B Lines in Lung Ultrasound

Lung ultrasound has come in vogue during the COVID pandemic.  LUS is simple to perform and can be readily done at the bedside.  LUS performed well, together with a proper clinical history and physical examination, can help clinicians reach a diagnosis quickly before needing to perform more extensive investigations like HRCT scans of the lungs.

Indentification of B line artifacts in the lungs can mean pulmonary oedema (heart failure), interstitial syndrome (interstitial lung disease), infections (viruses or bacteria) and ARDS (acute respiratory distress syndrome).

LUS is a useful screening tool at the bedside in ward or emergency room.  The ultrasound machine can also be used to scan other organs of the body (heart, blood vessels, liver, kidneys, etc) at the same sitting providing more useful clinical information.

Leong Sin Nam Tomb vandalised

Leong Sin Nam's tomb vandalised. Not a pretty sight at all. Two cement statues torn off the sidewall and thrown onto the floor. The heads of the model guards detached at their necks. The worship alter also ripped off from the table and thrown onto the floor.

Utter disrespect for the departed and needing the family to pay for repairs which the money could have been better given to charity for people lacking in food and clothing during the pandemic and floods.

We need more civic minded people to care for public amneties and private property. Distruction of property should never be condoned and the culprits should be brought to justice. 

Vandals damage tomb of late community leader Leong Sin Nam | The Star

独家︱梁燊南坟墓受破坏 2守卫像香炉遭推倒 - 地方 - 大霹雳 - 时事焦点 - 大霹雳焦点 | 星洲网 Sin Chew Daily

Blue Bloaters

Blue bloaters is the name used to describe COPD (chronic obstructive pulmonary disease) patients who are overweight, puffed up, having difficulty breathing, lacking oxygen (hence the blue, cyanotic discolouration) and have leg swelling due to right heart faillure.  COPD is mainly caused by cigarette smoking.

These patients are hypoxic with low oxygen saturation and some with carbon dioxide retention.  The brain adapts and is reliant on the low oxygen in the blood to drive breathing.  As such, an overdose of oxygen, removing the hypoxic drive, will make them worse leading ultimately to deeper respiratory failure, carbon dioxide narcosis, respiratory arrest and death. 

Therefore, it is very important for caregivers to know exactly how much oxygen (litres per minute) to give to these COPD patients.  Some of these patients may only need to maintain their SpO2 at only 90% to 93% as they are used to these low oxygen to drive ventilation and to "blow out" the carbon dioxide. 

Please consult your doctor for medical advice and not to give too much oxygen to these COPD patients.  Arterial blood gas analysis is required to make a proper diagnosis for these patients.