PASSOVER 20/3/22 2000H - 21/3/22 0700H

ACUTE
Plan:
1. WI today
CHE LEAN BINTI MOHAMAD @ ISMAIL
Issue: 2. KIV BKA if pts agreeable
73y/o, Malay lady
Bed 22 1. Necrotising fascitis over the left foot 3. IV Albumin 20% 100cc OD x 3/7 (D2)
U/l DM, HTN, dyslipidemia,
- Done WD over left foot and ankle by Dr Fadzil on 20/3/22 4. Cont IV Clindamycin 600mg BD and IV unasyn 3g
H/O ray amputation of left 4th and 5th toe on
TDS
3/1/2022
2. Resolved ACS 2° anemia induced 5. Cont medical plan: Not for ACS tx
H/O ADHF 2° uncontrolled HTN- ROF 800cc
6. Trace urine C+S

SUBACUTE
Plan:
Issue:
OY AI CHIN @ OOI AI CHIN 1. Trace ESR, CRP and culture taken
Bed 15 Right thigh abscess with prostetic joint infection
U/l HTN 2. Continue IV cefuroxime 750 mg TDS
- done I&D, debridement and washout of PJI, removal of implant on
H/O CVA in 2021
19/3/22 by Dr Vijay and Dr Anas
Plan:
1. Trace cultures taken
PREMALA A/P P.KUPPUSAMY Issue: 2. WI and second look rewound debridement on
68 years old Indian Female 1. Seroma over left total hip replacement operation site Tuesday (22/3/22)
BED 16
U/L: DM, HTN, dyslipidemia Done wound debridement and vacuum assisted closure application over left 3. monitor I/O, If poor oral intake to start 2 pint
hip on 18/03/2022 NS/24H
4. cont IV Human albumin 20% 100cc OD x 3/7 (D3)

Issues:
1. Infected wound right foot
Plan:
2. Uncontrolled DM
LIEW AH LAN 1. WI D3, STO D14
3. Transaminitis sec to ?drug induced
61 yrs 2. Daily bactigrass dressing
Bed 20 ALT 21>998>581>388
Underlying DM 3. Continue IV antibiotics - IV Clindamycin 600mg
AST 18>1743>240>138
-s/c actrapid 6u tds BD and IV unasyn 3g TDS
T bili 10>30.9>37.8>44
-s/c insulatard 8u ON 4. Elevate right BKA stump
5. Trace infective screening sent
Done right BKA by Dr Fadzil on 20/3/22 @2240H-2330H

CUBICLE C/D
Issue:
LIEW KUEEN FAH Plan:
wet gangrene left 5th toe
82 years old 1. WI today
-Done ray amputation left 5th toe by Dr Fadzil on 20/3/22
Bed 2 U/l DM, Dyslipidaemia, HTN, IHD 2. trace & review cultures once available
- Done bedside reenforcement with adrenaline gauze and compression
- done CABG in private hospital 10 years ago, 3. cont IV unasyn 3g OD
bandage by Dr Syauqat on 20/3/22
ESRF on regular HD 2,4,6 (ROF 500cc), 4. next HD on 22/3/22
-post op Hb 7.1< 8.2
Peripheral arterial disease
Last dose of T Clopidogrel and 19/3/22
 PASSOVER 20/3/22 2000H - 21/3/22 0700H
ISSUE Plan:
1. Left leg and thigh necrotizing fasciitis 1. WI today KIV for secondary suturing later
2. Wet gangrene of right big toe 2. Cont IV antibiotic
3. CRE UTI (under ID) - IV augmentin 1.2g TDS
Bed 6 ROKIAH BINTI YAHAYA - T Nitrofurantoin 100mg QID 5/7
58 years old Malay lady -Done wound debridement over left lower limb and ray amputation over 3. Daily povidone dressing
U/L DM right big toe by Dr Fadzil 4. To take post transfusion FBC
-Done re-Wound debridement over left leg and thigh with VAC application 8. continue medical plan:
on 16/3/22 - Contact precaution for CRE urine
-Done Left above knee amputation and wound debridement of right foot by - If clinical deceleration haemodynamically unstable
Dr Fadzil on 21/3/22 @0105H-0205H with persistant temp spike > escalate to mecopenem.
Issue: Plan
IZARINA BINTI IBRAHIM
1. Infected previous ray amputation site & osteomyelitis over left midfoot 1. trace anemic workup
Bed 3 45 y/o, female
Post op Dx; Left foot necrotising fasciitis 2. trace FBC
Done wound debridement and bone curretage over midfoot by Dr Fadzil 3. WI today KIV for BKA
U/L DM, HTN, H/O BTL in 2012
21/3/22 @0005-0015H 4. Continue antibiotics -IV Unasyn 3g TDS
Issue:
prosthetic joint infection of left TKR Plan:
YEE POO SIEW - Done wound debridement, arthrotomy washout and vacuum assisted 1. for WI and second look rewound debridement on
BED 4
70 years old Chinese lady closure application over left knee under GA by Mr Sarbjit, Dr Shanjay on Tuesday 22/3/22
U/L HTN,Dyslipidemia 18/03/2022 2. KIV to change to antibiotics
-Culture(18/3/22): Staph aureus susceptible Oxacillin

ROZIAH IDRIS
59 y/o Malay lady Issue: Plan:
BED 7 U/L HPT, Dyslipidemia T3 & T4 spine metastasis TRO primary from left breast swelling (ASIA D) 1. Trace MRI report (20/3/22)

SELINA BINTI MOHD WAHIE
56 y/o Malay lady
BED 8
u/l H/O CA of mandibular in 2009, DM,
Dyslipidemia
Bed 14 NOR ZAINA BINTI ZAINUDDIN
EMOT 55 years old
Underlying
DM, HTN, dyslipidemia
CKD Stage 5 not on LTRRT
h/o stroke with Right hemiparesis in 2015
Post total thyroidectomy for Multinodular
goitre - on T. Levothyroxine since 2010
Right charcoat arthropathy
Issue:
Plan
L1 pathological compression fracture with Spine metastasis TRO Multiple
1. For CT TAP as planned Monday with CT cervical
Myeloma (ASIA E)
and thoracolumbar bone window
2. To request back skeletal survey reporting on
OGDS and colonoscopy done on 16/3/22. No tumours seen.
Monday
Issue: Infected surgical wound over the right foot Plan:
1. For WD over right heel (d/w Dr Theenesh)
Right charcoat arthropathy 2. Continue IV Unasyn 3g OD
Underwent fusion over right foot on 26/1/2022 3. Trace culture and CRP
4. Renbm at 4am 21/3/22
 PASSOVER 20/3/22 2000H - 21/3/22 0700H

CUBICLE E/F
Issue:
PATRINA CHAN FOONG MAY
Right diabetic charcot arthropathy with DFU
43 y/o, chinese female Plan:
Bed 32 - Done subtalar and midfoot fusion with screw fixation and locking plate
DM, HTN, Dyslipidemia 1. Keep drain until today (next F&A review)
with Jones procedure over big toe and girdle stone procedure over 2nd-5th
CVA in 2017 with right residual weakness
toe and hemisection of TA on 16/3/22.

FOO AU SIN
86 yrs Chinese Female
Plan
Bed 36 UL: Issue:
1. Left short PFN(ensure nephew come at 7.30am)
ELOT 1. HTN Closed left IT fracture
2. Trace PCR
C1 2. Dyslipidemia
3. For GXM 1 pint (1st case cm)
3. ? dementia- not on proper follow up

NEW CASE/TRANSFER IN PENDING EMOT/SEMI-E PENDING TRAUMA/ELOT TOTAL PATIENT

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