MY AnesthesiaWEB

Pain is the indication of suffering so why should we let it happen?

Monday, January 01, 2007

Difficult Airway


The other day, while I was running elective list, my colleague running the emergency OT called me. Went out to the reception area to see what's going on... Lo and behold, this is what we have (I have the patient's permission to use his photo as education material).


ThyroMental Distance is only 1 finger breadth. We proceed with caution.We explained to him his risk and also our options if we can't intubate him. Then he was induced with propofol and test ventilated to make sure we can ventilate him with face mask. Then my colleage did a lanryngoscopy and found that it was Cormack Lehane Grade IV. I took the McCoy blade and do another laryngoscopy and this time it is Cormack Lehane III with a good cricoid pressure. After confirmation of the laryngoscopy finding then only we gave suxamethonium followed by intubation without any problem. Post operatively, we informed him again about our finding and tell him to inform his next doctor if he had to go under another GA in the future. Who knows he might came in late at night and some heroes might book him for a GA case without notice the airway. It might just cause unnecessary stress to the anaesthtist at the wee hour.

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Friday, September 29, 2006

Phylloides Tumor---rare!

Thursday, August 31, 2006

im glad

Congratulations Ray, you are 90% not Malaysian.

That means you're as Malaysian as...


Guy Sebastian !

Wednesday, August 09, 2006

Lobectomy vs Pneumonectomy




The similarities:
1. Both have thoracotomy scars.
2. Both have reduced chest expansion and reduced AE.

The differences:
1. The signs of lobectomy are confined to lobe which is removed. The signs are similar to pleural effusion except it is not stony dull.

My playmate!


Fibreoptic Bronchoscope

Friday, August 04, 2006

I see Dead People!

"Disturbed" is defined as being troubled mentally and emotionally, it is when the tranquillity of your inner self has been destroyed. When was the last time you felt disturbed? What was the reason of you feeling that way?

48 hours ago i was extremely disturbed.I wanted to narrate this story earlier but i needed some time to separate myself emotionally from the scene before i can talk about it again. Ok ok...i am certainly exaggerating a bit, just wanted to recreate the atmosphere.

I visited the mortuary again some two days ago. I was accompanied by Tracey, my workmate. Just like good old CSI, they always team up. Our assigment for that day was a malay man in his 50s who apparently had extensive psychiatric disorder of some kind. He failed to respond to his mental health case worker for the whole week. He was then found dead, sitting in his chair in front of his dining table, with half a plate of his food still on the plate. Apart from his mental illness he was not known to have any medical illness.

He was still wrapped up in water proof plastic sheet when we entered the mortuary. The mortuary was dead quiet and cold as usual. The mortuary assistant unwrapped the body skillfully and alas...Tracey and i gave each other a stare when we picked up the strong smell. A smell that has been confined underneath the water proof and airtight plastic before that, the smell of the dead.

The body was estimated to be more than 4 days old. The epidermal layer of the skin has started to peel away, the skin has lost all of its elasticity and colour. The post mortem lividity has faded. The man's eyes were wide open, staring. The only problem was he ain't got no more eyeball. All the vitreous fluid in his eye must have been reabsorbed, his orbits were sunken and his eyeballs appeared excavated. His cornea appeared muddy. In other words, he looked very very dead.

We did the usual cutting and slicing to open up the body, but this time i got the honour of doing it. It wasn't as easy as i thought. Simple thing like gripping onto the internal organ can prove to be a daunting task, especially when you come to the bowel loops that have started to decompose. We cut the throat open....okay perhaps i should be more professional and say we made a linear horizontal incision at the level of hyoid bone. We found the key to the mystery right there. There was a big chunk of red meat measuring 5x3 cm lodged tightly at the entry of his trachea. The cause of death was simple...he choked himself to death. The old school docs will use the term cafe coronary. The bad thing was despite knowing the cause of death we still had to complete the autopsy by examining each and every other organ including the brain. Electrical saw started spinning again, producing a deafening noise that could potentially cause conductive deafness. Our protective instinct told us to hold our breath at the sight of the exposed brain. Brain tissue is very vulnerable to hypoxia (lack of oxygen), they die away quickly. The necrotic brain matter looked semisolid. If i have to use a common language to draw a picture i must say it looked a bit like a mixture of expired mayonaise and Seafood cabonara, thick and creamy. By then, i was consciously clenching my teeth, pushing my tongue against the hard palate and trying to keep my stomach content where it belongs.

Tracey was rather quiet after the session. She then revealed that she was feeling nauseated due to the intense smell from the decomposed tissue. After cleaning up after the autopsy session, me and Tracey made our way to the hospital canteen and picked up a box of deep fried wonton each. They looked rather nice. I then regretted because after a bite, i realised the wonton was not fully cooked. The semi raw pork filling inside the wonton reminded me too much of the dead man. It's amazing how similar different kinds of raw meat can smell. Tracey was still sipping on her hot tea, trying to suppress the nausea. I warned her about the wonton. Being trusting, she threw the whole box of wonton into the bin without trying any. I bet she would have made a mess on the cafe floor if she had not taken my advice and dispose the wonton.

On that same day i found out that the royal college of pathology in Australasia recently decided to add another exam to the already long list. Now instead of doing 3 exams i am required to sit 4. The new exam is a forensic practical exam. Not the nicest thing to know when i am still trying to overcome my lost of appetite.

Life is about making decisions. Some are harder to make. Some may end up as the root of regret. May be that is my fate now.....

Friday, June 23, 2006

Sigh...............

I broke up with SHINE.....yet again!
That would be my last thing I wanted to do but out of the flaming fiery me,I uttered the so unmagical word at the most uncondusive time.

sigh.............this time my words really pierced tru the heart! It was so disgusting that I did it on purpose well knowing that I dont mean a bit inside me.

What done cannot be undone...I just hv to live with it,for now

Wednesday, April 19, 2006

U trust me ahhhh?



Wonder why lawyers are missing in the list? Hmmmm................... :))