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hospital
I was scrolling my Quora and came across this question. It is an interesting question if we are trying to answer it from perspective of healthcare workers like me vs riders.
To be honest, I don't have motorcycle license and have no skill to ride it as well. Haha.
And after working in the hospital,
I WILL THINK TWICE BEFORE RIDING ANY MOTORCYCLES. T___T
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| https://www.quora.com/Why-do-people-not-wear-a-helmet-while-riding-a-motorcycle |
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**WARNING - THIS POST CONTAINS WOUND IMAGES**
Let me share with you a recent case I attended in the Emergency Department.
It was the morning of last day of Ramadhan, maybe around 4am. The patient was a 16-year-old boy, if I am not mistaken. He was referred from a klinik kesihatan that was 40km away, with the impression of: To Rule Out Skull Fracture.
Resources in Klinik Kesihatan can be limited, they can do chest xray, but not others. I've experienced a lot of referral to rule fractures from KK and to be honest, skills of doctors and medical assistants in KK are amazing. They are usually the primary team to stabilize patient in areas without hospital.
So, back to this case, he was brought in on a wheelchair, with lots of gauzes covering different parts of all four limbs. He could even walk from the wheelchair to the bed.
Usually, when we attend trauma cases, we use ATLS as guidance.
ATLS - advanced trauma life support.
The PDF itself is almost 500 pages! -_-'
Starting with A - airway + cervical
- Patient able to speak in full sentences, no gurgling or stridor, no foreign bodies in the mouth/ nose, not on cervical collar, range of movement of neck was full.
Proceed with B - breathing + ventilation
- Here, we usually use the acronym IPPA - which means Inspection, Percussion, Palpation, Auscultation
- I - breath spontaneous, not tachypneic, chest rise was equal bilaterally, no chest wound
- P - resonant percussion bilaterally
- P - no clavicle tenderness, no chest tenderness, chest spring negative, no subcutaneous emphysema / crepitus
- A - lung was clear, equal air entry
- Don't forget to check the oxygen saturation too (SpO2)
Then, C - circulation
- check other vital signs - blood pressure, pulse rate
- CCTVR - Color of skin, Capillary refill time (CRT), Temperature of extremities (is it warm/cold), pulse Volume, pulse Rate
- for this patient, it was all normal - pink, CRT <2s, warm peripheries, good pulse volume, pulse rate around 60-70.
- then, we checked the abdomen - soft, non tender, not distended, no abdominal wound.
After that, D - disability
- GCS was full E4 V5 M6, pupils 3mm/3mm equal reactive
Finally E - exposure / environment
- Here, we inspected the whole body from top to bottom, from front to the back.
- This boy has abrasion wound everywhere - shoulder, elbow, hand, shin, foot. But there was no swelling, no limb deformity, no limb tenderness, no limited range of joint movement (means, he can bend all joints normally) - so we don't expect any fractures here.
- There was no spinal tenderness / step deformity during log roll
- But the head was covered with bandage and we could see some blood stain. When we open the bandage, fuhhhhh there was jagged wound, quite big one! the skull was exposed. And there was no skin flap to cover back the skull.
- We gave him antibiotics and painkiller too.
- FAST scan done, no free fluid.
Something like this but smaller around 6cmx6cm size.
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| https://www.slideshare.net/vipinvenugopalnair/free-ld-flap-for-scalp-reconstruction-dr-vipin-v-nair |
Okayy, I know there are LOTS OF MEDICAL TERMS here haha. It is okayyyy, you don't have to understand everything. :D
To make it easy, generally we can say that this patient was stable clinically, vital signs was okay. Just, if there was no jagged wound on his scalp, he didn't even need to be referred to tertiary hospital.
Biasalah orang accident mesti akan calar balar sana-sini. Takde patah, kira alhamdulillah sangat dah. Tapi untuk dia ni, kulit kepala dah terbukak, tengkorak terdedah camtu. Nak jahit kulit kepala pun tak boleh.
We managed to request CT brain in view of the wound was big and skull was exposed - just to rule out any skull fracture or any possible bleeding in the brain (ICB - intracranial bleeding).
Alhamdulillah, turned out CT brain was okay - no ICB, no skull fracture.
So, what we did for his jagged wound - we referred him to Surgical Team so that they can refer the patient to Plastic Team. In big hospital, you can see lots of sub-specialty for Surgery - neurosurgery, plastic surgery, ear-nose-throat, hepatobiliary team etc. But, we don't have such sub-specialties here. There nearest one for that is HRPBI - Hospital Ipoh.
If the wound was a simple laceration like the one below, usually we can suture it ourselves..
| https://www.medicalimages.com/stock-photo-image-image9257585.html |
I feel sad for his father, he looked very tired and when the surgical team informed him that the patient will be transferred to Ipoh, we could see his 'pasrah' face. I believe the importance of parenting, but kids nowadays can be beyond control.
This is one kind of accident that actually can be avoided.
Why?
The boy is underage, without licence, without helmet, went out riding motorcycle with his friends around 12am, speed at least 80km/hour and the mechanism of accident was as I expected - he said "kawan main motor himpit-himpit, saya tak boleh control motor tu yang terbabas"
Rasa sedih bila jumpa kes macam ni.
And there were countless cases like this EVERY SINGLE DAY.
So, if you guys or your family members are motorcycle riders, do remind each other kay.
Always wear helmet.
200530
SM, Perak, Malaysia
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| Picture from my previous post. :) |
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