FROM Medical tribune www.medicaltribune.net:Binge drinking risks CV health
In brief,the cardiovascular benefits of moderate alcohol consumption do not apply to young people. In fact, binge drinking may put them especially at risk for developing atherosclerosis.
In a 15 year follow-up of >3,000 young drinkers, U.S researcgers found a direct dise response between alcohol concumption and coronary calcification. The prevalence of atherosclerosis increased significantly in ppl who drank >14/drinks per week. [Am. J. Epidemiolo 2005;161:423-22].
In the elderly,moderate alcohol consumption of 1 unit-2 units confers slight protection against CV disease.
Thursday, August 10, 2006
Wednesday, June 14, 2006
Another Night in the ER.
It was a pretty good night last night.Busy till the mornng but doable. I was team leader again (3 nights in a row!). I think the first night was the worst. However,instead of >200 people a day,our statistics have shown that only about 120 ppl come a day.A marked reduction since the world cup started. Hmm, that means a lot of cases that don't really need to be seen are seen!
Last night itself,within the 10 hours;there were nearly 50 patients in the cubicles (NON ACUTE,and i mean NON ACUTE). A lot came after 10p.m. In the ER,it was okay. However,in the Resuscitation room it was full!. A lot of people come really late at night. When i arrived at 9,the cubicles were empty. Then,at 920,just as the ER was filling up;there were 10 files in the cubicles!. A lot of it were cases that could have been seen in a GP clinic. Not even 15 minutes later,there were 16 files. I sent three doctors to cover it and had to cover the ER and Resusc.
None were urgent enough to be seen immediately. Most cases would not even be seen at a GP clinic in canada. It was complaints like fever for 1 day with obvious causes like coughs and colds. I've been in worse shape and still out and about.
Some silly parents had not even given their children fever medication (which they had at home) and had not sponged nor bathed their child nor pushed fluids. I say silly because in the time they wasted to come,with high temperatues,their children could have fitted if predisposed. A general IQ level before procreation?. There's a distinct lack of sense.
What to do when your child has a fever?
1. a fever is a temperature more than 37-37.5 degrees centigrade.
2. paracetamol is adequate. Please don't be silly and ask for "more power medicine lah". Aspirin is not recommended at all.
3.It will go it's course. It will not go away just after one day. Don't be silly. Don't start saying "doktor bodoh" just because the fever doesn't resolve after one day. Who's bodoh lah?. Have you bothered even reading up?. Do you think there's a magic pill for everything?.
4. Tepid sponging is the best way to cool a child down. Take room temperature water(from the tap),soak a hand towel in it,wipe it all over especially the head,abdomen,armpits and groin. Yes,it's uncomfortable. It does the job and works even better if someone else fans the poor child too. I've done this since i was 9 for all my siblings and cousins. When i was sick,this was done to me. Please don't be stupid. If you care for your child,just do it. Don't show your concern by being abusive to staff who are trying to help you. One lady had time to make up a graph to chart her child's temperature and subsequent fitting.What she didn't chart is that SHE DID NOT DO ANYTHING IN HER OWN POWER to decrease the temperature.What she did do was YELL at my staff nurses. In the pediatric ward,no one wanted to go near her or the child except the consultant who had to. This lady is a typical Malaysian lady who is abusive but incompetent. My nurses had their hands full and had tried to teach her how to do the sponging but she refused.Insisted on Voltaren suppositories.
5.Please do not bundle up the poor kid .How's the heat going to dissipate?.
6.Encourage the child to sip,sip,sip. Of course no one wants to eat or drink.Even adults are like that. However,the body requires more water when there's a fever. Chldren get dehydrated easily as their bodies are composed of more water.
7.A child is adequately hydrated when they pee often,the pee is yellowish or clear (not concentrated), they have tears, their mouth and tongue is moist.
8. If the child has persistent temperature >38.5 despite all these measures,go to a GP first!. Some infections like tonsillitis have very high grade fevers. Most viral fevers are high grade reaching 40 degrees. The key is hydration,cooling down,rest and meds at the right time.
9.if your child vomits everything out or has decreased urine frequency or the pampers are not soaked as usual,come to the ER. please don't overexaggerate,i had one mum last night say her son vomited everything out the whole day. he did look dry and lethargic and since he could not keep anything down (ACCORDING TO THE MUM),we placed an IV cannula to replace the fluids lost. Only after 30 minutes,she said she had given me the wrong idea and he had only vomited once.This was after she spent the 30 minutes whingeing saying it was too painful,must we put this is in.... You daft woman!.DO NOT LIE!.
10.if your child has a heart condition,kidney problems,endocrine conditions,please come immediately.
I keep reading in the newspapers about when to seek the doctor. These articles in the Star's Health section are good because it is done by a group of peers. Some of the articles done by pharmacists are dodgy. In fact,i've had so many horror cases because of "i got the drug from the pharmacistlah,he say good one" that i'm surprised they don't get sued. PHARMACISTS ARE NOT DOCTORS. In Canada, Australia, UK,NZ they DO NOT HAVE THE POWER TO PRESCRIBE. Don't believe me?. Check it out.
It was a pretty good night last night.Busy till the mornng but doable. I was team leader again (3 nights in a row!). I think the first night was the worst. However,instead of >200 people a day,our statistics have shown that only about 120 ppl come a day.A marked reduction since the world cup started. Hmm, that means a lot of cases that don't really need to be seen are seen!
Last night itself,within the 10 hours;there were nearly 50 patients in the cubicles (NON ACUTE,and i mean NON ACUTE). A lot came after 10p.m. In the ER,it was okay. However,in the Resuscitation room it was full!. A lot of people come really late at night. When i arrived at 9,the cubicles were empty. Then,at 920,just as the ER was filling up;there were 10 files in the cubicles!. A lot of it were cases that could have been seen in a GP clinic. Not even 15 minutes later,there were 16 files. I sent three doctors to cover it and had to cover the ER and Resusc.
None were urgent enough to be seen immediately. Most cases would not even be seen at a GP clinic in canada. It was complaints like fever for 1 day with obvious causes like coughs and colds. I've been in worse shape and still out and about.
Some silly parents had not even given their children fever medication (which they had at home) and had not sponged nor bathed their child nor pushed fluids. I say silly because in the time they wasted to come,with high temperatues,their children could have fitted if predisposed. A general IQ level before procreation?. There's a distinct lack of sense.
What to do when your child has a fever?
1. a fever is a temperature more than 37-37.5 degrees centigrade.
2. paracetamol is adequate. Please don't be silly and ask for "more power medicine lah". Aspirin is not recommended at all.
3.It will go it's course. It will not go away just after one day. Don't be silly. Don't start saying "doktor bodoh" just because the fever doesn't resolve after one day. Who's bodoh lah?. Have you bothered even reading up?. Do you think there's a magic pill for everything?.
4. Tepid sponging is the best way to cool a child down. Take room temperature water(from the tap),soak a hand towel in it,wipe it all over especially the head,abdomen,armpits and groin. Yes,it's uncomfortable. It does the job and works even better if someone else fans the poor child too. I've done this since i was 9 for all my siblings and cousins. When i was sick,this was done to me. Please don't be stupid. If you care for your child,just do it. Don't show your concern by being abusive to staff who are trying to help you. One lady had time to make up a graph to chart her child's temperature and subsequent fitting.What she didn't chart is that SHE DID NOT DO ANYTHING IN HER OWN POWER to decrease the temperature.What she did do was YELL at my staff nurses. In the pediatric ward,no one wanted to go near her or the child except the consultant who had to. This lady is a typical Malaysian lady who is abusive but incompetent. My nurses had their hands full and had tried to teach her how to do the sponging but she refused.Insisted on Voltaren suppositories.
5.Please do not bundle up the poor kid .How's the heat going to dissipate?.
6.Encourage the child to sip,sip,sip. Of course no one wants to eat or drink.Even adults are like that. However,the body requires more water when there's a fever. Chldren get dehydrated easily as their bodies are composed of more water.
7.A child is adequately hydrated when they pee often,the pee is yellowish or clear (not concentrated), they have tears, their mouth and tongue is moist.
8. If the child has persistent temperature >38.5 despite all these measures,go to a GP first!. Some infections like tonsillitis have very high grade fevers. Most viral fevers are high grade reaching 40 degrees. The key is hydration,cooling down,rest and meds at the right time.
9.if your child vomits everything out or has decreased urine frequency or the pampers are not soaked as usual,come to the ER. please don't overexaggerate,i had one mum last night say her son vomited everything out the whole day. he did look dry and lethargic and since he could not keep anything down (ACCORDING TO THE MUM),we placed an IV cannula to replace the fluids lost. Only after 30 minutes,she said she had given me the wrong idea and he had only vomited once.This was after she spent the 30 minutes whingeing saying it was too painful,must we put this is in.... You daft woman!.DO NOT LIE!.
10.if your child has a heart condition,kidney problems,endocrine conditions,please come immediately.
I keep reading in the newspapers about when to seek the doctor. These articles in the Star's Health section are good because it is done by a group of peers. Some of the articles done by pharmacists are dodgy. In fact,i've had so many horror cases because of "i got the drug from the pharmacistlah,he say good one" that i'm surprised they don't get sued. PHARMACISTS ARE NOT DOCTORS. In Canada, Australia, UK,NZ they DO NOT HAVE THE POWER TO PRESCRIBE. Don't believe me?. Check it out.
Emergency?.What emergency?
City folk are soft. KL people in general are silly when it comes to their health. They'll jump on any bandwagon,buy any supplement, cuss out doctors yet not really take measures to prevent illnesses. Nor do KL folk have any sense regarding what is an emergency or not. Last year, Dr Chua Soi Lek released a statement regarding abuse of the ER by the public. Yeah,he's right. Cases that should not be seen at all in hospital (in any developed country) will insist and persist in showing up to emergency. These people are the worst. They are relatively healthy, a lot very cheapskate, silly and abusive towards emergency staff. They show no respect or courtesy at all from the moment they come in.Yet,they play the victim. Look,let's go over the triage system.
Triage basically a french that means to sort out. During the Napoleonic wars (most innovative techniques were developed on the battlefront), surgeons had to quickly suss out who would benefit most from intervention. If someone was dead or injuries too grievious they were tagged black and left. People with broken limbs an breathing and talking would benefit most and tagged urgent. People who coud walk,stand,shout..well they could hold off and get themselves to treatment tents.
How it translates NOW:
triage 1: you re a goner if we don't resuscitate you NOW
triage 2: you have a potentially lethal condition.May progress to triage 1.
triage 3: no life-threatening presentation of illness.sometimes a 3 may be changed to a 2. Illness is dynamic. If you sicken,of course will change the level of your priority.
triage 4:as my specialist say...they can m*****. normal vitals,waiting time here and oz is 4-6 hours. Don't bitch,don't shout,you actually should not be seen at all in the ER.
In the Emergency,anyone who's seen by the MEDICAL ASSISTANT-who's a paramedic is assessed at the door. For some reason, just because the majority are male,the public assumes they are doctors. They are not. They have specific skills and are trained to recognise danger signs. ANY danger signs noted, these patients are pushed into the ER. At a red box,the team immeditely sees the patient. Notes whether or not this person is an impending collapse (TRIAGE 1/Resusc) or may have a life-threatening event: heart attacks, strokes, irregular heart beats, diabetic complications, asthma attacks, trauma.
However, a lot of people get very tetchy and yell if you ask very important questions. I have never,ever had anyone in Canada or Turkey or Nepal,shout at me because i was trying to do my job i.e save their lives. Malaysian people are extremely rude. Surprisingly,they are taken aback if you are stern with them. In fact,i polled all my colleagues. Most of us were trained in Australia, Ireland and the U.K. We bothered coming back because our families are here. However, we are all shocked at how poorly the Malaysian governmentand public treats the medical community. Why the brain drain?. Because neither the government nor the public respects our profession. Trust me,i have offers from the private sector here and other countries too. I stay because i really like emergency medicine and because my family needs me. Whenever i want to leave,someone will sicken from worry. This is blackmail.
I think the best thing to do now,in this platform; is to highlight what makes this job interesting. What's fascinating. What we could also do without?. If your doctor asks you,"what is the problem tonight?"; just bloody answer. PLease don't say "i have file here ahh,you just look lah". Look,this is Malaysia. The records people can't be bothered to even answer their bloody pagers to retrieve your file from the records office. At 2 bloody a.m. Plus,if you are not responsibe enough to know your medical problems and your medications,what does that say about your attitude to your health?.
A worrying trend is the tendency for a certain group of people to use the hospital as a dumping ground. Elderly parent,child with chronic problems,mental problems...get dumped in hospital. Yes,ALL ethnic groups do this although we see a certain group do it very frequently. There's elderly neglect going on in Malaysia and it stinks.
The worst thing about being exposed to The Ugly Malaysian is that a lot us eventually get fed-up and return to the countries where we are trained. It's not even the pay. It's the respect, quality of life and the chance to bring up your children in a more civilized society. Say what you will about social breakdown. from what we've seen and experienced,things are definitely better for our profession abroad.
City folk are soft. KL people in general are silly when it comes to their health. They'll jump on any bandwagon,buy any supplement, cuss out doctors yet not really take measures to prevent illnesses. Nor do KL folk have any sense regarding what is an emergency or not. Last year, Dr Chua Soi Lek released a statement regarding abuse of the ER by the public. Yeah,he's right. Cases that should not be seen at all in hospital (in any developed country) will insist and persist in showing up to emergency. These people are the worst. They are relatively healthy, a lot very cheapskate, silly and abusive towards emergency staff. They show no respect or courtesy at all from the moment they come in.Yet,they play the victim. Look,let's go over the triage system.
Triage basically a french that means to sort out. During the Napoleonic wars (most innovative techniques were developed on the battlefront), surgeons had to quickly suss out who would benefit most from intervention. If someone was dead or injuries too grievious they were tagged black and left. People with broken limbs an breathing and talking would benefit most and tagged urgent. People who coud walk,stand,shout..well they could hold off and get themselves to treatment tents.
How it translates NOW:
triage 1: you re a goner if we don't resuscitate you NOW
triage 2: you have a potentially lethal condition.May progress to triage 1.
triage 3: no life-threatening presentation of illness.sometimes a 3 may be changed to a 2. Illness is dynamic. If you sicken,of course will change the level of your priority.
triage 4:as my specialist say...they can m*****. normal vitals,waiting time here and oz is 4-6 hours. Don't bitch,don't shout,you actually should not be seen at all in the ER.
In the Emergency,anyone who's seen by the MEDICAL ASSISTANT-who's a paramedic is assessed at the door. For some reason, just because the majority are male,the public assumes they are doctors. They are not. They have specific skills and are trained to recognise danger signs. ANY danger signs noted, these patients are pushed into the ER. At a red box,the team immeditely sees the patient. Notes whether or not this person is an impending collapse (TRIAGE 1/Resusc) or may have a life-threatening event: heart attacks, strokes, irregular heart beats, diabetic complications, asthma attacks, trauma.
However, a lot of people get very tetchy and yell if you ask very important questions. I have never,ever had anyone in Canada or Turkey or Nepal,shout at me because i was trying to do my job i.e save their lives. Malaysian people are extremely rude. Surprisingly,they are taken aback if you are stern with them. In fact,i polled all my colleagues. Most of us were trained in Australia, Ireland and the U.K. We bothered coming back because our families are here. However, we are all shocked at how poorly the Malaysian governmentand public treats the medical community. Why the brain drain?. Because neither the government nor the public respects our profession. Trust me,i have offers from the private sector here and other countries too. I stay because i really like emergency medicine and because my family needs me. Whenever i want to leave,someone will sicken from worry. This is blackmail.
I think the best thing to do now,in this platform; is to highlight what makes this job interesting. What's fascinating. What we could also do without?. If your doctor asks you,"what is the problem tonight?"; just bloody answer. PLease don't say "i have file here ahh,you just look lah". Look,this is Malaysia. The records people can't be bothered to even answer their bloody pagers to retrieve your file from the records office. At 2 bloody a.m. Plus,if you are not responsibe enough to know your medical problems and your medications,what does that say about your attitude to your health?.
A worrying trend is the tendency for a certain group of people to use the hospital as a dumping ground. Elderly parent,child with chronic problems,mental problems...get dumped in hospital. Yes,ALL ethnic groups do this although we see a certain group do it very frequently. There's elderly neglect going on in Malaysia and it stinks.
The worst thing about being exposed to The Ugly Malaysian is that a lot us eventually get fed-up and return to the countries where we are trained. It's not even the pay. It's the respect, quality of life and the chance to bring up your children in a more civilized society. Say what you will about social breakdown. from what we've seen and experienced,things are definitely better for our profession abroad.
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