ACCIDENT AND EMERGENCY NURSING 2008

January 2012

2012-01-29T08:39:00.001+08:00

Almost a month since we entered 2012. I have been busy (as usual), focusing on work and other things in mind. I posted some pics of what I've been doing on the first month of 2012....

Short trip....1.1.2012

Gorgeous roasted duck...

Staff BBQ at Serasa Beach 23rd January 2012

Abuse Case

2012-01-04T02:06:00.000+08:00

http://www.borneobulletin.com.bn/sunday/news/jan1h11.htm

Adapted from Sunday Borneo Bulletin 1st January, 2012

The above incident occurred on December 15th, 2011. A 2 year old female child was abused by guardian and was witnessed by her mother presence. The abuser - mother's boyfriend, allegedly hitting the victim which causes her to worsen over time as these 'parent' did not know that she is bleeding to death from the intestines.

It was stated that the victim died from Septicaemia - infection in the blood. This was caused by the guardian repeatedly hitting the victim's stomach which then causes internal injury within the intestine.

In cases where assumed Non Accidental Injury (NAI), hospital or clinic are required to report these cases to be managed further by medical professionals.

Banned Health Product

2011-12-30T01:27:00.001+08:00

Banned health product - "Curvy" contains Sibutramine.

Ref: Borneo Bullettin - December 29th, 2011 - Thursday.

http://www.borneobulletin.com.bn/thu/dec29h10.htm

This was just released by Ministry Of Health announcing the dangers of consuming the above product.

"Sibutramine is an appetite suppressant that causes high blood pressure, irregular heartbeat and sleeping disorders through prolonged use, and it is prohibited in human food or ingredients under the Public Health (Food) Regulations (R1 of Chapter 182)."

This reminds me of one of the famous "Bangkok Pill" which was once sold in the market. From various statements, some people claimed that it had once caused the person to become somewhat "crazy"(sorry for my use of the term).

Aside from Sibutramine (appetite suppressant), other drugs such as; Dexamethasone (steroid) are commonly used in the ingredients. For most people, they wouldn't know whether such medicine is safe or not. In most businesses, these drug were used to achieved the fast effect, ignoring the side effect present when consumed especially in the long term.

The editor/blogger....

2011-12-24T01:49:00.002+08:00

Hello everyone!

I would like to give some input about this blog. On the title of this blog was named "accident and emergency nursing 2008". It was created in 2008 as for my A&E Nursing Course back in 2008 - hence the name. As for now, i have been working in Out-Patient Department here in Brunei Darussalam. Living the life of an Emergency Nurse has been my dream but in some cases, you never got that dream. Although i have worked before in A&E in my early years. However, referring to my clinical duties in Community Clinic, somehow, we do need our knowledge on how to handle certain emergency cases. If other country might not see this or may consider it irrelevant, back to where i work, we do receive cases that we can categorize as semi-urgent and urgent - not all cases in Community Clinic appears to be 'cold cases' or follow-ups.

I once thought that nurses in community has lessen their nursing practice due to their working environment - but i was wrong. And i can't deny that it is obvious that not all of them have the experience on handling emergency case. And yes we did our rotation when we were a student. But that does not mean we are considered a pro.

Indeed some practices practiced in hospital setting/ emergency department are still needed even when you are put to work in a community setting in Brunei.These includes, to name a few - cannulation, nasogastric insertion, suturing and urinary catheterization. Emergency cases doesn't come all the time but when they do, you have be get all the necessities on hand.

As of now, nursing practice has change drastically when year after year of practice, those who are familiar with emergency procedures are put in the front line - this includes myself. One of the duties of a nurse is to teach. This gives me the responsibility to teach my colleagues on certain things in order to familiarize when such situation arises.

Okay! I think i have said enough. I don't want to get philosophical at the end.

Another Freak Accident After Just One Day Apart.....

2011-12-22T00:20:00.000+08:00

Adapted from Borneo Bulletin dated December 21st, 2011 - Wednesday

http://www.borneobulletin.com.bn/wed/dec21h1.htm

By Hakim Hayat, Siti Hajar & Dean Kassim

ABOVE & BELOW: Tourists from Brunei Darussalam are seen near the wreckage of their bus after it hit a tree in Tuaran, Sabah. BERNAMA	This photo taken at around 2.30am this morning (Wednesday) shows a tearful reunion between a mother and a daughter upon learning that they both survived the tragedy. - YAZID ANUAR

A holiday outing turned tragic yesterday afternoon when a Brunei-registered bus travelling from Tawau towards Kota Kinabalu, carrying 31 Bruneian passengers, crashed into a tree and split into two, claiming the lives of six people and critically injuring several others.

According to Malaysian news agency Bernama, it was also believed that there were children, but their number and their ages had yet to be determined at press time.

Tuaran Police Chief Department Superintendant Zaharuddin Rasip confirmed to the Borneo Bulletin in a telephone interview that the accident happened at around 3.05pm yesterday, when the bus lost control at Kilometre 8.9, Jalan Tamparuli in Ranau.

According to him, the bus overturned twice, grazed a tourist bus on the opposite lane and slammed into a tree 30 metres away before splitting into two on a downhill stretch nearby. The force of the impact was so great that the roof of the bus was ripped open, Zaharuddin Rasip added.

He informed the Bulletin that the total number of people on board the bus at the time of the incident was 33, including an Indian driver and an assistant driver.

It is understood that two of the passengers died at the scene, while one of the victims died en route to the Tuaran Hospital. Another three people, meanwhile, succumbed to serious injuries while receiving treatment.

Tuaran Police Department late last night released the names of the deceased - Abdul Manan Ishak, 50; Pengiran Hjh Zohra Pengiran Zainal, 61; Dayang Norhayati Abdul Hadi, 61; Faridah binti Haji Husni, 60; Hjh Azizah bte Hj Jamaludin, 57; and, Haji Sapawi, 60.

At press time, Zaharuddin Rasip confirmed that another six people were critically wounded, 12 were in semi-critical condition and nine others sustained minor injuries.

According to him, half of the victims were transported to Queen Elizabeth Hospital in Kota Kinabalu to receive further treatment due to limited space at Tuaran Hospital.

In a telephone interview with a spokesperson for Tuaran Hospital's Emergency Department late last night, it was disclosed that the bodies of four victims were at the hospital. The rest of the injured were, meanwhile, being treated at Queen Elizabeth Hospital.

When contacted by the Bulletin, a staff at Queen Elizabeth Hospital confirmed that a number of Bruneians were receiving immediate medical attention at the Emergency Unit. No further details were disclosed.

A Royal Brunei Police Force (RBPF) spokesperson, at press time, confirmed that the death toll stood at six (four men and two women).

According to the police, Syarikat Pengangkutan Daba, a tour operator with an office in Kg Tungku in Gadong, was the tour operator in charge of the travel package.

Zaharuddin Rasip told the Bulletin that the bus was owned by Sunshine Borneo Tourism & Travel.

A representative of Syarikat Pengangkutan Daba said that the tour operator's office had been receiving calls from relatives of the victims all day. It was disclosed that officials from the company were making their way to Kota Kinabalu to assess the situation and to make further arrangements.

He revealed that the 31 Bruneians were travelling on a group package on the bus bearing registration number KJ3067. The group was led by Haji Tarsad.

The Bulletin has also learnt that officials from the Brunei Consulate in Sabah were busy making arrangements at both hospitals in Sabah to provide any assistance to the victims.

A broadcast by Malaysian state television channel, TV1, last night aired an interview with an unidentified Bruneian passenger who survived the ordeal. Describing the moments before the crash, he claimed that passengers could smell burning rubber, which he believed came from the bus's engine 'belting'.

The bus was allegedly being driven at high speed at the sharp bend and the bus driver was allegedly attempting to overtake three other vehicles, he further claimed.

"Before we knew it, the bus lost control, overturned and hit the tree," he said.

As word of the accident spread via social networking sites and wire news agencies yesterday evening, worried relatives of the victims inundated the hotlines of several government agencies, as well as the Borneo Bulletin Hotline, to find out more about the condition of their loved ones.

It is understood that the group had arrived in Sabah last Friday, before travelling to Tawau, where they spent a night there. They were scheduled to spend another night in Kota Kinabalu before heading back to Brunei today (Wednesday).

Motor Vehicle Accident.. in 2011 from Local Papers

2011-12-20T23:29:00.005+08:00

Another 3 lives lost in horrific accident (From Borneo Bulletin dated Monday December 19th,2011)

By James Kon & Siti Hajar

The number of road fatalities has increased yet again following a tragic accident that took place an hour-and-a-half past midnight yesterday, claiming the lives of three people - two passengers of a saloon vehicle and a motorcyclist.

Less than 24 hours prior to this incident, a 20-year-old male succumbed to multiple injuries in another accident that occurred at 2.24am on Saturday.

According the Royal Brunei Police Force (RBPF), the deceased were passengers of a saloon car - a 19-year-old male youth and a 31-year-old woman - who were part of a group of four individuals travelling along a bridge within the vicinity of Ban 6 in Kampong Kilanas on their way to Jerudong from Limau Manis. It was during this commute that their vehicle veered off the road into oncoming traffic and struck a 33-year-old motorcyclist who was killed upon impact.

It is believed that the driver of the vehicle, who at press time was fighting for his life at RIPAS Hospital, was driving under the influence of alcohol, according to the police.

Shortly after, the vehicle slammed into a stationary vehicle at a junction. Fortunately, the driver of the vehicle parked at the junction escaped with only minor injuries.

The last nine days has seen the deaths of five individuals, three of whom were youths between the ages of 18 and 20, at three separate locations, including the Rimba and Hassanal Bolkiah highways. Between January and October 2011, of the 37 deaths recorded then, almost 50 per cent of them were youths between the ages of 18 and 28.

With the latest fatalities, Brunei's road deaths for 2011 has jumped to 45, making it the second highest number of road-related deaths in recent memory. In 2007, 56 people died as a result of road-related accidents.

In the Sunday Bulletin news report, "RBPF Calls On Driving Schools To Help Curb Road Accident", which was published yesterday, the RBPF reminded the public to be on alert when driving especially during heavy rain and to strictly obey the country's traffic acts and laws.

What was also highlighted by the RBPF was the need for driving schools to play a more in-depth role in educating its students of not just the standard modules that are taught but also to teach would-be drivers the importance of driving carefully, being courteous to other road users and be patient.

"It should be reminded that preserving road safety should not just be concentrated on related agencies, but it should also become a social responsibility of all road users," the RBPF had highlighted.

Human error has been marked as the main cause of road accidents, while driving during bad weather such as heavy rain has also been considered a major contributor to this growing problem.

Fines and imprisonment are typical penalties for road violators and these range from $1,000 to $20,000, and a jail term ranging from six months to three years, depending on the severity of the crimes committed.

According to the RBPF, those found guilty of causing death as a result of driving under Chapter 27 (1), Road Traffic Act (RTA) Paragraph 68 would be fined $20,000, jailed for seven years, and suspended from driving for a period of three years. Meanwhile, those found guilty of driving whilst intoxicated or under the influence of drugs would be fined $10,000, jailed for two years, and barred from driving for three years under Chapter 26 (1) of the RTA Paragraph 26.

Those found guilty of dangerous driving will be fined $10,000, jailed for two years and suspended from driving for three years under Chapter 28 (1) of the RTA Chapter 26, whereas those who are found guilty of reckless or inconsiderate driving would be fined $5,000 and jailed for a year under Chapter 29 (1) of the RTA Paragraph 68.

Those found guilty of using a mobile phone whilst driving could be slapped with a $1,000 fine and/or jailed for six months. Repeat offenders will be fined $2,000 and/or jailed for a year under Chapter 29A (1) of the RTA Paragraph 68.

Sutures

2011-12-18T15:36:00.002+08:00

Image taken by verbal permission from individual...

Image taken by verbal permission from individual..

Suturing requires expertise and experience which normally done by nurses in Brunei, if you can see these are samples of sutures (usually done with interrupted technique), are done by nurses in Brunei. Regular advice to individual resulted a free of infection, thus, cleanliness of the wound could be meet.

2011......

2011-12-15T01:02:00.002+08:00

it has been awhile i haven't post an issue or case or anything in this blog. Well, i am back!

Nursing practice has changed over the years.

For this matter, sooner or later, i will be making this as my blog. Due to inactiveness of the community i intended to change for the sake of keeping this blog alive..

Nursing Care for Seizures

2010-09-03T22:28:00.001+08:00

this is a link where i obtained the following article....

http://nursingpub.com/nursing-care-for-seizures

What is a seizure?

A seizure is an episode of abnormal electrical activity in the brain. A seizure, just like headache, is a symptom rather than a disease.

What is epilepsy?

Epilepsy is a diagnosis given when a person has two or more unprovoked seizures.

Difference between seizure and epilepsy:

All people with epilepsy have seizures but not all people with seizures have epilepsy. A seizure is a symptom of an underlying condition. Epilepsy is a clinical diagnosis assigned to a patient having more than two unprovoked seizures.

Types of Seizures:

There are two main categories of seizures: -

1. Generalized Seizures

a. Tonic Clonic Seizures (Grand mal)

b. Absence Seizures (Petit mal)

2. Partial Seizures.

a. Simple partial

b. Complex partial

Tonic Clonic Seizures (Grand mal)

Signs and symptoms:

1. Sudden loss of consciousness

2. Muscle rigidity and stiffening

3. Jerking movements

4. Shrill cry

5. Incontinence

6. Apnea (pt may turn blue)

7. Dilated Pupils

Absence seizures

Signs and symptoms

1. Sudden behavioral arrest

2. Staring

3. Unresponsiveness

4. Only last for 1-15 seconds

Simple partial seizures:

Signs and symptoms

1. No alteration or loss of consciousness

2. There could subjective symptoms reported by the patients in absence of objective signs (smell, sound, taste or visual perception)

3. Pt remains awake and aware, sometimes unable to communicate until the seizure is over

Complex Partial Seizures:

Signs and symptoms

1. Alteration of consciousness (Not complete loss of consciousness)

2. Automatisms: Simple repetitive uncontrollable actions performed during the seizure.

a. Lip smacking

b. Chewing

c. Picking at clothes, etc

3. Patient has no awareness of what they are doing

4. Patient cannot remember what happened

5. This is the most common seizure by those diagnosed with epilepsy.

Causes of seizures:

1. Trauma

2. Drug overdose

3. Alcohol or drug withdrawal

4. Non-compliance of anti-epileptic medications

5. Stroke

6. Febrile

7. Intracranial processes and increase in intracranial pressure. E.g. tumors. A seizure occurring in an adult without any obvious underlying cause like alcohol, etc should be evaluated for brain cancer.

8. Infections. E.g. Meningitis

9. Metabolic and electrolyte imbalance. E.g. Uremia and Hyponatremia

Nursing Responsibilities and Priorities During Seizures.

What Do I do?

1. Remain calm. This is your strength during any medical emergency. Make it an active process and tell your self: “I need to remain calm to help the situation and avoid causing errors, accidents or downright malpractice”.

2. Mark the seizure start time.

3. If a patient is standing, lay them to the ground and roll them to the side

4. If the patient is in bed, roll them to the side;

5. The patient can never swallow their tongue. Never place anything in patient mouth or try to open their mouth. This can compromise the airway or cause more harm to the patient.

6. Never hold the patient down or try to stop their movements. This can cause injury to the patient. Instead, protect the patient from hitting hard surfaces with soft puddings like pillows.

Priorities

ABC assessments

1. By rolling the patient to the sides, you may achieve a patent airway.

2. Administer 100% oxygen

3. Check oxygen saturation. It may be below 90 due to apnea. The patient may turn blue on the lips and fingers. Do not panic!

4. Patient will have oral secretions. Suction at bedside to keep the airway patent.

5. If help is available, establish an IV- line for possible IV medication administration if the seizure continues for a long time (Status epilepticus). You do not have to have a physician order to start an IV line in this case.

All about Tetanus......

2010-06-09T22:34:00.002+08:00

Reference - Department of Health (March, 2010), South Australia, Tetanus
http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=303&id=1659

Tetanus is a serious illness, which can be fatal. It is caused by the tetanus bacteria (germs) getting into a wound or cut and producing a toxin (poison) which affects the nervous system.

Spores of these bacteria are in the soil world wide. Few people in Australia get tetanus because of the protection given by immunisation but tetanus kills many hundreds of thousands of people world wide every year, many of them very young babies.

ALERT!
Deep cuts and bites are likely places for tetanus bacteria to grow but they can grow in a small clean wound. If a child or adult has an injury which cuts the skin, it is important to check as soon as possible whether the person is fully immunised against tetanus.

Who is at risk?

Any person who has NOT been immunised against tetanus is at risk.
In Australia, adults are affected by tetanus more often than children either because they have not been immunised or because the protection they originally had from immunisation has decreased as they have grown older. Approximately 10 adults per year are diagnosed with tetanus in Australia.
Newborn babies can get tetanus if the mother has not been immunised, often after unsterile treatment of the umbilical cord stump.

What you can do

Make sure that all family members are fully immunised and get a booster if a person has a deep or dirty wound.
A person with tetanus will need hospital treatment.
The person will be watched closely for any breathing problems and given medicine to control the spasms. The person will often need to be in hospital, in intensive care, for several months.

Protecting your family from tetanus

Immunisation works! In World War 2 all Australian Servicemen were immunised against tetanus and none developed tetanus (unlike previous wars).
Because tetanus germs can grow in even small wounds, the only protection is a full course of immunisation for all the family.
The first 3 doses (the "primary course") are given at 2, 4 and 6 months with the whooping cough (pertussis) and diphtheria vaccines.
Booster immunisations are needed to keep up immunity - boosters are recommended for children before they start school (4-5 years) then around 15 years of age. If the person has had a full course of immunisations, one extra booster around 50 years of age is recommended unless the person has had a booster dose in the previous 5 years.
Any adult who has not had 5 doses of the vaccine should have the vaccine at any age.
Adults born in other countries may not be fully immunised. They should be encouraged to be immunised. Adults as well as children need protection against tetanus.

Issues on HIV in Brunei (from Borneo Bullettin dated June 9th, 2010 Wednesday)

2010-06-09T22:20:00.004+08:00

HIV cases still a concern in Brunei

By Siti Hajar

Even though government bodies as well as private institutions have taken steps in promoting awareness against promiscuous activities, cases of HIV/AIDS are still being recorded, with high chances that other members of the general population may unknowingly get infected with the deadly disease.

Ever since the establishment of surveillance in 1986, 56 local cases have been recorded by the end of 2009 with an additional three cases this year.

"You're talking about human nature," said Dr Hajah Ramlah, Director-General of Health Services, when taking into consideration that the Sultanate highly values conservative practices.

"A big majority of the cases know that HIV/AIDS is the result of indulging in high-risk behaviour," she added.

"We can give so much information (on HIV/AIDS) but it is up to the individual to practise it."

A number of the cases have succumbed to the deadly virus and only 20 carriers of the virus are still being monitored and treated by the Ministry of Health.

Meanwhile, according to Dr Ahmad Fakhri, a medical officer under the Disease Control Division, the concentrated age range for HIV/AIDS is between 20 and 29 years. Some cases have also seen senior citizens as well as newborn babies who have contracted the virus from either or both parents during pregnancy.

"This is probably just the tip of the iceberg," he said referring to the number of cases and urged those who have placed themselves at risk to get tested. He also added that most cases are not aware that they were carriers of the disease until they were screened for HIV/AIDS or after they consulted a medical practitioner when they fell ill.

HIV, or 'Human Immunodeficiency Virus', infects cells of the human immune sys tem and destroys or impairs their function. Infections due the virus results in the progressive deterioration of the immune system, thus leading to 'Acquired Immunodeficiency Syndrome' or AIDS, leaving the individual more susceptible to a wide range of infections.

An estimated 33.4 million people worldwide were recorded living with the disease with an approximate two million deaths by the end of 2008.

Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial.

2009-08-30T13:34:00.002+08:00

BMJ (2008)

Alastair D Hay, consultant senior lecturer in primary health care,1 Ce´ire Costelloe, trial coordinator,1
Niamh M Redmond, trial coordinator,1 Alan A Montgomery, senior lecturer in primary care research,1
Margaret Fletcher, reader in children’s nursing,2 Sandra Hollinghurst, senior lecturer in health economics,1
Tim J Peters, professor of primary care health services research1

ABSTRACT
Objective To investigate whether paracetamol
(acetaminophen) plus ibuprofen are superior to either
drug alone for increasing time without fever and the relief
of fever associated discomfort in febrile children managed
at home.

Design Individually randomised, blinded, three arm trial.
Setting Primary care and households in England.
Participants Children aged between 6 months and 6 years
with axillary temperatures of at least 37.8°C and up to
41.0°C.

Intervention Advice on physical measures to reduce
temperature and the provision of, and advice to give,
paracetamol plus ibuprofen, paracetamol alone, or
ibuprofen alone.

Main outcome measures Primary outcomes were the time
without fever (<37.2°C) in the first four hours after the first
dose was given and the proportion of children reported as
being normal on the discomfort scale at 48 hours.
Secondary outcomes were time to first occurrence of
normal temperature (fever clearance), time without fever
over 24 hours, fever associated symptoms, and adverse
effects.

Results On an intention to treat basis, paracetamol plus
ibuprofen were superior to paracetamol for less time with
fever in the first four hours (adjusted difference
55 minutes, 95% confidence interval 33 to 77; P<0.001)
and may have been as good as ibuprofen (16 minutes, −7
to 39; P=0.2). For less time with fever over 24 hours,
paracetamol plus ibuprofen were superior to paracetamol
(4.4 hours, 2.4 to 6.3; P<0.001) and to ibuprofen (2.5
hours, 0.6 to 4.4; P=0.008). Combined therapy cleared
fever 23 minutes (2 to 45; P=0.025) faster than
paracetamol alone but no faster than ibuprofen alone
(−3 minutes, 18 to −24; P=0.8). No benefit was found for
discomfort or other symptoms, although power was low
for these outcomes. Adverse effects did not differ between
groups.

Conclusion Parents, nurses, pharmacists, and doctors
wanting to use medicines to supplement physical
measures to maximise the time that children spend
without fever should use ibuprofen first and consider the
relative benefits and risks of using paracetamol plus
ibuprofen over 24 hours.
Trial registration Current Controlled Trials
ISRCTN26362730.

Uploaded picss....

2009-02-25T23:07:00.003+08:00

hi guysss.....FYI...i have uploaded pics of our gathering on last 14th Feb 2009 at Aneka Rasa restaurant....i posted them in my facebook..which i guess most of u already know or by auto ..ur pic will appear in your own album...

am not posting it here as i have experienced slow connection of just uploading fews pics which i always had since my main connection does not fully covered from where am staying...

so ...those with facebook....enjoy ur pics...and one more..i just realized..i did not take more picss that time as am busy with singing and entertaining u guysss....

ok ...ciao...

Announcement on the 14th February 2009 Dinner

2009-01-26T14:46:00.005+08:00

To DAEN 2008.....how u people doing??? sure u guys ok ....with works and all....so we decided to have dinner gathering on the said date which will took place in ANEKA RASA (FIRST FLOOR) in Qlap ....Zalin n Seri are responsible for the booking... AS OF 29TH JANUARY 2009...ZALIN JUST CONFIRMED ME ON THE VENUE...WE SHOULD START AROUND SEVEN-ISH....AND COST PER HEAD WILL BE $15.00.....

THEME...all of us if possible should wear in "RED'' ...jgn lupa...theme baju merah!!!!!

to all great voices...bawa2 tah cd ato!!! luah kan tia suara.... FYI as usual ..Diva Nizam will be singing familiar tunes ...think u guys know what i mean...haha...which will follows...Zalin Damit..Liza Taylor...Seri Bungsu...all great singers tooo...

ook...lau ada news i will inform lagi ok... AND ITS ALL SET!!! DONT FORGET BRING YOUR FAVOURITE KARAOKE VCD....

December 2008...apa saja ku buat nie ...

2008-12-30T21:48:00.003+08:00

hi semua ...hows holiday? ok ...since holiday started eat, sleep, eat sleep, jalan2, jumpa kawan..and more...ok i had all the pic edited with the discovery of pic edit from adobe photoshop.... yeah sofy i know am new...baru me tejumpa ....comment please...

taken in tungku beach ..three models aka closest frends posing..

another shot...

this one was masa puasa ariatu but i edited to make it more lively....

hahhhh...this one was in Belait beach...its me frendzz..me in zombie effects...i wanted it bright but alum cuba kai darker effect....ok dats all....

Announcement !!

2008-12-13T16:20:00.002+08:00

People of DAEN 2008...nizam here to announce the closing of our account membership from www.highbeam.com which will be no longer active as due to date from 13th december 2008..please take note for those who are related......anyhow...the full access will still be accessible until 25th February 2009....

Thanx guys....and BTW...our blog will still remain active so feel free to put more infos....this blog will remain of our happiness, sadness, memoirs..together...although we will be no longer come in contact for sometimes from now on....

Enjoy holidays and see u guys in 2009!!

BBQ at Pantai Seri Kenangan November 23, 2008

2008-11-23T23:26:00.006+08:00

ok guys..the pics are not in coordination ..ngalih ku kan put in order so i just dump everything nie ah .... kami ada BBQ at the respective beach .....it was a lovely day... attendees were of course griller hafiz and his friend joe kah his name..shahrin and GF, jack and GF, halinah and her two kids, zalin, ida and hubby, raliza with hubby and son, sofy and shema...whos missing? hmm eddy, amal, seri and damit..(FYI damit came early she had to go for a function)....ok observe the pics...

two love birds (bet u know sapa nie dri belakang ah)

hmm..ketawa ku nie pic ah...wats wrong with this pic? anak c linah yg bini2 atu was brought along with the wave so badannya pun ikut sama...haha

delicioso...chixs bbd'ed by Hafiz....thanks for him to conquere the bbq...we just have fun n eat ...

haha...penghulu looking at the foods..mmmm kekanyangan ya nie sudah at this time..haha

pic from behind....

the same log i took with sofy....this is edited one i can feel the loneliness from this pic...just like me..

shema with her lappy...zalin busy makan non stop..kalau ku estimate i think she ate within one hour...stop and then continue...hmm so much food guysss

posing for a sausage...hmmm u think that's how sofy eats a sausage? by sucking it or....hehe

shema..earlier part checking mails from her lappy...

mmmm apa nie ah? sofy from side view....

childhood days....sofy u have long legs..impossible to slide that easily...

zalind second round....no its first round..she opened a can so its a starter of the event...

EXAM FEVER!!!!

2008-11-17T00:14:00.004+08:00

oowhhh.... most of us experiencing adaptation of fever, nausea, headache, constipation, abdominal cramps...u name it...all presented signs and symptoms of temporary state of nervousness on the coming exam....it sucks u dry ...well its three days ahead now...read, read and read....

X rayss...

2008-11-14T16:37:00.002+08:00

Skull #

Pelvic # (obviously u can see the detachment)

Case Scenario....

2008-11-14T16:14:00.002+08:00

A 25 years old guy - Matt, involved in a road traffic accident at about 10 am. He was driving alone. It happened that he collided with another car, but the other guy he got into the acccident was all fine. But not for Matt... on arrival of the paramedic at 10:20 am, on assessment, he was alert, respond to verbal stimuli but complain pain on the abdomen, head, neck area and right arm. There was a big laceration on the parietal area with profuse bleeding noted.

Blood pressure 90/50. Pulse 110, Respiration is 14/min Spo2 is 89% GCS scores was 10 by 15. .......

Hard cervical collar was applied with use of hard board with body strapping as for immobilization of the body. Full blast Oxygen given via mask delivered. Thick application of bandage was applied onto Matt's head as to stop bleeding. Initial IV access was started by administering Haemacele of 1000mls. Question asked to Matt and denies any previous medical or surgical history. So, he was very fine guy before the accident.

Arrived o AED about 10:30am....wat would be the next interventions??.....ABCD people....we are now in the secondary survey!!!

REVISION WEEKSS........

2008-11-11T00:49:00.003+08:00

hello people!!! post basic students of various specialties are now facing exam which will be held on the 20th and 22nd of this month of november 2008. there it goes.....revision, literature reviewsss...and stress all summoned up towards the end of these courses....arghhhhh stress, stress and stress. hey its non stop...however, AE students are still being posted in the AED in the respective area...so at this time of this week...either work or revision or both?! luckily...grateful to the AE staffs, hope u guys understand our situation these days....we are facing some serious matter here...its to determine whether we go through the course or the other way round...your choice people!!

just to help some of the important topic to be covered....one of our colleague found a very interesting site on the management of polytrauma here it is .....

1 . http://www.rcsed.ac.uk/eselect/cc11.htm (author Neil M. Nichol) very interesting site as to cover up the management of such case...if u guys go through "next module" u will find more managements of different cases.....so i think its very useful resources.....

2. Another web site i found pertaining to the course management..i obtained from the medical blog of RIPAS team click the (The Nightingale's Page)...they posted some links with interesting topics which might help in your revision....hey its +- 2 weeks from now..so u wont have the full time to start fresh i assumed!!!

3. Next is, as of polytrauma case hintsss........ ABCDE!!!!!

4. http://www.moh.gov.bn/satisticshealthguidelines/indicators.htm ..... or http://www.moh.gov.bn.... this link u guys to our Ministry of Health website if u need statistics of your favoured cases....the latest statistics was that of 2006. hmmm i heard there's already 2007 edition but as if you see in the website, it ended up to 2006 version only.....for this purpose..it helps u to answer some of your queries of the pertaining problem...banyak kah nda case anie di Brunei?...sumthing like that....

ok people...enjoy your revision...and discussion....

Rainy Monday, November 3rd 2008

2008-11-03T22:16:00.005+08:00

rain started since midday about 12 noon...quite heavily and stops awhile around 1:40 pm....it continues again sometime about 6pm...off and on...till around 9:30pm. AED in RIPAS was also busy in the afternoon..well..it's been busy all the time anyway.

encountered patients in resus area....cases such as Intra Cranial Haemorrhage (ICH) and Epilepsy...later i talk about these patients.... and even in medical wards both female and male alike were full out of empty beds to occupy the in coming patients....arghhh where else to put them?! up to the medical to decide....stress continues as these awaiting pts to be transferred to the respective wards...and thank God! paeds wards at least not a real much concern regarding admission.

back to the resus area...yess both patients (ICH and epilepsy) developed stages of fits somehow for either a minute or few minutes...cant really tell u guys how long exactly the episodes last...the ICH patient was confirmed through CT scan done and it was very obvious that u can see the depressed of certain part of the brain....hmmm i forgot which part sorry for that...given IV Diazepam 10 mg to settle his state of epilepsy....hmmmm..at this stage not sure if he is supposed to be put on IV steroids as to relieve or reduce ICPressure (ICP)...it is known steroid does this job....anyhow...maintaining O2 sat with delivery of O2 via mask has been continued till his admission around 4 pm plus.....(he came before 1:30pm)...due to unavailability of bed in the medical ward...

next epilepsy patient from some are (can't tell u where he's from exactly!) while in the AED, had developed several episodes of fits which lasted <1 minute...took sometime till seen by medical on-call to order IV diazepam 5mg....while CT scan, no meds given ..hmm am afraid somthing terrible will happen...fits patient with no meds send for CT scan? think about it..it will harm u and ur career as a nurse....this is where nurses role came to us....assure is it ok pt send for Ct scan without any meds prior to the procedure??? ....it was a tough decision coz if anything happen..the blame is on u(nurses), not others.... where is assurance, where is safety for us and for patient??

it seems that AED on Monday was actually like any other day busy as usual....per se, 'datanglah beramai-ramai bagi memeriahkan suasana di AED'. i know its not funny but it depends on u people to decide....AED nurses are used to endless work and duty in this dept.

interesting case also, one child came in with # radius (i think) it was a green stick #(?le or re?) ...MUA was done in the dept with assistance of another medical officer..well done guys...the infamous Ketamine came up as a sedative for this pt...Ketamine is well known drug as for children as a sedative....the MUA was done as soon as the child has 'fall asleep'...or not actually asleep...but mcm 'heng' sekajap....i wonder what actually this child experience?? is it pain but no voice or really 'heng' abis!? i look up in his eyes give him a smile..just to say hello to him and how he's worked out after admission of ketamine....yes he was totally unresponsive....i like to say goodbye sometime for pt under sedative...as for me is to make them comfort...banar kah tu?

anyhow..he got through an another x-ray was done to confirm the MUA was a success.... only three cases shown ....in fact there's more but i cant tell everything in detail....am not a camera surveillance btw...

the time is 10:45 pm and is still raining......wat a wonderful life..u think so?

Outing at Cikgu Zaleha's Saturday 1st November 2008

2008-11-02T03:27:00.003+08:00

saturday....2nd house of cikgu zaleha...another function...ermm this commemorate late raya celebration....however....i failed to produce group pic with cikgu zaleha..sorrrrryyy for that again..i think i was too busy with karaoke..hehe.. ermm....gengzzz yg lain mana??? eh nanti u all kalau ada function lagi mesti kamu attend ahhh....esp. function that involves our AE group 2008......so next one will be compulsory for all AE PBS.........

cikgu zaleha, with zalin and fatimah.... at the back was cikgu punya'anak buah'. sorry no name..

sofy and shema..busy playing games with zaleha's daughter and son...

sofy and shema...

cutey ...ida's son...eeee gigitan meliat!!

ermmm for me ..i interpret this pic mcm org be kelaie..nda betagur(kidding!!)..haha..ok..on ur left Dr. eddy and right Dr. Da

for this issue...not much pics were taken ...sorry again...so actually amongst those attendees not included here were..cikgu mai, cikgu jainah, cikgu sendi, matron hj julaini, cikgu rahim...sorry guys..we were too busy with singing and stuffs...nda lagi te ambil gambar...plus amoy, timah, raffee, hj salleh(AE tutong), iskandar and hj helmi (AE temburong)..also attended at zaleha's house......from AE post basic 2008...thanks alot for the treat...we appreciate it!!....

Eating Out at Cikgu Salmah's on Friday 31st October 2008

2008-11-02T02:34:00.005+08:00

hi guyss...this week was busy with invitations...so friday at salmah's house as to celebrate her daughter graduation plus raya celebration...btw...congrates for her daughter on her achievement. here were some of what we upto while at her place.... (sorry for cgu salmah, her pics turn out blur so i dont want to post the pic....)

wats so funny about this pic? hehe see how sofy reacts!! haha

me (posing for nothing)

group pics ..these guys are the only one who attended as for representing the AE group

some menu available..

sofy and seri...

haha..look how sofy and seri behaves...

hjh zalin and me(nizam)...

hahaha..love this pic..sofy looks so full..people! dont judge from outside of her slim figure!!

seri and her hubby....

Thursday, October 30th, 2008..College of Nursing...

2008-10-30T12:48:00.003+08:00

Guysss..ok just to update our event for the date stated above....morning around 9.30am, Critical Care Nursing held a Raya Open Class, venued in their classroom...lovely chocolate cake....compliments to Fahmy's wife...then after around 12 noon....Operating Theatre Nursing group also held a Raya Open Class venued in the first floor of the College's Library....

So wats with the study event for thursday?

Ck. Zaleha went in around 8 plus am. Gave a briefing on both papers for the exam (1 and 2). so guys wat u have in mind for paper 1? (see previous post for reference wat we're talking about)

Paper 1...from observation process...i see that most of us would have done PBL issue.....u know what to do already is just in the matter of reading and reviewing them.

Paper 2....80% will do Shock and its management process and pathophysiology and so on...only 2 stated for cardiac emergencies...(me and raliza)....this reflects on the ACLS......

so cana? ......hope we get through this exam....btw.....rumoursssss about who going to KL...latest was only 12 post basic student from various specialty would go....so ck.zaleha informed us there were 'some' who will go....huh...i know i dont! we...am looking forward to work in other hospital on the 2 weeks of december!!! yeayyyyyy.......

ok guysss dats all for now...will post another one.....byeee

EXAM FEVER!!!!

2008-10-29T00:47:00.002+08:00

hi guysss....now raya is almost over...the last will be the big exam which will be held at the end ov November. then after will be the International Nursing Conference which will takes place in The Mall, Gadong.

ok guys just to review back our exam papers titles; (only answer one for each paper)

Paper 1 - three sets of questions will be ask.
1. PBL a.k.a problem based learning. right now i think u guys know what it is....so query topics will be multiple trauma cases..(apply GCS, Head injury, AVPU, Primary and Secondary assessments).

2. Reflective Practice in AED. based on our experience whether good or bad

3. Ethics. ethical issues (sudden death, bereavement, medication errors......endless)

Paper 2 - also three sets questions will be ask...
1. Cardiac emergencies (ACLS people!!!!)

2. Geriatric emergencies (common cases e.g. fall copd, fractures......) and its management and all

3. Shock!! (wat common type of shock presents in AED?) include its pathophysiology of shock need to be reviewed....

ok people!!! its time to review ou studies and findingssssss..................

26TH October, 2008....Celebration of Raya and Teacher's day by the College of Nursing, PAPRSB....

2008-10-26T21:31:00.005+08:00

ok guysss.....raya celeration from the CON, PAPRSB. so this also brings us to celebrate teacher's day as well..so 2 in 1 nie ah...it takes place in manggis mall on the 4th floor so from AE group whos attending?? the two faces belowwww....

zalin and nizam attending the raya brought by CON...

with cikgu zaleha (and children) and cikgu sendi(the back)...

the two emcees....fahmi and cikgu fatimah arni with her daughter...

jemputan....

nice cake!! for remembering teacher's day....

sorry guysss....nda banyak pics ku upload sini....but if u wana see more nanti ku liat kan..ok

EPs' submssion on Saturday 25th October, 2008....

2008-10-26T20:53:00.004+08:00

it was a very gloomy saturday.....it was the day that post basic students have to submit their EPs' for the year 2008.....lots of fear...uncertainty....last minute changes.....sleepless nights...and more....this was experienced by some of student, that includes me.......see and witness the pics taken below...

discussion? or last minute changes???

a very happy face...finish early..hehe

mmmm wat metz? final check....damets here with ck. hjh salmah...she brought her printer too...

final check before signature of 'declaration' by ck. hjh zaleha...6 of us in all under her...amal was being penalize before submission her EP

four copies of our EPs' sofy, amal, jack and me...the EP has caused alot of distress for this year...hehe

presenting EPs' sofy(again), linah, seri, zalin and shahrin(from ur left to right)

me (nizam) being checked and yes indeed i feel nervous.....damn

next will be WRITTEN EXAM!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

EXTENDED PROJECT DUE ON 25TH OCTOBER 2008.....

2008-10-25T02:42:00.002+08:00

hi people.....its been quite sometimes since the last post on october 13th, 2008.....this is due to finishing our project....so-called thesis or assignment..

all of us were busy with the laptops...damn i dont get to pic them....but i'll try to post some pics on the day we submit the thesis...which is today!!!!!

so, we have to prepare 4 sets of the thesis. simple and clean...which consists of black binder on the side and transparent no colour covers....

hmmmmm.....we did encounter problemsss on finishing the project. only God knows what it takes...although some of u guys don't think its a big deal but hey...this project determine our passing...the breakthrough and the answer to the course....

so...we feel that it would be the last for everything for this group (this is my feeling).....the worst was when i typed the acknowledgement part in the project....thanks for the AE group of 2008.....mmmmm i dont wana cry, i dont wana !!!!!

okay people....dats all for now...KIV for the pics....settling of our EP @ thesis @ assignment!!!!

Zzzz....!

2008-10-13T18:20:00.005+08:00

Nizam was sleeping, while waiting us doing PBL assignment!

Cukup dengan snoring nya lagi whohaha.....

Eh! bpindah gtu ya layah2 at the back of the Library Ripas...jauh layarnya kmana kah?

Raya Outing...College of Nursing Saturday (Oct, 11th 2008 started at 10 am) and Raya at Sofy's (Oct 12th, 2008 Sunday PM)

2008-10-13T03:07:00.007+08:00

Ok guys ...we decided to have raya at the college in our classroom ... we did managed and it was a success...love it!! we invited CCN and PAEDS groups as well...lovely morning. enjoy!!

Ah? Tecengang C ida ...apa ah?!

Spot the supermodel? hint; wearing the cara melayu....

Group shot along with the CCN group

AE guys...

AE ladies..

Again!! men of AE 2008

Trying to fit the college's logo..

Kanyang lapas makan....

hmmm...Seri wat are u trying to say here?

AE Post Basic 2008...memorabilia

Paed's nurses...

wahh..bebaris kamu ah...notice that all holding plates

This was on the next day (Sunday Oct, 12th) raya at sofy's house in K. Belait.. love her spaghetti sauce made by her brother... (p/s; searching the right light for group pic)

Along with Zalin's sister and Nurul. Penghulu brought along her hubby and her 2 kids.. (hmm wats wrong with the light?!!)

At last...this (for me) finally we found the right light..thanx Sofy..and psst nice house u got!

Raya Outing....on Friday 10th 2008 PM

2008-10-13T02:38:00.003+08:00

hey guys!!! okay first raya outing was on the stated date above...wow its nice to have raya with colleagues....first stop was at Ida's place.....came along was Shuriani brought by Zalin. Mind you these photos were not edited... i only posted the group photos not including Sofy putting the chocolate staining on her front teeth..haha...well dear u have to get your photo personally...next Raya outing in the college and at sofy's house will be up soon....

Ida's house with her husband and cute baby!!

Cute baby!!

Nizam holding Ida's baby...mmmm gigitan ku!!

At Damet's house in Kg. Keriam..

Sofy enjoying soto at Penghulu's house..complements on your taugeh salad!!

At Penghulu a.k.a Raliza...

SELAMAT HARI RAYA AIDIL FITRI......

2008-09-30T19:15:00.003+08:00

Sungkai on 25th September 2008 Thursday

2008-09-27T01:45:00.005+08:00

The sungkai was held as a closing for out last meeting for clinical attachment during the fasting month of Ramadhan....here it goes...

problem solving....hmmm

what happened in the morning? lecturesssss

busy woman!!

babu raja...got stuffed after big meal.....

lots of plate...yum yumm chomp chomp

zalin smiling...haha

sungkai!! eat shahrin, eat....hehe

with cikgu zaleha..

eat dametzz while u still can...

Pic testing...

2008-09-18T20:20:00.003+08:00

here is a production, well testing actually.. of using a subject on aperture mode...i honestly love this style of taking pictures as i love the blurry effect of the background thus making the main subject stands out....

1, 2, 3....learning slowly

My Pic Post.....edited

2008-09-15T23:35:00.006+08:00

beautiful me...yuck!! hahah

my outing with my outside friends in bukit shahbandar...posing time guysss.. (nizam is wearing shirt from Linea and Sony is wearing shirt brought by Calvin Klien, the other three are miscellaneous designers)

3 in 1 lectures for the day of Sept 13th 2008...

2008-09-15T23:06:00.003+08:00

OK guys .....last Saturday lectures...we encounter three lectures in all which covers ethics and clinical managements....all about paeds....

okay guysss....here is the promised summary for the lectures presented...

first day in the morning..lecture from the court council regarding law on children..the presentation was done by the staffs from the court council itself and basically ..

children for as long as they are a child...hm mm forgot the age group are protected under the law as not to do harm when we (nurses) are treating them. consent from parents should be obtained and their attendance during examination should be considered..

i think we already know this but we just don't know that there are laws that actually mentioned about children in Brunei....mm i know i don't!

About 10.30am...another lecture by Dr. Wilson Chong from the AED regarding Paed resuscitation...you should look;

1.Resp rate (more than 60/min is abnormal)
2.Spo2 (90% below is abnormal)
3.HR (85-190/min) for child below 2 years...and gets even less as they grow..
4.BP (mind the cuff!!, in AE the cuff mostly are for adults and u know adult cuff affect BP result in child!!)
5.Urine output (very common in children as they easily get UTIs...and other illnesses)

the BP measurement differs in children (payah kan xplain! hehe) ok for urine output.. 1.5m-2 ml/kg/hour for child infants and younger child.

older child and adolescent 1ml/kg/hour.

p/s resp arrest = cardiac arrest in children!

the 3rd lecture was presented by Dr.Suresh from the paed team....his lecture was very interesting but to consider its application in AE setting, it can be futile.

there u go guys....

Blood Donation on 16th Septemebr 2008 at 8pm in RIPAS Blood Bank

2008-09-15T22:59:00.003+08:00

People!!!! Ok blood donation Hari Selasa anie....8pm onwards in RIPAS...got the invitation from the medical unit team...so who's coming??? i wana donate!!!!

Case Queries??

2008-09-11T21:27:00.001+08:00

Okay guys simple one....wat u do??? ACLS!!!!!!!!!!!!!

Case Queries??

2008-09-09T21:04:00.003+08:00

What is abnormal in this ECG? Posted few days ago and someone answer, hyperkalemia...yes indeed it is. Noted esp. V1 V2 and V3 shows a high peak T wave which is not supposed to as the one is usu. the R wave...it is expected R wave to be in its highest at V1 to V3 and goes down by V4 to V6. So what are the possibilities of pt to have hyperkalemia? what drug to consider? what 'nurses' play our role here?

Reply - Sept 11th, 2008... ok the same person stated the Rx for this pt. Included Resonium 15 mg, 10 units of Humulin R in 50 cc of 50% Dextrose, 10% of Calcium Gluconate....put the pt on cardiac monitoring....as for Mx in AED, 2nd biochemist analysis not always initiated and usu. done when the pt is in medical ward. But hey, u did mentioned it and mostly its what has been done so far...well done!

hmmm....does these pt does not eat anything? so u just ask the pt to eat wateva he/she wants? not listed...diet on low potassium....tall peak T wave caused by high potassium...medical/nurses intervention will not improve if pt is 'babal' on his/her diet...u see..as people says..'you are what you eat'...i know its not easy to tell pts to restrict their diet but then ...i always remind meself...pt has every right and yes so does US (nurses)...they refuse us, let it be. Kejam kah tu? hehe ok sooner i would end this conversation...i would post another queries for this blog...

Obstetric - Cord Prolapse by Dr. Ohn Htwe

2008-09-09T18:58:00.004+08:00

Woahhh people why so many gynae and obstetric lecture nowadays ah? one lecture after another....anyway, this is very useful for ER nurses when encountering such case. Bare in mind, most obstetric case, labour, etc are only handle by female health care members. So, its a bit hard for male staffs to think about such management, but we watch videos and hope to witness such cases one day..(amin!)

What do you know about cord prolapse(CP)? so far i only know 'Rectal Prolapse'...prolapse suggest that the descending of wat eva into an opening, hence its name. In CP, the cord lead the way ahead of the baby (The Cleveland Clinic Foundation, 2008(2)) Effect, is upon the baby, he/she can get strangulated leading to death, asphyxiation and eventually death.

From our lecture, CP is when the cord descend through the cervix alongside (occult) or past the presenting part (overt) in the presence of rupture membrane(adapted 2008 new definition also from the US). For as long as u see the cord coming through the vagina during labour, always suspect CP.

CP occurs 0.1-0.6% in every birth, aproximately, it happens 1 in every 300 birth(The Cleveland Clinic Foundation, 2008). This also tops 1% in breech delivery. CP causes death(25%-50%from asphyxiation)...banyak to beb!! so why death? ..

1. Due to mechanical compression between the presenting part and bony pelvis.
2. Cause the spasm of the cord vessel (restricted blood supply to the baby).
Also, causes hypoxic ischemic encephalopathy and cerebral palsy.

Management of CP, u can insert 500 cc of normal saline into the bladder via foley's catheter which is describe as to create effect of compression as to prevent the baby from coming out further. Another way, placing two fingers into the vagina and pushing back the baby inwards, the other hand might be needed to put pressure on the suprapubic area. This has to be done until the mother reaches Operating Room or until the obstetrician has arrived to the ED(depends).

Assessment includes, feeling the pulse as for the baby...by assessing the cord to feel if there is a pulsating feeling is going on. Supply the mother with sufficient oxygen(first and always a priority). If no pulsating cord felt..proceed by ultrasound or doppler(doppler was not mentioned inthe lecture so this has to be questioned as doppler also serves in the assessment of present HR of the baby).

Additional info might be need or added....feel free to comment

Clinical Presentation of Shoulder Dystorcia by Dr. Indulekha

2008-09-09T12:02:00.003+08:00

Tuesday Sept, 9th, 2008. morning. we had lecture on another case in gynaecology (2nd day of women issues labour). lecture starts at 10.30am but AE group only arrived around 11am...lecture we heard was at 11 am....please dont blame us on this...

Shoulder Dystorcia bring fear to doctors and midwives (Weiss, no date) from www.about.com

So, what happens in shoulder dystorcia? it happens when the baby shoulder, per se, got stuck if u see in outer view, it seems that the baby's head is stuck around the labia majora (Correct me!)

This fenomena carries risks; namely for the baby, leads to fracture (e.g. clavicle), distress...

For the mother, it will creates injury to the cervix, vagina and ... add more here please

This happens when the baby is big (macrosomia) and post term pregnancy(which leads to midforceps delivery).

Amazing news! Management of Shoulder Dystorcia has their own algorithm

1. Call for help, inform gynae doctor and paediatricians
2. Traction assisted with the mother expulsive effort
3. Large episiotomy ( normal is around 1 cm or it depends)
3. Adequate analgesia (usu. Pethidine IM)
4. McRobert's manoeuvre (flexion of the thigh and then abduction, requires 2 helps)
5. Suprapubic pressure
6. Woods Corkscrew manoeuvre
7. Delivery of Posterior Shoulder
8. Worst comes worst, Rubin Reverse corkscrew, All Fourrs, Zavanelli, Fracture the Clavicle, Cleidotomy (cutting the clavicle) and Symphysiotomy.

N.b this algorithm comes if each attempt does not work effectively.

Thanx!! Comments encourage...

Gynaecology - Ante-Partum Haemorrhage and Post-Partum Haemorrhage by Dr. On Fei Wen.

2008-09-08T23:44:00.003+08:00

After Geriatric Case Management, within the same day (monday 8th sept. 2008), we browse into the world 'down under' (as the aussies always said) haha!! you guy know what i mean....

so APH and PPH....triggers emergency nurses plus the gynae nurses (a.k.a bidanz)....to deal such patients..even though emergency nurses only handle the first what-to-do kinds of stuffs....we measure BP, fetal HR, blood routines plus bleeding time and cross match....we do have to know what exactly happens in the uterus...why bleeding, why so important? YES, we try to save some lives here okay....so here i go again....

The lecture presentation given was a bit on a fast pace...probably some of us were not concentrated during the lecture...REMINDERS FOR STAFFS ALIKE!! NO VE TO BE EXAMINE IN ANY PREGNANT LADY!!!

APH...u think about placental abruption or placental praevia...these two were the most thinkable diagnosis or thoughts we might have to think about when a pregnant lady comes via the AED.

Assessment includes most of the statements i mentioned above...CARE TO ADD MORE IN THE COMMENT AREA..

Worst comes when continuous bleeding will lead the mother to experience blood loss (hypovolaemic shock) so IV hydration needed to be sustained along with blood 'O' negative (which are obtained from the cross match....

P. Previa - occurs when the placenta is in the lower segment of the uterus. Consists of four types. Risk factors include; increase of age, previous history, smoking and cocaine use...

When the mother is in the 3rd trimester, this case should be a concern but before that is not a worry (as mentioned by the lecturer).

Danger for mom, haemorrhage, sepsis and placenta accreta (p.accreta describe as abnormal attachment of the placenta in the myometrium-mid layer of the uterus wall) which leads to further bleeding worse is death...happens in 1:2500 birth (wikipedia,2008).

Danger for fetus, preterm birth, groth restriction, malformation....what do u expect if the baby was delivered for the expected delivery date (EDD)?

P.Abruption - from wikipedia 2008 stated that, this is when the placenta is detached from the uterus while the fetus is still inside...this results, of course, bleeding. Lecturer stated that bleeding PV but the placenta is in normal position. Risky moms are with history of hypertension, increase of age, lower socioeconomic status and smoking.

TO NOTE HERE...BOTH RESULTS BLEEDING SO WHEN IT OCCURS IT NEEDS TO BE WITHHOLD OR STOP

Mx is to save the life of the mother first (gynae issue)....

So, if not settled? mother will experience, Shock, Disseminated Intravascular Coagulation (DIC) and PPH.

POST PARTUM HAEMORRHAGE

Blood loss of +- 500 ml after delivery and continuous for more than 24 hrs.

2 types, first and second....1. occurs in delivery and the first 24hr. 2. bleeding continues upto 6 weeks post partum.

Causes? No contraction of uterus, Haematoma, Vaccum effect, remnants of placenta

Who will be at risk? For emergency C-section, Elective admission mothers, Big baby, Haemophilia, Von Willebrand's disease (jarang di brunei).

Rx? Blood transfusion O negative, FFP (i think Frozen Fresh PLasma-check again ok)
They did include medications but i dont dare to state it here ..do add kan for me in the comment area......to suggest syntocinon, carboprost, oxytocin....to check again if these drugs included ...

okay guys ....arghh wats on my head now???!!

Follow-up Gerentology Case Presentations

2008-09-08T23:06:00.003+08:00

Four case management presented on monday lecture 8th september 2008 back in our class. all four cases seemed to be the most occuring event while you guys are at work in the department.

Cases management presented;

1. Group 1 (Diana, Shahrin and Jack) - Elders in case of Malnutrition...comments needed...what do u think in older people with malnutrition issues? is it common? does this case comes alone without secondary illness?

2. Group 2 (Zalin, Ida and Seri) - This group presented with LCD presentation on issue about physical abuse...is it common in Brunei? Facts!! Every year, between 500,000 to five million of elders in America are physically abuse (Breaux, 2002) Link - http://www.nygec.org/

Back to Brunei, so do u think it happens? Few years ago, an old woman was being dumped by ?daughter or maybe daughter in-law? It was an alarming for ORANG MELAYU BRUNEI. Being malay does not mean we can't be abusive even to our parents! So make comments....

3. Group 3 (Eddy, Sofy and Nizam) - Presented with Half LCD as that time there was an electrical malfunction, hehe....so ..this group presents a case of COPD or Chronic Obstructive Pulmonary Disease....combination of two powerful yet very sickening disease; namely chronic bronchitis and emphysema....look out in Wikipedia for further infomation.

Yes, COPD is a very common illness esp. among the elderly why? Due to old age, obviously! old people don't have the energy...some old people yes.. but some not...face the fact of life....its very distressing as these COPD patients always visits the department with the same problem...so need anymore to explain?.....please do...

4. Group 4 (Raliza, Halinah and Amal) - Presented verbally with issue of fall among elders....stated by ?RIPAS in Brunei (i think!)...four to five cases in a week involves fall among elders in the emergency department...so what are the 'commons' of fracture tends to occur??? this is fun....so aside of degenerative process...osteoporosis...it is not surprising elderly will have such incident.

So people.....post comments on these topics....discussion here are appreciated!!!

Gerontology Nursing Case Presentation.

2008-09-06T22:53:00.004+08:00

Four case presentation of this section will be discuss next week ..... very interesting yet sometime needs more good heart and strong will within us.... am enjoying this!!!

In AE context....how we will manage such people?

Bowling on August 30th 2008...

2008-09-03T00:38:00.001+08:00

Insya Allah nanti ketani buat gathering cemani lagi ok.............

SELINGAN......

2008-08-29T17:40:00.002+08:00

presenting my favourite flower....amarilli in italian...or in english amaryllis...not so much fan of roses...this flower does not have a distinct smell, however. it comes with different colour but i only have them in pink....grown in hot n wet climate, as in brunei, for instance and cant stand in cold climate. westerners value them as amarilli is one of the most beautiful thing that God has created....

ACLS - Ventricular Fibrillation/ Pulseless VT

2008-08-29T00:00:00.003+08:00

hmmm ....ok here it goes...

1. Primary Assessment, check for Airway, Breathing, Circulation and Danger (O2 mask, Check pulse, alert resus team)

2. Wat do u see on cardiac monitor??

3. Yes its VT...

4. Defib of 360J delivered to the pt...

5 a. Return to Normal Sinus Rhythm?.....yes...assess vital signs inform transfer to CCU?

5 b. NO? Still in VF/VT.... (follow the below)

6. Do Secondary survey....assess ABCD (put on intubation, start ambubag, start IV)

7. Administer 1 mg of Adrenaline and wait for 1 minute...

8. Defib of 360J .......(remember drug-shock-drug-shock)

9. Administer another 1mg of Adrenaline IV

10. Defib of 360J

11. Optionals....u choose whether Lignocaine 100mg or Amiodarone 150mg and wait for 1 minute...

12. Defib of 360J

13. Another set of Lignocaine 100mg or Amiodarone 150mg...wait for 1 minute

14. Defib of 360J

IS IT TRUE.... NURSES ARE DOCTOR'S ASSISTANT??

2008-08-28T01:25:00.003+08:00

POST COMMENT....PLEASE.....

U THINK NURSES SERVE AS DOCTOR'S ASSISTANT? I KNOW I DON'T ALTHOUGH WE WORK TOGETHER, WE HAVE OUR TASKS AND THEY HAVE THEIR OWN....

SO WHAT DO U THINK?

....ACCORDING TO DAILY NEWS I READ AROUND CIRCA 2007 FROM uNITED kINGDOM...THOUSANDS OF NURSES WOULD BE CUT OFF FROM THEIR JOB DUE TO SHORTAGE (meaning budjet!!).....SOME REBELLIOUS NURSES FROM THIS PARTICULAR HOSPITAL DECIDED TO WALK DOWN THE STREETS IN THE UK...AS THEY OPPOSED TO THIS REMARK...BUT IN THE END THEY TEND NOT TO ....U KNOW WHY? BECAUSE OF 'PATIENTS' .... THEY CARE SO MUCH THEY COULD NOT LEAVE THEIR WORK TASK AS PATIENTS NEED NURSES TO LOOK AFTER THEM......

SO WHAT DO U THINK PEOPLE? OR SHOULD I SAY 'NURSES'??.....

SATURDAY AUGUST 24TH 2008 - BREAST FEEDING ANNIVERSARY + JOGGING AT TASEK LAMA

2008-08-24T11:09:00.004+08:00

ZZZZZZ......

ATTENDING BREAST FEEDING SEMINAR...

RESPONSIBLE FOR OUR VERY LIGHT REFRESHMENT..

ENTRANCE....

cK. sENDI N cK. zALEHA

CHATTING DURING LECTURE....CHATTY MIDWIVES

SPEAKERS INCLUDE; sALMAH, dATIN SURAYA AND 3 OTHERS...

AFTER EXCERCISE......AT TASEK LAMA

On second thought.....

2008-08-22T20:50:00.002+08:00

helleww...people..

ok...thanks to Sofy for the change of features of our website...(psst love it!!) we start clinical last Monday August 18th, 2008. and noises came to us regarding our extended 'one hour' clinical time...so how u like it? i know am not... i dont care, cuz they dont know how we feel about it till they experience it...anyhow...lots of pics here so when are we gonna put some infos of our lovely job?

i have just seen a particular site talking about their work n presented some cases...do u guys think we gonna do it too?...please support me with this idea...there's a lot more ways how we keep our selves informed....ever heard of "work smart not work hard"?? it is true in some cases....

so to begin with ....i might put some info (hopefully)...and expect u guys to read it...

arghhh....here we go again!!

Faces of emergency nurses

2008-08-21T19:31:00.004+08:00

Today (21/8/08) we all went to the mall to have a visit regarding World Health Day sponsored by JPMC's Gleneagles and our Ministry of Health *salutes*.. As Dametz would say "Hari Sejantung Sedunia!" hahaha. Anyways most of us are in the pictures. I think Eddy saja nada. Mana inda, sibuk ngangkat kerusi jua, sibuk dating jua wahahaha. Okay, most pictures were taken by me (Sofy) and my picture was taken by sexy Nizam! thanks babe! bah, sudah tah menaip, enjoy the pictures everyone!

Hjh Zalin in colors..

Nizam being sexy-licious!

Paramedic OFF duty!

Hjh Amal with Ibu Ida :)

Dametz and Penghulu a.k.a Babu Raja

Jack's Angan dan Sedar! Chewah~

Linah melirik..

Saren, our leader in class!

Seri, texting ngan hubby kali..

JUST TO SHARE A COUPLE OF PICS HERE....COMMENTS PLEASE!!!

2008-08-19T22:41:00.002+08:00

Two pics here i took when i was in the beach sunday august 17th 2008...photography really is my passion....(it's simple but am just starting) so be nice....

RELAXING SATURDAY!! AUGUST 16TH 2008

2008-08-17T02:53:00.003+08:00

Memory...... pic of previous week.....

2008-08-16T01:09:00.005+08:00

THANKS TO SOFY......

NIRMALANS

VISIT TO PANAGA HOSPITAL, THURSDAY AUGUST 14TH 2008

2008-08-14T16:26:00.002+08:00

hahahahaha...candid picss here...check lagi di bawah sal i can only post 5 pics at a time...

seri...and who's that half face?

damn it!! what have i eaten?! imagine how much oil/fatss u ate from a sausage, mayo, corn beef??!

liza n zalin....

walk thru somewhere in Panaga hospital...candid for shahrin

side view of dametzzz...hahahaha

VISIT TO PANAGA HOSPITAL, THURSDAY AUGUST 14TH 2008

2008-08-14T16:05:00.003+08:00

HELLO NURSES!!! OK SOME PICSS ON OUR VISIT ...POSTED ON THE SAME DAY...I JUST ENJOY THE TRIP....

after brief introduction of Panaga Hospital

realistic food pyramid...

hmmmm..apa ah?

arghhhh dont realize how much sugar i took !!

AED of Panaga Hospital..

UPDATESSSS.....

2008-08-07T13:30:00.002+08:00

HI GUYSSS.... ok here are some updates of our work. DATES NOT INCLUDED

1. Upcoming of our group work about Ethics.

2. Problem Based Learning, each qrp given the same story with 2 different patients.

3. Ugama test ....hmmm test on the 12th august 2008

4. Assignment for Nursing Management (a very short assignment)

5. Extended Project due 25th october 2008

.......any new additional info, feel free to add!!!

BACK FOR MORE!!! WHERE THE **** U GUYSSS??!!!

2008-07-25T19:35:00.002+08:00

THIS SITE HAS BEEN IN ACTIVE FOR QUITE SOMETIMES....AM BUSY TOO BUT I STILL MANAGE TO AT LEAST UPDATE SOMETHING.... OK HERE I GO AGAIN, UP COMING EVENTSSSS.....SO JUST WAIT...;)

BACK TO COLLEGE....

2008-07-14T18:04:00.002+08:00

hi guysss after one month holiday, we're back again to college!!! starts on July, 17th 2008...college, study, ep, clinical competencies..... all back into our routine life again....

so enjoy college and study!!!

Holiday Season June 16th till July 14th 2008....

2008-06-16T15:46:00.003+08:00

one month holiday!!!!!yeayyyy hope u guys enjoy ur holiday and yes i am ..... first week of holiday stuck in the college as...'membayar hari bekaraja' ....oklah i dont mind pulang.... but at least we finish most of our log book right? and in addition me (nizam), will present 2 additional discussions as of for my very safe site in regards with the clinical competencies....i mean saja kan menambah so masa abis cuti krg nda payah ku ingau kan log book lagi....ok guysss sana saja ....more newsss to cummm ok....

CONGRATULATIONSSSSS ON ACLS GUYS!!!

2008-06-05T15:53:00.002+08:00

hi ...just to congratulate all post basic ae students 2008....damn that MCQS' sure not very easy...nizam here...arghhhhhhhhhhhhhh shit i had to take the third attemptbut eventually i still get thru........thank God for all His trials and i am glad though deep inside me ..i dont feel satisfied but anyway i still get thru though.......ok enjoy guysss... wish on everythinggg...got something lagi nie....hmmm thinking for singapore again....hehe

ABC of Sinus Arrhythmias....bla bla bla

2008-06-03T00:23:00.002+08:00

Ok here is about .... normal looking QRS... QRS dulu baru P

NO? maybe VF, VT, Torsades de Pointes, Asystole, Idioventricular????

Yes? are QRS nya atu sebaya? (morphology?)

Then tani liat rah P wave.........normal kah nda?

NO? AF, Atrial Flutter, Junctional Rhythm or SVT

YES? P ada relation kah dengan QRS? start to think for heart blocks

ACLS REVISION ..... HEART BLOCK?

2008-06-02T23:29:00.003+08:00

whats the difference BETWEEN THOSE? there are first degree, 2nd degree type 1(wenckebach) and type 2 (mobitz2) and 3rd degree heart block...RX LASTLY IS BY TRANSCUTANEOUS PACING (antar Gleaneagles ja!!!)

First Degree - stated that PR interval is more than 5 mm (meaning more than 1 big box).

Second Degree; Type 1 - Known as Wenckebach. it is when PR interval has been prolonged till at one time P wave is all by itself.

Type 2 - known as Mobitz 2. PR interval is constant and normal but then some P wave does not followed by QRS. ( OH YEAH I GOT IT NOW!!!!)

Third Degree - P wave has no relation with QRS complexes ( ani sanang ).

N.B all abnormal wave forms should be at least identified 3 or more !!

Advance Cardiac Life Support (ACLS) ON 2ND JUNE TILL 5TH JUNE 2008. VENUE COLLEGE OF NURSING

2008-06-01T22:35:00.003+08:00

hi guyssss enjoying three days break? i did!!! ok now back to reality ACLS is coming and pooooffff!!! if we get thru this we will be considered all through as we are taking AE course (obviously) arghhhhhhhh i just wana cry nowwwww.... remember what will u do in emergency cardiac patientssss...... ok follow me... food for thoughtssss!!!

Shockable waves are ----- PULSELESS VENTRICULAR TACHYCARDIA & VENTRICULAR FIBRILLATION.

in any emergency situation never forget DRABC!!! Danger, Respond, Airway, Breathing, Circulation.... whatever the situation might....

ok so u call for help if no respond from the patient...call 991 or alert medical team on call on that day since ur in hospital....

again what do u mean by NAVVEL? INGAT SAJA PUSAT..HEHE ok if IV access cannot be establish.... 6 medications can get through via ETT tube...Naloxone, Atropine, Ventolin, Verampamil, Epinephrine(adrenaline) and Lignocaine.

so after u call for help....do 30 chest compressions with 2 rescue breathes via ambu bag dont forget airway or if u can do insert ETT tube...which u have to master in ACLS....attempt AED of 360 J(mono) or 150-200 J(bi)...

masih lagi VF or pulseless VT?? start 30 chest compressions and 2 breathes....give IV adrenaline 1mg 1: 10 000 dilution of 9 mls saline and 1 mls adrenaline then after 1-2 mins compressions...do another shock of 360 J... meaning finish 5 chest compressions tu baru bagi shock...

then on and on .....till bila? sampai dapat almost near normal wave or the doctor call it off!!!

Therefore; i can get through this ....we all can!!! May Allah bless post basic AE students 2008!!!

PICTURESSSS....VISIT TO KB HOSPITAL

2008-05-05T17:49:00.002+08:00

VISIT TO SURI SERI BEGAWAN HOSPITAL - KUALA BELAIT MAY 3RD 2008

2008-05-05T17:18:00.003+08:00

hi guysss......check bawah for description...................ada lagi nie ku add .....just browse

paediatric ward

labour ward...
AED...
hi guysss...so we went to KB hospital for a social visit (mmm can i say that?) to familiarize the setting of the hospital... first not much impressed with the outer part but the inside...mmm i must say am very impressed!!!! i love the current setting of the wards especially; paed ward, medical, gynae ward....ae too was quite nice. it was interesting to hear the management of each places we visited as of what we're lacking of if we compare to our general hospital .... das ist RIPAS hospital... home for the student nurses and doctors to practise their skills (indeed)!!! after visiting KB hospital, we went for lunch with both ae students and the icu students, not to forget our tutors. sampat lagi ku menyanyi tu...pantang te jumpa microphone bah ...gatal tah suara anie kan menyanyi..hehe...so enjoy the picsss guysssss!!!

HIV/AIDS - Is it a big problem in Brunei?

2008-04-26T23:35:00.006+08:00

Wow! It seems like this month is a huge hit for our blog. Alot of activities yes? So today's activity was a talk about HIV/AIDS, presented by the Brunei Youth and Culture (I think!), one of them is our teacher's daughter.

It was a very interesting talk, well-presented by them. They included videos regarding HIV/AIDS, group discussions, role-play, debate and sing along sessions. Very well prepared I must say! It took almost 2 hours for the workshop.. It was almost 4pm at that time and I needed to go back home to KB since mama ku pun menyuruh jua mencari barang arah Giant ah. It ended after all (for us!) when the electric current got tripped! So apa lagi, sneak out lah kami macam tikus. Heheh. Overall I enjoyed my time today! Hope you guys feel the same way too. Jam, pigang tangan lagi tani Jam? Hahaha.

Pictures!!!

Group Discussion

Still group discussion ;)

A pose from Hj Amal

An overview of the crowd

Inda sanang kalau inda begambar bah.. Mun paham bisai!

Hjh Amal and Eddy

Me and Dametz being silly!

Clinical attachment @ Tutong Hospital

2008-04-22T18:02:00.005+08:00

Today will be the 2nd day of our posting at Tutong Hospital.. So far, there hasn't been alot of cases. But yesterday we all had the chance to go out for ambulance call. Oh yeah, yang kana posted ke Tutong is me (Sofy), Nizam, Eddy and Halinah. The setting of the department is way different from RIPAS and SSB Hospitals.. They have alot of doors! I was lost on the first day, banar tah! Haha tapi siuk jua.. tambus menambus. They have resus room, and it contains 2 beds. Plastering room connected to the resus room.. And their doors macam arah OT, main betakan saja. Eddy suka tu! They have suture room as well, also 2 beds. They have dayward too but jarang bepakai since its from the nursing counter and inda cukup staff kan cover jua. So they have another dayward right infront of the nurses counter. Nebulizer room is also there but they planned to change it. Oh yes, according to them, they have Ortho clinic in the department twice a month but which day I don't know. They have this room and its tainted. We call it the Black Room and by the color, you know that room is for what.. Untuk menyimpan mayat! Haha. Si Nizam takut tu. Hehe. Bah, enough talking.. As usual, there will always be pictures, so here they are!

The Consultation Room

Day Ward

A Plastic Laryngoscope

Eddy, Daniel and me

A weird-looking cervical collar!

Portable Ventilator Machine

Bili-check

The Resus Room

The Suture Room

The Black Room (The Death Room)

Thomas Splint (Portable)

The Surgical Kit

The Medical Kit

Eddy being capi-capi!

14th Convocation - First Aid Standby

2008-04-17T11:34:00.005+08:00

And so finally the time has come for the new nurses to have their graduation day, held at The Chancellor Hall, UBD today. We, the PBS, were selected to be the first aiders. It includes me (Sofy), Dametz, Shahrin and Jack. Tapi si Jack awal pakai bebola naganya (mcm ceta ninja, ILANG!) - Alasannya? "Hey! Its my day!" FYI guys, its his birthday today! So Jack aka ROZAIMEY, HAPPY BIRTHDAY!!!

Anyways, it was a fine day and thank God there were no patients. We were expecting people coming in with Hyperventilation. Mana tau kekajutan meliat Princess, heheh. But so far, its a cool flow. So apa lagi kami, merayau-rayau lah taking pictures! Nizam was there too tapi ia student council.. Sing with me Jam! "Y...M...C..A!" Cawiiirrrrrr! Bah back to the story, we hung out with the veteran paramedics. Uncle Hamdan ahh, awal-awal pagi sudah kusut ani bah! "Bah eh, mana minuman panas? Lapar parut ku nie.." Sian Shahrin going around finding food for them. Baik jua Nizam ada, told us there were food provided at the back. Apa lagi, Uncle Hamdan tarus eh kesana, inda lagi menuleh ke blakang! LOL! Cali laa..

And there were these veteran securities jua. Sporting-sporting urangnya eh.. Bibiran jua nyamuuu! But I can say we all laughed alot jua lah.. I had fun today.. Really! I'm not saying just because today's Jack's birthday! Bwahahahahaha! Awu bah i'll stop.. Oh yes! We met Amrul and Hj Bobby (Lui) in their gown.. Cute eh si Amrul ah, baru tah nampak senyuman nya atu.. Hj Bobby macam biasa saja.. Lului. Believe it or not, he came to UBD with his bike and asked his friends to bring his gown and songkok. Sudah abis, suruhnya Ka Pidah (the wifey) membawakan gown nya and songkok and sijil nya.. Ianya tukar lah to his gears! Betuah..

Bah cukup tah, its picture time!!!

Dametz and the paramedics

Me and the paramedics

Shahrin and Birthday Boy (Jack)

First aiders! (Kirai control Jack!)

Para-para graduan! (Amrul and Hj Bobby)

Posing maut yo!

Us and cikgu Maimunah

Us in the Chancellor Hall

INFO ABOUT TRAVEL TO SOUTH KOREA

2008-04-16T00:54:00.004+08:00

hi guyssss nizam here....ok i spoken to ck. siti about this and she actually was very intrigued when i told her that some post basic students (PBS) wana join the trip. As u guys aware, the fare would be B$1700, its worth it darlingss as korea is not a cheap place to stay and bukan selalu ketani ke sana right?

so kalau kamu mau, please give me your full passport details by this saturday 19th april 2008 and the payment before 22nd may 2008. ada lagi ku inform kamu nanti di class.....

so cemana? u guys mau? bukan selalu tani buat study trip...i know its pricey but its only for this year..... i let u guys decide la..... it would be fun though kalau tani banyak ikut...hmmmm cemana ku belanja krg sana ah ?! hehe

Sushi Night!

2008-04-14T22:47:00.005+08:00

Its been hell of 2 weeks working in AE RIPAS.. So we decided to take a break by dining in Excapade Sushi tonight.. There were 12 of us, plus the medical students with partners! Baik jua sporting durang ah.. Lucky us! The medical students are Dane (Gigolo kami nie haha), Nuoorul (Hyena laugh!) and Tini (Sebut R dengan betul dan jelas pleaseee) For the past two weeks working with them, its a whole lot of fun! So on behalf of the AE group, I dedicate this page for you guys.. Enjoy..

Fun Night @ Excapade Sushi

Tini and Partner (Mus) *Kacau tangan si Dane ah.. Puuun mau jua!*

Nuoorul and partner (Faisal)

Our favourite guy, Dane!

I don't know their names tapi riuh Excapade Sushi leh durang!

Eddy, Dametz and Nizam.. Wasted usul si Nizam ahh..

Me and my baby!

Its a fun night.. Nanti lagi ber-ambuyat-ing tani otay?.. Belabih duit nie yo.. InsyaAllah na ku pakai, bulan tua pulang nie haha. Paham-paham saja ahh.. Anyways, I had fun with you all and hope the fun won't stop til here.. Next time lagi hang out kays? Alrightie.. buhbye!

CONTINUE....

2008-04-08T06:05:00.002+08:00

Seri
Sofy
Nizam

CONTINUE....

2008-04-08T05:54:00.002+08:00

Hjj Amal
Jack
Hjh Zalin
Shahrin
Diana Damit

PRE HOLIDAY FEAST!!! 19 MARCH 2008

2008-04-02T02:40:00.003+08:00

eddy
halinah
raliza @ penghulu
sapa nada pics nya nanti ku mendownload lagi ok...... i just do random here hope u enjoy!

ok guys uploaded on wednesday first april....am so busy as well....missing and a bit bangang after holiday...hope u guys enjoy holiday and clinicalss....here are the pics during our feast heehe

MENUAI PADI 16 MAC 2008 DI LABI, BELAIT

2008-03-17T04:35:00.004+08:00

HI GUYSSS ok report, aku ke Labi, Belait representing the student council, brought up by our MINISTRY OF HEALTH - bahagian kesihatan, my God i have to wake up at about 4:45 am on sunday! actually, aku kan bangun kul 4am ..ntah am so damn tired i only heard it on 4;45am. ok so, am not surprise sangat sal bangun terlalu awal anie, banyak kali dah berlaku time org lain cuti aku terpaksa bangun awal menghadiri majlis cemani anie. so il post u some pics here ......

anie..student council members nie....posing dlm kul 5 lalu pagi....hehe

ok kami sampai labi ....rupanya ..nursing students yg paling ramai time atu....am so impressed!! ada org bomba jua and org kampung labi turut hadir sama...so sun is shining..kami mcm cacing kepanasan hahaha

ok anie first kami turun padang, haha i really laugh at this point, kalau kan meliat org tebangkang iatah masa nya nie..hahaha.....anyway, siuk jua ah menuai padi ah....maklumlah first time.....

hasil pendapatan kami......bukan sanang kan menghasilkan beras anie.....menangis jua mata meliat

MARCH 8TH 2008 BASIC LIFE SUPPORT (BLS)

2008-03-13T23:47:00.005+08:00

this is pre-class of BLS we hav fun ..am having fun time taking picsss. the very front row is our so-called kaka, penghulu...hehe..jgn marah ...we're being open here. i wana have good time this year..jarang tani cemani..tahun anie saja nie....

these two ladies.. sofy and dametz ...hehe well our group judging from the shirts... our new shirts' coming by again...its blue in colour and freakin nice!!! so our group starts the BLS show always remember DR ABC! in the name of God u will survive!! (pls check if i made any errors here)

D - danger... for the casualty, environment surrounds him/her. kalau sasak banyak org..suruh lapangkan jgn kan menyasak ...spectators jauhkan tah!!

R - response, shake the casualty's shoulder and speak up near to their ears 'r u okay??' suruh spectator or ur friend to call ambulance!!! ASAP

A- airway. check airway to see obstruction but dont attempt to remove anything from casualty's mouth unless its obvious.

B - breathing. check by head tilt, chin lift but suspect spinal injury, do jaw thrust!! check for 10 seconds...no breathing give 2 immediate breathes.

C - circulation. carotid pulse or radial pulse for 10 seconds...

no pulse? proceed CPR above the xiphoid process of two fingers, do 30 compressions no deeper between 1.5 inch and 2 inch to prevent risk of fracture ribs. then give 2 breathes..continue for 5 cycles non stop. universal procedure both are the same for children and adult. if regain breathing n pulse ..proceed to recovery position...or if non, continue till ambulance arrive and u got damn tired.

here are from the mental health nurses, performing CPR. nice show....anyway i will try my best to show the rest as well.

FEAST ON THE 19TH MARCH 2008 - WEDNESDAY

2008-03-06T17:03:00.002+08:00

ok so semua agree untuk bawa makanan for our first holiday feast as what we have decided on the above date. so please bring ur food, drinks, dont forget fork and spoon, cups, probably ice cubes (mau cold drinks nie). ok this corresponds for our first 10 days of this year holiday break. next one is on june or july? which will be a month's holiday.... so i have my own plans so hope u guys have yours too!! am looking forward to it.....yeayyyyyy!!!!!!!

CONGRATULATION TRIAGE COURSE!!!!

2008-02-29T22:07:00.002+08:00

yesssss!!!! we did it!!! our group are the second group to pass overall...... how it change the way i see triage nowadays. congratulation guysss group tani semua pass in the assessment. but however we still have some course; BLS, ACLS, BTLS, & MTLS (overseas)...please check kan ku lagi ah and do make a change if i am wrong here....

for me, its my first start on the way to success.....we all have the same feeling for this. i wana make our group for the year 2008 - diploma in accident and emergency nursing - rocksssss!!! we have to stay together, enjoy everything that we are learning....we do this, In the Name of Allah, we will get through!!!!

TRIAGE COURSE 26TH FEB - 28TH FEB 2008

2008-02-26T23:23:00.002+08:00

ok... we started triage course for 3 days, first am a bit anxious about what and how triage course is handled. we gone through introduction and run almost all the emergency cases via the body systems. i really had no idea and i was not prepared what it would be like to be in the course. stress, tension, anxiety .. all presented during the first day what will happen in the next 2 days?! damn am not feeling good this week... i just want it done ASAP.

anyway, first review of day 1.... always remember what to ask during triaging patients in AnE or outpatient clinics, whether to be put in P1 or P2 or P3. we were taught the first is to ask the general condition of the patient. u have answers if u ask for more questions, though i thought some question that we ask sometimes are just not included in the assessment given by the instructor, so probably they just compromise or they would say 'it did not stated ...' know what i mean ?

from asking the GC of the pt, we move to a SOAPE - a procedure that lead us just like any other forms of procedures - writing assignment has it own system as well right? Subjective, Objective, Assessment, Plan and Evaluation which stands for the SOAPE.

its a very interesting day for the first since we usually and commonly do triage all the way during work time. but somehow we never use this approach. all of us were having hard times coping with the approach. its not easy as it may look. but to do this u have to love it!!! whatever its circumstances maybe.

well by now am loving it!!!! hmm what will happen next?

UPDATES ON HIGH BEAM ....

2008-02-25T22:09:00.002+08:00

ok here it goes, i inquire the bank about the transaction and i was informed that the last two weeks of the registration was not been acknowledge. so what i did was, i re-register high beam and what u can see now is that u guys are able to access the site once again. so i guess i have to wait another one week and i have to call back the bank if my transaction is approved. hmmm am a bit anxious about these on-line thing... i used to pay-off on-line but these one doesnt seem very convincing...but i hope it will be alright ...

ST ELEVATION ...ECG...MANAGEMENT

2008-02-21T00:28:00.002+08:00

ok another post here...showing ST elevation in leads II, III and aVF which it indicated the inferior part of the heart. Heart rate is about 83 beats per minute which is a normal sinus rhythm and of course with ST elevation. and i think there are ST depression in v5 and v6? care to argue with that ?? how about the RR progression? hmm there is RR progression but for me it seems like it not getting any higher though. Please refer to the calibration if u look in V5 and V6, no progress of the RR wave? Others include - the speed is 25 mm/sec, standard and chest leads has 10 mm/ mv, so there are no alteration or argument with that. Okay now the problem is...usually will the patient experience pain as of the presence of Myocardial infarction? or it has been treated earlier that what is shown could be an old MI?

please discuss this!! we need to know....managements of MI with elevated ST? what do u do ?

WHAT CAN U TELL FROM THIS ECG?

2008-02-16T03:27:00.004+08:00

ok gangs!!! i posted an ecg sample though ia bagi tau its normal rhythm ok say its not there and remind u ..result can be deceiving sometimes right? always remember first step u see the P wave and i have calculated the heart beat from measuring the heart beat and what a surprise at least i made a discovery (hmmm like as if am the teacher now!) ah wateva!! am stilll learning and am crushing my brains out to learn this!!!! i think most of us here has difficulty to learn ecg i might say it is not easy and it takes time to learn although we encounter ecg almost everyday during our working time but mind u ...who takes a damn as long as u see there is a result right? abis saja buat ecg u show tarus the doctor....but yeah it might not happen most of the time but it does happen (u always show to the doctor)....as long as the patient is still alive!! haha wat the heck, am looking forward to achieve this in fact all of us right?

A trip to Paris?.. (Posted by Sofy)

2008-02-12T19:24:00.000+08:00

So it was a typical day.. (Monday).. as usual, study, learning, eating, memalat-ing, etc etc.. The college had prepared a trip to UBD's library that pm. The whole point of us going there..well..just to hear 'taklimat' and took a tour I might say.. Heheh. Anyways, the UBD is damn huge! And they have this new upcoming buliding (sedang membuat lah).. Awu tebuat UBD ada budget aah.. Untuk college kitani inda tia ada budget! Buruk kali ah college kitani.. Aww c'mon guys, just admit it! It does look dull right? The size, the location, the colour! Mun budget cukup bah, alah UBD atu kali.. Haha I wish! No offence UBDians, its a compliment, and envy!

Okay back to the story.. We almost got lost there searching for the library... And people say Brunei is a small country.. *yeah* tell me about it! Tapi last2 tejumpa jua lah, urg Brunei kali aah heheh.

Sudah sampai sana tepaksa lah menunggu troops lain, baru buleh masuk. So while waiting for the rest, we took some pictures!

The AE students.. plus 1 CCN student *wink*

Students from CCN and MHN

Hmmm.. Something looks weird here.. Haha lui eh ko ani..

Naahhh ani lagi lului dari laki2 di atas aah.. ~Di hati mu~

Hahaha siuk eh meliat durang ani.. Ada2 saja bah.. Sapa na boring, cuba tah.. There's some more funny incidents happened jua sana. I'm not gonna tell the story.. But all I can say is it involved me (Dr Sofy), Reza (Dr Reza), Dametz (audience), and Ayang (Tumpah) hahaha jangan marah aahh.. I'm not gonna publish the story so DON'T WORRY!

Otay, so there were...I don't know, 3 or 4 floors? I'm not sure jua, lalai mengetawakan si Tumpah ah.. *chuckles* We were brought to this room called 'Viewing Room' and yeah they were some viewers... and viewees. Hehe mun teacher Shirley meliat, fail kali ih English ku.. Bah awu awu, we used that room for the briefing of the library.. Here's a picture of it..

This is the viewing room.. Kami liat TV tarus surfing jua sana.. Wait, let me break it down.. Kami liat TV, the lecturer surfed the net. He was just showing some of the sites that can be accessed for articles and journals. But honestly, I still don't get it pasal I wasn't concentrating.. Falui wah si Dametz ah, ada2 saja bunyi dibuatnya.. Mcm bunyi kucing baru bangun tidur!

Wow macam panjang sudah.. Bah I'll stop now, I hope you enjoy reading this.. And also the pictures.. Sangal sudah jariku menaip.. Ukan p*** menaip ahh.. I repeat.. JARI! Hehe otay thats all folks! Ciao~

Sofy xxoo

AE's Anatomy! (Posted by Sofy)

2008-02-09T22:45:00.000+08:00

Yup, this picture was taken just now before noon.. Masing-masing kelaparan so begambar pun berabut..

So this is a replica of Grey's Anatomy..

Here's another pose.. Cawwwiiiirrrrr~

Wanna see the most scariest picture of all??? I took it lively in front of me!

That is one scary dude slash old lady! Wakakaka~ "INSERVICE DARI MYANMAR"

Bah don't forget to leave comments once you see this! Adios chickano!

Sofy xxoo

GUYSSSS!!!! GUNAKAN TIA BLOG AH!!! (NIZAM)

2008-02-09T17:17:00.000+08:00

OMG where the hell are you ppl? ngalih ku menaip....hahahaha anyway, thanx for the attendance for the election of president and vice-president of the student council...nasib kamu sign semua attendance tadi ah. ok anyhow, use the highbeam.com .... i myself having trouble finding my own topic jua so...sama2 susah sama2 menangis ah ...... i decide not to change my topic for EP, well is just hat am interested in the topic that i have selected. so with the use of highbeam.com, pubmed.com...etc, hope u can find your related articles.

Sofy in da house!

2008-02-06T18:53:00.000+08:00

Eh Jam, panjang2 bah buat blog atu.. We hafta entertain the people here! Yo AE students of 2008, jgn lupa pakai baju ECG tani on Saturday otay?.. Bergambar tani nie.. Jam, is it possible ka if tani begambar tarus ke studio? White background laa.. Baru ada watak Grey's yo! Haha. Think about it and then let me know yea.. Pictures..pictures..pictures.. God! We need pictures ahh.. Inda apalah, untuk sementara ani we use this picture saja, at least our blog doesn't look plain riiight?

Atu rugged!! Ngalahkan Grey's Anatomy tani ani aah.. We'd make a big hit.. Haha i wish! Bah atu saja kali dulu.. Nanti2 lagi mempost (Rojak Language)..

People! PLEASE visit us more often!! Jgn sekali dua, inda membari-bari tu!

Sofy xxoo

ok sal highbeam!!!!

2008-02-06T17:07:00.000+08:00

bah aku register dah rah highbeam!!!!! mana kamu ??? alum kamu online kah???? pls do something about this blog!!!!!!!!

hahahahahaha!!!!

2008-02-05T01:04:00.001+08:00

ok guys its me nizam...i have set up this website for our usage...post all important events, documents (not ur assignments!!) or anything...we have to start active!!!!

ACCIDENT AND EMERGENCY NURSING 2008

January 2012

Abuse Case

Banned Health Product

The editor/blogger....

Another Freak Accident After Just One Day Apart.....

ABOVE & BELOW: Tourists from Brunei Darussalam are seen near the wreckage of their bus after it hit a tree in Tuaran, Sabah. BERNAMA

This photo taken at around 2.30am this morning (Wednesday) shows a tearful reunion between a mother and a daughter upon learning that they both survived the tragedy. - YAZID ANUAR

Motor Vehicle Accident.. in 2011 from Local Papers

Sutures

2011......

Nursing Care for Seizures

What is a seizure?

What is epilepsy?

Absence seizures

Signs and symptoms

Signs and symptoms

Signs and symptoms

What Do I do?

Priorities

ABC assessments

All about Tetanus......

Who is at risk?

What you can do

Protecting your family from tetanus

Issues on HIV in Brunei (from Borneo Bullettin dated June 9th, 2010 Wednesday)

By Siti Hajar

Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial.

Uploaded picss....

Announcement on the 14th February 2009 Dinner

December 2008...apa saja ku buat nie ...

Announcement !!

BBQ at Pantai Seri Kenangan November 23, 2008

EXAM FEVER!!!!

X rayss...

Case Scenario....

REVISION WEEKSS........

Rainy Monday, November 3rd 2008

Outing at Cikgu Zaleha's Saturday 1st November 2008

Eating Out at Cikgu Salmah's on Friday 31st October 2008

Thursday, October 30th, 2008..College of Nursing...

EXAM FEVER!!!!

26TH October, 2008....Celebration of Raya and Teacher's day by the College of Nursing, PAPRSB....

EPs' submssion on Saturday 25th October, 2008....

EXTENDED PROJECT DUE ON 25TH OCTOBER 2008.....

Zzzz....!

Raya Outing...College of Nursing Saturday (Oct, 11th 2008 started at 10 am) and Raya at Sofy's (Oct 12th, 2008 Sunday PM)

Raya Outing....on Friday 10th 2008 PM

SELAMAT HARI RAYA AIDIL FITRI......

Sungkai on 25th September 2008 Thursday

Pic testing...

My Pic Post.....edited

3 in 1 lectures for the day of Sept 13th 2008...

Blood Donation on 16th Septemebr 2008 at 8pm in RIPAS Blood Bank

Case Queries??

Case Queries??

Obstetric - Cord Prolapse by Dr. Ohn Htwe

Clinical Presentation of Shoulder Dystorcia by Dr. Indulekha

Gynaecology - Ante-Partum Haemorrhage and Post-Partum Haemorrhage by Dr. On Fei Wen.

Follow-up Gerentology Case Presentations

Gerontology Nursing Case Presentation.

Bowling on August 30th 2008...

SELINGAN......

ACLS - Ventricular Fibrillation/ Pulseless VT

IS IT TRUE.... NURSES ARE DOCTOR'S ASSISTANT??

SATURDAY AUGUST 24TH 2008 - BREAST FEEDING ANNIVERSARY + JOGGING AT TASEK LAMA

On second thought.....

Faces of emergency nurses

JUST TO SHARE A COUPLE OF PICS HERE....COMMENTS PLEASE!!!

RELAXING SATURDAY!! AUGUST 16TH 2008

Memory...... pic of previous week.....

VISIT TO PANAGA HOSPITAL, THURSDAY AUGUST 14TH 2008

VISIT TO PANAGA HOSPITAL, THURSDAY AUGUST 14TH 2008

UPDATESSSS.....

BACK FOR MORE!!! WHERE THE **** U GUYSSS??!!!

BACK TO COLLEGE....

Holiday Season June 16th till July 14th 2008....

CONGRATULATIONSSSSS ON ACLS GUYS!!!

ABC of Sinus Arrhythmias....bla bla bla

ACLS REVISION ..... HEART BLOCK?