Hari Raya Haji = CPR

I m late to ward today...supposely going to ward to clerk patient for seminar and for tuesday's ward round in the morning but end up sleeping soundly till 2pm (woke up and sleep back of coz). Thus, i clerked a TB case n Ward 6 then i head to my ward (Ward 2) to cover beds, i have 3 beds to cover. Well, after clerking 1 patient, i decided to look into the case note and write down the important notes. At tat time, i was still be able to joke ard with the nurses over the counter. At 3.13pm, a relative of a patient came to talk to the nurse, asking her to see her relative. after the nurse saw the patient, steadily, she said to other nurse, "patient collapse". And she take out the emergency trolley from treatment room, and i too, follow them to the patient. Once i approach the patient, there was no attending dr or houseman, i checked the pulse, listen to the breath sound, auscultate...no pulse, no breathing. Immediately i start chest compression. While the nurse there busy settling up high flow mask, in fact, i donno y they put the mask on the patient as she is not breathing. So, i ask them to put oropharyngeal airway into her mouth, and later they recovered the ambu bag and start bagging. HO comes 2 min later, she ordered to give Atropine, and Adrenaline 1 amp each. And i keep doin the chest compressions...and...i broke 3 ribs, i heard crack sound..3 times. 4 min later, MO on cal came, he said my chest compression technique was soft :(..thus ordered the nurse to do it... The MO order the nurses to give more amp of Atropine and Adrenaline, in the end 6 amp for each drug hav been given, and yet patient has no response. The MO intubate the patient but i think he intubate the stomach more likely as the abdomen getting distended and distended. Hm..Hm...20 min has past, no respiratory effort, no heart beat and pupils are fixed and dilated, she is pronounced dead..at 3.31pm. Then, i cont my work clerking the next patient :)...wat a CPR day...

HPV Vaccination against Cervical Cancer but...

Cervical cancer is the second commonest cancer among the females worldwidely as well as in Malaysia. It mostly affects women of the age between 35 to 55 years old though ladies other than this age group can be affected as well. But not every lady out there suffer from it. Only those who are at high risk, to name a few eg. first sexual intercourse at an early age, multiple sexual partners or sex activity with partner who's promiscuous etc are especially vulnerable to it as cervical cancer is highly associated with Human Papilloma Virus (HPV) which is transmitted readily through genital contact most of the time though not all of the time.

Having said so, not all of the HPV can lead to cervical cancer. Only a few like HPV type 16, 18, 31, 33, 35, 39, 45, 51 out of hundred over types of recognized HPV is associated with cervical cancer. So, Malaysian Ministry of Health has come out with a circular to screen all the ladies who are sexually active yearly (if 2 normal consequent results are obtained, then every 3 years) via Pap smear in order to detect subtle changes in cervical cells before it progress to precancerous or cancerous so that cervical cancer can be prevented.

This is the most effective way in preventing cervical cancer until June 2006, when US Food and Drug Administration (FDA) approved Gardasil, a quadrivalent HPV vaccination against HPV 6, 11, 16 & 18 (Cervarix, a bivarent HPV vaccination against HPV 16 & 18, though already available in certain country but is still being assessed by US FDA) . It has showed that females between 9 and 26 years old can be benefited from these vaccination. Therefore, everyone is running into their embrace since their introduction.

However, while we are overwhelmed by the advantage, according to Daily News from Medscape on July 26, 2008 which i came across few days ago, serious neurologic like Guillain-Barré syndrome , thromboembolic, and autoimmune complications have been reported in patients who received human papillomavirus (HPV) vaccines. Although not the norm, Dr.Diane Harper, MD, from the Dartmouth Medical School in Hanover, New Hampshire, a principal investigator of clinical HPV vaccine trials for both Merck (Gardasil) and GlaxoSmithKline (Cervarix) suggests that the events are grave enough to encourage caution. According to the US FDA on June 30, 2008 also, more than 9700 adverse events have been reported since the vaccine was approved 2 years ago. Of these, 94% were nonserious (fainting, pain at the injection site, headache, nausea, and fever) and the remaining 6% was severe.

So, whether to be vaccinated to prevent cervical cancer, it is subjective. From my point of view, even if we are vaccinated (i mean ladies), we still stand a chance to have cervical cancer as the vaccine available is not against all the types of HPV. What is the utmost important prevention is still the basic -- to practise healthy sex hygiene while undergoing Pap smear from time to time.