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Friday, June 28, 2019

Sunday, June 23, 2019

Orogastric tube measurement

Neonatal Resuscitation Program (NRP 7th edition) : The Summary


NRP Book Online, for Pakistani Region by AAP
https://reader.aappublications.org/textbook-of-neonatal-resuscitation-nrp-7th-ed/1



QUESTIONS TO ASK BEFORE EVERY BIRTH:
1. what is the gestational age?
2. is amniotic fluid clear?
3. how many babies are expected?
4. are there any other risk factors?

Every birth should be attended by 1 skilled person  in the initial steps of newborn care and PPV, whose only responsibility is the management of the newborn.
If there are risk factors, there should be 2 qualified persons attending the birth.
In case of need for resuscitation, qualified team should be immediately available having skills in passing ETT,chest compressions, emergency vascular access, and medication administration.



Equipment check list
https://reader.aappublications.org/textbook-of-neonatal-resuscitation-nrp-7th-ed/38


target body temp at birth is 36.5 to 37.5 degC

sniffling position
https://www.maskinduction.com/uploads/3/1/6/4/31643965/an-infant-in-the-sniffing-position_orig.jpg

drying is not necessary in a PreTerm <32Wks gestation, who may be wrapped in a
food grade plastic bag.

5 STEPS of NEWBORN CARE RIGHT at BIRTH
provide warmth/open airway/clear secretions/dry/stimulate

then,
you have to access baby breathing(good;crying/apneic/gasping?)
& the baby heart rate using stethoscope in 6 seconds (6x10= ___) (cut off 100bpm)

OXYGEN DELIVERY EQUIPMENT:
Free Flow Delivery Devices(tubing/mask/flow inflating bag and mask, T piece resuscitator and mask/open reservoir(tail) on self inflating mask)
CPAP tightly held flow inflating bag/T piece resuscitator/


If there is meconium stained amniotic fluid, suction to be done first, before drying.

If there are "additional" risk factors, newborn be given care at the radiant warmer.


indications for positive pressure ventilation:
apnea/gasping/HR <100bpm / O2 sat low despite free flow O2 or cpap


spO2 probe be placed on right hand or wrist ( preductal spO2)


Initial AMBU at:
21% FiO2  (if gestational age <35 wks, then upto 30% Oxygen)
10 L/min 02 flow
spO2 probe attached
40 to 60 breaths/min (Breathe , Two, Three)
PIP 20cmH2O
PEEP 40 mcH2O



HEART RATE may be evaluated after 15 secs of starting PPV.


Ventilation Correction Steps
MR    SO   P   A
















Friday, June 21, 2019

Usb to vga adapter

Fresco logic


 Invoke HKEY_LOCAL_MACHINE\SYSTEM\CurrentControlSet\Services\intelppm, and change "Start" registry value from 3 to 4, and then reboot. This disables the Intel C state management. You need a reboot to let registry setting take effect.

Tuesday, June 18, 2019

Insulin and dextrose infusion for hyperkalemia

Since we do not have 50 percent DW available, so if we wish to use 10%DW we can divide insulin dose by 5

And 1 hr infusion mah be enough., repeat as needed.



Hyperkalemia management harriet lane



Thursday, June 13, 2019

Saturday, June 8, 2019

Typhoid fever guidelines aga khan university

https://drive.google.com/file/d/10Xe2gEEkd0-YMbKs9SllBsQWRASUvHSi/view?usp=drivesdk

Meethi Eid



The strong plants

Roses, shrubs, have immense strength to withstand harshness.
I see that they bear hottest sun and warm winds without water for days, in a small pot, they withstand heavy storms and rains, their leaves do not give up in shaky cold weathers.
Such strong plants.
They bear all.
And then , in the extreme of weathers, all at once, they give beautiful flowers .

When other plants wilt, when humen are hiding indoors due to weather extremes, roses stand it all outdoors.

Monday, June 3, 2019

Gamezone 118 in 1 retro

1.Super Jack


2.Paper Boy


3.Defender


4.Space Invaders


5.Monkey Kong 3


6.Gradious


7.Galaga


8.Arkananoid


9.1942


10. Super Contra


11. Duck Hunt


12. Sky Destroyer


13. Pac Man


14. Bomberman


15. Track & Field


16. Tetris II


17. Millipede


18. Pinball


19. Kung Fu


20. Dig Dug


21. Wild Gun Man


22. Warp Man


23. Lunar Ball


24. Golf


25. Exitebike


26. Road Fighter


27. F1 Race


28. Lode Runner


29. Battle City


30. Raid On Bay


31. Mappy


32. Pooyan


33. Tennis


34. Base Ball


35. Clu Clu Land


36. Balloon Fight


37. Ice Climber


38. Binary Land


39. Mario Bros


40. Five Dots Chess


41. Hogan Alley


42. Jewellery


43. Burger Time


44. Son Son


45. Mach Rider


46. Sqoon


47. Chinese Chess


48. Gyrodine


49. Wrecking Crew


50. Adventure Island


51. Route 16


52. Star Force


53. Exerian


54. Formation Z


55. Macross


56. Combat


57. Circus Charlie


58. The New Type


59. Lone Runner 2


60. Monkey Kong


61. Zippy Race


62. Wrestle


63. Popeye


64. Nuts & Milk


65. Devil World


66. Chack Pop


67. Front Line


68. Hyper Sports


69. Urban Champion


70. Arabian


71.Monkey Kong 2


72. Galaxian


73. Joust


74. Knights Fight


75. Karateka


76. City Connection


77. Dr. Mario


78. Leagand Kage


79. Spartan X


80. Gemios


81. Galc


82. Clay Shoot


83. Thexder


84. Challenger


85. Door Door


86. Twinbee


87. Aladin


88. Mickey Mouse


89. Bird Week


90. 10 Yard Fight


91. Ninga III


92. Star Soldier


93. Badminton


94. 100m Dash


95. Green Island


96. Power Contra


97. Power Mario


98. Golden Runner


99. City Road


100. Ringside


101. Building Wall


102. Long Jump


103. Coco Island


104. Space Contra


105. Sun Fan Mario


106. Bridge Fighter


107. Horse Circus


108. 100m Hurdles


109. Fighter Contra


110. Swimming Mario


111. Javelin Throw


112. Burther Contra


113. Skeet Shooting


114. Triple Jump


115. Archery


116. High Jump


117. Jump Island


118. Fire Fighter


Endurance

Human body can endure.
Anything.
It can sustain in all environments.
It can endure all hardships.
This is an old teaching, from sufis, saints, and a message from the lives of all great men in history: man can be whatever he wishes to be.
Victor Frankl is of the view that as long as there is meaning in any struggle, a fascinating end point, humen body can endure under worst circumstances.
He says that it is man's search for meaning in life that matters.
Contrary to Freud, who argued that it's mans search for happiness in life.
But, in combining both if the arguments its perhaps man's search for meaning , and then the happiness in life.

Recollections....
Fasting/ Ramzan ! In summers.

Summers of 2014 and Ramzan, in June and July, then 2015, and then 2016.....
Residency, specially, CMO duties.......