Tracheostomy for Ventilated Patient

Doctors struggle to accurately predict which patients will require prolonged mechanical ventilation.  Doctors need a clear understanding of the nature and typical course of chronic critical illness.

Communication about chronic critical illness should begin before its onset and, ideally, as early as the initiation of mechanical ventilation (or even at decision-making about whether to initiate ventilation).  Doctors should inform not only of the risk of death in the ICU, but also the chance the patient might survive but remain dependent on the ventilator and other intensive therapies for a prolonged period. 

These initial discussions allow a longer time for doctors to “cultivate prognostic awareness” i.e. the capacity to understand prognosis and the likely illness trajectory and help patients and families prepare psychologically and practically for further developments.

Based on the available evidence, routine placement of tracheostomy prior to day 10 of mechanical ventilation is not indicated. General consensus is that a tracheostomy should be placed after day 10 if the patient is likely to require more than a few additional days of ventilation i.e. the patient will neither be liberated from the ventilator nor die in the near future i.e. the patient is chronically critically ill.

Benefits of tracheostomy include:

Improved patient comfort

Easier oral care and suctioning

Reduced need for sedation or analgesia

Reduced accidental extubation

Improved weaning from mechanical ventilation

Easier facilitation of rehabilitation

Earlier communication and oral nutrition

Facilitated transfer to lower level of care

Early Complications:

Bleeding

Air leak causing subcutaneous emphysema, pneumothorax, pneumomediastinum

 

Damage to the swallowing tube (esophagus)

 

Injury to the nerve of the vocal cords (recurrent laryngeal nerve)

 

Tracheostomy tube can be blocked by blood clots, mucus, or pressure of the airway walls.

Late Complications:

Accidental removal of the tracheostomy tube

 

Infection in the trachea and around the tracheostomy tube

 

Trachea may be damaged by pressure from the tube resulting in bacterial infections and scar tissue formation

Delayed Complications:

Thinning of the trachea from the tube rubbing against it (tracheomalacia)

Ipoh Founded by Hakka Made Vibrant by Cantonese

This presentation is by Dr Richard Ng who is an Ipoh City Councilor.  

There are several facts which I find very interesting:

• Paloh Ku Miu was the Chinese Temple located near the Kinta River Jetty where the Chinese immigrants arrived.  The deity was brought from Penang to Ipoh by Leong Fee.  Leong Fee came to Malaya during the 1st wave of Chinese Migration.
• The table on Chinese ethnicity in the late 1800's and early 1900's showed that the Cantonese outnumber the Hakkas in Ipoh.
• The Hakkas were mainly tin miners whereas the Cantonese were mainly traders. 
• In the early days the Ipoh settlement was mainly located on one side of the Kinta River.  On the other side of the river the Chinese reared pigs.  The pig styes produced an overwhelming offensive stench for the settlement depending on the direction of blowing wind.  The British relocated the pig styes far away from the settlement and Yau Tet Shin bought up the land to build houses.  This was the beginning of the New Town of Ipoh across the other side of the Kinta River. 
• The Cantonese Trail has many interesting heritage sites. Very importantly it also included many business sites in the City.  These sites will be of great interest to the people of Guangzhou who are also Cantonese.  They will be willing to explore Ipoh to find out why their clansmen migrated to this place in the early days.  

The presentation is rather long but I am sure it will be worth your time going through the whole presentation. 

 

LSN Tomb Repaired

Today 19th January, is the Death Anniversary of Leong Sin Nam.  Very glad to see the statues restored and put back in their original positions.  Some bolts were added to securely fasten the statues to the base.  

Here we see members of Perak Kaying Association paying their respect to LSN.  Conspicuously absent were the food offerings and the Min Tet School band due to COVID Pandemic SOP regulations which had to be followed strictly.  Also noticeable was the dwindling crowd.  This ceremony has been in existenence for the last 82 years. 

How to Start Church Mentoring Programme

The church mentoring programme has to start with a willing believer who volunteers to become a mentor to either believers or pre-believers.  The mentor needs to have the spiritual gifts and talents which are desirable to the mentee.  The mentor need not be a perfect person but must be spiritually matured.  

Mentorship to believers can be formal as through sermons or Bible studies.  Mentoring can also be informal like during small group meetings, youth and senior fellowship meetings.

Mentees can learn and be transformed in their work cultures, attitudes and skills.  They can also gain knowledge on how to self improve. Bible knowledge can be imparted by the mentor or self learnt from books or web.  

All these teachings and transfer of knowledge can occur in the church, workplace, Alpha on line course, Kopitiams, restaurants or even while holidaying or travelling. 

The mentor-mentee programme for pre-believers should be regarded as an introduction of life skills and knowledge.  It allows for the building of trust and the establishment of long term relationships between mentor and mentee thus forming a base for future evangelism.  

Mentor Mentee Programme

Some notes on how to start a Mentor Mentee programme for youths in church.  

The Mentors must be seen to possess personal values which can be passed on to Mentees.  And the Mentees must have a desire to learn from their Mentors.  There must be a match in needs and also personal chemistry to develop a good learning experience. 

The Mentor must be willing to offer his services of teaching.  Perhaps it will be a good idea to provide a CV of the Mentor so that the Mentee will have an idea of the kind of learning experience he or she will gain from the programme.

Some of the other valuable assets of the Mentor are work experience, professional knowledge, corporate or public status, Christian Bible knowledge and leadership qualities.  The Mentor needs to be authentic and honest in his work.

Some points to consider when starting the programme include time and place of meetings, frequency of meetings and their duration.  Postings of 3 months with rotations amongst other Mentors serve best the interests of both Mentors and Mentees.  The engagement can also be in the form of an internship or a career placement. 

   

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