Surgeon's Log 3

Lesson learnt from Grey's Anatomy Season 6 Episode 6

Trauma Surgery

To always check for inhalational burns in a burn victim no matter how well the patient appears to be.

Check for burnt signs in the throat and any soot coming out from the throat.

Inhalational burnts can involved the whole respiratory tract & lungs.

This leads to oedema of the respiratory lining due to inflammation.

The airway can be blocked any time when the swelling is big enough to occlude it.

Thus, the patient needs to be intubated STAT.

Inflammatory mediators released will get into the circulatory system and it can cause disseminated intravascular coagulation.

The patient can bleed from everywhere and the bleeding will be very difficult to stop.

p/s: This is a note i wrote for myself and to share with whoever interested.

My blog posts are automatically RSS feeded to my Facebook account as a "Note".

Paedodontist's Log 1 & Surgeon's Log 2

Morning: Children's Dentistry

My clinical partner's 5-year-old super duper cute boy patient came today for stainless steel crown placement. He has super duper long & curved eyelashes and big round eyes *^.^*

He looked like just been dragged out of his bed to the clinic, reluctant to talk, just responded our questions by either nodding or shaking his head. Fearing of making him cry, we let him played with the teeth model. He brushed diligently on the model using the correct technique that my partner taught him 2 weeks ago, we kept praising him =D

We used a mouth prop this time to keep his mouth open as he felt asleep on the dental chair during the previous visit and closed his mouth :P

He was very cooperative throughout the 2.5 hour session, good boy!

In the end, he went home as a "Superboy" with a shiny metal crown in his mouth =)

Lesson of the day: to not polish the crown with handpiece immediately after seating as the vibration will break the cement seal or disturb the setting process of the cement.

Afternoon: Oral Maxillofacial Surgery

Was supposed to have Minor Oral Surgery session but both patients didn't turn up.

The oral maxillofacial surgeon-in-charge brought our group for wardrounds at Orthopaedic Surgery ward & Otorhinolaryngology ward.

Orthopaedic Surgery ward

Saw a motor vehicle accident trauma patient with zygomatic complex fracture. Learnt how to approach trauma patients to perform examinations. Concentration was put on head and neck region - our region of interest =)

Otorhinolaryngology ward

Saw a very young patient (probably around 20 years of age) who has had 2 times of Squamous Cell Carcinoma of the maxilla due to recurrence. She just had maxillectomy & radical neck dissection. A very long tracheostomy tube was there on her neck. Poor girl. Learnt about the importance of placing incisions out of the lines of aesthetics to avoid leaving a bad scar =)

Why make me cry? :'(

Early in the morning already been made shedding my tears during lecture... I wasn't saddened (not to worry!), just touched to tears by the video clip put up during Geriatric Dentistry lecture. Sometimes i do feel good letting my tears trickle down my cheek without caring too much about people looking at me. I'm a girl, hence the right to have shallow eyes (as what the Chinese says about people who cry easily) :P

Surgeon's Log 1

Today is Oral Maxillofacial Surgery day for my group as we spent the whole day at OMFS Dept for both morning & afternoon clinical sessions.

Morning

Had extraction clinics. Did extraction on a osteoporotic & hypertensive old lady with history of cardiac enlargement & angina pectoris.

Extracted her retained 13 root & 36 bony spicule (it felt like tooth fragment to me though...).

Retained 23 root was also indicated for extraction but it showed periapical radiopacity (denser than surrounding bone) surrounded by a faint zone of raiolucency. The surgeon in-charge told me that it's sequestrum (radiopaque) surrounded by a zone of inflammatory front, which is the host reaction to contain the sequestrum.

I was very grateful to have come across an article which explained that bis-phosphonate (a drug used to treat osteoporosis) could cause osteochemonecrosis, when i was searching for journals for my Social Behavioural Science project literature review.

My patient took 1 pill of Forsamec once a week, which explained the condition.

During the attempt to extract her badly carious tooth 44, the crown & half of the root was broken, leaving a conical root fragment which was slightly mobile but too stubborn to be elevated out from the socket.

A full thickness mucoperiosteal flap was raised and several unsuccessful attempts were initiated to elevate that stubborn fragment out of the socket. That root was then suspected to be either ankylosed/ hypercementosed.

My patient was ushered into the minor operating theatre and a minor oral surgery was then performed by the surgeon to remove that hypercementosed root fragment.

Did my 1st ever suture on a human being today, thanks to my dedicated supervising surgeon =) I learned a lot today!

Lunch hour

Attended a rescheduled Orthodontics revision session. The orthodontist in-charge was very kind to have brought tidbits & peanuts for us considering it's lunch time.

Afternoon

Had Minor Oral Surgery clinical session.

I'm very grateful to have my clinical partner to be my assistant for the surgery as we've already built up a very good rapport =)

Luckily my hand didn't tremble too much when i was cutting on the mucoperiosteum. First-timers are always nervous & it's always best if the supervisor is an encouraging teacher as we are handling scalpels here which cut! That's the purpose of we going to the dental school, to learn =)

Raising a mucoperiosteal flap is like deboning a chicken, stripping its flesh from the bones. It sounds disgusting, but the feeling when doing it is good =D

Drilling the alveolar bone was the most surprising part to me as never did i know that bone was so much softer than dental enamel! I guess that explained the higher radiodensity of dental enamel =)

Sectioning the tooth was the only time when a dental surgeon can forget about avoiding the pulp when drilling into a tooth! Just drill into it for that tooth is deemed to be extracted :)

I think i need to practise more on suturing :)

Talk about Give & Take

“I have learned now that while those who speak about one’s miseries usually hurt, those who keep silence hurt more.” C. S. Lewis

"Most of us can forgive & forget; we just don't want the other person to forget that we forgave." Ivern Ball

"Too many women are dying & suffering in silence. We need to get this disease on the radar screen." Elisabeth Ross

"Never be bullied into silence. Never allow yourself to be made a victim. Accept no one's definition of your life, but define yourself." Harvey S. Firestone

"Silence is exceptionally loud in an eloquent person." Eunice Soh

"Silence is the only thing i'm able to give if words couldn't be comprehended." Eunice Soh

Bowling

Went bowling just now

1st time playing, didn't score high but i think it's quite reasonable :P

Fun!

Conjoin dentistry

Had a long day at Oral Maxillofacial Surgery Department for both morning & afternoon clinical sessions.

Morning

I love giving injections! :P

Learnt how to utilise the empty extraction socket of the adjacent removed root for removal of the other retained root of the same tooth.

Lesson of the day: never give up trying again on my own before switching on the red light too quickly to ask for help from the supervisor =) Self-confidence is very essential in whatever we do in our life, as long as we know whatever we are doing is correct & ethical :)

My partner had a very interesting case today. We were lucky to have an orthodontist who happened to be at the OMFS department at that time & was very willing to come over to give her opinion & teach us :)

In the end, other Oral Maxfac surgeons, General Dental Practice specialist, Dental Surgical Assistant, etc. also came to our cubicle to have a look at the patient :P

I cannot disclose further details to protect the patient's privacy :)

It's nice to see specialist of various specialties come together to discuss about a case & share their opinions. It's really an eye-opener to me :)

Stood for more than 3 hours :'(

Afternoon

Had minor oral surgery session. Stood for another 2 hours, hardly see a thing due to the small oral cavity of Homo sapiens >.<