Wednesday, November 10, 2010

Mari berkenalan dengan sahibah medik UIA 2008

Mari kita berkenalan dengan Batch ana - yang terdiri daripada 2 usrah yang berlainan...
Pengalaman bersama mereka sangat best!!!
UKhuwwah fillah..
Shamina ( Houseman : Hospital Serdang)
Nur Syaqina ( Houseman: HOspital Kajang)
Norihan ( HOuseman : HOspital Sarawak)

Nor Azhani (Houseman: HOspital Selayang)

Nabilah (tengah pregnant time ni , HOuseman: Hospital Sg Petani)

Nadiah Yaakob (HOuseman:Hospital Serdang)

Nur Zurairah (Houseman: HOspital Kangar,Perlis)

Nurul Huda (HOuseman: Hospital Melaka)


Norasila (HOuseman:HOspital di Johor)

Noorul Hashimah (HOuseman: HOspital Kajang)


Hanim Hanapi (Houseman:HOspital Kangar,Perlis)

Sekarang masing-masing sudah berpisah..namun harapnya masih di jalan da'wah yang sama)














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October 20, 2010 — Chest compressions should be the first step in addressing cardiac arrest. Therefore, the American Heart Association (AHA) now recommends that the A-B-Cs (Airway-Breathing-Compressions) of cardiopulmonary resuscitation (CPR) be changed to C-A-B (Compressions-Airway-Breathing).

The changes were documented in the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, published in the November 2 supplemental issue of Circulation: Journal of the American Heart Association, and represent an update to previous guidelines issued in 2005.

"The 2010 AHA Guidelines for CPR and ECC [Emergency Cardiovascular Care] are based on the most current and comprehensive review of resuscitation literature ever published," note the authors in the executive summary. The new research includes information from "356 resuscitation experts from 29 countries who reviewed, analyzed, evaluated, debated, and discussed research and hypotheses through in-person meetings, teleconferences, and online sessions ('webinars') during the 36-month period before the 2010 Consensus Conference."

According to the AHA, chest compressions should be started immediately on anyone who is unresponsive and is not breathing normally. Oxygen will be present in the lungs and bloodstream within the first few minutes, so initiating chest compressions first will facilitate distribution of that oxygen into the brain and heart sooner. Previously, starting with "A" (airway) rather than "C" (compressions) caused significant delays of approximately 30 seconds.

"For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim's airway by tilting their head back, pinching the nose and breathing into the victim's mouth, and only then giving chest compressions," noted Michael R. Sayre, MD, coauthor and chairman of the AHA's Emergency Cardiovascular Care Committee, in an AHA written release. "This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body," he added.

The new guidelines also recommend that during CPR, rescuers increase the speed of chest compressions to a rate of at least 100 times a minute. In addition, compressions should be made more deeply into the chest, to a depth of at least 2 inches in adults and children and 1.5 inches in infants.

Persons performing CPR should also avoid leaning on the chest so that it can return to its starting position, and compression should be continued as long as possible without the use of excessive ventilation.

9-1-1 centers are now directed to deliver instructions assertively so that chest compressions can be started when cardiac arrest is suspected.

The new guidelines also recommend more strongly that dispatchers instruct untrained lay rescuers to provide Hands-Only CPR (chest compression only) for adults who are unresponsive, with no breathing or no normal breathing.

Other Key Recommendations

Other key recommendations for healthcare professionals performing CPR include the following:

•Effective teamwork techniques should be learned and practiced regularly.
•Quantitative waveform capnography, used to measure carbon dioxide output, should be used to confirm intubation and monitor CPR quality.
•Therapeutic hypothermia should be part of an overall interdisciplinary system of care after resuscitation from cardiac arrest.
•Atropine is no longer recommended for routine use in managing and treating pulseless electrical activity or asystole.
Pediatric advanced life support guidelines emphasize organizing care around 2-minute periods of continuous CPR. The new guidelines also discuss resuscitation of infants and children with various congenital heart diseases and pulmonary hypertension.

The authors of the guidelines have disclosed no relevant financial relationships.

Circulation. 2010;122[suppl 3]:S640-S656.

Additional Resource
The 2010 AHA guidelines for CPR and emergency cardiovascular care are available on the AHA Web site.

Clinical Context

When the AHA established the first resuscitation guidelines in 1966, the original "A-B-Cs" of CPR were to open the victim's Airway by tilting the head back; pinching the nose and Breathing into the victim's mouth, and then giving chest Compressions. However, this sequence resulted in significant delays (approximately 30 seconds) in starting chest compressions needed to maintain circulation of oxygenated blood.

In its 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, the AHA has therefore rearranged the steps of CPR from "A-B-C" to "C-A-B" for adults and children, allowing all rescuers to begin chest compressions immediately. Since 2008, the AHA has recommended that untrained bystanders use Hands-Only CPR, or CPR without breaths, for an adult who suddenly collapses. The new guidelines also contain other recommendations, based primarily on evidence published since the previous AHA resuscitation guidelines were issued in 2005.


Study Highlights

•The AHA has rearranged the A-B-Cs (Airway-Breathing-Compressions) of CPR to C-A-B (Compressions-Airway-Breathing).
•Chest compressions are therefore the first step for lay and professional rescuers to revive an individual with sudden cardiac arrest.
•This change in CPR sequence applies to adults, children, and infants, but excludes newborns.
•"Look, Listen and Feel" has been removed from the basic life support algorithm.
•Other changes in CPR recommendations for basic life support include the following:
◦Rate of chest compressions should be at least 100 times a minute.
◦Rescuers should push deeper on the chest, resulting in compressions of at least 2 inches in adults and children and 1.5 inches in infants.
◦Between each compression, rescuers should avoid leaning on the chest so that it can return to the starting position.
◦Rescuers should avoid stopping chest compressions and avoid excessive ventilation.
◦All 9-1-1 centers should assertively give telephone instructions to start chest compressions (Hands-Only CPR) when cardiac arrest is suspected in adults who are unresponsive, with no breathing or no normal breathing.
•Dispatchers should provide instructions in conventional CPR for individuals who have presumably drowned or have had other likely asphyxial arrest.
•For attempted defibrillation with an automated external defibrillator of children 1 to 8 years old, the rescuer should use a pediatric dose-attenuator system if one is available, or a standard automated external defibrillator if the pediatric dose-attenuator system is not available.
•A manual defibrillator is preferred for infants younger than 1 year.
•Key guidelines recommendations for healthcare professionals include the following:
◦Effective teamwork techniques should be learned and practiced regularly.
◦To confirm intubation and monitor CPR quality, professional rescuers should use quantitative waveform capnography to measure and monitor carbon dioxide output.
◦Therapeutic hypothermia should be incorporated into the overall interdisciplinary system of care after resuscitation from cardiac arrest.
◦For management and treatment of pulseless electrical activity (asystole), atropine is no longer recommended for routine use.
•The new guidelines do not recommend routine use of cricoid pressure in cardiac arrest.
•For the initial diagnosis and treatment of stable, undifferentiated regular, monomorphic wide-complex tachycardia, adenosine is recommended.
•Pediatric advanced life support guidelines offer new strategies for resuscitating infants and children with certain congenital heart diseases and pulmonary hypertension.
•The pediatric advanced life support guidelines emphasize organizing care around 2-minute periods of uninterrupted CPR.

Clinical Implications

•In its latest guidelines, the AHA has rearranged the A-B-Cs of CPR to C-A-B. This change in CPR sequence applies to adults, children, and infants, but excludes newborns.
•Key guidelines recommendations for healthcare professionals include focus on effective teamwork techniques, use of quantitative waveform capnography, and incorporation of therapeutic hypothermia into the overall interdisciplinary system of care. Atropine is no longer recommended for routine use for management of pulseless electrical activity (asystole).
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http://cme.medscape.com/viewarticle/731231?src=cmemp&uac=114065MY
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Thursday, May 20, 2010

AMANAT DARI PEJUANG...



“Aku hanya berwasiat pada kalian andainya kami tiada – teruskanlah perjuangan ini, tingkatkanlah dakwah kepada masyarakat, mantapkanlah tarbiyah diri, keluarga dan anak-anak didik kalian yang ada.”
Demikian antara amanat yang ditinggalkan oleh Ketua misi konvoi Lifeline4Gaza dari Malaysia ke Gaza, Sdr Noorazman Mohd Samsuddin yang akan berangkat ke Turki pada 19hb Mei nanti. Amanat tersebut dibuat selepas senarai peserta konvoi dari Malaysia diumumkan. Peserta konvoi dipilih dan disaring oleh penganjur utama projek, Pertubuhan Hak Asasi dan Bantuan Kemanusiaan (IHH) yang berpusat di Turki. Seramai 6 orang sukarelawan dan 4 orang wakil media dari Malaysia akan menyertai konvoi kapal antarabangsa bersama-sama dengan lebih daripada 600 orang peserta dari puluhan negara.
“Saya bagi pihak peserta yang lain menyusun sepuluh jari memohon maaf sekiranya ada apa-apa kesalahan, kesilapan yang dilakukan sebelum ini.
Sekiranya kami tidak pulang ke Malaysia, maafkanlah kesalahan kami, halalkanlah makan minum kami, bantulah keluarga kami.”
“Semoga Allah terima semua amalan kita.”
“Ya Allah! Kuatkanlah hati-hati kami atas jalanMU.”
Beliau juga meninggalkan pesan kepada seluruh warga yang prihatin dengan perjuangan membebaskan bumi Palestin agar terus berjuang tanpa henti. Begitu juga kepada semua yang cakna dengan masa depan umat agar mempertingkatkan usaha dakwah kepada masyarakat dan memantapkan usaha tarbiyah bermula dengan diri dan ahli keluarga dan seterusnya anggota masyarakat.
“Aku hanya berwasiat pada kalian andainya kami tiada – teruskanlah perjuangan ini, tingkatkanlah dakwah kepada masyarakat, mantapkanlah tarbiyah diri, keluarga dan anak-anak didik kalian yang ada.”
“Jangan biarkan darah yang gugur di bumi Al-Aqsa menjadi hujah menentang kita di hadapan Allah atas kelalaian, kemalasan dan kejumudan amalan-amalan kita.”
“Ya Allah! Bantulah kami”
Peserta konvoi dari Malaysia akan bertolak ke Istanbul pada 19hb Mei dengan kapal terbang untuk menaiki kapal yang sedang menunggu di sana. Konvoi kapal dijangka akan bertolak dari Istanbul ke Antolia (Antalya) pada 21hb Mei dan akan belayar ke Gaza dua hari kemudian. -ihhh
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Wednesday, May 19, 2010

poem from a teacher




You are my good students

Not because you never drift away

But you keep your track after a drift


You are my good students

Not because you never make a mistake

But you make correction after a mistake


You are my good students

Not because you never fall down

But you stand up stronger after a fall


You are my good students

Not because you never cry

But you keep your composure after a cry

You are my good students


Not because you are so extraordinary

But because you are ordinary persons with extraordinary attributes


POEM from Dr marzuki ( internal medicine lecturer, IIUM )

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Tuesday, May 18, 2010

Program HO/MO




Pelapis KKH Anjur Seminar MOHO



Ibarat menganyam, lama menyulam tikar melarik coraknya. Hasil titik peluh ahli-ahli Kelab Kesihatan HALUAN (KKH) dan pentadbir pendidikan HALUAN di negeri-negeri yang mempunyai universiti pengajian perubatan, kini anak-anak muda lulusan perubatan berjaya menganjurkan seminar MOHO (Medical Officer / House Officer) mereka pada 17 April 2010.

Seminar sehari suntuk di Kajang, Selangor itu dirancang dan dikendalikan sepenuhnya oleh tenaga muda doktor-doktor lelaki dan wanita dari Wilayah Tengah. Seminar penuh bermanfaat itu melibatkan generasi pelapis KKH dan telah disertai oleh sekitar 30 orang doktor dari seluruh Semenanjung Malaysia.

Para doktor muda pewaris KKH
Seminar ilmiah sehari yang bersifat ”a get-together” itu dimulakan dengan pembentangan kertas kerja oleh Haji Noorazman Mohd Shamsuddin bertajuk ”Pemantapan Ukhuwah di Alam Pekerjaan”. Seterusnya, seminar disusuli pula dengan slot forum yang telah dipanelkan oleh pakar ortopedik Dr Basir Towil, pemilik klinik yang berjaya Dr Nor Azian Hasnan, dan pakar radiologi Dr Suraiya Ibrahim. Berbagai pengalaman ahli KKH seniors dikongsikan bersama sebagai inspirasi kepada golongan muda.

Para MOHO bergembira dengan pertemuan itu kerana selepas itu mereka disajikan pula dengan sesi brainstorming pada sebelah petangnya. Setiap peserta diberikan ruang dan masa secukupnya untuk bertanya dan melepaskan sesak di dada akibat tekanan dalam alam pekerjaan di hospital yang sangat mencabar bersama para doktor seniors yang sudah lama berpengalaman.

Sessi terakhir daripada Dr Syed Haleem Syed Hasan al-Haddad cukup menyentuh hati dan berjaya mencerna minda peserta untuk mengharungi kehidupan sebagai doktor muda yang kerap tidak cukup rehat dan tidur berbanding graduan di bidang-bidang lain. Kalam akhir diperindahkan lagi dengan mutiara amanat daripada seniors-seniors pakar KKH seperti Dr Noram Ramli, Dr Burhanuddin Busu dan Dr Mohd Zamrin Dimon sebagai pelabuh tirai.

Amnya, seminar itu telah berjaya mencapai objektifnya dan menimbulkan kesedaran tentang betapa pentingnya untuk terus hidup sebagai seorang dai’e dan da’iyah di jalan Allah SWT, kerana itulah tuntutan ke atas setiap profesional Muslim yang sentiasa bimbang akan datangnya hari pembalasan.

Sehari selembar benang, lama-lama jadi kain
Jasa seniors kami kenang, jumpa lagi di tahun lain.

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Laporan oleh Dr Sharifah Khaida Syed Shahab
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Monday, May 17, 2010

RASHES!!






A 45-year-old woman presents with a 2-day history of a pruritic rash. The rash started in her axillae and groin and has since progressed to the rest of her body. She has also developed a fever this morning. She has been taking azithromycin for a recent diagnosis of pneumonia. She has no known history of drug allergies.

Hint: She has tolerated azithromycin once in the past, with no adverse effects.

45-year-old woman presents to the emergency department (ED) with a 2-day history of an acute-onset, mildly pruritic rash. The rash started in her axillae and groin and has since progressed to the rest of her body. She then developed a fever this morning. She was diagnosed with pneumonia 4 days ago and has been taking azithromycin since that time. She was previously in good health, and her past medical history and family history are negative for psoriasis, arthritis, and other significant medical conditions. She has no known history of drug allergies. She does not smoke and drinks an average of 2 glasses of wine each week. She is a teacher, and she has 2 young children at home.


On physical examination, the patient appears to be in no acute distress. Her vital signs include a temperature of 102.0°F (38.9°C), a pulse rate of 88 bpm, a blood pressure of 124/76 mm Hg, and a respiratory rate of 16 breaths/min. Fine crackles are auscultated in the left lower lung field. A complete skin examination reveals hundreds of nonfollicular pustules on erythematous bases diffusely spread over her face, trunk, axillae, groin, arms, and legs. The lesions are without any crust or scale. No lesions are observed on her palms, soles, or mucous membranes. The remainder of the physical examination is unremarkable.


Laboratory tests are obtained.

The white blood cell count is elevated at 16 × 109 cells/L (normal range, 4.3-10.8 × 109 cells/L), with a moderately elevated total neutrophil count of 14 × 109 cells/L (normal range, 1.3-6.7 × 109 mg/L) and a slightly elevated eosinophil count of 0.37 × 109 cells/L (normal range, 0.0-0.3 × 109 cells/L).

The C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are also elevated, at 84 mg/L (normal range, <10>
Culture and Gram stain of several pustules are obtained and are negative.

A punch biopsy of a pustule on her leg is performed. The histology shows spongiform subcorneal pustules, edema of the papillary dermis, marked perivascular infiltration of neutrophils, and exocytosis of a few eosinophils.


What is your answer?

(a) Acute generalized exanthematous pustulosis

(b) Leukocytoclastic vasculitis

(c) Pustular psoriasis

(d) Subcorneal pustular dermatosis

(d) Toxic epidermal necrolysis
( CME MEdscape)

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Dari Mata..jatuh ke hati?







Sila pilih jawapan anda ... Selamat Mencuba
Choices of Answers:

A)Thyroid eye disease: Proptosis

B)Interstitial Keratitis : ocular syphilis

C) Conjunctivitis
D) Corneal arcus


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