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Something to take note.

I passed through this postpartum hemorrhage news.
Its kinda old news, but it was sad and heartfelt, our hands could not only made to heal, but could make even more collateral damage to the patient, family as to the community.

Only we wish and pray that our god spare our dirty hands from this unforgiving mistake. Amin.

http://kamagong.org/

legnote : i have nothing to say.

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O&G – pap smear

Here is an excellent video technique for obtaining pap smear.

there some parts in OSCE we need discuss in pap smear.

if i have time, i add it on later.

if i were have the time !

http://www.medicalvideos.us/videos-217-Obtaining-Pap-Smear

Do you guys heard about Sim’s speculum?
The story of the invention is quite amazing.

here’s the link :
http://theblogthatatemanhattan.blogspot.com/2009/03/invention-of-sims-speculum-surgical.html

legnote : this is use in D & C, Uv prolapse and UV fistula, i think.. 😀

Do you remember Trousseau’s (trous·seaus) sign?
Honestly, i don’t! So here i put some pictures for us (especially me) to remember.

its a hand of VE !

they say, its a sign of a obstetrician hands, its a VE hand. haha.

The meaning of it : its just a sign of tetany (spasm of muscle due to interrupted blood supply, due to the condition of hypocalcemia, its exaggerated)

How to do it :

3 minutes inflate of cuff >SBP, obstruct brachial artery

The other meaning of trousseau’s:

the other meaning, a bridal dress

Its a bridal dress!

haha, see the relation?

its a french word, “Trousseau“, by a French physician Armand Trousseau, he had a gastric cancer himself and have another trousseau’s sign of malignancy.

legnote : bridal dress does cause spasm on your wedding day 😀 !

Haha, you got that right, after hours of trial run, because i tried to get the hang of WordPress (mind you with the capital W) the fonts and appearance amazed me, but the fallbacks are its not as user friendly as those popular blogspots! A few try here and there, a bit of pain in the ass, and whoala, you got a decent webpage. Well, i cant put things much, i hope the information counts! drop me your 2 cents, i’ll try to improve now and then. see ya!

dandan
legnote:Something about the logo of WordPress strikes me. i wonder! appreciate some inputs from you! 😉

O&G – Episiotomy

As we all know, a known case for OSCE’s. drop by a comment and feedback will ya.

Prof’s Azhar said they loves to ask this, well this info is courtesy of Prof’s Azhar and Dr. Sivakumar (left the college)

1.Prepare the episiotomy repairs set;

-Drapes
-Instruments
-Forceps
-Needle holder
-Scissors
-Swabs
-Gauze
-Pads
-Roller gauze

-Cleaning solution
-May include Catheter
Episiotomy instruments

-Analgesia ;Lignocaine
can be given thru:
-Local infiltration
-Pudendal injection
-Epidural

2. Take consent, and explain about the procedure ( how, what, why and any worries?)

3. Ensure good lightning

4. Assess the tear
1st degree tear -involving vagina mucosa and skin
2nd degree tear -tears involving mucosa and perineal muscle (levantor ani muscle)
3rd degree tear -tears involving anal sphincter
4rd degree tear – tears involving external and internal anal sphicter and anal mucosa

3rd degree and above – do in OT

5. Suture as quick as possible

Using Suture material
Polyglactin 910 – rapid (Vincryl)
Catgut chromic
Catgut & Vincryl

Polyglactin 910 has been shown to have less pain and less analgesic use.
Reduced wound dehiscence and resuturing of the wound

*Count swabs and instrument before and after *

-Objective suture : to achieve good anatomical alignment and haemostasis.

6. Identify the apex
Suture above the apex and make a knot.
Ensure haemostasis

7. Continuous non locking sutures till reach the fourchette

8. PR examination – to look if you had accidentally suture the anal

9. Check wound again for missed tears & bleeding

10. Don’t forget to look for swabs or instruments and needles!

fav ques:
What layers that you sutured step by step

1st- Vagina Mucosa.
2nd- Perineal Muscle
3rd- Superficial skin

Legnote: those pics are there for a reason. Inadequacy and inaccurateness should be address. thanks!