MY LAST POSTING IN HOUSEMANSHIP finally It's ED posting !

 Bismillahirrahmaanirrahim

As I'm writing this, I know this is the last week in my ED posting in my elective posting. Can't believe I left this blog of mine unattended for 2023 haha it must be a miserable year to pass through tho. 

And I decided to write this while I recharge my introverted soul to write something at least in this blog. 

Now I'm in my last posting ED, the one that I enjoyed so much even tho it was one of the most tiring and challenging postings.  We have 3 shifts in ED for HO : 7am-7pm, 10am-10pm, 10pm-10am.

ED HKL

In ED we have few zones, compared to my medschool days in Kuantan, which is triple larger than HTAA. Sometimes, at this rate, I really want to change my hospital to HTAA Kuantan haha.

Imagine we have 2 red zones.

• Resus 1 - all respiratory cases we treat here. have 10 beds but can occupy up to 22 patients if we "sumbat" like in a sardine can.
• Resus 2(Amber zone) - all polytrauma MVA cases, MI with ongoing chest pain or in shock, dengue in shock, overdose and ingestion cases and other miscellaneous cases. Can fill up to 18 beds.  Most of the time this is the most 'pecah' zone. I cried twice after working in this zone because it was so overwhelming with less manpower. 
• Yellow zone - less severe trauma cases, dengue not in shock, ACS.
• Yellow psychiatry - all PSY not overdosed cases, the schizo, the aggressive case all put here, can fill up to 8 patients. It's my least favorite station, and it gives me a headache.
• Green zone for all mild cases.
• Observation zones - Yellow extensions, Yellow Observations, Isolation ward 1/2A/2B/2C
• Decon area - for active TB or COVID cases
• Paeds ED in HTA - 2 weeks

Resus 1 - for all respi cases 

Resus 2 - the busiest zone most of the time 

Yellow Zone peads ED HTA - HO allocated only in YZ in PED

ED HKL is one of the large ED in Malaysia, but for now, half of the departments are under renovation. I cannot imagine those days when ED was not under renovation, the space was so much larger compared to my time. I can't imagine because even this small space we can't keep up with the number of patients coming in every single hour. And I was right, according to my senior who just came into ED HKL from ED in another hospital, they also said ED HKL is one of the busiest ED in Malaysia (but I think ED HTAR would be busier than us tho, dunno cuz I have never been there, but the rumours was like that lah). The yellow zone and the resus 2(Amber zone) especially, sometimes it was soooo crowded that we couldn't even pass through cuz the mobile beds were so close to each other.

But sometimes there are those days when the number of patients is bearable, especially on weekends and long holidays. That is why I like to work on the weekend compared to Monday because it was a 'Monday Blues' ISTG. 

I learnt in ED how to clerk and manage cases as fast as possible because there are so many patients to look for. MO here are also very independent. Even the specialist would be the one who will clerk, insert branula and manage the patient alone. Everything must be done fast so that the patient can be saved and the admission will be expedited. I remember someone told me that in PAC we have to insert all the large bore branula, it's not really hard cuz their veins will be so prominent in pregnant ladies, while in ED all green lines must be inserted - fast, but in different situations - dehydrated/unconscious patient with collapsed veins where most of them come with unstable conditions. 

So far ED is one of the most 'thinking about houseman' posting that I've been going through. We got 1 hour of rest to eat and solat. And the only posting that provides free courses throughout our 4 months here. 

The courses that we attended for free :
1. Basic Life Support - I learn how to CPR/put on AED
2. Basic Trauma Life Support - same in BLS but in trauma patient
3. Dengue - a very detailed version of ED management of dengue, I learnt a lot here even though I came from a dengue ward during medical
4. Transfer of critically ill patient(TOCIP) course
5. Advanced Cardiac Life Support - we learn how to shock a patient/ how to do transcutaneous pacing in severe bradycardia cases
6. Airway course - learn how to intubate patient by using video laryngoscope and direct laryngoscope
7. E-FAST course - learn how to do FAST scan in trauma patient

We need to finish the course and have an exam after each course. 

Our ACLS course was done in the Simulation Ward in SCACC HKL

ACLS exam after the course which is one of the most nerve-wracking exam in all courses

In ACLS we are examined by Emergency Physicians with a real-case scenario

In ACLS we learn about the defib machine and how to use it in different settings - synchronized cardioversion, transcutaneous pacing, etc

In every course, the department will involve all staff like HO, MO, MA, staff nurses because all have different roles in managing real patient 

Equipments in Airway course

Video laryngoscope simulation by facilitator

Exam in real case scenario in Airway course 

We also learn about ventilator settings - the hardest of all

Compulsory end-of-course picture ! Airway course 

We learn how to transport patients in TOCIP course

BLS course

E-FAST course in trauma patient

The bosses are so nice and almost all like to teach us. I can call them a family. Emergency physicians(specialists) are like our parents, our Medical assistants and nurses are like our brothers and sisters, and our Medical officers are like our teachers.

One of the memorable night shift in resus 2 with my fav MO + MA + SN

Drinks bought by my fav MO paeds ED Dr Adrian

Grand Ward Round involving all staffs - EP,MO,HO,MA,SN on every Monday/Thursday morning. The topic is selected based on any interesting real case from the night shift before 

We are allowed and taught how to do certain procedures that I can't do in the other postings such as intubation, arterial line insertion, pleural tapping, peritoneal tapping, pericardiocentesis(done by EP and MO not me haha). 

Pericardiocentesis

My 1st arterial line in Resus 2 on intubated severe DKA patient, also I remember this is my first intubation Alhamdulillah

My 2nd last art line 

my last art line on my last night shift in ED

1st time to set up the transcutaneous pacing with my colleagues in a severe bradycardia 2 to extensive MI patient in Resus 2

This is my first encounter with Metalyse - IV medication for KILLIP 4 MI patients, sometimes we give Streptokinase in certain conditions. FYI this meds cost us about RM3k for each bottle.

In certain cases that fulfilled the criteria for PCI in IJN, sometimes HO need to accompany the patient to the IJN with an ambulance for rescue PCI

Of course, there are some challenging days when I felt that it is so much for me and I just want to finish this posting eagerly haha

Accompany intubated/unstable/delirious patients to CT scans are sometimes is the only time I can sit down in the whole 12 hours of working - countless stroke protocols with CT brain

Urine toxicology - one of the most common tests done in psychiatry patients. The challenging parts of taking of PSY corner in Yellow zone are sometimes you are handling aggressive patients that need sedation and restrains. I don't mind clerking and taking care of suicidal patients but really don't like dealing with aggressive patients cuz they might harm me lol that's why I'm so grateful that this station got 1 male MA to standby most of the time

Whatever happened before, I am truly grateful for this posting, Alhamdulillah. 

I will add some pics later. Thanks for reading !