alex.tan's New Writeups

April 3, 2003 (idea)

2003-04-03T08:23:13Z

On my day off today from working in the SARS ward, I get a call from an old friend now working in Sydney. She's asking me about our mutual friend, the doctor colleague of mine that I mentioned on a few days ago.

She asks me if he's in a coma. I struggle to find the appropriate words to say. I tell her he's still alive, that his prognosis is very poor. I want to tell her that he's not in a coma, he satisfies the criteria for brain death but I can't. I end up telling her he has "brain damage".

He was born in the same year as me. It's now close to a week that he has not displayed any neurological recovery. The only good thing going for his prognosis is that he is young.

He still is unresponsive to any physical stimuli. His family and fiance are still hoping for a miracle.

His death will be big news in Singapore - when? I cannot confirm.

It could have happened to any of the doctors here. Yours truly included.

Life is fragile

Brain death (thing)

2003-04-03T08:05:51Z

Brain death is the state where there is global ischaemia of the brain while the body is maintained through artificial ventilation and the heart continues to function. In the era of modern medicine, the state of brain death has been taken to be synonymous with death.

The diagnosis of brain death requires at least the following:
1. widespread cortical destruction - deep coma, unresponsive to all forms of stimulation.
2. brainstem damage - there must be an absent pupillary light reaction and the loss of oculovestibular and corneal reflexes
3. lower brainstem damage - indicated by complete apnea

The diagnosis of brain death should ideally be done by more than one senior physician, preferably those not primarily involved in the patient's care.

The principal reason to diagnose brain death is so that the patient's organs can be used for organ transplantation. It is largely accepted nowadays that a patient who…

March 31, 2003 (idea)

2003-03-31T08:38:04Z

Today is my birthday. I turn 27 today. I was supposed to be spending the day home with my parents in my hometown, Kluang - just an hour and a half's drive away from where I am in Singapore.

Instead, because of the SARS (Severe Acute Respiratory Syndrome) outbreak, I've been roped in to help out with the Infectious Diseases team who have understandably been overwhelmed with the huge amount of patients now warded in Tan Tock Seng Hospital with SARS. Over the last week or so I have been on the frontlines in SARS patient care in Singapore.

I have sent my share of patients down to ICU, I have admitted new patients, I have taken bloods, written up medication lists, done discharge summaries. I have seen cases ranging from Singapore's 4th and 5th new index cases to people who really shouldn't be admitted for SARS because they probably don't have it.

However, that's not why I'm rambling on here. I am not happy today because one of my friends is dying from SARS. He was a…

Aripiprazole (thing)

2003-03-25T03:38:36Z

One of the funkier new antipsychotic medications to hit the market. Like the other atypical antipsychotics, it has activity at dopamine and serotonin receptors in the brain. It is used in the treatment of schizophrenia.

A warning has gone out recently because of this drug's name. The '-azole' ending of this drug name makes this drug sound like it is one of the proton pump inhibitors (such as omeprazole, pantoprazole, lansoprazole) which are used in treating gastric ulcers. However, aripiprazole and these drugs are in an entirely different class of drugs altogether and confusing the two can lead to some really unnecesary side effects...

Severe acute respiratory syndrome (thing)

2003-03-25T03:21:46Z

Severe Acute Respiratory Syndrome or SARS is an emerging infectious disease that causes a type of atypical pneumonia.

Etiology

The initial outbreak is thought to have begun in the province of Guangzhou in China. From here, the infection is thought to have been brought to Hong Kong by a medical professor who eventually succumbed to the disease. He stayed at the Metropole Hotel in Hong Kong where he ended up infecting multiple people from all around the world, including especially a few people who subsequently brought the infection to Vietnam, Singapore and Canada.

SARS is now thought to be caused by a new, novel (and as yet unnamed) coronavirus that is spread by close contact with someone already infected with SARS.

In late May 2003, studies from samples of wild animals sold as food in the local market in Guangdong, China found that the SARS coronavirus could be isolated from civet cats. This suggests that the SARS virus crossed the…

Nad (idea)

2002-12-16T15:16:42Z

NAD is one of my favourite acronyms in the medical world. Depending on the context, it can mean "No Abnormalities Detected", "No Apparent Distress" and, my personal favourite, "Not Actually Done".

So ... when they come after you to sue you for negligence or whatever and they ask you, "So, Dr. so and so, when this patient Mr. J Smith died of a dissecting aortic aneurysm that you missed, you were the medical officer who first examined him and noted 'NAD' right beside the space for cardiovascular examination. Just what did you mean by that?"

... then, you will say, "I meant 'No Abnormalities Detected', of course", while wondering if you had really meant 'Not Actually Done' all those years ago ...