ICU 22/11/19

DATE/ SP ONCALL BED NO/IC/RN DETAILS OUR PLAN OTHER DEPARTMENT PLAN

15/11/2019 BED 14 41/ M/ MALE 1. DUODERM PATCH OVER SACRAL SURGICAL

MR SYUKREE AMIR B MAIDIN U/L DM SORE DX:
PRN 820928085587 DX: SACRAL SORE 2. CONT. DAILY DRESSING 1) UGIB SECONDARY TO FORREST 1A D2 ULCER
- LAPAROTOMY AND UNDERRUNNING DONE
BBA: CRE 2) LEFT LUNG EMPYEMA
- CHEST TUBE INSERTED ON 21/10/2019

ICU
DX: CAP WITH PARAPNEUMONIC EFFUSION
- FOR MECHANICAL VENTILATION
- KIV CECT THORAC CM

NEPHRO
DX: WORSENING AKI

16/11/19 CTW BED 1 22/INDIAN/MALE 1) CHECK XRAY OF LEFT FEMUR ONCE ICU
MR. SYUKREE RICHARD A/L DX: PT STABLE - EXTUBATED ON 22/11/19
KUMARESAN 1) DEEP LACERATION WOUND OVER RIGHT SHOULDER 2) FOR EOD DRESSING OVER LEFT - KIV CT BRAIN IF PERSISTENTLY RESTLESS
970718055201 2) CLOSED FRACTURE OF M/S LEFT FEMUR FEMUR
3) CONT ICU PLAN
* POST OP D6 FOR WOUND DEBRIDEMENT AND T&S OF RIGHT 4) STO D14
SHOULDER AND ILN OF LEFT FEMUR (16/11/19) 5) CONT ABX
HB: 12 TO 7.9 6) KIV REFER SURGICAL AFTER
PREVIOUS PR BROWNISH STOOL REVIEW STOOL FOR OCCULT BLOOD
7) KIV FOR LOOD TRANSFUSION CM IF
HB CM LESS THAN 8G/DL
21/11/2019 CTW BED 3 64/MALAY/MALE 1) IVD 3 PINT NS/24 HOURS SURGICAL
MS AISHAH MD AMIN BIN ANIS U/L DM, HPT 2) FOR RECON NAIL OF RIGHT FEMUR - LEFT 6TH AND 7TH RIB FRACTURE
550629015995 ALLEGED MVA ON 21/11/19 @ 7AM (CAR VS CAR) (ZIMMER) - BILATERAL LUNG CONTUSION
DX: CLOSED RIGHT NOF (BASICERVICAL) FRACTURE WITH 3) TO APPLY RIGHT LL SKIN TRACTION
IPSILATERAL MIDSHAFT OF FEMUR FRACTURE (WINQUIST 2-3)
ICU
- FOR EARLY MOBILIZATION
- ON RTF. TO ASPIRATE ON OT CALL
20/11/19 CTW BED 4 17/M/FEMALE 1) STO D14 NEUROSURGICAL
MS AISHAH INTAN NIRWANA BINTI ALLEGED MVA (MB SKIDDED) ON 20/11/19, 0630 H 2) INFORM ONCE XRAY OF RIGHT DX: POLYTRAUMA WITH SHI
NOR FAIZUL DX: 1) CLOSED RIGHT LATERAL CLAVICLE FRACTURE SHOULDER AVAILABLE - POST OP FORR RIGHT FRONTAL BURRHOLE AND
020220010760 2) DEGLOVING WOUND OVER RIGHT FOREARM 3) EOD DRESSING ICP INSERTION @20/11
- DONE WD+ T&S AND LIGATION OF BASILIC VEIN 4) CONT OTHERS - AIM TO COMPLETE CR TODAY

TRAUMA
- DID BRONCHOSCOPY

OMFS
-DX: MULTIPLE FACIAL BONE FRACTURES
18/11/19 BED 25 44/M/MALE 1. CONT IV TAZOCIN FOR NOW MEDICAL
MS EVELYNN MOHD HASRI BIN MOHD U/L DM, HPT, CCF, H/O CVA 2. NOT FOR DEBRIDEMENT AT THE 1) DECOMPENSATED CCF
HAFIS MOMENT 2) ANURIC AKI
751014017039 DX: BULLOUS CELLULITIS OF LEFT LL 3. DAILY ORTHO REVIEW - ONGOING CVVHDF
- PROBE TEST NEGATIVE 4. TRACE CULTURE ONCE AVAILABLE
- USG LL: NO EVIDENCE OF DVT 5. DAILY NORMAL SALINE AND
BACTIGRAS DRESSING

WEST 4
13/11/19 BED 11 30 YEARS OLD/ INDIAN/MALE 1. CONT ARMSLING SURGICAL
MR. LEE ANANDEN KANISAN NKMI,NKDA 2. TCA ORTHO 3 WEEKS UPON DISCHARGE DX: RIGHT 5TH RIB FRACTURE
ALLEGED MVA (MB VS MB) ON 13/11 - ON VM 8L/MON
PRN DX: RIGHT AC JOINT DISRUPTION (ROCKWOOD 3) -INSERTED CHEST TUBE 14/11/19
- EXTUBATED ON 15/11/19
- CT THORAX (18/11):
A) LEFT LUNG COLLAPSE WITH
MEDIASTINAL SHIFT
B) MULTIPLE RIB FRACTURE
C) RIGHT RENAL INJURY GRADE 3
21/11/19 BED 3 30/I/M 1. FOR RAY’S AMPUTATION OF RIGHT BIG TOE SURGICAL/PLASTIC
MOHANA RAJ U/L DM, ICE CHASER UNDER LAOT WITH WALLANT ANALGESIA DX: ALLEGED ELECTRICAL BURN
MS AISHAH 890929045185 DX: WET GANGRENE OF RIGHT BIG TOE DFU INJURY WITH 20% SECOND
*PATIENT REFUSED FOR OP UNDER LAOT DEGREE BURN
- IV MORPHINE
- CMC + BACTIGRAS DRESSING
- CONT ABX
- KNBM
- PLANNED TO REFER ENT TODAY
21/11/19 BED 6 60/ CHINESE/MALE 1) NO ACTIVE ORTHO INTERVENTION FOR NOW TRAUMA
LAU KOW HONG ALLEGED FALL FROM HEIGHT (15 FEET) @ 21/11/19 @1630H 2) ADEQUATE ANALGESIA - MULTIPLE RIB FRACTURE WITH
MS AISHAH 590616086053 DX: 1) LEFT SUPERIOR PUBIC RAMI FRACTURE WITH ISCHIAL LUNG CONTUSION
TUBEROSITY FRACTURE (NON-DISPLACED) 2) STOMACH CONTUSION
PRN - NO FOOT DROP - KIV FOR EXPLORATORY
LAPAROTOMY IF DEVELOP
PERITONITIS

NHDU
DATE/ SP ONCALL BED NO/IC/RN DETAILS OUR PLAN OTHER DEPARTMENT PLAN

7/11/19 BED 8 37/MALAY/MALE 1. OFF BACKSLAB NEUROSURG

MS MAHAZURA ISZUAN ISMAIL NKMI/NKDA 2. ORTHO REVIEW PRN SEVERE HEAD INJURY
PRN ALLEGED MVA (MB VS CAR) 7/11/19 3. IF DISCHARGE TCA ORTHO HIS LEFT FRONTAL EDH, RIGHT OCCIPITAL EDH
DX: CLOSED RIGHT DISTAL 3RD TIBIAFIBULA # 4. DAILY DRESSING OVER PRESSURE SORE -DONE CRANIEC 7/11/19

SURGICAL
- EUA DONE ON 13/11/19

7/11/19 BED 9 28/MALAY/FEMALE 1. KEEP RIGHT LL BACKSLAB NEURO SURG

MISS MAHAZURA NOR ANIZA BINTI NKMI/NKDA 2. FOR ILN RIGHT TIBIA (KANGHUI) LATER SEVERE HEAD INJURY RIGHT
PRN ZAINUDDIN ALLEGED MVA ON 7/11/19 3. TO BOOK CASE ONCE FAMILY CONSENTED FRONTOPARIETAL SDH
911019016780 DX: CLOSED B/L INFERIOR PUBIC RAMI AND SUPERIOR 4. CONSERVATIVE MX FOR PELVIC # DONE CRANIEC 7/11/19 & 9/11/19
RIGHT PUBIC RAMI 5. TO DISCUSS BACK WITH FAMILY MEMBER ON CR OFF
CLOSED RIGHT M/S TIBIA AND HEAD OF FIBULA SUNDAY
FRACTURE SURGICAL’
LEFT ACETABULUM WALL FRACTURE GRADE 3 LIVER INJURY
-CONSERVATIVE MX FOR NOW
18/11/19 BED 1 19/M/MALE 1. FOR PHILEDAPHIA COLLAR NEUROSURGICAL
MS EVELYNN PUTRA AFFANDI ALLEGED MVA ON 10/11/19 2. TO ASSESS NEUROLOGICAL FUNCTION LATER DX: SEVERE HEAD INJURY
000611011527 DX: C2 VETERBRA BODY # MILDLY DISPLACED ONCE PATIENT GCS FULL - SELF EXTUBATED ON 22/11/19. 3AM
 - IN ACCORDANCE TO FINDINGS FROM KHOO TECK
PUAT HOSP SG SURGICAL
DX: B/L UPPER LOBE LUNG CONTUSION

ID
HAP
- ON IV TAZOSIN
19/11/19 BED 2 21/M/MALE 1. REVIEW XRAY RIGHT SHOULDER ONCE NEUROSURG
MS EVELYNN M. HAZWAN ALLEGED MVA ( MB VS MB) ON 19/11 AVAILABLE PO 12H LEFT DECOMP CRANIECTOMY + CE +
901027035931 DX : CLOSED # OF RIGHT CLAVICLE 2. KEEP ARMSLING FACIAL DURAPLASTY + EVD INSERTION FOR
ICB MONITORING FOR SEVERE HI
- CONT CR

SURGICAL
RIGHT 3RD-6TH RIB #
- CONSERVATIVE MX
21/11/19 NHDU 5B 65/M/MALE 1) BACKSLAB OF RIGHT LL NEUROSURGICAL
MS AISHAH MUHAINI BIN DANURI ALLEGED MVA (MB VS CAR) @ 21/11/19, 1330 H 4) TRACE OFFICIAL CT CERVICAL AND BRAIN MODERATE HEAD INJURY
540911015703 DX: 1) OPEN COMMINUTED FRACTURE OF DISTAL 1/3 REPORT - CT BRAIN REPEATED ON 22/11/19
OF RIGHT TIBIA/FIBULA (GUSTILO 2) 5) FOR WD AND EXT FIX OF RIGHT TIBIA LATER
2) RIGHT SUPERIOR PUBIC RAMI FRACTURE 6) IV CEFUROXIME 750MG TDS
7) STRICT DCC OF RIGHT LL
*PATIENT NOT IN BED, WENT FOR CT BRAIN DURING 8) BD WASHOUT TILL OP
PERIMAIN ROUNDS ON 22/11/19

NSM
DATE/ SP ONCALL BED NO/IC/RN DETAILS OUR PLAN OTHER DEPARTMENT PLAN

22/10 BED 2 34 Y/O NEPALESE MALE 1. FOR DAILY POVIDONE DRESSING + NEUROSURGICAL
MS EVELYNN GHARTI ALLEGED MVA (BICYCLE VS CAR) ON 22/10/2019 COMPRESSION DRESSING 1. SEVERE HEAD INJURY, NEGATIVE CT
06944357 2. INFORM BACK ORTHO BEFORE DISCHARGE FINDINGS
DX 3. FOR WCM - CONSERVATIVE
1. CLOSED LEFT MIDSHAFT FEMUR FRACTURE 4. OFF HEPARIN - DONE TRACHY 4/10/19
(WINQUIST II)
2. CLOSED LEFT MIDSHAFT CLAVICLE FRACTURE 2. ATLANTODENTAL ASYMMETRY TRO
3. T2-T4 TRANSVERSE PROCESS FRACTURE LIGAMENTOUS INJURY
-DONE KNAIL LEFT FEMUR 3/11/19
- WI DONE 6/11/19 SURGICAL
4. LEFT KNEE HEMARTHROSIS-ASPIRATED BLOOD 1. LEFT HEMOTHORAX
- CHEST TUBE INSERTED 23/10/2019
CHECK XRAY S/B MS EVELYNN REMOVED 29/10/19
 NOTED ?HEMATOMA OVER SURGICAL SITE CHEST
- STO DONE OVER PROXIMAL AND DISTAL WOUND 1. HAP –ON IV BACTRIM AND CEFUROXIME
2. PERSISTENT LEFT LZ CONSOLIDATION
NOTED PROLONGED APTT ( 37.3) ON 17/11 /COLLAPSE TRO PTB/SARCOIDOSIS
PT 11.7, INR 1.08
ID
SWAB C+S (LEFT LEG) 18/11: NO GROWTH - OFF CLOXA
- START IV MEROPENEM
- CONT CEFTAZIDIME BACTRIM 2 WEEKS
- BLOOD C+S REPEATED ON 18/11
19/11/19 BED 9 22/M/MALE 1. FOR ORTHO TEAM TO SEE BACK ON SUNDAY NEUROSURGICAL
MS EVELYNN SHAHRIL AMRI ALLEGED FALL ON 19/11 TO DISCUSS BACK OPTIONS MILD HI
960821016607 DX : 1) CLOSED RIGHT D/E RADIUS # 2. TO INFORM ORTHO IF PATIENT DISCHARGE - TO REPEAT CT BRAIN ON PTD5 OR EARLIER
- DID CMR+ FLPOP OF RIGHT UL BEFORE SUNDAY IF GCS DROP
2) AVULSION # OF RIGHT ILIAC WING - CONT NEUROMONITORING

*CHECK X RAY NOT ACCEPTABLE DENTAL

STI
- TO CONFIRM ORBIT # WITH CT SCAN LATER

EAST 2
DATE/ SP ONCALL BED NO/IC/RN DETAILS OUR PLAN OTHER DEPARTMENT PLAN

21/11/19 BED CB10 64/M/F 1) FOR CONSERVATIVE MX SURGICAL

MS AISHAH ZAINON ISMAIL U/L BREAST CA STAGE 4 2) REFER PHYSIO FOR WCM DX: BREAST CA
PRN 541204015450 REFERRED FOR LEFT HEAD OF FEMUR FRACTURE 3) CONT OTHERS - TO ARRANGE MRI SPINE
22/11/19 BED 12 6/M/F 1) FOR BEDSIDE SUTURING OF GAPING WOUND SURGICAL
MS AISHAH WARDAH BINTI ABDULLAH POD4 FOR RIGHT BKA FOR SEPSIS SECONDARY TO 2) WI CM PVD
581128016182 RIGHT BIG TOE GANGRENE - CURRENTLY ON FEEDING

REFERRED BACK FOR WOUND GAPING OF BKA STUMP

PSY
- REFERRED AS PATIENT REFUSED TO SPEAK
- PLANNED TO DISCUSS BACK WITH
SURGICAL TEAM FOR FUTURE CARE PLAN

1ST CLASS
6/11/19 BED 35 77/C/F 1.CONSERVATIVE MX SURGICAL
MS MAHAZURA ANG SUA ENG U/L LEFT MASTECTOMY 13 YEARS AGO FOR BREAST 2. REFER PALLIATIVE -LEFT BREAST CA STAGE 4
PRN 420830015334 CA 3. MRI WHOLE SPINE UNDER KIV LIST ON REGULAR MORPHINE
DX: LEFT BREAST CA WITH METS TO
BONE.LUNG,LIVER APS
- FOR PALLIATIVE RADIOTHERAPY FOR
PARAPLEGIA PREVENTION
16/11/19 BED 22 83/C/FEMALE 1. NO ACTIVE ORTHO INTERVENTION HEMATO
MR SYUKREE TEE YOK LAN U/L : H/O RIGHT FEMUR #. PLATING DONE IN 2015 2. CONT HEMATO PLAN TRO MULTIPLE MYELOMA
360303015066 AT H. SUBANG 3. CONT ANALGESIA -BMAT DONE 17/11
PRN MINOR THALASSEMIA NOT ON BLOOD - DISCHARGE HEMATO
TRANSFUSION
MEDICAL
MRI THORACOLUMBAR (13/11) DX: LIKELY LUNG CA WITH BONE METS
- T4 TO SACRAL MULTIPLE COMPRESSION #
INVOLVING T5,T7,L1,L3,L4
- # AT L1,L3,L4 LED TO MILD CENTRAL SPINAL
STENOSIS

NOTED PR BROWNISH STOOL WITH BLOOD STAINS

EAST 4 PALLIATIVE
26/9 BED 1A 53 Y/O MALAY MALE PLAN: SURG:
MR SIM MOHD AZMAN BIN U/L ADVANCED HEPATOMA, HEP B, RVD 1. NO ACTIVE ORTHO INTERVENTION DONE CECT TAP ON 26/9
NGADIMAN P/W ABD PAIN FOR 1 MONTH 2. FOR MRI SPINE AS PLANNED RESULTS:
660207015335 REFERRED FOR SPINAL METS EXPLANSILE LYTIC MASS WITH
PRN - MRI SPINE CANCELED SOFT TISSUE COMPONENT
DX: INVOLVING:
ADVANCED HEPATOMA WITH BONE METS - LEFT LATERAL 5TH RIB
- LEFT POSTERIOR 6TH RIB
- RIGHT TRANSVERSE PROCESS OF
T12 VERTEBRA
- LEFT ILIUM
- AWAITING S/W FOR PLACEMENT