Good bye M.J

The video starting from 8:45 triggered a strong feeling deep inside my heart, all I want to say is: Dad, I love you. To Paris, Prince and Blanket, be strong.




His brave 11-year-old daughter Paris, shielded from public view most of her life by a mask, stepped up to the microphone and spoke of her love for her famous dad and the heartbreak she feels from his death.

"I just wanted to say ever since I was born, Daddy has been the best father you could ever imagine," Paris, fighting back tears, her uncles and aunties protectively standing behind her, told the 20,000-strong audience inside Staples Center and a worldwide audience estimated in the hundreds of millions.

"I just wanted to say I love him so much."

Paris turned and buried her head in her songstress aunt Janet's arms. The rest of the Jackson clan, including Paris' brothers, Prince Michael, 12, and Blanket, 7, moved in and the family shared a group hug (http://au.news.yahoo.com/a/-/entertainment/5710149/tributes-mark-jacksons-final-curtain/)

好吊哦

I love Serena Parker 超吊的

Ward round (2/7/09) with Joel

8 am - 11.45 am

Hand over meeting, X-ray meeting, ward round, MDM (multi-discipline meeting), X-ray tutorial

1) Venous insufficiency - heamosiderin deposition (dark brown colour, swollen, venous ulcer over lateral maleolus) , fluid tablet given), risk factor of the pt = weight

2) Clot in lower limb's vessel (vein? artery?) - Use D-dimer test, risk factor for coagulopathy( stasis, hypercoagulability, pregnancy etc), use Well's Criteria for DVT/PE

3) HSV encephalitis - sad case, nursing home soon, palliative care for next episode of infection, do not come back anymore (presentation handout given)

4) Diabetes - poorly controlled? pt have AF ( use CHADS 2 score to assess AF stroke risk), from CHADS 2 - use warfarin if high risk, aspirin for lower risk, remember HbA1c (average blood glc level over last 3 mths), diabetes - micro (peripheral neuropathy, retinopathy, nephropathy), macro (heart, brain and peripheral such as intermittent claudication)

5) Hyperobstructive cardiomyopathy - extra heart muscle, stress echo ordered, narrowing of blood outlet due to extra muscle

Extra:

1) check CTPA
2) check normal glc level (6-7?), CO2 (35-45?)
3) Anticoagulation ( start with LMW Heparin - Clexane)

X-ray:

1) Use ABCDEF guideline (Airway, Bone, Cardio, Diaphragm, Everythingelse, Fluid/Fat)

2) Do not forget fat esp breat tissue (turning X-ray brighter/white), so lower or middle lobe of lungs reduced penetration !!!! do not assume that's pneumonia) - how to diff pneumonia at these regions for female pt? compare both side's density

3) Nasogastric tube in wrong position

4) Cardiomegaly - >60% width of AP film, use thumb and little finger

5) Hyperinflated lungs - lungs expand below 6th anterior rib, COPD female pt - breasts small due to thin and cachexia, will get barrel chest, diaphragm flatten

6) Cardiomegaly witth heart failure - pul. edema with deposition of interstitial fluid, normally base of the lung - auscultation - crackle sounds, can see lung fissures!, hilum enlarged (same size as lower vessels) esp the vessels going to upper lobe (use Newton's gravitational theory), clearly suggestive of pulmonary hypertension

7) Pneumothorax - lung's edge clearly visible, not "attach" to the chest cavity

8) Atherosclerosis - aortic wall calcification, ring of calcification

9) Kyphosis - Osteoporosis a risk factor - do not forget post menopausal OP, on X-ray size of vertebrae smaller, wedge compression fracture?, normally anteriorly, hyperdensed vertebrae

10) learn air bronchogram - visible air-filled rings

11)Visible enlarged bronchi - risk factor = cystic fibrosis, Diagnosis = bronchiectasis， on auscultation - trachea breath sounds, not vesicular

Cool!!!!!!!!!!

Diarrhoea

Divided into acute or chronic

Acute = <48-72 hours

Acute vs chronic = no weight loss

Acute = low BP, decreased skin tugor, tachy, dry mucosa

Acute = do not miss antibiotic related diarrhoea (Clostridium Difficle), Tx = vancomycin (does not come in tablet), metronidazole

Chronic = do not miss nocturnal diarrhoea (diabetic neuropathy)

Coeliac disease = biopsy

Interesting morning

累了.够了

我好累哦!

真希望可以痛快地休息一番！

精神上， 健康上 全军覆没！

够了， 真的够了

一年的假期 可以吗？ 有必要吗！

Burnie

又再不能睡了。。。。 三点了，无聊， 在 UTAS 网站 search 了一下 Rural Clinical School 的资料

是的， 小弟可能要离开 Hobart 了， 人生有时候就是充满考验。 记得曾经有一个大师说过：“人生充满考验，它等在前头，慢慢的折磨你， 活在这个世界上， 一个人就要克服种种障碍， 千万别被它打倒！”

22 年了， 从小就擅于解决问题，相信这一次，我一定能处理妥当！

干吧碟 。。。。。。。。。