Burn day!!!

admitted second degree  50% burn over upper torso and face, electively intubated.

Q - "What is second degree burn?" - Mr. Hanafiah

Q - "What is parkland formula?" - Mr. Hanafiah

A - "Parkland formula is used to guide initial fluid resuscitation during the first 24 hours. The formula calls for 4 ml/kg/TBSA burn (second and third degree) of lactated Ringer's solution over the fast 24 hours. Half of the fluid should be administered over the first eight hours post burn, and the remaining half should be administered over the next 16 hours. The volume of fluid given is based on the time elapsed since the burn."

Q - "Why is it 4ml in parkland formula?" - Mr. Hanafiah

Q - "Does burn pt needs transfusion?" - Mr. Hanafiah

Q - "Does burn causes blood loss?" - Mr. Hanafiah

Q - "Tell us about inhalation burn?, how do you pick it up?" - Mr. Hanafiah

A - "Soot, carbogenous odor, coated black tongue" - Reg (can't recall who)

"Stridor comes late" - Mr. Hanafiah

Q - "Why is carbomonoxide dangerous?" - Mr. Hanafiah

Q - "How to treat carbomonoxide?" - Mr. Hanafiah

Q - "50% burn what is the prognosis?" - Mr. Azim

A - "80% Mortality [50% + age (30)]" - Mr. Azim

"infection is a big problem in burns!" - Mr. Hanafiah

zairul

SWORD

Ngoo had a busy night, just came back from Termeloh posting in full throttle. He presented a case of a man with worsening chronic left medial maleolus ulcer. ABSI right leg was 0.62 and left leg 0.7.

Q - "Why do you think its venous ulcer?" - Mr Hanafiah
A - "the location of the ulcer is at the medial aspect where the long saphenous runs...." - Ngoo

Q - "How do you treat venous ulcer?" - Mr Hanafiah
A - "Dressing, graduated compression stocking...." - Ngoo

Q - "Why is it call graduated compression stocking?" - Prof Razman

Q - "Does ABSI matter before starting patient on compression stocking?" - Mr Hanafiah

Case 2:
74 year old bed bound after a stroke two days ago presented with obstructive jaundice. Per abdomen no mass palpable. CT scan showed mass at head of pancreas with necrotic centre.

Q - "How does pancreatic mets to the brain look like?" - Prof Ismail

everybody looked puzzled and turn their faces away from Prof.

A - "I also don't know the answer, I just know how to throw question only" - Prof Ismail....... ha.....ha.......ha

Q - "Why do CT scan?" - Prof Ismail
A - "The answer for a surgeon is to know resectability" - Prof Ismail

Q - "What are the resectability criteria in pancreatic head of tumour?" - Mr Hanafiah
A - "encasement of portal veins, liver metastasis, size does not matter for head of pancreas......" - Ngoo

"If there is present of only one liver mets, it won't change the management. i.e. palliative stenting" - Prof Razman

Q - "Which stent is better for palliative case?" - Mr Azim