, taking medicine and see the outcomes and if the medicine do not show any positive outcomes, operation would be the ones.

Then the patient asked where should the surgery be done. So the doctor said most patients were going to Jerudong Park Medical Centre (JPMC) or to Singapore. The doctor informed the patient that it would cost around BND 40K per surgery. It really shocking tho, the price. Huhu...

Around noon, one patient admitted in the ICU because of Diabetic Ketoacidosis. So we monitored everything, and yes the glucose level is very high as the result stated 'Hi' in the glucose meter. Then we checked alongside the protocol monitored of Diabetic Ketoacidosis such as the ketones level, potassium and so on. So the first hour, the patient are administered with 1000 ml or 1 litre of Normal Saline (500 ml of both sides of the arm). Then reduced to 500 ml on the left side (either arms could be done). The right arm were inserted with cannula on the brachial artery. It is to ease when taking blood for any monitoring.

Oh yes, before I forgotten, the Sister taught us about basic reading of the Electrocardiogram (ECG) rhythm. In ECG, there are 12 leads and it divided into two types ; chest leads and limb leads. Chest leads consist of V1 to V6. While Limb leads consist of RA, RL, LA, LL. The AVR, AVL, AVF consists in the limb leads.

The highest electrical current of the leads is Lead 2. as it crosses the heart. AVR always reading upside down (downwards) because it has negative access or downwards deflection. It always shows negative as the electrical current travels parallel to the heart from right to left, while AVR from left to right. It travels away from the heart.

Oh yeah, about the patient the other day (in my previous post) that has bradycardia has passed away at 7.45 pm on 18th May 2016. We are very sorry for the patient for their loss. It was a great experience for us to involve in reviving even though it only lasted for few hours.

Okay, that's all for today. Sorry for the late post. I should have posted this last night.

Love,
        D.

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