Posts

ETD: DKA with electrolyte imbalance secondary to infective AGE

I am kinda guilty for missing the DKA initially in this case. Luckily my boss found my mistake and rectified it. 75 years old lady, underlying hypertension, DM, dyslipidaemia, AF on warfarin, brought in by son, claimed to have 2 episodes of fall, presented with less responsiveness and body weakness. Our initial walking diagnosis is TRO intracranial bleed because of history of fall and history of taking anticoagulant. Further history noted patient had been having poor oral intake for 1 month with abdominal discomfort and loose stool for past few days, however we were too focused on the history of fall, as patient looked drowsy and weak, so we decided to hydrate the patient and send patient for CT brain first.  CT brain was normal. We were thinking it could be some kind of electrolyte imbalance, given the history of poor oral intake and some ongoing loose stool episodes, which makes patient weak and fell down at home.  My EP came for round after lunch, she immediately found something unu

ETD: Septic shock secondary to infected scalded wound

This is definitely one of the most bizarre case I have seen in ETD so far. This patient was referred from private hospital to us after some alleged mismanagement that caused harm to patient. 55 years old uncle, underlying hypertension, diabetes mellitus, history of ischaemic stroke in 2018 without residual weakness, and chronic kidney disease not on dialysis, apparently very bad DM control on OHA and insulin, initially was presented to private hospital late April with bilateral lower limb scalded wound after he soaked his legs into hot water. Bedside debridement was done in private hospital and patient was treated as infected bilateral lower limb scalded wound, because wound swab C+S noted growth of 2 notorious organisms, which are Staph aureus sensitive to cloxacillin and cefepime, and Enterococcus faecalis sensitive to augmentin but resistant to cefepime. He was then started on IV cloxacillin and IV cefepime. However he developed reduced consciousness after started on treatment for 5

ETD: Obstructive jaundice for investigation

I have completed 5 mandatory postings, currently tagging in final posting, which is the Emergency and Trauma posting. Day in day out I see a lot of interesting cases, I think it is worthwhile to share these interesting cases in this blog as the blog has been abandoned for a long time. This case I saw few days ago was a 60 years old gentleman, came in complained of generalised body weakness and abdominal discomfort for 3 to 4 days. When we first saw this gentleman, he appeared to be restless and looked really yellow, and it was an obvious full blown jaundice. At first we thought this is some kind of decompensated liver failure secondary to liver cirrhosis or hepatocellular carcinoma, but upon further questioning, the family member mentioned they only realised the jaundice in past few days and worsening on the day of visiting ETD. He was previously NKMI, not known of any liver disease, hepatitis infection or malignancy, had a history of right bimalleolar fracture, done ORIF and plating 7

O&G: Molar pregnancy with hyperthyroidism

Actually I wrote about this case when I was on my flight back to Sibu from Penang, but I did not save it so everything just gone when I touched down at Sibu Airport. Nevertheless this is still an interesting case so I rewrite everything to share with you guys. This case is a 20+ years old lady, G3P1+1A upon admitted in March, LMP on mid December, presented with prolonged PV bleed since January and fever on the day of admission. Patient noted to have passed out some POC-like structure prior to admission, and from scan we noted thickened ET, so the provisional diagnosis in PAC was incomplete or maybe septic miscarriage. The initial HCG level taken is around 1500k, which is insanely high. But interestingly, patient also found to have enlarged thyroid swelling and tachycardia during her admission. Therefore we referred medical team to rule out thyroid storm. But medical team didn't seem to think she was having thyroid storm, because she still looked quite comfortable despite having fev

O&G: Unstable lie for external cephalic version (ECV)

This is a case of a 30+ years old lady, G5P4 at 39+0 week period of gestation, electively admitted to ward for external cephalic version due to unstable lie. The fun thing is we just had the CME for unstable lie last week, so some knowledge is still fresh in head, and it is excited to see some real cases after you have your theory discussion. So for unstable lie, patient need to be admitted for lie chart, and if it is a breech, an ECV would be performed. If ECV fails, then options like vaginal breech delivery or LSCS would be considered. Unstable lie is only diagnosed when the patient is term. And this patient obviously has the most common risk factor which is high number of parity as this patient is a grandmultipara. However other risk factors need to be screened as well including placenta praevia, polyhydramnious, fetal anomalies or even pelvic tumours. And since this patient is admitted for ECV, there are other contraindications for ECV to be screened as well.  The lie chart is plot

O&G: Ruptured ectopic pregnancy with u/l heterotrophic pregnancy

My first case here would be a ruptured ectopic pregnancy with underlying heterotrophic pregnancy. I was called to OT yesterday as I was the EMOT Houseman of the day. I was quite unhappy when I was informed about the case because nobody from antenatal or gynae ward informed me to get ready beforehand. When I reached the OT, only I knew that the case wasn't from the ward but from the emergency department, it was a case of ruptured ectopic pregnancy. Patient is a middle age lady, with history of complete miscarriage about 3 weeks ago, presented to ETD with lower abdominal pain and anaemic symptoms complicated with shock. The BP was low and requiring inotropic support. Initially case referred to surgical team to rule out acute abdomen, CXR no air under diaphragm, AXR no dilated bowels, bedside scan noted some free fluid at Morrison pouch. They also ordered for amylase to rule out pancreatitis. The initial walking diagnosis was septic shock secondary to intraabdominal sepsis. Case then

My First English Blog

Hello everyone. I am Lao Huang, a Malaysian junior doctor (houseman) in Hospital Sibu, Sarawak Malaysia, currently 5th month of life as a doctor, working my ass day in day out, at the same time trying to attempt MRCP paper so that my career is in my own control, not by the system. I am an 8-year-old blogger, owning a blog 老黄的连篇废话  written in Mandarin, mainly sharing about my life as a houseman, please feel free to visit the site if you can read in Mandarin as well. This is my 2nd blog, and my first English blog, inspired by friend Khoo who is also a houseman and blogger. She often shares interesting cases in her blog, which makes me wonder why can't I do the same too. I am not as expressive as I used to be in Mandarin when I try to write in English. So I decided to start an English blog, not only I can improve my English writing skills, I also can connect to the international community if my blog happens to be shared to people in other countries. You may see grammatical or vocabula