The 3rd Malaysian International MMA Medical Students conference held at Melaka-Manipal college has just concluded (2nd - 5th June 2011).
I
must say that it was a huge success given the limited resources they
have, especially since the committee members themselves are busy medical
students, many of whom are clinical students.
I
wish that more medical students from Universiti Sains Malaysia could
attend, and I hope that the Persatuan Sains Perubatan USM can play a
bigger and more active role in promoting the conference to the students
and at the same time, actively presenting free papers. I am impressed by
the quality of the papers presented by the students, from
Melaka-Manipal, Universiti Malaya, IMU, Penang Medical, UNIMAS, etc.
And these student presenters are not just the 4th and 5th years, but
many of them are 3rd years. In fact, one of the participants who won the
2nd place of oral paper is a 3rd year student from Universiti Malaya. I
am pretty impressed by the methodology and statistics that he
presented. USM students should actively get themselves involved in such
projects -- projects that can be simple, yet meaningful and clinically
relevant (instead of just doing it for the sake of doing as a chore or
pre-requisite on something irrelevant).
I
talked on 2 topics: 1) Pitfalls in the management and resuscitation of a
trauma patient 2) Tips on interpreting X-rays in emergency department.
Besides I was also asked to be one of the judges the oral and poster
presentation. Overall, the clinical students were appreciative of my
talks, but from my conversation with the pre-clinical students (year 2
and some year 3s), they were lost and not able to follow through the
presentation. Nonetheless, the theme of the conference is a rather
clinical one: Trauma - Constructing The Future, Growing From the Past.
In
my first talk, I first talked about the various sources of errors
(right from pre-hospital and triaging to patient disposition) in
managing patients in emergency department, particularly in a case of
trauma patient. I talked about the Rasmussen model of human error --
skill-based errors, rule-based errors and knowledge-based errors, and
then move on to talk about three common erroneous attitudes that can
render a healthcare provider prone to error: diagnostic labeling, false
negative prediction and false attribution. Most of us as doctors are
prone to commit the 'sin' of diagnostic labeling. I then use detection
of hemorrhagic shock in trauma as a specific model of discussion because
undetected hemorrhagic shock is one of the most tragic thing that can
happen to a trauma patient. I talked about the dangers of depending on a
drop of BP before diagnosing hemorrhagic shock, and how we should use
Shock Index, Mean Arterial Pressure as well as newer markers such as
lactate level and lactate clearance to assist us in early detection of
hemorrhagic shock.
In the 2nd presentation, I
talked about the common useful X-rays in managing a trauma patient -- I
focussed particularly on three important X-rays - Cervical, chest and
pelvic X-ray. I taught them about how to interpret cervical X-ray in the
context of trauma and used hangman fracture and Jefferson fracture as
particular topics for discussion. I talked about chest x-ray: criteria
to qualify for an adequate good chest x-ray film, and discussed on
pneumothorax and traumatic aortic dissection. I reminded the students
that tension pneumothorax is not supposed to the radiological diagnosis,
it is a clinical diagnosis; and a doctor is supposed to "destroy" the
radiological evidence of a tension pneumothorax rather than allowing it
to manifest. I also talked about the tips on interpreting a pelvic X-ray
-- the importance of visualizing the integrity of the three pelvic
rings, tracing the integrity of iliopubic and ilio-ischial line,
radiologic 'U' as well as the tear-drop sign. I talked a bit on
maxillofacial X-ray, tracing the elephant trunks of Dolan lines, as well
as a quick introduction on tripod # and Le Fort #. And then we run
through some important things on interpreting wrist, elbow and lower
limb X-ray. It is not possible to go through every details in a single
talk. I also made the disclaimer that I am not a radiologist, and my
talk is geared rather on correlate X-ray findings in the context of
clinical setting of managing a trauma patient and therefore the talk
would be pragmatic rather than technical.
Below are the slides that I used for my presentations:
Tips for interpreting x ray in trauma
View more presentations from Chew Keng Sheng
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