MEDTECH INTERNSHIP SHENANIGANS

LAYING THE FOUNDATION — WHAT TO READ BEFORE INTERNSHIP 🥼 LONG TIME NO UPDATE! Hello po Interns! Many have been asking in my dms on what to prep or read before deployment for duty. Very gasgas na line and you might hear it all the time, but it’s always the BASICS AND MUST KNOWS I highly reco watching doc jem’s tiktok vid about it, which is MTLE-centered but the insight’s applicable to internship prep as well https://vt.tiktok.com/ZSBS1b9WY/ BASICS: these are the foundations that you should have mastered or understood by now Example PHLEB: most appropriate site for venipuncture, proper labelling HEMA: blood smear, microscopy CC: serum vs. plasma SERO: TTIs CM: proper collection of specimens, BACTE: staining principles, different media types HISTO: tissue processing BB: blood typing, component prep, deferrals MUST KNOWS: these are the critical values, pre- and post- analytical precautions Example PHLEB: foot extraction, is it allowed or not? HEMA: machine showed an abnormally inc/dec blood cell, what to do next? CC: hemolyzed samples, accept or reject? SERO: window periods CM: urine dipstick principles BACTE: specimen handling and transporting HISTO: temperatures for waterbaths, fixation, etc. BB: discrepancies, specimen rejection Be familiar also with our NRLs and learn about the principles of each machine used (magkakaiba po per laboratory and this will be discussed by your staff) For me, it’s also good to have a read sa quality control lalo na sa Levy-Jennings. Again, shamlesd plug, I have made a quick note about it here: https://t.me/+nei1VYivDDM0NGE1 Honestly, you don’t have to overthink internship kasi matututo rin kayo in the long run. Basta ang golden rule sa internship ay ASK IF YOU DON’T KNOW WHAT YOU ARE DOING. My dms are always open for any queries and I will try my best to help! My contacts are here: https://linktr.ee/brainrotgaIore Sharing my favorite verse as well for motivation 💗 “Stretch out your hand to heal and perform signs and wonders through the name of your holy servant Jesus” Acts 4:30 Have a fruitful internship and God bless everyone! Love you all 🫶🏼

Kapag nagsasalin ng dugo sa tube, if may bubbles sa syringe, wag niyo na isali kasi minsan yun ang cause ng hemolysis. This is how I label the tubes: Patient Name, Age/Sex DOB Time of Extraction Date of Extraction MTI Surname Ang turo sa amin, basta may nakta kayong ugat na sa tingin niyo pwede kumuha, go, no one is stopping you. Personally, I experienced extracting blood sa forearm, sa paa, sa legs, other than antecubital. I never tried arterial kasi natatakot ako but for experience’s sake, I always assist the staff who does it. I also get days where all my extractions fail and I assure you, that’s okay! May mga araw na sablay talaga tayo but we should always make the most of it, volunteer to ward if you have to para matuto kayo. Do it with your partner or do it alone. Nothing’s more satisfying than a successful blood extraction, lalo na kapag in-endorse sa’yo yung patient. Happy duty everyone and have a blessed day!

PHLEBOTOMY This is the most exiciting part of internship for me, not only you get to explore the hospital floors but also get to witness tons of different scenarios. For phlebotomy, patient identification is very crucial. We have Outpatient Dept (OPD) extraction and Inpatient extraction (dito tayo nagw-ward). This is not new to you guys, always greet the patients and introduce yourself. Ask their full name, birthdate, age and sex. Explain why you are there with them, tell the patient what tests are to be done, explain the procedure. So like, I made a very simple script (make it simple lalo na kapag sa public hospital kayo), do not use jargons like “i’m your phlebotomist” kasi hindi lahat alam yon but if you insist, why not introducr the word to them diba? So ang scipt ko every time na nagw-ward ako is “Hello, Ma’am/Sir, good morning/afternoon/evening” “Ano nalang po ang full name nila?” “Birthday?” “Ilang taon na at kasarian?” “Ma’am/Sir, tutusukan ko kayo ha, kukuhaan ko kayo ng dugo kasi nag-order ho yung doctor niyo ng lab tests, for CBC and Chem” While you’re conversing, mag-prepare ka na ng gamit. I’m not a yapper around patients kasi nahihiya ako but may makikilala kayo na kayang kausapin sila, pwede niyo naman sila kumustahin, build a short conversation while extracting. Follow thr 3-4 inches rule sa tourniquet. Huwag mahiya kumapa, may mga restrictions tayo theoretically na hindi nasusunod in real life like paghawak ulit sa site while you’re extracting kais minsan na-out of vein or fishing. Kapag nagw-ward tayo, make sure na may ibabalik tayo sa lab na dugo but kung sablay kayo, it’s okay, you can always endorse naman lalo na kapag hard to extract (HTE). Remember your order of draw so I dont know how other hospitals manage this, prior warding, we check the requests for the tests and sinusulat na namin sa upper tight corner yung order ng tubes para pag-akyat, hahanap nalang ng patient at extract. Btw, you cannot extract blood from an arm with IV and fistula. Always choose the free arm. Let’s say wala kayong makapa, super HTE ng patient, you can extract blood sa kamay. Kung manipis ang ugat, palitan niyo ng 25 gauge (from 1 cc syringe) yung needle ng hawak niyong syringe. Take note lang na medyo mabagal yung flow. If mahirap na naman kunan sa kamay, resort to feet. Pwede naman tayo mag-extract sa paa, if you are not confident, ask for a supervision ng staff pero kung batak ka na, pwede naman AS LONG AS HINDI DIABETIC ANG PATIENT, NEVER EVER EXTRACT BLOOD FROM A DIABETIC PATIENT’S FOOT! Whenever you encounter patients with doctors na nahihirapan din humanap ng ugat, minsan nags-suggest sila na mag-catch nalang tayo ng dugo which is a no-no dapat and we should always consult muna sa staff natin kasi hindi naman tayo hawak ng doctors nor nurses. Arterial puncture, although bawal, minsan ginagawa rin natin kapag super need na ng dugo and walang makapa at makuha both arms and legs, lalo na kapag manas si patient, no choice na talaga. Make sure na marunong muna kayo, but hindi siya advisable, kung papayagan kayo then go. When prepping things pala, always take the cotton pad first kasi yan madalas ang nakakalimutan. Be mindful lalo na kapag mag-isa kayo sa warding, mahirap asikasuhin yan while nakatusok pa yung syringe. Take note sa orientation ng needle, bevel up, check your angle, the depth and direction of the vein. You can fish naman, isalba niyo lagi yung backflow na nakuha niyo. Let’s think about the patient na ilang beses nang natusukan, of course nasasaktan din yan kasi may sakit siya. Don’t let them feel na parang pinagp-praktisan natin sila. If a patient refuses, you can explain why need natin kumuha but if they insist talaga, punta kayo sa nurse station and inform the nurse na ayaw ni patient magpakuha then sjla na bahala mag-relay sa physician nila. Labelling is the most important thing! Do it after extraction ha, sulat agad, keep in mind the inversions needed.

CLINICAL MICROSCOPY As mentioned sa previous sections, there should be an assigned area for sample receiving. Sa CM, always check the containers, if tightly sealed, no leaks, properly labelled and collected. Here are the things interns are allowed to do: • Urinalysis • Fecalysis • Initial reading of slides • Kits for H. pylori, FOBT, FITC, PT Always keep in mind the factors na super important sa CM like physical examination and clarity ng submitted samples. Mga must knows about urine lalo na yung crystals, parameters ng reagent strip, mga info na related sa stool, etc. ALWAYS ask for the principle ng machines. Take note why we use certain kits or para saan ang NSS or iodine, lalo na sa fecalysis. Include parasitology in your review kasi dito sa CM natin siya mae-encounter, focus sa egg morphology. Here’s a copy of the pocket notes I made for reagent strip and urine sediments https://drive.google.com/file/d/1W79BsiGDjkwpbssZ-hOxwGHSOZKOfNWz/view?usp=drivesdk

Good morning and Happy Monday ☀️ Maninira ang ako ng mood today para sabihing, we, interns are not exempted on holidays and on special days. We are already considered as workers-on-training and to add the cherry on top, in line pa tayo health care. That means, may pasok tayo sa Christmas, New Year, Holy Week, and on other holidays. Sa St. Lukes and EAMC, if you are absent on holidays, 5 days na make up duty ang kapalit. Iba-iba ang grading system per hospital but may bawas sa grades ang absences. I don’t recommend risking it, lalo na kapag first in niyo palang kasi baka ma-delay kayo sa second in. Pero ayaw ko kayo mandohan AHHAHAA do whatever you guys want sa schedules niyo 🙂‍↕️

CHEMISTRY / SEROLOGY SECTION In this section, super duper crucial ng pre-analytical checking dahil magiging errroneous ang result if we are careless. Check the sample if it is hemolysed, icteric, or lipemic. Here are some reminders lang na napansin ko na halos similar sa first and second hospi: • Samples for Bilirubin testing ay dapat covered (usually carbon paper yung gamit) • For samples na may presence ng chyle, dapat natin siyang tanggalin kasinkapag sinalang siya sa machine, there’s a possibility na magkaroon ng aspiration error. • Always ask and confirm sa staff if allowable ba yung sa tingin niyo ay hemolysed, kasi minsan, may mga hard-to-extract (HTE) patients tayo or may requests yung doctors for STAT • If may machines na need i-uncap yung tubes, DO NOT FORGET TO UNCAP, kasi baka masira yung probe ng machine so either babayaran mo yun which (napakamahal ng machine) or baka ground for repeat internship Also, hindi lang blood and pin-process natin sa Chemistry. We also have urine and body fluids. Each hospital, magkakaiba ang protocols sa processing but these are the things na need i-take note whenever we encounter these • Total Volume • Color • Transparency Be knowledgeable about OGTT, HbA1C, Hepatitis profile, Tumor Markers, and CRP because favorite yan tanungin ng staff. ALWAYS WEAR YOUR GLOVES! LALO NA KAPAG NASA SEROLOGY NA KAYO. Another precaution pala, may mga carriers yung machines, dun nilalagay yung tubes. So may barcode yung tubes natin na dapat laging naka-face outward, para ma-scan. AVOID ROTATING THE TUBE WHILE IN THE CARRIER kasi prone to smudging yung barcode (unless super sosyal ng printer at sticker na smudge proof talaga). Tendency niya kasi is hindi siya mar-read ng machine. Sorry I can’t provide pics for that kasi hindi talaga ako nagp-pic ng barcodes, PATIENT CONFIDENTIALITY ABOVE ALL pa rin.

Up Next: Chemistry/Serology, Clinical Microscopy, Phlebotomy, Molecular Biology, Machines and their principles If there’s any other request, you can send it here ☺️ https://curiouscat.live/brainrotgalore_

Histopath Internship Notes Note: Does not include machines and their principle

HISTOPATH SECTION Whenever we receive specimens, double check always! Histopath is different from the other sections, since under siya sa Anatomic Pathology, uncommon na sa’tin yung specimens na mar-receive natin plus wala tayong masyadong gagawin don and more on preparation lang tayo. But we still have a lot to do for tissue prep and cytology. For me, cytology yung pinakamasayang gawin kasi hands on ka talaga compared sa tissue prep. Anyway, based on my experience, here are the things interns are allowed to do: • Tissue block prep (kasama niyo ang pathologist sa grossing room) • AUTOTECH (irl, wala nang masyadong gumagamit ng autotech, ibang machine na) • Embedding (TIP: press the tissues all the way from the bottom ng molding tray to avoid having bubbles once mag-harden yung wax) • Trimming (so far the easiest job, madalas hanggang coarse trimming lang tayo pero pwede ring fine trimming, basta supervised ng staff) • Sectioning (madalas staff lang gumagawa neto but they will allow you naman to practice, mga meticulous kasi patho pagdating sa slide, nagagalit din sila minsna kapag pangit yung gawa) • Fishing Out (you will eventually learn thr technique, idk what tip to give kasi own experience lang talaga makakapagturo sa inyo) • Staining (we have machined available and mas prefer siya compared sa manual staining, to reduce the lapses na rin) • Mounting (we also have machines available for this but they always preper doing it manually) • Labelling (gumagawa lang tayo ng stickers for this) It is important to know the basics sa Histopath, like steps in tissue preparation, common reagents used, mga factors associated, temperature, etc. (kung anong nasa gregorios actually) Always careful lang tayo in this section kasi recollection is out of our options. Iwasan malalaglag yung contents ng tissue blocks, lalo na if prior embedding kasi we don’t know whose who. Be knowledgeable also sa Immunohistochemistry and Frozen Section because you will definitely encounter pneumatic tube system (not sure if lahat ng tertiary hospitals ay meron neto). Histopath is fun honestly pero nakaka-degrade ng utak yung amoy sa loob, definitely not one of my favorite sections 😅

Channel name was changed to «MEDTECH INTERNSHIP SHENANIGANS»

BLOOD BANK SECTION As mentioned previously on the first two sections, we have a receiving area for pre-analytical checking. Here are the things usually sent sa Blood Bank: • Lavender top - abo typing, crossmatching, coomb’s test, malaria test • Red top - coomb’s test, NAT test • Yellow top - serological test (Syphilis, HIV, HBV, HCV) • Replacement blood bags • Requests for blood bag securing First thing to take note are the must knows sa BB: • Blood donation criteria (take note sa reference values for physical examination like weight range, pulse rate, blood pressure, etc.) • Deferrals (hindi lahat, usually ang kinukuha lang natin interns ay sleep, last meal, alcohol consumption, menstruation, tattoo/piercing, smoking. the rest like medication ay doctors na ang bahala) • Blood components and their uses, designated storage temp and additives Madaming pwedeng gawin sa Blood Bank, you can do • Technicals: blood typing, crossmatching, welding of blood bags, prepping components • Receiving and Releasing: assisting nursing attendants, doctors, relatives regarding securing of blood bags, receiving of replacement blood bags, releasing of blood bags • Call: in charge of the initial workup sa securing ng blood bags, updating of availability ng requested component and even crossmatching status (lalo na kapag stat and OR yung nag-request) • Bleeding area: initial profiling and screening of donors (you will get their details, their vitals, interview them) Always take note of the important procedures like crossmatching, thawing, releasing of blood bags, etc. Please seek for the staff’s assistance bago galawin mga blood bags okie? Kasi may intern na ginawa niyang open system yung dapat na closed 😭 Familiarize on the machines used, esp yung mga centrifuge (mode for hard spin and soft spin) and again, yung mga principles nila Ex. Apheresis: Continuous Centrifugation Hindi biro magiging shift sa Blood Bank kasi ngarag ka sa sobrang toxic but again, this differs sa hospital na papasukan niyo. Those mentioned above are my personal experience, both sa first and second hospitals that I went to.

Disclaimer: Everything sent here are just from my POV as an Intern, both from my experiences sa Private and Public hospital. Huwag din kayo mahiya mag-dm sa twitter 😅 Ako yung nahihiya minsan kasi super late ko mag-reply but I will try to answer 😊

HOSPITAL SCREENING: Exam and Interview For authenticity purposes, I have tried to apply to two hospitals. Ito lang mga napansin ko sa exams (not guaranteed na the same sa lahat ng hospitals) but literal na BASICS and MUST KNOWS siya. Ex. • What crystal is found in an acidic/alkaline ph? • RA 5527 is also known as? • Jaffe reaction is used for what? • Plasma vs. Serum • Order of Draw • ABO Bloof Group Honestly, ‘yan lang mga tanong na nar-recall ko haha! The exam is nothing much to worry about kasi I swear, kaya siya nang walang aral basta alam niyo yung basics pero I highly suggest na magbasa pa rin (pwede na sa Ciulla) For the interview part naman, usually yung bungad nila is INTRODUCE YOURSELF then proceed sa: • mode of transportation • where do you reside • what are your parents’ work For my experience, huli pareho yung “BAKIT ITONG HOSPITAL ANG NAPILI MO” Basta just be yourself, tell the interviewer that you are eager and willing to learn and that their institution is the best teaching hospital to have your practice. Congratulations ulit Interns and Good luck sa inyong internship journey!

MICROBIOLOGY SECTION As mentioned sa Hematology section, there will still be another receiving area inside. Usually, negative pressure na dito since need i-practice yung containment. Keep in mind the pre-analytical variables —always double check if the specimens are properly collected (sterile container always!) with proper patient identifiers. In this section, interns are allowed to: • operate machines: blood culture, vitek, (we had genexpert before sa private but sa current ko, wala) • prepare plates: we do the streaking • prepare slides for gram stain/AFB/KOH • prepare culture media (if private, no need kasi binibili nalang) • prepare sample disposal • do anti microbial susceptibility testing • do temperature checks sa room, machines, incubator, and refrigerator Don’t overthink! Make sure you know the basics about gram staining, biosafety cabinets, especially medias (bonus if may alam sa antibiotics) Bring head caps, extra gloves, alcohol, and masks. Report to staff if may nangyari lalo na kapag may spillage or anything serious. Ask questions! Be attentive!

HEMATOLOGY SECTION In this section (this applies in general actually), we have receiving area for the samples and test requests. Again, you have to countercheck every details pa rin kasi minsan, nakakaligtaan ng unang nag-receive or yung floater. Ex. Hindi lahat ng samples na sin-submit sa Hema ay blood, minsan may CSF din for cell counting. The bottle number should be #3 (remember #1 is chem/sero, #2 microbio) This depends na sa hospital, before nung nasa private hospital ako, wala kaming ginawang logging but every test request ay ginagawan namin ng delta check. Delta check: a quality control tool that involves the comparison of laboratory test results with results obtained on previous samples from the same patient And now that I’m in public hospital, we log every test request for tracing and census. Always keep in mind yung pre-analytic variables bago mag-proceed (check for the presence of clot and if adequate ba yung sample) Staff na ang mago-orient sa inyo sa analytical and post-analytical phase. Here are my tips lang: • Ask questions and take down notes (especially yung principles ng machines) • Always mix the EDTA tube bago isalang sa machine • Madaming activities na pwedeng gawin like PBS, reading of slides, processing of routine tests, and other miscellaneous stuff like census, temp check, etc. • Be prepared bago pumasok kasi minsan may QnA portion (usually about cbc, poikilocytes, venipuncture — mga must knows) • Take note of the possible flaggings and yung parameters na affected if overfilled/underfilled ang sample • You don’t need to know/study everything in one go, huwag ma-pressure lalo na kapag first day kasi matagal-tagal ka pa so just take your time lang sa loob • Goods if you ask your staff how to interpret histograms and how to do quality control (madalas staff lang gumagawa nito) • Dapat alam niyo proper waste disposal • Wear your gloves always (kapag may nakita kayong seniors or staff na walang suot, wag tularan hahaha) May post-tasks (either quiz or practical) kayo before umalis ng section hence the note-taking mentioned. You can ask your seniors naman kung ano yung coverage or sa staff mismo pero huwag madismaya if di nagsabi kasi ganon talaga 😂 As much as possible, be punctual, avoid absences, be sensitive sa environment, baunin ang presence of mind. Okay lang magkamali pero huwag naman ulit-ulitin. Lastly, respect your cointerns and staff.

𝗜𝗡𝗧𝗘𝗥𝗡𝗦𝗛𝗜𝗣 𝗕𝗔𝗦𝗜𝗖𝗦: 𝗥𝗲𝗰𝗲𝗶𝘃𝗶𝗻𝗴 𝗼𝗳 𝗦𝗮𝗺𝗽𝗹𝗲𝘀 • Check the tube/bottle if properly labeled with patient identifiers (patient full name, age/sex, dob, date and time of extraction, extracted/collected by) • Both tube/bottle and request slip should be indicated with the date and time of extraction as well as the one who extracted/collected the sample • Request should also have the diagnosis and the name of the requesting physician • For anticoagulated tubes, check for presence of clot (you can eyeball or rim the clot, if present, then REJECT and ask for recollection) • Confirm the tests requested to the floater (in cases of insufficient quantity, ask them what test they would like to prioritize and request for another recollection) • Be aware of the appropriate tube tops used in a test (e.g. HbA1C = purple) • Specimens for bacterial culture should be submitted at room temperature • Take note of fasting samples (REJECT if time specified is not met) 𝗖𝗥𝗜𝗧𝗘𝗥𝗜𝗔 𝗙𝗢𝗥 𝗦𝗔𝗠𝗣𝗟𝗘 𝗥𝗘𝗝𝗘𝗖𝗧𝗜𝗢𝗡 • Mislabeled tube • Clotted/Hemolyzed/Icteric/ Lipemic sample • Overfilled or Underfilled tube (especially for Coagulation tests) • Expired tube • Inappropriate container ( e.g. unsterile container for samples needing sterile conditions for Microbiology) • Improper collection (e.g. Ethanol test, should be collected under anaerobic condition) • Samples intended for Microbiology but comes with formalin • Delay in floating (stability time has exceeded) • No request form • Leaking containers The floater is usually informed when samples are rejected and for preventive measures, it is better to ask them for their name and include the date and time of the submission (just in case the physician asks for update). This is just a general scope of sample receiving criteria, detailed instruction is still dependent on the hospital.

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