Monday, January 30, 2012

Dilemma

It was around 10 30 a.m when I arrived home. The condition is quiet and no sign of living could be detected by the cone and rod receptors of my eyes. I gave salam and searched for the people for sake of my keyrooms that I left here before I went back Malaysia. The maid suddenly appeared and asked about my room number. I told her to wait so that I could check my room number. I was about to check my room number when my hair cells were stimulated by a sound of coughing from a little kid. My 'heart' was knocked that time. Seemed that various neurotransmitters are released in some parts of my tiny brain before I could decided to ask for the little boy condition. The mother then response by saying that her child was having a fever for one day and he seemed too weak to response to the vibration of my vocal chord. He had taken medication for the fever but the condition remained the same. The fever seemed to be stable for a period of a day. He did have other symptoms such such cough, vomiting and history of passing loose stool yesterday. The cough symptoms was more prominent then other symptoms. He had been having this symptom for two days. The day before, he had passed loose stool, with porridge-like consistency, in a small volume, and there was neither mucus nor blood in the stool. The frequency was two times. He did also complaint of vomiting, in a small amount, containing whatever he had been eaten before. The history of asthma, chronic cough, alergic rhitinis as well as other form of allergic was denied. The family history of asthma, chronic cough, alergic rhitinis as well as other form of allergic was also denied. The immunization status was completed until 9 months of age. I checked the kid and from the physical examination revealed febrile (I did not have battery for my termometer so that I could not check the temperature), tachycardia, tachypnea. The pharynx appeared hyperemic and tonsil was slightly enlarged (T2) Other physical examinations were within normal limit. I was seriously confious because The differential diagnoses were a lot to be ruled ( DF, acute rhinopharyngitis, measles, mild pneumonia )out but the onset of fever was just a day. This was a real challenge to me because I did not have anyone to consult with but just based on my experiences and knowledges gained from my previous clinical rotation. My education to the mother was simply make sure good hydration with clear fluids and ORS when the kid was having diarrhea, eat in a small portion of food but frequently, continue taking paracetamol half tablet (BW= 19 kg, one tablet is 500mg, peds dose for paracetamol is 10- 15 mg/kg/times 4-5 times daily), compress with warm water at the axilla and head. Then I told the mother I will buy zink to improve the intestinal mucosa due to diarrhea and considering of giving antibiotics. By the way, I really doubt wether did I really need to prescribe antibiotics because the disease might be caused by virus and antibiotic has no use in that. I did have other dilemma about the antibiotics chosen. Should I give amoxicillin or other group of penicillin or macrolides groups because the age of the boy was 5 years and 4 months. According to the certain reference we need to give macrolides if the age if above 5 years because epidemioloically, the causative agent is different so that the antibiotics choices are different. The thrid worries was related to the potential side effect of amoxicillin if I chose that drug (allergic reaction or perhaps the severe one - Steven Johnson Syndrome).

At last I decided to give antibiotics because I am afraid of mild pneumonia that can turn into severe. My treatment was based on WHO guidlines for mild pneumonia which was 25 mg/kg/time, two times daily for three days. I chose this because of the sign tachypnea and cough). I did not say that my treatment was right but people this was my first experience and I really hope for the best for the kid. The treatment might be over but I did also think about the acute rhinopharyngitis that might be caused by streptococcus group A beta hemolyticus that might lead to rheumatic fever which was the leading cause of heart problem in Indonesia.

I hope that everything is going to be fine to the kid. This is my learning process but I do not want to harm anyone. May Allah bless Us.

New department....

The spirit of learning again not just for the future career but as a step to know myself better is developing. It's psychiatric department now and I really hope that I can get a lot in just a 4-week rotation in this department.

I was engaged in this field when I was in my undergraduate programme. It was because of the thesis that I chose to be done. It is for me a very interesting department. I am not hoping of becoming a psychiatric but I really want to know more perhaps in detail in every single entity in this department.