Wedding Bells

A couple of days back, I attended the wedding of one of my college buddies. It was held at the other side of Metro Manila, but the trip is worth it. After being engaged for nearly a year, he was finally married to his long time girlfriend of 7 years. Saw some old faces but unfortunately some buddies weren't able to make it to the wedding day. It was a garden ceremony held in a resort in Bulacan. It was quite gloomy that day and rain eventually fell, even so the ceremony still proceeded although it started quite late. The reception was held on the same venue and food was serve after taking pictures with the couple was done. All in all it was a good ceremony celebrating their love through marriage in this heart month. To my good friend Rhekz, congratulations and best wishes.

Dead on Arrival

We will be having an audit for our charity cases for the month of January in a couple of days, and Ill be assigned to ICU admissions for the said month. Sometime in the middle of last month, a 42 year old male, who was a hospital personnel, admitted to the ICU and came in due to unresponsiveness. It was noted that a couple of minutes prior to arrival at the emergency room, the patient was doing moaning sounds and was noted lying on the floor. Suddenly one of his roommates stood up, and called for help to bring the patient to the hospital. It only took the patient's group of roommates around 5-6 minutes to reach the emergency room but upon arrival, patient was noted to have no heart rate and no blood pressure. He was declared dead on arrival.

Upon arrival, resuscitation was immediately done, CPR was done, epinephrine given, intubation was done and eventually after 10 minutes, patient responded and eventually was revived. On work-up it was noted that he suffered from an acute myocardial infarction, hence myocardial infarction regimen was started and patient was admitted to the ICU. Upon arrival at the ICU, he was noted to be with stable vital signs, but seizure episodes were noted to be starting. Seizure were attributed to hypoxic encephalopathy since a patient was noted to be asystole (no heartbeat) for some minutes. Anti-seizure medications were added to his treatment regimen. I endorsed the ICU to the incoming resident knowing that this patient won't make it to next day.

Next day came, I went to the ICU to put my things and upon seeing him the next day, I big smile formed in my face, he was awake, although a little bit disoriented, he has stable vital signs and no seizure recurrence was noted. Patient was eventually extubated and transferred out of the ICU in the next days and eventually discharged. When I asked him if he remembered anything, he told me the last thing he heard were people screaming to bring him to the hospital. A second chance of life happened infront of me, hope he could nurture and take care of it.

An Old Patient's Demise

It’s been a gloomy and rainy Monday; the rain drizzled since late last night and continued until morning which somehow made me late in coming to the hospital. The early hospital atmosphere was filled with cold air ushered by the water drops from outside. Upon arrival at the office, loud chattering about yesterday’s events were heard all over, then the outgoing ICU resident entered and directly held my shoulder and told me news that somehow coincided with the gloomy weather outside. The patient situated on ICU bed no. 2 just died early today. She recounts that the nurses called her attention, a sudden change in cardiac rate, from tachycardia to bradycardia, was noted and eventually the patient went into cardiac arrest. Resuscitation was initiated, CPR done, epinephrine given, ambubagging and fluids adjusted were done. A couple of minutes later, inspite efforts to revive his heart, it did not respond and he was eventually declared dead.

Looking back 3 months ago, when I was still the IM resident assigned to the ER, the above patient was brought to the ER due to unconsciousness. On history and examination, the initial impression back then was that the patient suffered from a stroke. A CT scan was done which revealed a massive infarct on his left cranial hemisphere causing him to be down to GCS 3. A neurosurgery referral was made which booked the patient to a stat craniotomy to relieved the elevated intracranial pressure. He survived the first few critical days in the ICU. His sensorium eventually increased, bit by bit in the next days but a persistent fever caught him. Possible causes entertained were ventilation acquired pneumonia or a possible abscess formation on his surgical site. Diagnostic measures were planned however, due to financial compromised a repeat CT scan, blood, sputum and urine cultures were not done. In the next days, inspite of the occasional spiking fever, patient was noted with eye opening and occasional spontaneous movement. He was fighting the disease that’s been tormenting his body, but unfortunately the financial aspect didn’t give him a good fighting chance. During those days, how I wish for a better health care system here in the Philippines, for better health insurance that could cover all of a patient’s expenses form day 1 to the day of discharge. A health system that won’t inhibit a patient from seeking medical consult because of financial reasons. It might not be happening now, but how I wish it would be a reality in the coming months or in the coming years.

It his last few days, he was noted to have much improved sensorium with spontaneous eye opening. But the financial aspect of the family leads him to his untimely demise.

Rest Day Sunday

After a grueling week being at the hospital, I finally got may first Sunday off for the month of February. A woke up pretty late, doing some stretches and finally hitting the television. Plan to be do some non-hospital stuff this afternoon, probably play some computer games and head to church later. I have to refill my batteries for tomorrow another day at the hospital awaits. Im actually yawning doing this post... my much needed rest...

Uncontrolled Diabetes

A 69 year old male, diabetic and hypertensive, sought ER consult last night due to sudden vomiting of 3 episodes associated with crampy abdominal pain. His initial symptoms just started a couple of minutes before going to the emergency room. At the ER, patient's blood glucose was taken and the CBG machine read it as "HI". An intial dose of bolus insulin was given via intravenous route and his blood sugar levels were monitored.

Diabetes mellitus or commonly termed as diabetes is a chronic metabolic disease that gives a person a high sugar level. This is caused by decreased or no insulin production or resistance to insulin or a combination of both. Diabetes could also occur in pregnant patients which termed as Gestational Diabetes. Other patients could also develop diabetes when thay have had surgical procedures involving the pancreas. There are also diabetic emergencies like your diabetic ketoacidosis and your hyperglycemic hyperosmolar crisis.

A patient with an uncontrolled elevated blood sugar could have target organ damage. Diabetes can give you kidney damage, neuropathies, blindness, a risk factor for stroke and heart disease and many more. Studies have shown that for diabetic patients who have controlled blood sugar levels,end organ damage can be prevented or delayed. Its highly advisable for patient with diabetes to seek physcision consult, be vigilant in controlling their appetite, and be compliant with their medications as to prevent morbidity and even life threatening complications.

Run Run Run

I spend my afternoon running in a nearby village park. I gain quite some weight during the past 2 years so its high time to lose them before I finished my residency training. When I started running at first I was doing ok, then after a couple of minutes after I felt the burden of carrying my whole weight.. I really need to trim down.

Studies have shown that exercise could prevent chronic disease like diabetes, cardiovascular diseases, obesity,and many more. Getting in shape is no easy task, but it is a task one overweight person should undergo to stay healthy. Looking to lose weight soon :)

Tumor Seizure

A 24 year old female presenting with seizure was admitted to the ICU yesteday. She was diagnosed with anaplastic astrocytoma last 2008 and underwent craniectomy for removal of her tumor. She was doing ok from 2008 up to late last year, she even went into college and graduated from engineering. She started to feel some back pains late last year and was diagnosed to have lumbar spine metastasis and eventually underwent radiotherapy. Hours prior to admission she was noted to have upward rolling of eyeballs which prompted consult.

Astrocytomas are brain tumors coming from brain cells called astrocytes. They could occur in any part of the brain but most commonly occurring in the cerebrum. They could occur in any age group but the said tumor is more prevalent among adults particularly the middle-aged group. Symptoms include headaches, double or blurred vision, vomiting, changes in mental status, seizure episodes, and difficulty in speech. Main treatment options include surgery, radiotherapy, and chemotherapy. For our patient, she initially underwent cranial surgery, unfortunately for her there was note of seeding of the primary tumor in her lumbar spine which is currently being treated with radiotherapy. Patient is currently maintained on anti-seizure medications and hopefully improvement will come in the coming days.

Your Common Diarrhea

A couple of months back, I was assigned to report on a common topic which is diarrhea. I was informed by my infectious disease consultant to find common and some rare causes of diarrhea. So I did some research for my report about the common disease diarrhea.

Diarrhea is defined as passage of stools of >200g/d and is categorized to acute, persistent and chronic. Diarrhea affects million of people around the world annually and is a major cause of mortality worldwide. I dealt with the infectious causes of diarrhea which are usually common among acute diarrhea. Chronic diarrhea have a wide range of causes aside from infectious causes. Viruses like your rotavirus and adenovirus, bacterias like your campylobacter and salmonella, Protozoans like your amoeba and giardia are just some of infectious causes of your common diarrhea.

The corner stone of treatment for diarrhea is still fluid replacement. Fluid replacement with water plus your oral hydration salts are indicated on patients with diarrhea. Antibiotics to cover for your common bacterial and protozoal causes are given if they are indicated. Antimotility agents could also be given in adjunct to your oral hyrdration and antibiotics.

Diarrhea might not be an easy disease after all.

Will Try to Blog Again

Its been months since I have last posted on this blog, been quite busy with hospital staffs and some year end festivities. For this year, I'll be assigned to the ICU area and will find time to do some blogging. Hopefully I could do entries everyday for my blog. Looking forward to a bright blogging year for me.