kena tegur dgn member kenapa lama x post. sekali post yg pening kepala pulak kan. sorry lah hhaha .

so sape2 nk try give full diagnosis utk ABG kat bawah ni silakan ye jgn segan2 ok so jom kita interprete ABG ni. so tulis balik mcm ni:

pH 7.228 -acidosis

pO2 193 - wah so high, wean down o2 stat

pCO2 29 (normal 40) -turun 11

HCO3 13 (Normal 24) -turun 11

Hye gais

masa round, u saw an ABG & u were like "ni respiratory acidosis ni"

then MO come "eh this is Chronic respiratory acidosis"

Then your specialist come "walao, ni acute on chronic respiratory acidosis"

then consultant come "eh got concurrent metabolic acidosis sumore" then you were like "eh where got lah ??"

i know some of you already know how to interprete ABG so well ady. BUt ill just put it out there for those yg still find ABG a tad difficult to read. ill try to simplify it for you

WARNING: Long post

hye gias..

a bit about NSAIDs

All traditional NSAIDs are both COX1 and COX2 inhibitor
(non-selective COX inhibitor)

semua ada sifat2 analgesic, antipyretic and anti-inflammatory COX1 ni dia mcm house-keeper. dia ada kat gastric lining and it helps protect us from gastric ulcer.

The problem is, NSAIDs inhibit this good isoenzymes (COX1). so patient ada risk develop ulcer

So all NSAIDs are gastric irritant sebb dia inhibit COX1 ni.

Hye gais...

Today is about "kak start Norad!"

meremang kalau keluar ayat ni

Lets talk about noradrenaline

Bnyk persoalan. berapa dose dia, bila nk taper up/down

ape maksud single strength/ double strength and why

bila nk start 2nd line vasopressor

aku cuba kupas kat sini k sebelum kita go further, suka aku nk igtkan thread ni just rough idea, mcm baby step aje

and if you guys still igt my prev post regarding adrenergic receptor, so dpt la idea how norad work

Hye gais..

things they might not teach you about Dengue Fever lets talk about warning signs... that you think is not warning signs

let me just get a few things straight in managing DKA
1. Hypovolemic shock kills patient first
2. Then K derrangement
3. only then acidosis Fluid resus is key. a lot of people cant wait to start insulin. they think insulin is the star here. no its fluid!

nak setting bipap based on abg ni senang je
1) abg show PaO2 < 60 (pt hypoxemic) means ada oxygenation problem
2) abg show low pH with high PaCO2 >45 means ada ventilatory problem bipap ada dua setting
Ipap
Epap (sama macam PEEP) pressure nk maintain alveolar keep on opening during expiration.
Pressure support = Ipap - Epap

harini i nk cakap pasal ventilator *sigh ...
okay so kita ada bnyak mode of ventilator, assist control, simv, aprv, pressure support bla bla. but i will focus on yg common kita guna kat ward n red zone which is simv. simv tu mcm mana eh? basically dia mcm ni. contoh la eh CONTOH. i dpt pt umur 54yo, malay, lady. berat 50kg. intubated sebb airway protection. so i set up
-RR 12
-Tidal volume (TV) 400 mls
-peep 5