2nd time in the OT~

so 1st OT i went in was Dr Osman's (he's the only malay surgeon in that hospital, selain tu ada sorang chinese muslim, Dr. Quah, O&G (nama muslim dia no one knows)). He was performing a mastectomy and i thought it was the usual mastectomy.. but when i approach him.. he said this patient has accessory breasts..!! meaning the patient has more than 2 la. adeih. she complained of pain during her period thats why she made the decision to remove the congenital anomaly.~ anomalies...... its not like a tumor or anything, the accessory breasts can actually lactate!! T_T

and also i'm gonna share with you guys this technique the anesthesiologists nowadays use to inject local anesthetic in the patient. Usually we hear the typical local anesthetic where you insert in needle between L4 and L5 into the subarachnoid space kan? tapi actually not just there, we know its also known as regional anesthetic so tak semestinya kat L4 L5 la kan. ok that day i was shown the "interscalene brachial plexus block" where local anesthetic is injected to the brachial plexus!! haha.. only a pro knows how to locate the brachial plexus by using the knowledge of surface anatomy. so this is how you do it..

this device is called a Stimuplex. What does it do? it stimulates nerves. so in this case, we're trying to locate the brachial plexus right? by using this device, we are able to locate it and stimulate the muscles that are supplied by the brachial plexus, such as the arm.




here's the guideline. see where the yellow arrow is pointing at? (ha tu my dad dah mark siap2 guna pen, so dont think that that line will be there when you're trying to find the interscalene groove) yes that is the interscalene groove, located between the scalenus anterior and scalenus medius.. so you have to know that, anatomically, phrenic nerve is very near to the brachial plexus. (medial to the brachial plexus) and if you cucuk the local anesth. on the phrenic nerve, you'll paralyze half of the diaphragm.. hoho. in order to mengelak this, use la the stimuplex! see. very berguna one~ jangan main2, that thing expensive woo. so when you use the stimuplex to locate the brachial plexus, you activate it and set it to around 0.2 V, you will see the muscle of the arm twitching. that means you're in the right place!!


so finally you are now safe to inject the local anesthetic.. therefore this will help to lessen the post-op pain. (ni case fractured radius.. accident. tu la.. x berhati-hati..) when you have about RM10,000, you can buy the stimuplex and practise on yourself..or on your siblings! muahahaha~

X-ray of fractured radius.

"drive safely..think of your own bones.."