BLS n ACLS

with Dr Shah

BLS
1. Response
2. Breathing (<10s) - shallow n agony -> Activate BLS
    i. Call first - in cardiac event
    ii. Call fast - Paeds, drowning
    (CPR first then call for help)
3. Check pulse - for healthcare provider
4. CAB for 30:2 for 5 cycles
5. Check pulse

With AED (Automated External Defibrillator) -> ACLS

ACLS - Involving health providers
Pulse arrest
i. Asystole/ PEA
ii. VF
iii. Pulseless VT

1. Response
2. Check pulse
3. Start CPR
    i. Monitor
    ii. IV line

Chaotic pattern -> VF

Pads:
1. Right parasternal
2. Apex

1. I clear
2. You clear
3. Everybody clear
4. Bagging clear
5. Look at the monitor for spontaneous reverted rhythm

SHOCK @ 200J Biphasic
Or 360J Monophasic

Continue CPR for 2 minutes regardless of the rhythm
IV Adrenaline 1mg - every 3-5 min

* ROSC - Return of spontaneous circulation -> Post resuscitation care

If no ROSC
Repeat - if needed shock
+ IV Amiodarone 300mg

Assess 5H n 5T
Hypoxia - ETT
Hypovolemia - IVD
Hydrogen ion (Acidosis) - HCO3
Hypothermia Possibilities
Hypo/Hyperkalemia - ABG, to correct

Tension Pneumothorax - paracentesis
CardiacTamponade
Pulmonary Thromboemboli
Cardiac Thromboemboli
Toxins 

* Total Amiodarone - 2.2g/day

Post resuscitation care
1. Breathing
2. BP
3. CBD
4. ABG
5. CXR
6. Ryle's tube insertion

Flat line protocol1. Check leads
2. Increase amplitude
3. Lead select I, II, III

Case Senario
Complaint: Palpitation
ECG: VT

Symptomatic1. Chest pain
2. SOB
3. Altered mental status
4. APO
5. Hypertension
6. Sepsis

-> electrical cardioversion
i. Explain to patient
ii. Fentanyl n Midazolam
iii. 50-100J
iv. Sync
v. Cardiovert
vi. Check rhythm
vii. Check breathing

Elderly with AFCover with Heparin

Asymptomatic1. Adenosine 6mg, 12mg, 12mg
i. 3 way
ii. Large bore over cubital region
iii. Together with 10cc NS fast
iv. Hold the arm up

2. Betablocker
3. CCB
4. Digoxin
5. Amiodarone

AFi. Onset -> CVA?
<48H - rhythm control
>48H - do not control rhythm!! Rate control?

Rate controli. Elderly
ii. Digoxin
iii. Amiodarone - contraindicated for hypo/ hyperthyroidism

Rhythm controli. Young
ii. Warfarin for 2 weeks
iii. Transesophageal cardioversion - elective

AsymptomaticMonomorphic VT - Adenosine
* only in Monomorphic
Amiodarone 150mg over 10 min then infusion

Symptomatic Monomorphic VTi. Sync
ii. 100J
iii. Check rhythm
iv. Check pulse
v. Check breathing

BradycardiaSymptomatic
Atropine 0.5mg
Mobitz II n complete block -> high block - resistent to Atropine

Transcutaneous pacemaker
i. On
ii. Mode:
    a. Fix
    b. Demand - use this!!
iii. Set rate 70
iv. Energy level - increase till electrical capture -> mechanical capture -> secure

BP = cardiac output x TPR
CO = stroke volume x heart rate

Or use
Dopamine 2-10mcg/kg/H
Adrenaline 2-10

Adrenaline - b1 n a1

Dopamine Mcg/kg/min
BW x 3 = 50cc
1ml/H = 1 mcg/kg/min

Dopamine mcg/min
3mg/50cc
1ml/H = 1mcg/min

Asymptomatic
Usually 2° to medication - review medications

New Beginnings

Life on Purpose for Women by J.M. Farro

Forget the former things;

  do not dwell on the past.

See, I am doing a new thing!

  Now it springs up; do you not perceive it?

I am making a way in the desert

  and streams in the wasteland.  

Isaiah 43:18-19

Two years ago my older son, Joseph, moved out of our home. Coping with his absence alone would have been difficult enough, but around the same time of his departure, my younger son, John, graduated from high school. John was going to remain at home and attend a local college, and I was grateful for that. But his high school graduation would mark the end of my family' involvement with the Bible club my older son started 5 years earlier. During those years my life had been filled with countless club-related tasks, including driving teens home from weekly meetings, helping my sons put together Bible lessons, holding parties in my home for the kids, and organizing frequent concert trips. Once it was all over my life began to seem empty, purposeless, and meaningless. Feelings of being unneeded and unwanted overwhelmed me, and I didn't know how to stop the downward spiral I found myself in.

During this time I cried out to the Lord in desperation and despair. It was then that He showed me the verse in Isaiah 43. He revealed to me that He wanted to do a 'new thing' in my life, but first I had to 'forget the former things' and 'not dwell on the past.' God's awesome new plans for me would not unfold until I stopped feeling sorry for myself and let go of all the negative emotions associated with my profound sense of loss. I had to determine to put the past behind me and believe that God has wonderful plans ahead for me, or I would never 'perceive' the 'new thing' He wanted to do in my life. It wasn't easy for me. I kept thinking about all the special times I had shared with my sons over the past 20 years, as well as all the wonderful experiences I had had through my involvement with the Bible club. There were times I doubted that I would ever recover from my sense of loss. But as i prayed and depended upon God's grace to heal me and to help me let go of the past, the Lord began to unfold the 'new thing' He had planned for me.

Today my life is filled with more purpose and meaning than I ever dreamed possible, and I shudder to think of all the blessings I would have missed out on if I hadn't cooperated with God for my deliverance. If you are feeling today that your life is empty, meaningless, or purposeless because of your past experiences or a sense of loss, please know that God has awesome plans for your life. He says, "For I know the plans I have for you - plans to prosper you and not to harm you, plans to give you hope and a future." (Jeremiah 29:11) It doesn't matter how old you are or what your background is - God is able to fill your life with new purpose and meaning. Start asking Him to do something new and wonderful in your life. Trust Him to begin revealing the 'new thing' He has planned for you as you determine to let go of what lies behind and reach out for what lies ahead. Remember that endings pave the way for new beginnings. Today, be encouraged by the precious promise from God: "Arise (from the depression and prostration in which circumstances have kept you - rise to a new life)! Shine (be radiant with the glory of the Lord), for your light has come, and the glory of the Lord has risen upon you!" (Isaiah 60:1)

Prayer
Lord, I ask that You give me a new awareness of the awesome plans You have for my life. Help me to stop dwelling on the past, and to let go of all regrets, sorrow, and bitterness. Fill my life with new purpose and meaning, and use me to make a difference in people's lives for Your glory. Thank You for a new beginning and a fresh start!

* Take some time today to reflect on your dreams, and write down your top 3 goals. Keep them in a place where you can refer to them often - in your Bible or nightstand. Pray about them, and begin to take steps toward them as the Lord leads you.

What a timely reminder, as I prepare for the new beginning, I'm assured that He will give me peace that surpass all understanding and that eventhough the future is uncertain, He know what is best for me and He will lead me through. Thank You Lord for Your faithfulness.

Burnout!!

Purpose: To explore feelings of stress and burnout
              Bible cure for burnout


T.G.I.F
R & R - Rest & Refreshment
R - Remembering
eg: Birthdays, Mother's Day, Father's Day, Anniversaries, etc.

Genesis 1:14

And God said, "Let there be lights in the expanse of the sky to separate the day from the night, and let them serve as signs to mark seasons and days and years."

Seasons - Heb: Moedim

Specifically appointed times, special observances, special celebrations.

This passage in Genesis is referring to the fact that the regular movement of the sun, moon and stars establish a calender that can be observed by people from earth.

Leviticus 23:2

"Speak to the Israelites and say to them: These are My appointed feasts, the appointed feasts of the Lord, which you are to proclaim as sacred assemblies."

Feast - Heb: Moedim

The Lord is saying essentially, "These are My appointments with you!"

Leviticus 23:3

"There are six days when you may work, but the seventh day is a Sabbath of rest, a day of sacred assembly. You are not to do any work; wherever you live, it is a Sabbath to the Lord."

Genesis 2:1-3

Thus the heavens and the earth were completed in all their vast array. By the seventh day God had finished the work He had been doing; so on the seventh day He rested from all His work. And God blessed the seventh day and made it holy, because on it He rested from all the work of creating that He had done.

God deliberately set aside the seventh day of the week - later referred to as Sabbath in Scripture - as sanctified (dedicated to a holy purpose). The English word Sabbath is from the Hebrew word Shabbat, which means "a period of rest."

Exodus 20:8-11 Commandment #4

Remember the Sabbath day by keeping it holy. Six days you shall labor and do all your work, but the seventh day is a Sabbath to the Lord your God. On it you shall not do any work, neither you, nor your son or daughter, nor your manservant or maidservant, nor your animals, nor the alien within your gates. For in six days the Lord made the heavens and the earth, the sea, and all that is in them, but He rested on the seventh day. Therefore the Lord blessed the Sabbath day and made it holy.

The Sabbath was not intended by God as a ritualistic, religious burden for man to bear, but a blessing for him to enjoy.

Mark 2:27

Jesus said; "The Sabbath was made for man, not man for the Sabbath."

The Sabbath as it is defined in the Bible is a whole 24 hour period. In the Bible, one day ends and the next begins at sundown.

By taking the Sabbath command to remember seriously, you will have a whole refreshing day to come out of the rat-race and come to intimacy with the Lord.

T.G.I.S - Thank God It's Sabbath!!

'One Night With the King'
A perfect Finale for the study on the Book of Esther. A pleasant surprise to see John Noble in the movie. For a Fringe lover, it's like seeing someone you know acting ♥ 

A big 'Thank you' to Ps Eric for the effort and all the hard work over the last 10 weeks!! Another 'Thank you' for Uncle See for getting the movie and Garretts!! =) 

Thank you all my dear friends for making it tonight. Hope you enjoyed the movie and fellowship as much as I did!! ♥

Blog searching

Was running through google search to search for my lost blog.. It's always great to relocate them and all the long forgotten memory. Makes me all the more eager to keep a blog. For myself and maybe my kids =P to recollect good memories after a long long time.


Here's the link.. But i'm transferring them over here..
http://alisonlhy.xanga.com

Anakainos' 1st Wednesday Meeting

We had fun, found our buddies, and celebrated Adrian's birthday... And we had supper at Justin's favorite place, Atam Nasi Lemak =)

Thank God for lighting the fire in our hearts. It's good to see everyone on fire for God n striving to achieve the same goal. A group of people with different characters but same goal. That is to learn more about God and His Word and be ready to shine in the world!!

Thank You Lord for the passion, the love for each other and the choices each day. Help us to put you first in everything and to strive to be like You more and more each day. 

Thank You Lord for the fellowship time. Pray that You'll continue to lead us, guide us to be like you each day. I love You Lord!!

Happy Birthday

My 27th birthday will be one that I'll never forget. Unfortunately not in a good way.

The day started bright despite being on night shift. Birthday wishes that puts a smile on my face was flowing in from everywhere!! Shift ended at 8am and home i go!! Mel surprised me with a gift box with loads of cute things!!

Even double shift post night wasn't able to put me into depress mode!!

Unfortunately the day did not end as well as it started. At 5am i found out a shocking news. Julynn's husband of 1 year died the day before her birthday. I later found out that Brandon fell from the 4th floor of their apartment n plunged to his death due to hemothorax and multiorgan injury. And now we had to face the truth that Julynn is a widow n her life would be very different from their dream together.

Dear Lord, please hold our hearts together in this trial we face and we'll learn to trust You n draw strength from You. I love You Lord!

PINARD'S 
Past pointing - finger nose test, missed finger 
Intentional tremor - finger nose test, zigzag path 
Nystagmus 
Ataxia 
Romberg's test - unstable on standing still for 30 sec 
Dysdiadokinesia - hand coordination test 

Finger-to-nose test. 

A. Normal: Smooth trajectory throughout movement. 

B. Cerebellar hemisphere dysfunction: Tremor increases in amplitude as finger approaches target. 

C. Parkinsonian: Tremor may be present at initiation of movement, but smoothes out as finger approaches target. 

D. Essential tremor: Low-amplitude fast tremor throughout trajectory, may worsen as finger approaches target.

Urine toxicity test 
1. MAMP - Methamphetamin 
2. KET - Ketamin 
3. COC - Cocaine 
4. BZD - Benzodiazepine 
5. AMP - Amphetamine 
6. THC - Tetrahydrocannabinol (product of cocaine) 
7. PCP - Phencyclidine 
8. OPI - Opioid 
9. MDMA - Methylenedioxymethamphetamine

CLC Orang Asli Mission Trip

A group of 29 of us set out for the orang asli village at Cameron Highlands on the first day of June. We reached the 19th mile orang asli village at 4pm the same day.

We were welcomed warmly by the 19th mile Lutheran Church pastor, Ps Chu and the members. We started the session with the songs 'Hari Ini' and 'Dalam Yesus Kita Bersaudara'. We could hear the joy and love from the singing.

We then had games with the children where we were able to experience the purity of childhood. Then it was skit time where the children took part in puppetry and retold the Garden of Eden story!! What an eye opening experience as to how well they know the story and their talents!! After that, we had a hygiene talk where we emphasized on the importance of hygiene in daily life.

The sessions ended with prayer for the orang asli ministry, the members and in return they prayed for us. We then bid our goodbyes and headed to our lodging place for the night, the Lakeview campsite.

Day 7 - Get a Life!

A shy person shrinks back from many things that she should confront. There are many things she would like to say or do, but she's paralyzed by fear. I believe we must learn to step out into things and find out what God has for us in life.

A more timid approach may protect individuals from making mistakes, but the result is that they spend their lives wondering "what could have been." Bold people, on the other hand, make more mistakes, but they recover and eventually find what is right and fulfilling for them.

Making mistakes is not the end of the world. We can recover from most mistakes. But one of the few mistakes we cannot recover from is the mistake of never being willing to make one in the first place! God works through our faith, not our fear. Don't sit on the sidelines of life wishing you were doing the things you see other people doing. Take action and make the most of life!

Pray: Lord, I put my trust in You and look forward to moving into new areas of life. I will not sit on the sidelines any longer. Amen.

Numbers 14:8, 9 

If the Lord is pleased with us, he will lead us into that land, a land flowing with milk and honey, and will give it to us. Only do not rebel against the Lord. And do not be afraid of the people of the land, because we will devour them. Their protection is gone, but the Lord is with us. Do not be afraid of them."

Day 6 - Venture off the Path

If we want to be encouraged in our own individuality and independence, we must sow the same type of freedom and respect into other people's lives. "Live and let live" should be our motto.

There was a time in my life when I was rather narrow-minded, and I well remember judging and rejecting one woman in particular who was a rather unique nonconformist. She dressed eclectically long before it became stylish. She was not rebellious against authority, but she was unpredictable and determined to live her own life. She was sort of like the wind - you never knew exactly what to expect. That bothered me, because in those days I was more of a legalist. Everything had to be one way - usually my way.

I look back now and think I probably missed out on a great relationship with someone who could have nurtured freedom in me. But, like many people, I was fearful of living outside the norm.

If you are tired of living on the beaten path that everyone else walks, venture into the woods. Some people would be afraid they would get lost, but a confident woman expects to have a new experience that might be outrageously wonderful.

Pray: Lord, help me to see beyond my narrow limitations for people. I want to see what You see in them, but I'll never see it without Your touch. Amen.

1 Corinthians 12:27 

Now you are the body of Christ, and each one of you is a part of it.

Day 5 - What's the Difference?

The Bible encourages us to seek understanding. Read a couple of good books on the differences between men and women and also one on the differences in personalities. If you do, it may prevent thousands of arguments or misunderstandings.

Women offer unsolicited advice and give direction, and men usually don't take advice very well. The woman thinks she is just trying to help, but the man thinks she doesn't trust him to make the right decision.

When a woman disagrees with a man, he takes it as disapproval, and it ignites his defenses. Men only want advice after they have done everything they can do. Advice given too soon or too often causes him to lose his sense of power. He may become lazy or insecure.

Men are motivated and empowered when they feel needed. Women are motivated when they feel cherished. Men are visual creatures; once an image is in their head, it's hard to get it out.

Women are more inclined to remember emotions or how something made them feel. Seek understanding first, then speak.

Pray: Lord, I want to be a woman of wisdom and understanding. Help me comprehend why men are the way they are and how I can improve in my communication and friendships. Amen.

Proverbs 4:7 

Wisdom is the most important thing; so get wisdom. If it costs everything you have, get understanding.

Day 4 - It's Not About Age

Timothy, Paul's "spiritual" son in the ministry, was very young, and he was fearful and worried about what people thought of his youth. Paul told him to let no man despise his youth. It really does not matter how old or young a person is. If God calls someone to do something, and they have the confidence to go forward, nothing can stop them.

How you respond to your age and, for that matter, how others respond is really up to you. We all age in years, but we don't have to get an "I'm too old" mindset. Moses was 80 years old when he left Egypt to lead the Israelites to the Promised Land.

Confident people don't think about how old they are; they think about what they can accomplish with the time they have left. Remember, confident people are positive and look at what they have, not what they have lost.

Even if you are reading this devotion and let's say you are 65 years old and feel you have wasted most of your life doing nothing - you can still start today and do something amazing and great with your life.

Pray: Lord, You used people of all ages throughout the Bible, and You can use me. Today is a new day, and I am excited about what You have for me to accomplish. Amen.

1 Timothy 4:12 

Don't let anyone look down on you because you are young, but set an example for the believers in speech, in conduct, in love, in faith and in purity.

Day 3 - Consider Your Life

Today's verse is very important to me. I am an aggressive person who wants to be involved in everything, but I have learned the hard way that it isn't wise or even possible. We cannot do everything and do anything well. Quality is much better than quantity.

Verse 16 begins by saying she "considers" a new field before she buys it. She considers her present duties and is careful not to neglect them by taking on new ones. In other words, she seriously thinks about what she is about to do and does not act emotionally without forethought.

Oh, how much better life would be if we all took time to think about what we are about to do before we do it. It is amazing how many things I don't buy if I just go home and think about it for a while. It is amazing how one good night's sleep changes our minds.

Emotions are fickle and ever changing. This is the reason why it is dangerous to do things based on high emotions without giving plenty of consideration to everything involved. Remember to think before you act.

Pray: Lord, I ask You to give me wisdom as to what I give my time and attention. Help me to be busy with the right things and to give my best to those things. Amen.

Proverbs 31:16 

She considers a field and buys it; out of her earnings she plants a vineyard.

Choleric!!

The choleric temperament is fundamentally ambitious and leader-like. They have a lot of aggression, energy, and/or passion, and try to instill it in others. They can dominate people of other temperaments, especially phlegmatic types.

Many great charismatic military and political figures were choleric. They like to be in charge of everything.

However, cholerics also tend to be either highly disorganized or highly organized. They do not have in-between setups, only one extreme to another. As well as being leader-like and assertive, cholerics also fall into deep and sudden depression. Essentially, they are very much prone to mood swings.

Day 2 - When You Feel Afraid

Just because ordinary people take steps to accomplish extraordinary things does not mean that they do not feel fear.

I believe the Old Testament hero Esther felt fear when she was asked to leave her familiar, comfortable life and enter the king's harem so she could be used by God to save her nation. I believe Joshua felt fear when, after Moses died, he was given the job of taking the Israelites into the Promised Land.

I know I had fear when God called me to quit my job and prepare for ministry. I still remember my knees shaking and my legs feeling so weak that I thought I would fall down. I remember the fear I felt then, but it frightens me more now to think of how my life would have turned out had I not faced the fear and pressed forward to do God's will. Fear does not mean you are a coward. It only means that you need to be willing to feel the fear and do what you need to do anyway.

Pray: Lord, thank You for the many examples in Your Word of individuals who stepped forward in faith despite their fears. Help me to do the same. Amen.

Ezra 3:3-4 

Despite their fear of the peoples around them, they built the altar on its foundation and sacrificed burnt offerings on it to the Lord, both the morning and evening sacrifices. Then in accordance with what is written, they celebrated the Festival of Tabernacles with the required number of burnt offerings prescribed for each day.

Day 1 - Believe In Your Value

Take a minute and look into your heart. How do you feel about yourself? If your answer does not agree with God's Word, I encourage you to begin today renewing your mind about yourself.

See yourself as God sees you. Study God's Word and you will find out that you are precious, created in your mother's womb by God's own hand. You are not an accident. You are valuable, you have worth, you are gifted, you are talented, and you have a purpose on this earth.

Not only must we ask God for things He has promised us but we must receive them (Until now you have not asked for anything in my name. Ask and you will receive, and your joy will be complete. John 16:24).

If you feel unworthy, you probably won't ask, and even if you do, you won't receive by faith. Don't let feelings rule you anymore. Take a step of faith and start improving your quality of life today. Believe that you make good decisions, that you are a valuable person with a great future, and something good is going to happen to you today!

Pray: Lord, I ask You to imprint Your love into the depths of my heart. I believe You have a great future for me and that I can walk in Your purpose for my life. Amen.

Isaiah 43:4, 5 

Since you are precious and honored in my sight, and because I love you, I will give people in exchange for you, nations in exchange for your life. Do not be afraid, for I am with you; I will bring your children from the east and gather you from the west.

The Confident Woman

A 14-day spiritual journey with Joyce Meyer 

Women are a precious gift from God to the world. We are creative, compassionate, intelligent, and, according to the Bible, equal to men.

But years of abuse and wrong views of women have caused many to lose the confidence God wants us to enjoy. We may feel that we're somehow "less" than men. Less valuable. Less worthy. The truth is, we are very valuable - to society, but more importantly to God.

God wants us to be courageous, respected, admired, promoted, sought after, and most of all, loved. And we can be!

Day 1 Believe in Your Value
Day 2 When You Feel Afraid
Day 3 Consider Your Life
Day 4 It's Not About Age
Day 5 What's The Difference
Day 6 Venture Off the Path
Day 7 Get A Life
Day 8 Our Vindicator
Day 9 Your Heart Desires
Day 10 In Due Season
Day 11 Boldness or Pride?
Day 12 The Prayer of Consecration
Day 13 Quiet Inner Confidence
Day 14 Be Courageous

End Of Ortho Posting Break

Day 4 of a 5 day break. 
Day 1 was a Saturday with Anakainos meeting then lunch afterwards. Came home for a nap then family dinner with grandpa.

Day 2 was a Sunday at Charis Christian Center then Orang Asli trip. Quite a good experience but i was distracted by my self-centeredness :-( it was all well until i became desperate. I'm sick of myself hunting for boyfriend. Really need a lot of prayer for this!

Went to Alvin's to collect my new Samsung S2 :-) Then went for dinner at Beng Fatt's for his daughter's fullmoon. Met Justin's girlfriend Kym finally. Will need to pray for this too. Of course Adrian n Pui Yan too. It was a mini reunion for CLC members of all these years. Some of them looks familiar but i can't recall their names!

Day 3 was a day trip back to sitiawan for beauty session with Ben! It was quite a rush session though. But it wasn't too bad in view that i had my hair done. It looks bad now but hopefully it'll look better later :-P

Nonetheless he's still in my mind :-(

Hopefully today will be a fruitful day with no nonsense. And that it'll be a good day spending time with God! :-)

"A Thousand Years"

"A Thousand Years" 

by Christina Perri 2012

Heart beats fast
Colors and promises
How to be brave
How can I love when I'm afraid to fall
But watching you stand alone
All of my doubt suddenly goes away somehow
One step closer

I have died everyday waiting for you
Darling don't be afraid I have loved you
For a thousand years
I'll love you for a thousand more

Time stands still
Beauty in all she is
I will be brave
I will not let anything take away
What's standing in front of me
Every breath
Every hour has come to this
One step closer

I have died everyday waiting for you
Darling don't be afraid I have loved you
For a thousand years
I'll love you for a thousand more 
And all along I believed I would find you
Time has brought your heart to me
I have loved you for a thousand years
I'll love you for a thousand more
One step closer
One step closer