whatever . .

sumtime i being thinking,
y does we have a fmly?
it's bcoz we will not be alone or wat?
n how can we satisfied every single 'heart' in the fmly,
it is beyond my dignity,
to obey every single advice that being throw to me,
i cant catch those thing with 2 hands,
guess wat, i extremely exausted with dis,
thera are a lot of thing i must think,
dis prob not in the list,
now probably i should write it down,
hoping it will leave me alone 4m the back door,
wtf,can anybody in dis world happy to see others happy?
y it's so hard, y it's so burden to others
i never ask for your advice or wat so ever,
i jus want u to walk away n get lost,
serious shit, u jus a pain in the ass

LALALALALA . . .

last night,i slept early, at 10.30
feel so sleepy n tired,more likely severe exausted,
mybe it's bcoz my daily routine,
woke up at 7, go to college at 7.30
n back home at 6pm,
god . . feel like working in office,
i tought that this clinical year would be easier,
but i was wrong,
"study in college" n "practical in hospital" was a different terms
in college more to spoon feeding, but in hospital more like take the spoon n swallow it at a time
yeah . . that what was happpening,
i tought it will be awesome wearing doctor's coat n hangging a stethoscope on the neck,
bring a "holy thick book around", sound kinda NERD
it will be more awesome if Dr House is my lecture,
at least he wouldnt call us rubbish,haha . .
recently i had found new virus that had spread spontaneously among mankind,
the 'influenza unlike symtoms' has been discover, bcoz the victim doesnt have flu,fever or sore throat,
sadly the was no vaccine for this disaster,
omg . . what was happening . .
the disease called 'DOTA',
yeahh . . pretty much like ROTA virus,
but this one more severe, direct attack to brain,
make us addicted, unconscious, loss of judgemental, feel like want to kill sumbody,
seriously i also infected,
god . . please save me . .
save me from the curse of DOTA

Respiratory examination

Position

Position - patient should sit upright on the examination table. The patient's hands should remain at their sides. When the back is examined the patient is usually asked to move their arms forward (hug themself position) so that the scapulae are not in the way of examining the upper lung fields. as many physicians around world request

The basic steps of the examination can be remembered with the mnemonic IPPA:
>Inspection
>Palpation
>Percussion
>Auscultation

Inspection

Tracheal deviation (can suggest of tension pneumothorax)

Chest wall deformities
>Kyphosis - curvature of the spine - anterior-posterior
>Scoliosis - curvature of the spine - lateral
>Barrel chest - chest wall increased anterior-posterior; normal in children; typical of >hyperinflation seen in COPD
>Pectus excavatum - sternum sunken into the chest
>Pectus carinatum - sternum protruding from the chest

Signs of respiratory distress
>Cyanosis - person turns blue
>Pursed-lip breathing - seen in COPD (used to increase end expiratory pressure)
>Accessory muscle use (scalene muscles)
>Diaphragmatic paradox - the diaphragm moves opposite of the normal direction on inspiration; >suspect flail segment in trauma
>Intercostal indrawing

Palpation
>Tracheal deviation - check whether trachea is in centre line.
>Tactile fremitus - the patient says boy-O-boy or ninety-nine, whilst physician sense with ulnar >aspect of hand for changes in sound conduction.
>Respiratory expansion - check whether expansion is equal
>Location of apex beat - check if there has been deviation of heart

Percussion



Middle finger strikes the middle phalanx of the other middle finger. The sides of the chest are compared.
>dullness indicates consolidation
>hyper-resonance (as can be simulated by percussing the inflated cheek) suggests a pneumothorax
>diaphragmatic excursion - normal is 3 to 6 cm.

Auscultation

>Inspiratory crackles (decompensated congestive heart failure)
>Expiratory wheezes (asthma, emphysema)
>Stridor and other upper airway sounds
>Bronchial vs. vesicular breath sounds
>Appropriate ratio of inspiration to expiration time (expiration time increased in COPD)