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

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

target body temp at birth is 36.5 to 37.5 degC

sniffling position

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

provide warmth/open airway/clear secretions/dry/stimulate

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

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

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


4.Space Invaders

5.Monkey Kong 3





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


Human body can endure.
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.

Fasting/ Ramzan ! In summers.

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