some more to share

it was last night class with dr yazli. at library teluk intan. as we climbed the stairs wondering what sort of class this is.

i was fortunate enough to be the first and eventually the sole presentor of the night.

what was interesting to share is on antibiotics. before we subscribe to the patient its important to know the aetiology or what organism that causes them.

you can actually diagnose by the sign. usually pustule producing wound involves stapylococcal bacteria.This type of bacteria is one you need to respect (bak kata dr yazli) as they can be present in many disease. among them is polymicrobial disease like diabetes. infective endocarditis, etc..

These are the things i learn that night:
1. among the things to ponder before giving antibiotics beside knowing their source or agent is identifying the patient allergic status.
2. sometimes you gave patient antibiotics and it doesn work. then you might be thinking of the resistent type. some resist to peniccilin. so think of giving the broad spectrum like augmentin, cloxacillin.

Also the dr ask my friend to present back the knowledge on cellulitis that we learn that morning.
These are among that we learn on bedside that Monday morning...

1. important to know the aetiology behind any wound, swelling,tender lesion. ask history of sea bath, river bath, soil as these have their own organism that can lead to cellulitis.
2. important to know whether there is blisters or not on the swelling as the presence of it may lead to necrotizing fascites which is a medical emergency (if left overnight can lead to extensive gangrene)
3. if it is NF then the pain must be severe, tacycardic, tacypnic the pressure may goes down and other unstable condition.(make sure not to miss these!!!)
4. So next management for NF is to refer to surgeon
5  So the risk factor for this patient is the underlying fillariasis(immunocmpromised) and obese
6. The physiology behind rigor is due to the release of high amount of pathogen like happen in malaria.
7. The way we ask for rigor is "does it shook the bed?"@gigil sampai gegar katil ke?"
8. Rigor are ways our bodies produce heat to adjust to the changes at the hypothalamus where the thermostat had been altered saying our body is cold whereas its not, also its important as only some disease can cause it.

All the same this patient that i clarked was very fortunate to own a very dedicated nice mum who had been taking care of him since the last 11 days in the ward. His mum praised his son as a good butcher and he is the breadwinner for the family since death of his husband 10 years ago. nice to hear a supporting mum.Also a dedicated son. May Allah heals his disease soon. insyaAllah.