Localizing Myocardial Infarction via ECG Leads
ECG leads correspond to specific regions of the heart:
πΉSeptal MI: V1, V2
πΉAnterior MI: V3, V4
πΉLateral MI: I, aVL, V5, V6
πΉInferior MI: II, III, aVF
πΉPosterior MI: reciprocal changes in V1βV3 (typically manifests as ST depression, tall R waves and an upright T wave)
Sometimes, myocardial infarction may extend beyond a single region.
β’ Example: ST changes in V3βV4 (anterior) plus I, aVL, V5βV6 (lateral) suggest an anterolateral MI.
=====
In certain circumstances, we will also perform posterior ECG and / or right-sided ECG, addition to the standard 12-lead ECG.
When to do a posterior ECG (V7βV9)?
π₯ If posterior wall involvement is suspected, especially when inferior or lateral STEMI shows ST depression in V1βV3 (highly suggestive when combined with upright T waves and tall R waves)
*Cut-off for posterior leads ST elevation: β₯0.5 mm in V7βV9 (β₯1 mm for men <40 years).
When to do a right-sided ECG (V3RβV6R; V4R is a sensitive marker for right ventricular infarction)?
π₯ Right-sided ECG is done especially if inferior STEMI (up to 40 β 50% of inferior MI have RV involvement). Those patients with right ventricular infarction may also have hypotension due to impaired right heart function.
Related posts:
βΆοΈ ECG leads placement
https://t.me/nota_perubatan/1573
βΆοΈ Have you heard of the mnemonic PAILS in interpreting ECG for ACS?
https://t.me/nota_perubatan/1181
#ECG@nota_perubatan
#ED@nota_perubatan
ECG leads correspond to specific regions of the heart:
πΉSeptal MI: V1, V2
πΉAnterior MI: V3, V4
πΉLateral MI: I, aVL, V5, V6
πΉInferior MI: II, III, aVF
πΉPosterior MI: reciprocal changes in V1βV3 (typically manifests as ST depression, tall R waves and an upright T wave)
Sometimes, myocardial infarction may extend beyond a single region.
β’ Example: ST changes in V3βV4 (anterior) plus I, aVL, V5βV6 (lateral) suggest an anterolateral MI.
=====
In certain circumstances, we will also perform posterior ECG and / or right-sided ECG, addition to the standard 12-lead ECG.
When to do a posterior ECG (V7βV9)?
π₯ If posterior wall involvement is suspected, especially when inferior or lateral STEMI shows ST depression in V1βV3 (highly suggestive when combined with upright T waves and tall R waves)
*Cut-off for posterior leads ST elevation: β₯0.5 mm in V7βV9 (β₯1 mm for men <40 years).
When to do a right-sided ECG (V3RβV6R; V4R is a sensitive marker for right ventricular infarction)?
π₯ Right-sided ECG is done especially if inferior STEMI (up to 40 β 50% of inferior MI have RV involvement). Those patients with right ventricular infarction may also have hypotension due to impaired right heart function.
Related posts:
βΆοΈ ECG leads placement
https://t.me/nota_perubatan/1573
βΆοΈ Have you heard of the mnemonic PAILS in interpreting ECG for ACS?
https://t.me/nota_perubatan/1181
#ECG@nota_perubatan
#ED@nota_perubatan
β€16
In a case of unconjugated hyperbilirubinaemia, can unconjugated bilirubin appear in the urine?
Anonymous Quiz
52%
Yes
48%
No
β€3
How to remove a pigtail catheter
Have you ever tried to remove a pigtail catheter for the first time and it just wouldnβt come out?
It feels stuck no matter how hard you try, until a more senior doctor comes over and shows you where to cut. π
Pigtail catheters have a coiled tip that anchors the catheter internally. Many also have a locking mechanism (usually a suture), that must be released before removal.
Steps in removing a pigtail catheter:
- Prepare sterile equipment: gloves, scissors / blade, dressing set / disposable sterile set, saline
- Unlock the pigtail: cut the suture at the hub that holds the coil (refer the video below)
- Withdraw the pigtail catheter gently, while applying counter-pressure to stabilize the skin around the exit site
- Inspect the tip of the pigtail catheter to ensure the full pigtail catheter is intact.
- Apply a sterile occlusive dressing.
- Watch for signs of infection or leakage
β οΈ Never pull a pigtail catheter with force. Always unlock the coil first.
Pulling with force can cause severe pain, tissue trauma or bleeding and risk of retained catheter fragments if the catheter breaks.
https://youtu.be/Jc1DKoC4rYQ?si=W5Plf46Q_OrTzGqs
#Surgery@nota_perubatan
#GIM@nota_perubatan
Have you ever tried to remove a pigtail catheter for the first time and it just wouldnβt come out?
It feels stuck no matter how hard you try, until a more senior doctor comes over and shows you where to cut. π
Pigtail catheters have a coiled tip that anchors the catheter internally. Many also have a locking mechanism (usually a suture), that must be released before removal.
Steps in removing a pigtail catheter:
- Prepare sterile equipment: gloves, scissors / blade, dressing set / disposable sterile set, saline
- Unlock the pigtail: cut the suture at the hub that holds the coil (refer the video below)
- Withdraw the pigtail catheter gently, while applying counter-pressure to stabilize the skin around the exit site
- Inspect the tip of the pigtail catheter to ensure the full pigtail catheter is intact.
- Apply a sterile occlusive dressing.
- Watch for signs of infection or leakage
β οΈ Never pull a pigtail catheter with force. Always unlock the coil first.
Pulling with force can cause severe pain, tissue trauma or bleeding and risk of retained catheter fragments if the catheter breaks.
https://youtu.be/Jc1DKoC4rYQ?si=W5Plf46Q_OrTzGqs
#Surgery@nota_perubatan
#GIM@nota_perubatan
β€16π₯1
Morphine is the drug of first choice for treatment of severe cancer pain
Anonymous Quiz
79%
True
21%
False
β€2
How to start Syr Morphine for severe and persistent cancer pain?
Aim to give regular dose (4 hourly) plus PRN dose for additional breakthrough pain
- PRN dose is similar to regular dose (example: Syr Morphine 5 mg 4 hourly + 5 mg PRN)
πSyr Morphine (natural opioids)
- Immediate release formulation
- Preparation: usually 2 mg per mL solution
- Onset of action: 30 minutes
- Peak action: 60 minutes after administration
- Duration of action: 4 hours
- Bluebook prescriber category: B (can be prescribed by Medical Officer)
- Prescribe in mg (not mL) to avoid confusion.
πSteps:
- Start at 5 mg 4 hourly and 5 mg PRN
- Calculate total morphine usage after 24 hours (regular dose + additional PRN doses used)
- Divide total dose by 6 to get the new 4 hourly dose
- Always remember to prescribe regular dose + PRN dose for syr Morphine
Remarks:
- In patients with renal impairment, the dose should be reduced or interval between doses should be increased
- In elderly, start with lower dose β 2.5 mg 4 - 6 hourly instead of 5 mg 4 hourly
πExample:
Total morphine required over 24 hours: (5 mg Γ 6) + (5 mg Γ 3) = 30 + 15 = 45 mg
New 4 hourly dose: 45 Γ· 6 = 7.5 mg
π New prescription: Syr morphine 7.5 mg 4 hourly and 7.5 mg PRN
Further reading:
- CPG management of cancer pain (2nd ED, page 21)
- Handbook of palliative medicine in Malaysia (1st ED, page 18)
#Medications@nota_perubatan
Aim to give regular dose (4 hourly) plus PRN dose for additional breakthrough pain
- PRN dose is similar to regular dose (example: Syr Morphine 5 mg 4 hourly + 5 mg PRN)
πSyr Morphine (natural opioids)
- Immediate release formulation
- Preparation: usually 2 mg per mL solution
- Onset of action: 30 minutes
- Peak action: 60 minutes after administration
- Duration of action: 4 hours
- Bluebook prescriber category: B (can be prescribed by Medical Officer)
- Prescribe in mg (not mL) to avoid confusion.
πSteps:
- Start at 5 mg 4 hourly and 5 mg PRN
- Calculate total morphine usage after 24 hours (regular dose + additional PRN doses used)
- Divide total dose by 6 to get the new 4 hourly dose
- Always remember to prescribe regular dose + PRN dose for syr Morphine
Remarks:
- In patients with renal impairment, the dose should be reduced or interval between doses should be increased
- In elderly, start with lower dose β 2.5 mg 4 - 6 hourly instead of 5 mg 4 hourly
πExample:
Patient X was started on Syr Morphine 5 mg 4 hourly with Syr Morphine 5 mg PRN. He required 3 PRN doses of syr Morphine over the past 24 hours.
Total morphine required over 24 hours: (5 mg Γ 6) + (5 mg Γ 3) = 30 + 15 = 45 mg
New 4 hourly dose: 45 Γ· 6 = 7.5 mg
π New prescription: Syr morphine 7.5 mg 4 hourly and 7.5 mg PRN
Further reading:
- CPG management of cancer pain (2nd ED, page 21)
- Handbook of palliative medicine in Malaysia (1st ED, page 18)
#Medications@nota_perubatan
β€34π11
Job list / Task list
βAt 3.30 pm, while flipping through the case notes of patient X, I realised that I had not requested an inpatient USG KUB for the severe AKI (the plan was given during the morning round). I quickly ran to the Radiology Department to request the inpatient scan. Luckily, it was granted on the same day, and I was asked to inform the ward staff to send the patient immediately to the Radiology Department for the USG KUB.β I encountered this situation a few years ago, when I was working as a new HO in the medical ward.
Having a job list in hand is important to guide us to work systematically. It provides a big picture of the pending, ongoing, or completed tasks, especially in hectic situations. We can also prioritise the tasks accordingly based on the job list.
Another example of teamwork is when one colleague is presenting during the ward round with the specialist, while another colleague from another cubicle helps to jot down the tasks given. By the time the ward round finishes, everyone can focus on the task list instead of spending time flipping through the case notes multiple times.
Basically, there are two different styles of job lists, depending on your personal preference. You can either group the tasks into different types or categories, or have a list of patients and jot down the tasks under each patient.
Or, if youβre a legend or there are not many tasks, you can just keep the list in your mind. π
#houseman@nota_perubatan
βAt 3.30 pm, while flipping through the case notes of patient X, I realised that I had not requested an inpatient USG KUB for the severe AKI (the plan was given during the morning round). I quickly ran to the Radiology Department to request the inpatient scan. Luckily, it was granted on the same day, and I was asked to inform the ward staff to send the patient immediately to the Radiology Department for the USG KUB.β I encountered this situation a few years ago, when I was working as a new HO in the medical ward.
Having a job list in hand is important to guide us to work systematically. It provides a big picture of the pending, ongoing, or completed tasks, especially in hectic situations. We can also prioritise the tasks accordingly based on the job list.
Another example of teamwork is when one colleague is presenting during the ward round with the specialist, while another colleague from another cubicle helps to jot down the tasks given. By the time the ward round finishes, everyone can focus on the task list instead of spending time flipping through the case notes multiple times.
Basically, there are two different styles of job lists, depending on your personal preference. You can either group the tasks into different types or categories, or have a list of patients and jot down the tasks under each patient.
Or, if youβre a legend or there are not many tasks, you can just keep the list in your mind. π
#houseman@nota_perubatan
β€16π3π1
Job list in a medical ward
Here are some typical tasks in a medical ward. You can organise them into a job list in whatever style that suits you.
- Blood taking
- Branula insertion
- New case clerking
- Discharge / KIV discharge
- PM review / Post HD review
- Imaging request
- Procedure
- Referral
- Trace lab result / radiology report / old notes
- X-ray
- etc.
#houseman@nota_perubatan
Here are some typical tasks in a medical ward. You can organise them into a job list in whatever style that suits you.
- Blood taking
- Branula insertion
- New case clerking
- Discharge / KIV discharge
- PM review / Post HD review
- Imaging request
- Procedure
- Referral
- Trace lab result / radiology report / old notes
- X-ray
- etc.
#houseman@nota_perubatan
β€5π1
Are you interested in medicolegal content?
Anonymous Poll
80%
Yesss π₯π₯π₯
9%
Yess ππ
11%
Yes π
π1
Advanced care planning (ACP).pdf
9.8 MB
Advanced care planning (ACP) a guide for healthcare practitioners in Malaysia (August 2024)
#guidelines@nota_perubatan
#guidelines@nota_perubatan
A 65-year-old man presents with progressive shortness of breath, orthopnea, and bilateral lower limbs swelling. On examination, he has elevated JVP, bibasal crepitations, and S3 gallop. Which of the following is the most likely diagnosis?
Anonymous Quiz
3%
Chronic obstructive pulmonary disease (COPD)
93%
Congestive heart failure (CHF)
4%
Pulmonary embolism
0%
Nephrotic syndrome
β€8
Iron chelation therapy in thalassaemia
When to start iron chelation therapy in thalassaemia patients?
Is this patient having iron overload?
πΈ Transfusion-dependent thalassaemia
- All patients with iron overload, i.e. serum ferritin >1000 ng/mL on two occasions at least two weeks apart, should be started on iron chelation therapy
- Target: serum ferritin <1000 ng/mL, liver iron concentration (LIC) <7 mg Fe/g dw and cardiac T2* >20 ms.
πΉNon-transfusion dependent thalassaemia
- Iron chelators should be started at β₯10 years of age if liver iron concentration (LIC) β₯5 mg Fe/g dw OR serum ferritin β₯800 ng/mL
- Iron chelators should be temporarily discontinued when liver iron concentration (LIC) β€3 mg Fe/g dw OR serum ferritin β€300 ng/mL
Footnotes:
- Optimisation of iron chelation therapy is important to prevent and treat multiorgan complications of iron overload in thalassaemia patients.
- Iron chelators should be started after discussion with a paediatrician / physician / haematologist
- Liver iron concentration is measured from MRI
Further reading: CPG Management of Thalassaemia (2nd ED, 2024)
#GIM@nota_perubatan
When to start iron chelation therapy in thalassaemia patients?
Is this patient having iron overload?
πΈ Transfusion-dependent thalassaemia
- All patients with iron overload, i.e. serum ferritin >1000 ng/mL on two occasions at least two weeks apart, should be started on iron chelation therapy
- Target: serum ferritin <1000 ng/mL, liver iron concentration (LIC) <7 mg Fe/g dw and cardiac T2* >20 ms.
πΉNon-transfusion dependent thalassaemia
- Iron chelators should be started at β₯10 years of age if liver iron concentration (LIC) β₯5 mg Fe/g dw OR serum ferritin β₯800 ng/mL
- Iron chelators should be temporarily discontinued when liver iron concentration (LIC) β€3 mg Fe/g dw OR serum ferritin β€300 ng/mL
Footnotes:
- Optimisation of iron chelation therapy is important to prevent and treat multiorgan complications of iron overload in thalassaemia patients.
- Iron chelators should be started after discussion with a paediatrician / physician / haematologist
- Liver iron concentration is measured from MRI
Further reading: CPG Management of Thalassaemia (2nd ED, 2024)
#GIM@nota_perubatan
β€10
"14 years old male with underlying Beta Thalassaemia major on regular monthly packed cell transfusion at Thalassaemia Daycare clinic in the hospital. He has a massive splenomegaly, causing intermittent abdominal discomfort."
Have you been wondering when should a Thalassaemia patient undergo splenomegaly?
Indication for splenectomy (in Thalassaemia):
β’ Packed cell transfusion requirement >200 - 250 mL/kg/year and severe iron overload could not be adequately controlled with iron chelation. [average blood transfusion requirement in transfusion dependent Thalassaemia is β180 mL/kg/year]
β’ Evidence of hypersplenism (persisting anaemia, leucopenia and thrombocytopenia)
β’ Massive splenomegaly that crosses umbilicus causing discomfort and risk of infarct or rupture from trauma
However, splenomegaly is not performed routinely in thalassaemia patients especially in a child <5 years old due to risk of sepsis and thromboembolism.
Splenomegaly in Thalassaemia is due to excessive destruction of red blood cells and extramedullary hematopoiesis. Extramedullary hematopoiesis could be significantly reduced by optimal blood transfusion and iron chelation.
Hence, pre-transfusion haemoglobin in transfusion dependent thalassaemia should be kept between 9 - 10 g/dL. Those with heart disease and clinical evidence of extramedullary haematopoiesis should have higher target of pre-transfusion haemoglobin β 11 - 12 g/dL.
Further reading: CPG Management of Thalassaemia (2nd ED, 2024)
#GIM@nota_perubatan
Have you been wondering when should a Thalassaemia patient undergo splenomegaly?
Indication for splenectomy (in Thalassaemia):
β’ Packed cell transfusion requirement >200 - 250 mL/kg/year and severe iron overload could not be adequately controlled with iron chelation. [average blood transfusion requirement in transfusion dependent Thalassaemia is β180 mL/kg/year]
β’ Evidence of hypersplenism (persisting anaemia, leucopenia and thrombocytopenia)
β’ Massive splenomegaly that crosses umbilicus causing discomfort and risk of infarct or rupture from trauma
However, splenomegaly is not performed routinely in thalassaemia patients especially in a child <5 years old due to risk of sepsis and thromboembolism.
Splenomegaly in Thalassaemia is due to excessive destruction of red blood cells and extramedullary hematopoiesis. Extramedullary hematopoiesis could be significantly reduced by optimal blood transfusion and iron chelation.
Hence, pre-transfusion haemoglobin in transfusion dependent thalassaemia should be kept between 9 - 10 g/dL. Those with heart disease and clinical evidence of extramedullary haematopoiesis should have higher target of pre-transfusion haemoglobin β 11 - 12 g/dL.
Further reading: CPG Management of Thalassaemia (2nd ED, 2024)
#GIM@nota_perubatan
β€7π1
Post-transfusion haemoglobin level (in transfusion-dependent Thalassaemia)
(i) What is the target?
ππ»13.5 β 15.5 g/dL
(ii) When to take the FBC sample?
ππ»1 hour after transfusion
Further reading: Handbook on Clinical Use of Blood (3rd ED, 2020), page 137
#GIM@nota_perubatan
(i) What is the target?
ππ»
(ii) When to take the FBC sample?
ππ»
Further reading: Handbook on Clinical Use of Blood (3rd ED, 2020), page 137
#GIM@nota_perubatan
β€13
Inhaler education is a pivotal role of pharmacists and other HCPs. Inhaler technique errors are highly prevalent and have been documented in up to 90% of patients. These errors, especially critical inhaler errors, are associated with poor disease control, adverse clinical outcomes, and increased burden on the healthcare cost.
At JKK Farmasi Respiratori, Amalan & Perkembangan Farmasi, KKM, we recognise the magnitude of this issue. In response, we are proud to present our validated national inhaler education videos. After two years of dedicated work, from storyboard development and filming to editing; the project has finally been completed.
We are pleased to announce that all nine inhaler technique videos are now available:
MDI : https://youtu.be/XoxVZ0InJjE?si=hL6Kpf4GrVdaaEm4
Spacer with mouthpiece: https://youtu.be/voskihsx6Fk?si=KiS-HjS2o-MmerGq
Spacer with facemask: https://youtu.be/CeXpwhD1-eU?si=qg33Jk8cvvbOy1J2
Turbuhaler : https://youtu.be/Uu2wuxEJ5VE?si=nYWxBCeyZ9ENiuRz
Accuhaler: https://youtu.be/bCOrmH8SPGw?si=sACT1Vtd8AM3I21k
Ellipta: https://youtu.be/SuL0w7pRt9Q?si=Kp-GRFoDdr3TLya4
Breezhaler: https://youtu.be/vEs1SB3pgrw?si=ULwthaJakmI1CN8e
Nexthaler: https://youtu.be/OTMiyDZVgB8?si=ePdGyDO3KyPiBDeg
Respimat: https://youtu.be/BidjblaNH3s?si=Y1z6wv6BwsL7GhFB
We would like to express our sincere appreciation to our collaborator, the Malaysian Thoracic Society (MTS). Special thanks also go to my hardworking JKK members, and the PUB team, KKM, whose commitment made this project possible.
Thank you for your continuous support.
Sincerely,
Dr Jaya Muneswarao, PhD
Pegawai Farmasi, Hospital Pulau Pinang
Pengerusi
Jawatankuasa Kerja Farmasi Klinikal
(Pengkhususan Farmasi Respiratori), KKM
Shared from https://www.facebook.com/share/16rG5omYwW/
#medications
At JKK Farmasi Respiratori, Amalan & Perkembangan Farmasi, KKM, we recognise the magnitude of this issue. In response, we are proud to present our validated national inhaler education videos. After two years of dedicated work, from storyboard development and filming to editing; the project has finally been completed.
We are pleased to announce that all nine inhaler technique videos are now available:
MDI : https://youtu.be/XoxVZ0InJjE?si=hL6Kpf4GrVdaaEm4
Spacer with mouthpiece: https://youtu.be/voskihsx6Fk?si=KiS-HjS2o-MmerGq
Spacer with facemask: https://youtu.be/CeXpwhD1-eU?si=qg33Jk8cvvbOy1J2
Turbuhaler : https://youtu.be/Uu2wuxEJ5VE?si=nYWxBCeyZ9ENiuRz
Accuhaler: https://youtu.be/bCOrmH8SPGw?si=sACT1Vtd8AM3I21k
Ellipta: https://youtu.be/SuL0w7pRt9Q?si=Kp-GRFoDdr3TLya4
Breezhaler: https://youtu.be/vEs1SB3pgrw?si=ULwthaJakmI1CN8e
Nexthaler: https://youtu.be/OTMiyDZVgB8?si=ePdGyDO3KyPiBDeg
Respimat: https://youtu.be/BidjblaNH3s?si=Y1z6wv6BwsL7GhFB
We would like to express our sincere appreciation to our collaborator, the Malaysian Thoracic Society (MTS). Special thanks also go to my hardworking JKK members, and the PUB team, KKM, whose commitment made this project possible.
Thank you for your continuous support.
Sincerely,
Dr Jaya Muneswarao, PhD
Pegawai Farmasi, Hospital Pulau Pinang
Pengerusi
Jawatankuasa Kerja Farmasi Klinikal
(Pengkhususan Farmasi Respiratori), KKM
Shared from https://www.facebook.com/share/16rG5omYwW/
#medications
β€19π2π2
How is essential thrombocythaemia (ET) commonly presented?
Anonymous Quiz
22%
Features related to thrombosis
27%
Features related to bleeding
51%
Incidental finding from FBC
β€4π±3
πππ ππππππ ππππ ππππππ πππ!
Seksyen HIV/STI/Hepatitis C, Jabatan Kesihatan Negeri Sarawak akan menganjurkan Webinar dengan topik βπΈπ£πππ¦π‘βπππ πππ’ ππππ πππ πππΌ πΆππ π (πΉπππ π‘ πππ ππ‘)β oleh Dr Lim Han Hua, Pakar Perubatan Penyakit Berjangkit, Hospital Umum Sarawak.
Tarikh: 26 Februari 2025(Khamis)
Masa: 2.30 petang-3:30 petang
FB JKN Sarawak
Seksyen HIV/STI/Hepatitis C, Jabatan Kesihatan Negeri Sarawak akan menganjurkan Webinar dengan topik βπΈπ£πππ¦π‘βπππ πππ’ ππππ πππ πππΌ πΆππ π (πΉπππ π‘ πππ ππ‘)β oleh Dr Lim Han Hua, Pakar Perubatan Penyakit Berjangkit, Hospital Umum Sarawak.
Tarikh: 26 Februari 2025(Khamis)
Masa: 2.30 petang-3:30 petang
FB JKN Sarawak
β€2
"60 years old female with history of recurrent stroke, admitted for orthostatic pneumonia. She is unable to speak since few years ago after stroke. On day 3 of admission, informed by staff nurse the patient has persistent elevated blood pressure. Abdominal examination by the attending doctor noted suprapubic distension. Urinary cathether was inserted and about 1 liter of urine was drained. BP subsequently was back to normal."
We always encounter patients with elevated blood pressure in the ward. What are some of the very common inpatient causes that need to be considered?
- Pain
- Agitation / Delirium
- Respiratory distress
- Acute urinary retention
- Sleep deprivation
- Chronic hypertension-related (hypertensive urgency / hypertensive emergency / undiagnosed hypertension / anti-hypertensive not yet restarted in the ward)
- Medications e.g. inotropes infusion
Learning points:
- Touch. Always attend and assess the patient thoroughly to identify the possible causes of elevated BP.
- Not all elevated BP requires anti-hypertensive in the first place. Always identify and treat the main cause. For example, if pain is the main problem, treat pain with analgesia then reassess BP and symptoms.
- Remember to document the assessment findings, what had been given and the management plan in the case notes. No documentation = never done.
@nota_perubatan
We always encounter patients with elevated blood pressure in the ward. What are some of the very common inpatient causes that need to be considered?
- Pain
- Agitation / Delirium
- Respiratory distress
- Acute urinary retention
- Sleep deprivation
- Chronic hypertension-related (hypertensive urgency / hypertensive emergency / undiagnosed hypertension / anti-hypertensive not yet restarted in the ward)
- Medications e.g. inotropes infusion
Learning points:
- Touch. Always attend and assess the patient thoroughly to identify the possible causes of elevated BP.
- Not all elevated BP requires anti-hypertensive in the first place. Always identify and treat the main cause. For example, if pain is the main problem, treat pain with analgesia then reassess BP and symptoms.
- Remember to document the assessment findings, what had been given and the management plan in the case notes. No documentation = never done.
@nota_perubatan
β€20
An important lesson learned today:
Newly discovered thrombocytopaenia without bleeding should not automatically prompt platelet transfusion. Identifying the underlying cause is more important, particularly in new-onset thrombocytopaenia. A peripheral blood film is a useful early investigation and may provide important diagnostic clues. Some causes of thrombocytopaenia, such as thrombotic thrombocytopaenic purpura (TTP), generally contraindicate platelet transfusion as it may worsen thrombosis, unless there is life-threatening bleeding.
#GIM@nota_perubatan
#ED@nota_perubatan
Newly discovered thrombocytopaenia without bleeding should not automatically prompt platelet transfusion. Identifying the underlying cause is more important, particularly in new-onset thrombocytopaenia. A peripheral blood film is a useful early investigation and may provide important diagnostic clues. Some causes of thrombocytopaenia, such as thrombotic thrombocytopaenic purpura (TTP), generally contraindicate platelet transfusion as it may worsen thrombosis, unless there is life-threatening bleeding.
#GIM@nota_perubatan
#ED@nota_perubatan
β€24π1
Good news, everyone!
Tired of digging through 200-page CPG PDFs during rounds? Stop scrolling and start healing.
AskCPG is your new AI-powered clinical assistant, designed to give you precise, evidence-based answers for your clinical practice in seconds, thus no manual searching required.
Rest assured, every piece of info is rooted from our evidence-based Clinical Practice Guidelines developed by MaHTAS. Trusted science, proven results.
How to get started:
1. Access the platform: Access it via the MaHTAS official portal or You can jump straight to https://cpg.qmed.ai/.
2. Ask your question: Type your clinical query in plain language (e.g., "What is the management protocol for dengue with warning signs?").
3. Get cited answers: Receive a concise, structured response with direct links back to the official CPG source.
This platform is built for the Malaysian Frontliner.
A huge shoutout to the team at QMed for developing this intuitive system. By collaborating with MaHTAS, theyβve made clinical guidelines faster, smarter, and easier to use at the point of care.
Give your clinical workflow an upgrade today: Try it out at https://cpg.qmed.ai/
#AskCPG #QMed #MaHTAS #ClinicalPracticeGuidelines #DigitalHealth #MedTechMY #kementeriankesihatanmalaysia
Shared from Malaysian Health Technology Assessment Section (MaHTAS) https://www.facebook.com/share/p/19JB9qxR56/
t.me/nota_perubatan
Tired of digging through 200-page CPG PDFs during rounds? Stop scrolling and start healing.
AskCPG is your new AI-powered clinical assistant, designed to give you precise, evidence-based answers for your clinical practice in seconds, thus no manual searching required.
Rest assured, every piece of info is rooted from our evidence-based Clinical Practice Guidelines developed by MaHTAS. Trusted science, proven results.
How to get started:
1. Access the platform: Access it via the MaHTAS official portal or You can jump straight to https://cpg.qmed.ai/.
2. Ask your question: Type your clinical query in plain language (e.g., "What is the management protocol for dengue with warning signs?").
3. Get cited answers: Receive a concise, structured response with direct links back to the official CPG source.
This platform is built for the Malaysian Frontliner.
A huge shoutout to the team at QMed for developing this intuitive system. By collaborating with MaHTAS, theyβve made clinical guidelines faster, smarter, and easier to use at the point of care.
Give your clinical workflow an upgrade today: Try it out at https://cpg.qmed.ai/
#AskCPG #QMed #MaHTAS #ClinicalPracticeGuidelines #DigitalHealth #MedTechMY #kementeriankesihatanmalaysia
Shared from Malaysian Health Technology Assessment Section (MaHTAS) https://www.facebook.com/share/p/19JB9qxR56/
t.me/nota_perubatan
β€26