3 IDIOTS+ Vacuum + Episiotomy

sape pernah tgok THREE IDIOTS (certa hindustan)..sejak bila plak sol tgok certa hindustan ni..ops..dah xde certa laen tgok je la..hehe

ade Aamir Khan berlakon sebagai Rancho yg tere giler sal engineering reka cam2 sampai ade satu part anak Viru (yg mengandung 2) nak bersalin sgt..tp sbb ribut semua jlan xleh lalu..so dia reka alat dr Vacuum untuk deliver baby tue..

wlaupun mmg impossible nak deliver baby guna alat vakum (yg cam kat umah 2).. sbb pressure dlm tue kuat sgt..

tp mmg ade cara vacuum untuk keluarkan baby kat hospital (jgn cuba ini dirumah ok!)..hehe

conditions yg perlukan vacuum

- vertex presentation;

- term fetus;
- cervix fully dilated (JALAN DAH BUKAK PENUH)
- head at least at 0 station or no more than 2/5 above symphysis pubis.

• Check all connections and test the vacuum on a gloved hand.

• Provide emotional support and encouragement. If necessary, use a pudendal block.

• Assess the position of the fetal head by feeling the sagittal suture line and the fontanelles.

• Identify the posterior fontanelle (Fig P-7).

FIGURE P-7 Landmarks of the fetal skull

• Apply the largest cup that will fit, with the center of the cup over the flexion point, 1 cm anterior to the posterior fontanelle. This placement will promote flexion, descent and autorotation with traction

• An episiotomy (kena potong skit) may be needed for proper placement at this time. If an episiotomy is not necessary for placement, delay the episiotomy until the head stretches the perineum or the perineum interferes with the axis of traction. This will avoid unnecessary blood loss.

• Check the application. Ensure there is no maternal soft tissue (cervix or vagina) within the rim

• With the pump, create a vacuum of 0.2 kg/cm2 negative pressure and check the application.

• Increase the vacuum to 0.8 kg/cm2 and check the application. (pressure yg digunakan sikit je..xla kuat cam vakuum umah)

ok,sbb ape la aku dok certa sal vacuum and episiotomy (epi)..sbb semalam one of my patient (G7P6)..ok,xsemestinya dah anak ke-7, suma beranak senang..kak kena buat vacuum extraction untuk baby dia..

dah fully tp patient clinically emotional non stabil..sampai aku ni tolaknye mau terhempas ke dinding ngan power dia 3kali dr aku (berat badan dia 3kali dr aku..xyahla aku mention berat aku ni sini..hehe)..aku ngan MO berpandangan sesama sndr je mase patient kate sakit, xmau meneran..beberapa kali aku ditumbuknye (sbb aku paling dekat ngan dia)..sabar2

terpakse meminta bantuan kat MO lelaki laen yg lebih gagah..dan suma decide nak buat vacuum wpun patient nak operate (komplikasi lagik byk kalo nak belah dr bersalin guna alat)..lagipun kepala baby still high (station atas lagik)..ngan prolong 2nd stage doc2 buat vacuum..

buat cam cara kat atas..kena potong skit untuk keluarkan baby..patient still kena push gak..(ramaila dlm 2 jadi cheerleader tak bertauliah)..hehe..memberi semangat gak kat patient yg dah putus harapan..lucky, she can do it!!

"kak sayang anak tak?" doktor taye

"sayang...." sayu giler dgr dlm sakit2 berdepan ngan kontraksi pain..dan semangat sayang anak tue la kak tue meneran gak..

alhamdulillah anak berjaya di keluarkan dan trus dibawa ke bilik resus untuk doktor peads (doktor kanak2) tgok..

dan selepas dikeluarkan uri..tempat yg potong td kena la jahit kan..

biasenye mmg doktor2 dan HO atau nurse akan jahit..so aku prepare je ape doktor nak untuk jahit..sbb doktor sapuan tue laki..kena la aku jd caperon (bukan kain apron yer..hehe)

tetiba..doktor taye "awak nak jahit?" (student xleh jahit..leh conduct normal delivery je)

dlm fikiran betul ke doktor taye ni..cam serba salah je nak jawab nak (of coursela nak kan bile lagik nak buat..nak tugu jadi HO lambat lagik..dah de peluang mst la nak)

"its all yours"..doktor mempersilakan aku mengambil tempat untuk suture perineum patient..cam upacara pe je

pakai glove sterile..pandang muka doktor sekali lagik..btui ke doktor ni?? ok,muka dia serius..so aku pun kena serius..

wpun pernah je suture kepala budak..luka2 tgn..kaki..tp untuk repair episiotomy xpernah kot..1st time

lagipun luka kat dalam..so, agak gementar skit..dah la suture yg aku pakai jenis Safil..xleh tarik kuat2 sbb cam kita jahit kain..kalo tarik kuat,kan kain cam berkedut2..sbb 2, alamak safil la plak.. biase doktor pakai Catgut je (perut kucing..hehe)

camni la gaya nak jahit epi..tp ni gmbr jahit kat model je..kalo nak bayangkan..suma kawasan 2 dah penuh darah..takut ade yg pengsan kot tgok..hehe

aku ngan tekun mengikut arahan doktor Sapuan wpun dia asyik dok buat lawak ngan aku..siap kate aku xmakan la (mmgla pose kan)..ngan kate aku ni da only scurvy patient alive (hampeh gler kot..penyakit yg xwujud dah kat malaysia)..vit C deficiency~~

seriusly pengalaman repair episiotomy sgt2 menyeronokkan (yela aku kan suka suture2 org)..hehe..so, pengalaman menrepair satu lagik tmpt..mmg seronok kot..susah student nak dpt peluang ni..wpun cuak kot sbb xpernh terfikir dpt peluang keemasan ni..

lagipun aku mmg nak improve skill menjahit aku (menjahit baju aku xmau..haha)..nak jahit org je..haha..nak kate nak jadi surgeon, insyaallah kalo ade peluang ..tp aku nak bahagian menjahit je ,agak2 boleh tak?? haha (benggong)

ok, ni bukan gmbr nota aku..gile mantap kan..aku terjumpe kat google..rase tercabar kot ngan gmbr ni..nak buat gak la nota camni..hehe

REPAIR OF EPISIOTOMY

Note: It is important that absorbable sutures be used for closure. Polyglycolic sutures are preferred over chromic catgut for their tensile strength, non-allergenic properties and lower probability of infectious complications and episiotomy breakdown. Chromic catgut is an acceptable alternative, but is not ideal.

• Apply antiseptic solution to the area around the episiotomy.

• If the episiotomy is extended through the anal sphincter or rectal mucosa, manage as third or fourth degree tears, respectively.

• Close the vaginal mucosa using continuous 2-0 suture (Fig P-41 A):

- Start the repair about 1 cm above the apex (top) of the episiotomy. Continue the suture to the level of the vaginal opening;

- At the opening of the vagina, bring together the cut edges of the vaginal opening;

- Bring the needle under the vaginal opening and out through the incision and tie.

• Close the perineal muscle using interrupted 2-0 sutures (Fig P-41 B).

• Close the skin using interrupted (or subcuticular) 2-0 sutures (Fig P-41 C).

FIGURE P-41 Repair of episiotomy

p/s: wpun xdpt conduct patient yg aku jaga slm 6jam sampai xdpt g bazar beli makanan..tp alhamdulillah ade hikmah di sebaliknye..dpt tgok vacuum (dpt sign) dan jahit episiotomy..thanx doktor..xlupe gak dpt penumbuk patient yg tgh skit..ouuucchh(melayang ke dinding)

pic dan info from google