Friday, October 21, 2011
kite hanya merancang Allah yang tentukan :)
Wednesday, October 12, 2011
kek lapis biskut marie :p






Friday, September 30, 2011
left closed fracture of schapoid and styloid process of ulnar & radius...perilunate dislocation...huuuuu....
Perilunate dislocations (see image below) and perilunate fracture dislocations are the most devastating closed injuries of the wrist.[1, 2, 3, 4, 5, 6, 7, 8] They often are missed on initial evaluation, leading to devastating complications. These injuries occur as the final stage of a spectrum of injuries progressing around the wrist in a radial-to-ulnar direction.
In the setting of a high-energy wrist injury, radiographs must be scrutinized carefully for perilunate dislocation or one of its variants. Prompt open reduction with ligamentous repair or reconstruction is necessary to achieve favorable results. Posttraumatic arthrosis may result following these injuries irrespective of treatment, requiring a late salvage operation.
akibat tekanan yang hyperextension pada wrist leh la jadi cam nie....
view dari tepi plak..
Pure ligamentous perilunar injuries of the wrist are classified as lesser arc injuries, while the transosseous variants are regarded as greater arc injuries. The mechanism of perilunate dislocations has been described as a 4-stage process, as follows:
- First stage - The RSC ligament and the scapholunate interosseous ligament rupture.
- Second stage - Dislocation of the capitolunate joint occurs as the injury progresses through the space of Poirier.
- Third stage - The lunotriquetral interosseous ligament ruptures.
- Fourth stage - The lunate becomes dislocated.
This mechanism has been reproduced in a cadaver model by applying pronation and ulnar deviation on a hyperextended cadaver wrist.
haa tgk cmne tgn dia..
SURGICAL THERAPHY
Surgical options include the following:
- Closed reduction and casting
- Closed reduction and percutaneous pin fixation
- Open reduction and open ligamentous repair with internal fixation or with percutaneous pin fixation
The surgical treatment of choice is open reduction and ligamentous repair with percutaneous pin fixation.
Once informed consent has been obtained and the surgeon has again identified the affected extremity, the patient is taken to the operating room. The patient is positioned supine on the operating room table, and the affected extremity is placed on a radiopaque hand table. Because the duration of the procedure may be long, padding should be placed beneath the knees and heels, and the use of a Foley catheter should be considered. An upper arm tourniquet is applied, being well padded, and the tourniquet is inflated after the arm is prepared and draped.
Attention is turned first to the dorsum of the wrist, where a midline longitudinal incision is made and the extensor retinaculum is exposed.
See image below.
The extensor retinaculum is divided between the third and fourth dorsal compartments, and the dorsal wrist capsule is exposed. The dorsal radiotriquetral and dorsal intercarpal ligaments are identified. A radially based, dorsal V capsulotomy is performed, with the base of the V at the intersection of the dorsal intercarpal and radiotriquetral ligaments. This capsulotomy preserves these dorsal ligamentous structures, which are known to play a role in the stability of the wrist, as seen in the images below.
Through this capsulotomy, accurate reduction of the radiocarpal and midcarpal joints is accomplished. It is imperative that the scaphoid be contained securely in the scaphoid fossa and that the lunocapitate articulation be reduced completely. The lunate is derotated from its dorsal position and is stabilized with a 0.062 Kirschner wire (K-wire), which is directed from the radial styloid into the body of the lunate.[20] The lunate reduction is extremely important, because after the lunate is reduced, the remainder of the carpus can be reconstructed. See image below.
The scapholunate ligament is identified, and 1 of 2 methods is chosen for ligamentous repair. One option is the placement of 2 small suture anchors into the defect of the scaphoid proximal pole. This defect typically is created following avulsion of the scapholunate interosseous ligament. The accompanying suture attached to the suture anchors can then be placed through the scapholunate ligament, with the ligament secured once the scapholunate interval is reduced. See image below.
Alternatively, 2 small drill holes are created from the defect in the proximal pole, exiting at the waist of the scaphoid along its radial ridge. These drill holes are created with a 2-mm drill, and a 2-0 nonabsorbable suture is placed through the scapholunate interosseous ligament. Once reduction of the scapholunate interval is ensured, a pair of 0.045 K-wires is advanced from the scaphoid into the lunate. A third wire is passed from the midwaist region of the scaphoid into the waist region of the capitate. Once the reduced scapholunate interval is secured, the sutures may be tied. See images below.
Similarly, an attempt may be made to repair the lunotriquetral interosseous ligament, although generally this is technically difficult. The surgeon often resorts simply to pinning the lunotriquetral interval percutaneously. The midcarpal articulation is stabilized with the pinning of the scaphoid to the capitate.
In the transosseous variants of the perilunate dislocation, providing internal fixation of the fractures is preferable. Scaphoid fractures, for example, should be reduced and stabilized with a cannulated compression screw, as should capitate fractures. Radial styloid fractures, triquetral fractures, and smaller varieties of capitate or scaphoid fractures may be better suited for reduction and stabilization with percutaneous K-wire fixation. The placement of percutaneous K-wires, as well as the assessment of the midcarpal joint reduction or of the scapholunate interval reduction, is carried out with intraoperative fluoroscopy.
Once the perilunate dislocation or the perilunate fracture dislocation has been reduced and stabilized successfully, attention is turned to the volar aspect of the wrist. An extensile carpal tunnel approach is used to expose the volar wrist capsule, and the carpal tunnel is released. A transverse rent in the volar wrist capsule is routinely found and should be repaired with 2-0 nonabsorbable suture. See image below.
The tourniquet is released prior to closure, and the wounds are closed once hemostasis is obtained. A sterile dressing is applied, followed by a well-padded volar plaster splint. External fixation should be considered in the setting of marked swelling or open wounds. It should also be considered when patient compliance is a concern or fixation stability is in question.
Following surgery, the hand should be elevated for 48 hours and the neurologic and vascular status should be monitored. Overnight admission to the hospital is recommended. A small pullout drain generally is recommended for both wounds. Sometime between postoperative days 3 and 5, the dressing and splint should be removed so that the wounds can be examined. At 10-14 days, the sutures are removed, and a short arm cast is applied. See radiograph below.
Following open reduction and ligamentous repair of the perilunate dislocation, the cast is maintained for 3 months. Radiographs are obtained periodically to ensure maintenance of midcarpal and radiocarpal reduction. Upon cast removal, the patient is placed in a removable splint, and gentle range-of-motion exercises are begun. Splinting is continued until 6 months postsurgery. Full activity is not renewed until 8 months postsurgery.
ok thats all...article nie diambil dari...rujukan yang lebih lanjut leh search sendiri yer!!
http://emedicine.medscape.com/article/1240108-workup#a0721
p/s : kepada yang berkenaan : semoga cepat cihat.. :)
Sunday, September 11, 2011
bukuku bercinta
ada orang kata orang yg bercinta kat fb nie tipu je..cinta palsu..yeke?nape ada org leh kawen walaupun kenal kat fb kan..palsu ke??..em ada orang kate org bercinta kat fb nie sekadar suke2 carik pakwe or awek..padahal masing2 d
a ada awek n pakwe..tapi yeke??..tapi skrg ramai org yg x rapat dlu2, jd rapat sbb ada fb..org yg x knal jd knal..ramai kwn leh share
minat dlm fb..
Cinta Muka Buku - Najwa Latif
Kita berkenalan hanya dalam laman muka bukuArtis/penyanyi: Najwa Latif
Kau hantar petanda suruh aku terima kamu
ooh.. Hati ku rasa sesuatu..
Dan pabila kau kata kau mahu jumpa aku
Ku gelisah berdebar hati rasa tak menentu
oohh.. Kenakah rasa itu..
Bagaimana harus bersua
Ku rasa gementar tapi bahagia
Perlukah kita cari peluang pertama
Walaupun kita tak pernah berjumpa
Banyak persoalan yang berada di minda
Banyak tanda tanya dan juga kata kerja
Otak kata jangan hati pula kata ya
Hidup tak menentu adakah ini cinta
Banyak soalan banyak juga jawapannya
Kata hati dan rasa tak dibiar saja
Setiap yang berlaku ada kebaikannya
Harus pejam mata dan cuba apa saja
Pabila kau renung tajam-tajam mata aku
Ku rasa sesuatu rasa yang ku tak tahu Oooo…
Ini cinta remajaku
Dan pabila kau katakan kau suka aku
Ku terdiam terkedu tak tahu mana nak tuju Oooo…
Itulah cinta yang satu, cinta di muka buku..
Bagaimana harus bersua
Ku rasa gementar tapi bahagia
Perlukah kita beri peluang pertama
Walaupun kita tak pernah berjumpa
Banyak persoalan yang berada di minda
Banyak tanda tanya dan juga kata cinta
Otak kata jangan hati pula kata ya
Hidup tak menentu adakah ini cinta
Banyak soalan banyak juga jawapannya
Kata hati dan rasa tak dibiar saja
Setiap yang berlaku ada kebaikannya
Harus pejam mata dan cuba apa saja
Pabila kau katakan kau suka aku
Ku terdiam terkedu tak tahu mana nak tuju Oooo
Itulah cinta yang satu
Cinta di muka buku

Saturday, January 22, 2011
Thursday, January 20, 2011
Practical Lagi dan Lagiiii...
22/1/2010 - 5/2/2010
HOSPITAL KUALA KRAI
6/2/2010 - 19/2/2010
HOSPITAL RAJA PEREMPUAN ZAINAB II (HRPZ II)
19/2/2010 - 25/2/2010
CUTI SEMESTER
26/2/2010 - 9/3/2010
KELAS TEORI
12/3/2010 - 22/4/2010
HOSPITAL KUALA KRAI
Jadual klinikal semester ni memang la terpaksa aku ke sana ke mari..takpe2
"Pengalaman la yang banyak Mengajar"
hehe sejak bila la aku asyik nak berpujangga nie..ish sengal3..
Semoga klinikal kali nie aku tak diketuk dan dikelentong oleh pesakit2 mental, aku tak pengsan bila terima kes accident kepala putus2,tgn putus2..aku tak lemah semangat dan bermimpi pelik2 lepas balik keje..aminn
semester 7
Assalamualaikum semua..
MEDICAL SURGICAL 9
PERAWATAN MENTAL
KECEMASAN DAN TRAUMA
MPW115
PENGAJIAN ISLAM
Tu adalah subjek yang diambil bagi semester 7 tahun 3 nie..
Perawatan Mental ( Psychiatric )
Haa first dengar je psikiatrik konpem dah pikir pasal "orang giler"...kan3 belajar ilmu mental nie memang best sebab dalam sedar tak sedar semuanya orang kat dunia nie boleh jadi normal dan tak normal dalam sesuatu masa..dalam kata mudah nyer semua orang penah rasa stress,depress,riang gembira tak tentu pasal, takot pada benda2 yang tak sepatutnya..takut tinggi,takut menda keras, takut air la..trauma macam2 lagi..haa tu semua boleh jadi bila kite tak mengawal mental kite dengan baik..heh3 yeke3..beza pesakit mental dengan orang biasa macam kite orang sakit mental tu dia cuma tak dapat mengawal mental dia dengan sempurna..mereka semua tak salah..sebab diaorang sume tu sakit dan tak dijaga..bila jumpa orang sakit mental nie korek tong sampah cari makanan kite lak lari2 dari dia..aku akui aku jugak macam tu dulu..bila dah belajar..aku pikir buat pe nak lari..dia jadi macam tu sebab takde orang yg jaga..Allah yang takdirkan dia sakit mental..pe salah nya kite belikan dia makanan dan kasi kat dia kan3..mane tau satu hari kite ditakdirkan berada di tempat dia..pikir-pikirkanlah~
Kecemasan & Trauma
Memang aku akui subjek yang nie agak berat nak belajar..sebab belajar menyelamatkan nyawa orang..tindakan kite dalam beberapa saat hingga 3-4 minit sahaja untuk membantu pesakit tu bernafas semula..belajar pembahagian2 kes2 di kecemasan dalam sistem "triage"..iaitu zon hijau,kuing,merah,putih..dan yang paling best belajar pasal "post mortem" dalam kes medicolegal.."post mortem" iaitu bedah siasat..belah mayat dari kepala ke kaki untuk mendapatkan bukti dan sample2..tengok gambar pun dah seram di belah nyer orang tu macam belah ayam kuarkan satu2..pastu jahit balik..alahai..hai..hai..lemah semangat..keje2 ahli forensik, doktor dan team2 bhg kecemasan..pastu belajar jugak pasal sistem "OSCC" One Stop Crisis Centre..tempat nie ada kat bhg kecemasan jugak iaitu bagi kes2 yang melibatkan rogol,cabul,liwat,keganasan rumah tangga dan macam2 lagi kes2 yang melibatkan maruah mangsa..mangsa akan diperiksa di bilik "OSCC" nie la...bagi kes2 kematian yang "accident" body sume dah hancur2 tu pun bawak ke sini untuk diuruskan..duduk keje kat kecemasan nie memang kena "kuat semangat" nak tengok sume2 yang tak dapat dibayangkan tu...so aku kena "BERANI"..
Pengajian Islam
Semester nie kami kena belajar subjek Pengajian Islam..aku bersyukur dapat kolej nie sebab banyak subjek2 agama diajar..semester lepas2 dah belajar fiqh & ibadah,akidah dan semester nie pengajian islam yang merangkumi semuanya...kelas diajar oleh ustaz awie..ustaz zawawi namanya..best ustaz nie sebab banyak merungkai masalah2 dan soal jawab kami walaupun tak berkaitan dengan pelajaran..contohnya soal hukum rambut yang disanggul tapi bertudung, mandi wajid, soal kawin, soal hubungan dengan bukan muhrim, hukum kami sebagai nurse perempuan merawat pesakit laki2, cara2 mendidik anak2, isu akhlak, isu buang anak, cara berpakaian dan macam2 lagi..ustaz jugak tegur kami dengan gaya sindiran..banyak perkara yang kite tak sedar telah dilakukan tanpa kite sedar menda tu berdosa..contohnya hubungan laki dan perempuan "couple"..kata2 seorang sahabat tentang couple iaitu semakin mesra kite sebelum nikah semakin hambarlah hubungan kite selepas nikah..sebab kemanisan berumah tangga tu dah xde..hehe dah2 udah lari tajuk nie..ape2 pun akan aku ingat kata2 nie sampai la aku diijab kabulkan..aminn satu hari nanti...bersyukur aku berada di kolej nie..dikelilingi sahabat2 yang selalu menegur dan nasihat..Alhamdulillah~
Monday, January 10, 2011
Saturday, January 8, 2011
Senyum :)
Pastinya akan damai hatimu kerana merasakan Allah tidak mentadbirkan segalanya untuk sesuatu yang sia-sia..bukan Allah tidak tahu deritanya hidupmu..patahnya hatimu..tapi mungkin itulah yang Dia mahu..kerana Dia tahu..hati yang sebegini selalunya lebih mudah utnuk dekat dan akrab denganNya..
Ingatlah alangkah manisnya ujian Allah..lantaran Dia yang menguji kita dan Dia yang membantu kita menghadapinya..
..InsyaAllah..
Every time you feel like you cannot go on
You feel so lost and that you’re so alone
All you see is night
And darkness all around
You feel so helpless you can’t see which way to go
Don’t despair and never loose hope
Coz Allah is always by your side
Insha’Allah Insha’Allah Insha’Allah
You’ll find your way
Insha’Allah Insha’Allah Insha’Allah
You’ll find your way
Every time you commit one more mistake
You feel you can’t repent
And that it’s way too late
You’re so confuse
Wrong decisions you have made
Haunt your mind and your heart is full of shame
Don’t despair and never loose hope
Coz Allah is always by your side
Insha’Allah Insha’Allah Insha’Allah
You’ll find your way
Insha’Allah Insha’Allah Insha’Allah
You’ll find your way
Turn to Allah
He’s never far away
Put your trust in Him
Raise your hands and pray
Oohh Ya Allah
Guide my steps don’t let me go astray
You’re the only one who can show me the way
Show me the way
Show me the way
Show me the way
Insha’Allah Insha’Allah Insha’Allah
We’ll find our way
Insha’Allah Insha’Allah Insha’Allah
We’ll find our way
Insha’Allah Insha’Allah Insha’Allah
You’ll find your way
