Wednesday, April 14, 2010

O&G ward round presentation (Obs case,new case)

Since ada yg request guideline ne n memandangkan 3rd year resit 2nd bash da nk masuk,i juz like 2 share guideline ne utk mereka yg bakal presenting utk memudahakan urusan.mngkin ada yg da lupe or yg belum tau lagi (2nd yr yg bakal masuk 3rd yr).walaupun tulis atas 2 “green style” doesn’t mean ada style lain,Cuma ada certain ward yg x kesah how we present.but 2 be safe,n for those nk masuk 5th yr better present better kan…green style 2 juz nk highlight style present ward green yg mmg “wajib” tip top.3rd yr,5th yr n registrar xde perbezaan when it comes to presenting at green ward, dats how d doctors at green ward treat us like adults,(n sometimes dat make us feel proud 2 be treated as such)..mintak2 sgt,pliz pliz pliz,tambah2 mana x cukup,dis is 4 d good of ourselves (bakal 5th yr),those who will b reassessed, 4th yr yg nk ke 5th yr,n juniors to contribute as much,we live to serve others.

Scenario 1: pt yg dtg from PAC,bkn electively admitted

Opening statement
1-This is _(1)_ with a _(2)_ currently at _(3)_ came to PAC due to _(4)_ with/without sign n symptoms of labour (such as??) admitted for_(5)_

  1. name,age,occupation,gravida n para
  2. known case of GDM on diet control,known case of what diagnose at what POA,previous hx of what,basically background history yg significant
  3. POA/EDD/EDD+?days
  4. d problem yg mmbawa de ke PAC,cthnya rupture membrane,reduced fetal movement,contraction pain,referred patient pun kn crita… If mmg da ada diagnosis,ckp je la,cthnya asymptomatic PPtype II,kn cakap at what weeks it was diagnose/due to latent phase of labour(tp nnt dr tanya lak,apa mmbuatkan kita ckp de latent phase of labor,if tau pepandai jawab,jgn ckp benda yg kita tatau)
  5. what was d plan yg de masuk ne IOL?ceaser?kena make sure plan 2 selari dgn pe complain de,kalo x dr akan tnye knp nk buat tu??sometimes pt masuk juz for observation or monitoring je,utk PP maybe for expectant management.

Followed by…
Her LMP was on the___ therefore EDD is on the ___


2-this is a planned n wanted pregnancy

3-she had +ve UPT test at (weeks of POA) / she knew she was pregnant when she missed period for (POA?) and had +ve UPT at __ . bole tmbah If he ada pg jmpa GP had another UPT test n a scan

4-dating scan?first booking?booking at PPUKM?

5-Antenatal screening—yg ne tgk tiket or buku pink 2 je,if ada MGTT yg dibuat bole ckp now.
If MGTT must be followed by—BSP—HbA1c and/or fructosamine.
BSP:how many times done,how many are abnormal or are all of them normal?if abnormal how abnormal was it,at what POA was it,what was d latest BSP result,was was done,insulin or diet control???yg ne pepandai la simplified,tgk tiket n tnya registrar if ragu2
HbA1c/fructosamine:if no HbA1c result,kn ckp HbA1c was not done,penting sbb ne yg determine control of sugar.1 poin penting yg blajar time ward round:if HbA1c is is high/slightly high but fructosamine is normal dis is previously very high sugar level but getting better control becoz hba1c is control selama 3 month dikumpulkan,if dalam 3 weeks 2 normal,tp HbA1c 2 tinggi sket,maknanya sblum 3 weeks 2 sugar de sangat tinggi sampai 3 weeks yg normal ne x dpt cover level sebelumnya.if dua2 normal,baru kita kata good control.kalo nk present nmpak sedap skit,she have good compliance to diet control,d blood glucose level was in good control as her HbA1c was normal,5.0%...barulah nmpak mcm kita ne berfikir bak kata most of d doctors la kan…

6-ANC eventful or not?if uneventful kena cakap : she had regular antenatal checkups and all of her ANC were uneventful.she had 12 ANC altogether (contohnya…)Eventful:her antenatal checkups was uneventful until at 16 weeks of POA she had UTI where she presented with suprapubic pain n bla..bla..bla..a UFEME and culture was done to confirm and it was positive for GBS,she was treated with what for how long…kat sini if pt 2 mmg known case of GDM,kn highlight glucose control,kalo PIH kn higllight BP control,if PP kn crita psl bleeding n scan,if IUGR kn crita psl serial scan n growth chart.dis is where we need to use our clinical knowledge….n look at d tickets..hihi…ingat,to present is not just to ask d patient blindly,always look at d tickets too.kan,x pasal2 dapat 1 quote

6.5-d event dat got her admitted at PPUKM,maybe bcause sign n symptom of labour.cthnya,at 37 weeks of POA she complained of contraction pain,n sudden gush of fluid,she came to PAC immediately

7-what happen at PAC—ne kn tgk tiket betul2,cari these points:
b)per abdomen
c)pelvic examination which consist of speculum n bimanual,n kira sekali ngan V/E la,tapi time present xyah la ckp pelvic examination show…mcm pelik je,ckp speculum examination found…V/E found…
d)CTG—reactive or not,ada pape abnormality x?

8-on admission…what was done,slalunya buat investigation,what was d result

9-during admission/at d ward…ada pape jadi x??bleeding?monitoring CTG?monitoring BP?yg ne pun kena ikut clinical knowledge n tgk tiket.if patient 2 duk lama,tgk dari day 1 sampai today,ada pape jadi x??if ada masalah cthnya UTI,bleeding,fever,how was she presented?what was done?investigations ape?treat dgn ape?outcome?ckp yg penting je la,slalunya ada dlm tiket…sekali lagi,rajin2 tgk tiket.nk lagi mudah tnya patient,selama duk wad ada pape jadi x,bape kali amek darah,penah demam ke,ada de bagi pape ubat,ada buat pape investigation,pas2 cari dlm tiket.

10-barulah masuk,and currently…patient is well with no acute complain,vitals are stable (ckp la result vitals de),if de on treatment pape,currently dis is day-3 of antibiotic treatment,pape la yg tgh current skang ne,if ada pape investigation yg penting,latest what what was what..tgk tiket.:P

11-haaa….kalo sampai kat sini,mmg knfem dr 2 berpuas ati dgn presentation anda,dis is d part where we say,so she is planned for,,,,,yg ne pun tgk tiket jer…kan ada tulis apa plan de kat ujung after every review…sometimes dr akan Tanya la,so what is your plan??so get ready with d plan,jgn xtau pt kita plan for what..
12-selalunya,kalo present camni,dr de jarang nk tnya pasal history lain,tapi kdg2 dr akan tanya,what are other relevant history,or what are other history u want to tell me,so kena tau gak.seqeunce de mcm biasa la kan, past obs>>gynea hx(include menstrual,pap smear n contraception)>>past med>>past surg>>drug>>allergy>>social

Scenario 2:pt yg electively admitted

Opening statement 2 jadi lain la kan,de jadi electively admitted for what n trus plan.Yg len sama je,Cuma selalunya xde part no (7) n part no (8) kadang2 2 de dtg with complain gak,so kn mention.investigation 2 selalunya ada,cari investigation apa yg de buat time de first admitted n compare dgn now or after treatment.cthnya,she was electively admitted 1 week ago at 36 weeks of POA for expectant management of PP.during dat timeshe complains of signs and symptoms of anemia, (such as…),where her Hb was found to be low,7.9,she was then transfused with 2 pints of packed red cells for the subsequent 2 days and post transfusion Hb was 9.0,overall,her Hb had been improving at the ward..n trus ke steps 9 n strusnya

Scenario 3:pt yg da pernah di present n dr ask for summary,short n sweet,katanya…

Opening statement sama,n terus ke steps 8(bukan terus 10 tau) tapi di summarized kan…

Scenario 4:pt yg mmg terlampau banyak kali di present,n dr ask for update

Opening statement n trus ke step 10,tapi if ada benda baru yg terjadi n dr xtau lagi,kiranya last present bnda 2 xjadi lagi,kena go back 2 step 8 utk dat particular problem

Scenario 5:dr 2 tatau langsung pasal pt 2,tp de nk dgr summary je,cthnya time consultant ward round (especially dgn prof har)

Opening statement,plus steps 8-11 disimplifiedkan. cthnya,on admission,she had sgn n symptoms of anemia,Hb was 7.9 n she was transfused with 2 pints of packed cells,post transfusion Hb was 9.0, otherwise her Hb at d ward had been improving. She also had UTI n was treated with T.Penglobe for 1 week currently she is on day 7 antibiotic treatment.

Guideline ne x rigid tau,if ada benda yg rasa mcm penting,nk masukkan,masukkan je..nk selit mana 2 sy suggest ikut timeline de.if u realize d beauty of d presentation is to make sure d listener can imagine d flow without having to go back n front again.use POA n how many days/weeks/years ago instead of dates,to make sure mmg nampak flow 2 cantiiikkk je…


Anonymous said...

I have not understood, what you mean?

Anonymous said...

Terima kasih untuk hal-hal yang baik