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We used the term DIL in the medical notes.

DIL which means dead-in-line are the process of informing the family members of patient regarding the serious condition.

The purpose of informing is vital because it’s enable the family members to prepare for the worst.

And during the process of informing, we seeks the family members permission on whether to proceed with active resuscitation in the event of cardiorespiratory arrest.

Selina, member of S.H.E, Taiwanese pop singing group, suffered 50% third-degree burn when mishap happened during filming a drama series in Shanghai.

News media are widely report the event. Unfortunately, they are failing to understand the severity of the event. They are still discussing the suppose wedding!

Selina’s father who appeared in the first news conference appeared to be calm. However, He unable to hide his emotion after knowing the dire situation of his daughter.

Burns  is difficult to treat and many people died from overwhelming sepsis.

The attending doctor must have have informed DIL to Selina’s father. This is standard procedure.

And let’s pray for Selina’s speedy recovery.


I seeing elderly gentleman who is a survivor of larynx cancer was bought in by family members despite being unwell for a month.

Clinically jaundice with pedal oedema and lowish BP, plus on and off chills give a diagnosis of sepsis underlying infective cause is entertained.

Writing down the last few sentence in the clerking notes and I’m just remember and asked about the medicine that he took from the ENT clinic.

It’s L-thyroxine and calcium lactate.

Hey, waiting a minutes, doesn’t he has feature of suggestive of hypothyroidism – the dry skin, depression, the pedal oedema which could be myxedema. He condition probably due to the side effect of radiotherapy after the removal of his larynx. The thyroid glands suffered damage due to radiation.

I just asked if he taking the medicine, patient’s wife just told me that he stopped taking it for a month after feeling rather unwell.

And that it, the diagnosis of hypothyroidism 2nd non compliant.



Cardiac resuscitation program (CPR) has undergone changes for past few years.

Almost in every new CPR guideline,  chest compression vs breathing ratio had changes many time.

It’s started with 5 compression with 1 breath in, then to 15:2,  30:2 and the latest is 60:2.

The latest CPR also change from airway-breathing-circulation to circulation-airway-breathing;

Extract from the executive summary of 2010 AHA Guidelines for CPR & ECC stated that

“is a change in the basic life support (BLS) sequence of steps from “A-B-C” (Airway, Breathing, Chest compressions) to “C-A-B” (Chest compressions, Airway, Breathing) for adults and pediatric patients (children and infants, excluding newly borns).

Basic Life support (BLS) algorithm has also changes with  “Look, Listen and Feel” has been removed from the algorithm.

The new BLS algorithm


Full guideline can be assessed at this URL:


I got pretty irritated every time I switched on 8 pm news last week.

So, what is so special with the gathering? the powerful, rich and famous or  just plain corrupt!

No matter how grand is the speech and how extravaganza and big budgets is, the end of the day what is our intention!

Do we implement the plan for the benefits of rakyat or just want to enrich our closed circle of friends.

Afterall, our friends are in dire need of this charity; my friends needs it to live a luxurious life.

Politicians must have the right intention and the right motive in his/her political careers.

Rakyat is questioning why you and your husband went to overseas for sponsored trip.

As usual, you spoke with confident while slammed and belittle the rakyat.

Are you very sure you had the right intention of promoting our tourism. Or it’s just fully sponsored trip and it’s just being power and in the position of doing?

DON”T worry, in the end of day, you shall be forgotten, just like the other.

Rakyat will remember the deed that you contributedeven you are long dead.



Doctors should and must make financial planning.

This is true especial to the junior doctors.

Many of fresh graduate doctors who just joined the services, are carried a large sum of loan.

Most of doctors who study in private Universities had borrowed from PTPTN. There are some borrowed from banks.

The starting salary for junior doctors in Ministry of health is actually better than other professions.

Therefore, argument against that doctors wage are too low is weak and unfounded.

What is more important that as a doctor who just starting their careers, we should be careful with the spending. Unless, you’re  had rich parent who can sponsored all your expenses.

Here are a few important notes:

1. Spend the money within limit

example: do not buy a car that beyond the ability, which mean buying a toyota vios is more practical than buying a camry

2. Reduced frequent of travelling

Airasia offerred cheap air tickets,  everyone can fly and doctors also can fly.

Too  many traveling will incurred extra-expense and time.

3. Careful with shopping

Girl like shopping and guy is the same. New Iphone, new SLR camera, new Audio CD players and so forth. The situation is worsen by the availability of credit card payment.

4. Must save for postgraduate study

MRCP UK exam written cost 536 pound. MRCP ireland cost 400 Euro (pls correct if i’m wrong).

We as a doctor should strive hard to become a specialist in our field of interest, so saving money for exam is a must.

5.  Must paid study loan

6. Doing locum

Working as locum is way to earn extra income. Do not overdoing it, it will definitely affect our work


October 2010
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