The idle mind ponders....

Life is a unique balance of right and wrong.... in order for us to move on we have to have struck a fine balance between them.... I supoose its a subjective thing..... we can only hope to live our lives with some conviction pray we enjoy life to a certain extent..... move in the river of time and hope we arrive at our maked destination......

Some times.... we might skid of the road, some times other drivers mis judge and slam into us.... but at the end of the day its up to us to pick ourselves up and move on....

..... A wise person once told me... life persay is actually problem free...... it is we ,humanity who creates all problems for ourselves..... we invite it with open arms...and at the end of the day have the odasity to blame one another.......

Such lost creatures we are....

This is central line which was done by me personally.. My first sucessful line... 

you can see the end of the central line at the medial aspect of the lung on the left side of this picture. 

Note the suturing on this patient.... you only see the thread on either end of the incision point. no criss crossing over the wound is seen.. Where is the rest of the thread.... well actually this is a subcutaneous suturing ... it is cosmetically much better.. This was actually done by ME all by myself... 

This is a CHEST X-Ray of a patient fitted with a PAcemaker...the pacemaker senses every P- wave and awaits for a QRS complex to be formed. If none are formed in a given time it will send an impulse to the ventricles to contract thus inducing a QRS complex.Eg.. in case of a heart block u find 2-3 P waves followed by 1 QRS complex.. So once a pacemaker is in for every P wave u have 1 QRS complex. This inturn increases the heart rate.... Cool huh.. its placed subcutaneously inder the skin over the Left chest wall 

This is how a pacemaker looks like . 

Lead II show's 2nd degree heart block for this patient .. Her heart rate was 30 -40 beats per min.....  

2nd degree heart block 

V2 .... THis is actually a Posterior wall infarct seen on V2, V3 and so on . In order to confirm this you invert this ecg seeing it from behind and u will find ST elevations....Mirror images.....a Right sided ECG is required... 

V3  

LEAD II ........ THe next 3 ecg Pictures show ST elevation at Leads II, III, avF ... Thus this patient has a Inferior MI 

LEAD III 

AT AVF 

A classic ECG finding in Ventricular tachycardia 

This Ecg was taken from a 70 year old indian female who has no known past medical history. she was found unconcious in her house by her grandchildren and was rushed to the hospital .. ECG in A&E showed deep T waves in all LEADS .... suggesting a wide infarct.. She was admitted to the CCu .... Ck/CKMB was marginally raised. she was started on S/C Clexane and Asprin and PLAvix.. No family members were around since time of admission.... there was no way to confirm or ask the premorbid status of this patient . Troponin T was taken twice both times tested negative.... patient was showing symptoms of dementia orientated to name but nothing else spoke with confusion.... she continued to be drowsy ...FInally after 3 days we managed to contact a family member and found that the patient was actually alert and very independant prior to this episode..... Prompting a CT scan of the brain sure enough there was a LARGE MCA infarct... Brain infarct also can have raised CK/CKMB as well as deep T inversion in all leads....  

lead II 

at V3 

these were from the rest of the leads 

What u are seeing is the inside of a bronchus of a 49 year old male who presented with Fever dysentry and cough for 3-4 weeks.... He had had recent travel history to bangladesh and developed dysentry there and gives history of drug abuse and active sexual life... on returning to malaysia he still had continious fever and Loss of weight....... on CXR a hypodense mass seen over the left apical region .....he was covered with antibiotics ...blood c&s was normal.... he was Anaemic Hb 8+... biopsy of this cobble shapped mass was taken. Proctoscopy reveled he has hemmoroids thus banding was done... a full CT thorax abdomen pelvis was done in view that the temperature refused to settle. CT showed a single ring like lesion on the brain . He discharged himself and wanted to wait for biopsy results at home. 3 weeks later once traced it showed necrotic tissue. fever still present. Ct guided biopsy of the mass was done. He was transfused again as HB still LOW. 1 week later biopsy results came back as Small Cell CArcinoma of the lung ,and the single round mass on brain was actually a metastatic lesion. Family wanted to discuss options before starting CHEMO Though strongly adviced to go for Chemo ASAP...in less than 2 weeks after confirmation of the results came, he started to develop Left sided seizures and was readmitted in emergency within 2 days he passed away..... Malignancy pulled wool over the eyes of us medical practisioners by hiding behing an atypical presentation .. It lead us to belive it was a travel related disease .... Immunocompramised disease..... and many more before settling to be the most fatal of em alll.....

A classic picture of pulmonary effusion ..... Diagnostic and theraputic treatment was pleral tap.... cause ?? malignancy 

This is a colonoscopy image in a 30 year old femala who is a known case of tuberculosis in remission with ESRF . She was readmitted for abdominal pain and on colonoscopy this was seen.... Even before the AFB x3 results are in she was started on ATT Just by looking at this .... WHY ????  

The answer is Because these 2 pictures were taken at the iliocecal junction and are classical images of Illiocecal tuberculosis. SUre enough the AFBx3 did come back as Positive and the she was retreated under our DOTS program. 

My darling doll