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      "body": "Congratulations @adnanyakub! You received a personal award!\n\n<table><tr><td>https://steemitimages.com/70x70/http://steemitboard.com/@adnanyakub/birthday1.png</td><td>Happy Birthday! - You are on the Steem blockchain for 1 year!</td></tr></table>\n\n<sub>_You can view [your badges on your Steem Board](https://steemitboard.com/@adnanyakub) and compare to others on the [Steem Ranking](http://steemitboard.com/ranking/index.php?name=adnanyakub)_</sub>\n\n\n**Do not miss the last post from @steemitboard:**\n<table><tr><td><a href=\"https://steemit.com/steem/@steemitboard/3-years-on-steem-happy-birthday-the-distribution-of-commemorative-badges-has-begun\"><img src=\"https://steemitimages.com/64x128/http://u.cubeupload.com/arcange/BG6u6k.png\"></a></td><td><a href=\"https://steemit.com/steem/@steemitboard/3-years-on-steem-happy-birthday-the-distribution-of-commemorative-badges-has-begun\">3 years on Steem - The distribution of commemorative badges has begun!</a></td></tr><tr><td><a href=\"https://steemit.com/steem/@steemitboard/happy-birthday-the-steem-blockchain-is-running-for-3-years\"><img src=\"https://steemitimages.com/64x128/http://u.cubeupload.com/arcange/BG6u6k.png\"></a></td><td><a href=\"https://steemit.com/steem/@steemitboard/happy-birthday-the-steem-blockchain-is-running-for-3-years\">Happy Birthday! The Steem blockchain is running for 3 years.</a></td></tr></table>\n\n###### [Vote for @Steemitboard as a witness](https://v2.steemconnect.com/sign/account-witness-vote?witness=steemitboard&approve=1) to get one more award and increased upvotes!",
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      "body": "![](https://cdn.steemitimages.com/DQmUkD43CUd36s22E8agQiv4tKCdNpVRLZbn5vdgzdC8nUZ/image.png)\nAn 80 years old man was diagnosed with bladder cancer and he was scheduled for surgery to remove the tumor. So before going to surgery, basically there are few steps that have to be check to ensure the operation and the recovery of the patient going to as plan. \n\nThese steps are carried out by the mastermind of the operation, the anesthetist. Anesthetist is the person who ensures the patient is in optimal condition before entering the operating theatre.  \n\nFor the purpose of discussion, let us divide it into:\n\n-pre-operative assessment in history taking\n-pre-operative assessment in physical examination\n-pre-operative assessment in laboratory evaluation\n\nPre-operative assessment in history taking\n\n<div class=\"pull-left\">https://cdn.steemitimages.com/DQmVoCxrGAzjDxVay5HUTqJpQmK9x5D71j6gqGxEB19XGtX/image.png/</div>During this visit, the anesthetist has to evaluate patient’s medical condition. This involves patient's current problem, any other known medical problems, previous history of anesthesia or surgery, any medication from previous till current ones, any allergy, relevant family history like family history of anesthetic complications, review of organ systems and time of last oral intake.\n\nPre-operative assessment in physical examination \n\nIn physical examination, it starts with the general examination. It comprises the general appearance of the patient. Observe for any signs of pallor, cyanosis, jaundice and oedema. Look for patient body size and most important, the BMI of the patient.\nThen, take the vital signs parameters such as blood pressure value, respiratory rate and temperature. \n\nAfter general inspection, move to other relevant systems such as cardiovascular and respiratory examination. Listen to the sound of s1 and s2 heart sound as well as the breath sound using a stethoscope.\n\nOne examination that compulsory is airway examination. In this examination, the anesthetist will have a look at the chin size (for micrognathia), neck for its mobility, any swelling or abnormality and oral cavity. For oral cavity, things such as mouth opening, state of dentition and size of the tongue must be noted. There is one classification called Mallampati classification, used to predict the ease of intubation. \n<center>https://cdn.steemitimages.com/DQmTYdoLMLQh42Xs9dK8xMLUUnvys5tqaWiHCNW5gPbBR6P/image.png </center>\n\nFinish with that, next is an examination at the site of anaesthetic drug administration such as spine for spinal or epidural analgesia.\n\nPre-operative assessment in laboratory evaluation\n\nCurrently, there is a lot of laboratory investigation that can be performed. But, it is not cost effective to perform all the test for all patient. There is a recommendation from Chapter of Anaesthesiologists, Academy of Medicine Malaysia stated that screening tests are based on patient’s age. The pecific test can be ordered according to patient’s medical condition.\n<center>https://cdn.steemitimages.com/DQmfG9f6FyRZ9JHvxCkQzEhzNrTbTy6KNgeWkpyTBtUrsTX/image.png</center>\n\nAll of these assessments are important to determine the anesthetic technique suitable for the patient as well as during the perioperative care. During this visit, developing a good rapport between anesthetist and patient is crucial as to reduce the preoperative anxiety. As a normal human being, we have this anxiety within ourselves. After deciding on the type of anesthetic technique, it is their job to inform and educate the patient about the anesthesia, perioperative care and pain management. It is time to discuss the anesthetic risks and obtain consent for anesthesia.\n\nBefore the surgery, the patient must fast overnight or at least 6 hours. The reason is to prevent the pulmonary aspiration of stomach contents during the anaesthesia. The patient can also be given anxiolytic to reduce the anxiety. Ranitidine (H2 antagonist), omeprazole (proton pump inhibitor) and metoclopramide can be given to increase the stomach pH and reduce the volume of gastric emptying.\n\nAfter all the investigations have been reviewed by the anaesthetist, and they satisfied, only then the patient can proceed with the operation.",
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      "body": "Hello steemian. I am Adnan, 23 years old. Currently, i am living at Kuala Lumpur, Malaysia capital city. I am studied medicine at Universiti Kebangsaan Malaysia (UKM). Insha Allah, 1 year more to finish my study. besides study, i also  worked at Angkatan Pertahanan Awam Malaysia, APM (formely known as JPAM) as a Leftenan Muda ( second lieutenant).\n\n![IMG_2165.JPG](https://steemitimages.com/DQmbiW7vsBLQqUDETEgARjmLpi6osqxqC8XV7uqf9YfBtqk/IMG_2165.JPG)\n\nMicrobiology and pathology are the subjects that captured my interest in pursuing my study in medicine. Did you know that our skin homes to billions of microorganisms? Yet you are still living in healthy until today. How come is it? (Haa.. I will write about this topic later). Not only microbiology and pathology, I also love geography and history. I do subscribe Nat Geo, Discovery Channel and many more just to feed my hungry brain.\n\nI have many hobbies:\n\nFirst, I like to collect car diecast such as Hot wheels, Tarmac, Kyosho and Ebbro. This is one of my limited edition models. \n\n![IMG_4274.JPG](https://steemitimages.com/DQmR3GM5Wx8YRpAomh6ueSwkYr9hMoBFcaA4NCUfbiAbVWP/IMG_4274.JPG)\n\nSince I was a kid, I was known as the motor enthusiast  by my friends and family. Currently I am owning 1 car which is Proton Wira Special Edition. I want to tell you guys that I am proud using Malaysian brand. For your information, Proton Wira is one of the best cars Proton ever made.  Even though it is 2018, you can still see this car on the road.  \n\nSecond is I love playing guitar ever since form 5. But due to some problem, I stopped for awhile and now continuing it.\n\nThird is I like martial arts. In the beginning, I join Taek Won Do class back then when I was in secondary school. But I did not managed to finish it because my sensei was being transferred to another school.  After that, I join Silat Gayung Malaysia. Halfway there, I stopped because of SPM. After SPM, I join Silat Cekak Pusaka Hanafi and managed to finish it. For the time being, I am a coach assistant in teaching Silat Cekak.\n\n![IMG_4868.JPG](https://steemitimages.com/DQmfMD783oowip6X7Rjw4XKTYVCJLstBDKx5bYaLht2GjMC/IMG_4868.JPG)\n\nSo basically, this is some facts about me. Looking forward to become a good blogger and if it is good enough, earning some cash :) . Thank you.",
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