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🚨 ACCS XI 2026 Registration Update Thank you for the overwhelming response! ⚠️ Only 20 participant slots remain for the 11th Acute Cardiac Care Symposium (ACCS XI) 2026. 📣 The Pre-Symposium Basic Echocardiography Workshop (ECHO) is also almost full, with only 3 slots remaining. If you have not registered yet, we encourage you to secure your place as soon as possible. ⸻ 🫀 11th Acute Cardiac Care Symposium (ACCS XI) 2026 📅 14 August 2026 – Pre-Symposium Basic Echocardiography Workshop (ECHO) 📅 15–16 August 2026 – ACCS XI & ECG Masterclass 📍 AC Hotel by Marriott Kuantan, Pahang 🎉 Special Offer: Register 5 delegates and pay for only 4 (4+1 FREE registration). 🏨 Special Room Rates for ACCS XI Delegates Book your stay at the exclusive ACCS XI delegate rate: https://app.marriott.com/reslink?id=1773905610910&key=GRP&app=resvlink Organised by the Pahang Heart Association, in collaboration with Tourism Pahang (Visit Pahang Year 2026), with support from NHAM, MMA, our industry partners, and MedTweetMY. 📝 Register here: Main Congress (15–16 August 2026) https://docs.google.com/forms/d/1sG7I4yeyClA2agXE3VFTtd4w487AMxq4rM46wbZwrKc/edit Pre-Symposium Basic Echocardiography Workshop (14 August 2026) https://docs.google.com/forms/d/1sG7I4yeyClA2agXE3VFTtd4w487AMxq4rM46wbZwrKc/viewform?edit_requested=true 📌 Please refer to the attached flyer for the full programme and registration details. We look forward to welcoming you to Kuantan!

APLS screening

ENA panels

Reaching 5th posting, currently in ortho. I literally the most stupid HO in ortho😂 I don't like ortho, even forgett those muscles whatever.. Keen to go for medical as floating..doakan everything smooth.. It looks so different when they check albumin to determine for high protein diet as it affects the healing process. While in medical, hypoalbuminemia can caused by a lot of things, esp liver and esrf. Hence we suggest for high protein diet.. even give IV human albumin if too low.

Tips If having difficulty to insert NG tube, can put it in freezer first. Then try again, insyaallah masuk

https://codeblue.galencentre.org/2026/03/house-officers-are-treated-like-modern-slaves-dr-ghazali-ahmad/

Poor R wave progression Normally, the R wave should increase in amplitude from V1 to V5/V6. 🧶 ECG features of poor R wave progression - R wave height ≤ 3 mm in V3 - Lack of gradual increase in R wave height from V1 to V6 🧶 Causes - Previous anteroseptal MI - Left Ventricular Hypertrophy (LVH) [often due to hypertension / aprtic stenosis] - Left bundle branch block (LBBB) - Dilated cardiomyopathy - Chronic lung disease (e.g., COPD) - May be a normal variant - Misplacement of ECG leads (leads V1 and V3 reversed) ⭐️ Poor R wave progression is not specific or diagnostic for heart failure. Some patients with Poor R wave progression have no heart failure or structural heart disease at all. It may warrant further investigations e.g. Echocardiogram.  Further reading: https://litfl.com/poor-r-wave-progression-prwp-ecg-library/ #ECG@nota_perubatan

Budesonide suspension for neb budesonide

‼️Neonatal Resuscitation‼️ 1️⃣ Initial Assessment ❗i. Term vs Preterm neonate? 🔅 both has different PPV requirement (see step 4) 🔅 some ddx are more commonly associated with preterm ❗ii. Tone, breathing, crying. 🔅 if good: proceed with routine care 🔅 if poor: proceed to 2. 2️⃣ Do this 5 Initial Steps: ❗i. provide warmth ❗ii. put baby in sniffing position ❗iii. clear airway with suction ❗iv. dry the baby with towels ❗v. try to stimulate baby to encourage crying, breathing 3️⃣ Evaluation after Step 2: ❗i. respiratory effort ❗ii. spo2 (60 - 65% in 1st min) ❗iii. heart rate 🔅 if good breathing effort, heart rate >100 bpm, but spo2 not within range: supplemental o2, spo2 monitoring, consider CPAP 🔅 if poor breathing effort OR heart rate <100 OR CPAP fail to increase spo2: proceed to PPV (step 4) 4️⃣ Positive Pressure Ventilation ❗i. Adjust flowmeter to 10L/min ❗ii. Set inflation pressure: 🔅 term: 20-25 cmH20 🔅 preterm: 5 cmH20 ❗iii. Set oxygen concentration: 🔅 term: 21% 🔅 preterm: 30% ❗iv. Deliver PPV at rate of 40 - 60 breath per minute, evaluate after 30 seconds (Step 5) 5️⃣ Evaluation post PPV: Heart rate 🔅 if heart rate > 100: post resuscitation care 🔅 if heart rate < 100: proceed with corrective steps (Step 6) 6️⃣ Corrective step: MRSOPA ❗M - Mask adjustment ❗R - Reposition airway .............................................. ( Re - attempt ventilation. Increase in HR should be evident in 15 seconds) .............................................. ❗S - Suction ❗O - Open mouth .............................................. ( Re - attempt ventilation. Increase in HR should be evident in 15 seconds) .............................................. ❗P - Increase pressure (PPV) 🔅 term baby: maximum 40 cmH20 🔅 preterm baby: maximum 30 cmH20 .............................................. ( Re - attempt ventilation. Increase in HR should be evident in 15 seconds) .............................................. ❗A - Airway intubation: ETT tube, LMA After breathing secured, proceed to next evaluation, step 7. 7️⃣ Evaluation after MRSOPA: Heart rate 🔅 if heart rate > 100: Post resuscitation care 🔅 if heart rate < 60: Start chest compression (Step 8) 8️⃣ Chest Compression ❗i. increase FiO2 to 100% ❗ii. 3:1 (compression:breathing) ❗iii. for at least 60 seconds 🔅 total 90 compression to 30 ventilation per minute 🔅 rescuers may consider higher ratio (eg 15:2) if arrest believed to be of cardiac origin 9️⃣ Evaluation after chest compression: Heart rate 🔅 if heart rate > 100: post resuscitation care 🔅 if heart rate < 100: continue ppv 🔅 if heart rate < 60: proceed to step 10, give IV epinepherine while continuing chest compression 🔟 IV Epinephrine ❗i. Route: 🔅 ET tube: Unreliable absorption, less effective. Give while establishing UVC 🔅 UVC: Preferred method, but requires skills. ❗ii. Dose: 🔅 ET Tube: 0.5 - 1.0 ml/kg 🔅 UVC: 0.1 - 0.3 ml/kg + 1mL NS flush 🔅 repeat dose every 3 - 5 minutes ❗iii. Reassess after 1 minute of chest compression + ventilation ❗iv. Volume expander (isotonic crystalloid) or blood product should be considered if suspect hypovolaemia (pale, weak pulse)

Electrolyte imbalances

Some hosp, stabilise first, watch out first time then scope. Some hosp, can go for urgent endoscopy. A bit confused here sbb first depends of the skills of operator, second depends on the condition of the patient. There's risk unable to secure the bleeder as poor visualisation kalau buat during active bleeding. Usually if unsure what type of ugib, go for pantoprazole first.

My MO ada share, waktu kat Sabah sarawak, they give EES to ugib pt. EES -> pro kinetic agent, motilin receptor agonist -> helps in gastric emptying So in this article, diorang ckp kalau ugib bagi EES, helpful to provide better exposure during endoscopy. https://pmc.ncbi.nlm.nih.gov/articles/PMC3793469/

Since here more to random sharing + my medschool notes in here, So I create tele channel for Paeds. I don't create surgery, o&g channel tele cuz maybe Im not a reader in that field..😅 Paeds: https://t.me/medx2467