medical ramblings

stray scribbles ~ obgyn: postpartum hemorrhage

2006-10-28T20:40:00.000+10:00

definitions

postpartum hemorrhage (PPH): blood loss of >500ml blood after a vaginal delivery or >1000ml after a C/S or >1500ml after a repeat C/S
primary (early) pph: pph occuring within the first 24 hours after delivery
secondary (late) pph: pph occuring between 24 hours and 6 weeks after delivery

causes - the 4 Ts

Tone - uterine atony
Trauma - vaginal/cervical/perineal tears
Tissue - retained placental tissue
Thrombin - coagulopathies

it's an obstetric emergency!!!

what to do

uterine fundal massage
call for help at the same time
get someone else to continue fundal massage or to get patient obs/vitals/amt blood loss and insert 2 large bore IV cannulae - send off bloods for group and crossmatch, FBC, platelets, coagulation studies and run IV fluids + syntocinon
if bleeding still persist, give IM ergometrine or IM syntocinon
check for obvious causes of bleeding such as tears, retained placental tissues (check placenta for completeness)
if bleeding still persists or cause of bleeding found, take to OT and repair/explore under anesthesia
if bleeding persists, give direct injection of PGF2-alpha to uterus
if bleeding persists, opt for surgical management - ligation of uterine arteries, hypogastric arteries or hysterectomy at worst case

light lectures ~ ethics: abortion

2005-11-09T14:47:00.000+11:00

just had an ethics class on "termination of pregnancy" yesterday and this is me jotting down things discussed during the class. some views may offend various people in various ways and in no way does the following represent my personal beliefs towards this controversial topic. there's way too much controversy embroiling it already and each side has valid and logical arguements so i'll be the runner that i tend to be and remove myself from the debate. should i encounter a patient in the future who is thinking of abortion, well i've already thought of that too. gonna have a sign on my practice office telling people this service is not offered on these premises and they should seek another medical practitioner who is agreeable to offer assistance in terminating pregnancies.

anyway, these are "light lectures" meaning that they're just the gist of the class ~ it's more for my own sake to have notes somewhere than anything really.

abortion - defined as a termination of a pregnancy
various viewpoints

conservative point of view believes that the fetus is human and to deny it the right to live would be considered murder. they emphasize on the intrinsic value of life (ie natural/god-given investment in the development of a human being)

liberal viewpoint is often expressed as the woman's right to choose

christian & non-christians both believe that it is wrong to terminate a pregnancy after the point in which the soul is enslaved in the mass of cells, making those cells a human being. whether this occurs at the moment of conception or 4 months down the line is another issue, depending on the religion in question.

despite the standpoint, most people agree that abortion is a grave and serious moral decision that should not be made for trivial or flippant reasons. what constitutes as trivial or flippant is also another area of debate i suppose... most people also agree that should the mother's life be in danger, it is ok to "sacrifice" the life of the fetus to maintain maternal well-being

Fx of abortion include obviously death and miscarriage of the fetus. psychiatric sequelae for the mother is generally mild and not enough evidence supports this being a public health issue.
The role of health professionals in all this is prolly the most directly relevant aspect of the whole lecture for me. There are "conscience clauses" that allow health professionals to refuse to participate in procedures when they have a conscientious objection to the procedure involved or when they have a moral objection to the disease concerned. That being said, health professionals still have the obligation to assis the patient in understanding her decision and other options possible, even if it means referring to someone else if one disagrees. in not doing so, one denies the patient any degree of autonomy in this decision.. a nono!
Legally, ACT is the only state that has formally legalized abortion in australia. in NSW, legislation prohibits the "unlawful" administration of drugs or use of any other means to deliberately cause a woman to miscarry. because the legislation mentions "unlawful," one would think that there's a "lawful" way of doing things, no? there are circumstances where abortion may be "lawful" but this falls under the defence of "necessity" whereby two conditions must be met - that the termination of pregnancy must be necessary and that steps taken must be proportionate to the danger being avoided
The role of the potential father was brought up at the end of the discussion... oddly enough, or not.. the father has no right in preventing an abortion. poor chaps ~ a few have taken their cases to court to no avail =(
Facts and such

artificial termination of pregnancy is common here

women in their 20s account for most abortions performed here
1 out of 5 aussie teens will become pregnant between 15 - 19 years old and about half will have an abortion

'twas an interesting and heated ethics lecture, i must say. kudos to our brilliant lecturer for trying to mediate the whole discussion despite some very strong opinions expressed!

stray scribbles ~ opthalmology

2004-09-20T02:45:00.000+10:00

Well, guess i should start with the anatomy of the eye as an intro.

Parts of the Eye

Gross Anatomy
¤ Cornea - transparent, anterior tough outer coat of the eye
¤ Sclera - opaque, posterior part of the outer coat. site of extraocular mm attachments. optic nerve leaves through cribriform plate.
¤ Limbus - junction between the sclera and the cornea.
¤ Ciliary Body - contains smooth ciliary mm (contracts to change lens shape and enable focusing). provides attachment for the iris. epithelium secretes aqueous humor and maintains ocular pressure. only has parasympathethic innervation.
¤ Iris - comprises of a smooth dilator mm (sympathetic innervation) and a sphincter mm (parasympathetic innervation) thta is attached peripherally to the anterior portion of the ciliary body
¤ Lens - comprises of an outer collagenous capsule, supported by zonular fibres running between lens capsule and ciliary body
¤ Trabecular Meshwork - meshwork of trabecular cells and collagen beams lining the angle formed by the iris and cornea (iridocorneal angle) overlying Schlemm's Canal, which conducts aqueous humor from anterior chamber into venous system to permit drainage.
¤ Conjunctiva - reflection of the sclera onto the underside of the upper and lower eyelids. is separated by a connective tissue layer (Tenon's capsule) from the sclera.

» Note the visual axis and how light falls directly on the fovea, not the optic disc/nerve (which is located medially).

stray scribbles ~ epidemiology

2004-09-17T03:06:00.000+10:00

Epidemiology is often called the science of public health. It is described as the study of the distribution and determinants of disease risk in human populations. Epidemiologists study a diverse range of health conditions as well as the impact that various exposures have on the manifestation of disease.

© American College of Epidemiolgy

The Terminology

¤ Confidence Intervals
¤ Confounders
¤ Relative Risk
¤ Sample Size

Applications

Study Types 101
The most common types are as follows:

¤ Cohort Studies
¤ Case-Controlled Studies
¤ Meta-analysis

Reassuring Resources

¤ Basic Questions on Epidemiology

changes.. for the better or worse?

2004-09-16T04:22:00.000+10:00

stumbled onto this article a while back and thought i'd dig it out after letting the link sit in my bookmarks folder for such a long time. tho it's a bit outdated (it hails from 1998), it still makes an interesting read.

On the brink of the new millennium, we are beset by change -- social, technological, scientific, economic; the list continues. These changes have affected all areas of life, including medicine, and the medical schools have had to respond. The past year has also seen new Deans at eight of Australia's 10 medical schools. We spoke to these eight Deans and to their two longer-serving colleagues to find what has been happening in medical education, and their visions for the future.

Full article is @eMJA: Lawson et al, A sea change in Australian medical education

the trend seems to be moving towards graduate entries into med schools and well, i'm more in favor of the move only because it wouldn't affect me anyway. specialized courses targeted at people with degrees under their belts are technically at an advantage because the students would have had more life experiences in general compared to school leavers. providing places at the graduate entry level is a bonus to everyone else because it frees up spaces for undergraduate medical courses such as the newcastle course. the downside is that some people may find graduate med school a struggle without proper prerequisites because they didn't undergo pre-med school like their US counterparts...

which leads me to my age old rant about being "americanized"... i have no clue what some of the reasons for this change of entry trends may be for australian med schools but i end up with the dejavu of the singapore education system to a lesser degree. just because an idea seems great doesn't mean that 1) it'll work in your country and 2) it'll work if you try to "customize" it by adopting only snippets

don't get me wrong.. i'm glad the system is changing, i'm glad that the deans are out to seek improvement. 'twas a small gripe that had popped into my head as the thoughts went streaming past. altho changes are good, i wish they'd (ie. the faculty here) would at least plan 2 steps ahead before implementing new cirriculums etc so we wouldn't end up with 5 different assignments due the same week or end up with 5 hour breaks due to miscommunication between the 6th floor peeps and the lecturers... or have the faculty forget we exist like what happened to the 4th years and their pediatric exams this year.. faculty forgot and had to email the papers to gosford. they got them printed out and ready with 5 minutes to go before the exams officially started. d'oh!

drumroll

2004-09-16T02:25:00.000+10:00

well, one email was all it took to convince me to ditch xanga...and i was so determined just a few hours ago to dedicate xanga to med ramblings and blogger to everything else!

so here i am, setting this site up before i type anymore on xanga ~
for memories' sake... or until xanga decides to delete the blog, here's the old one