Dr. Amalina Nudin

23/10/2022

23/09/2022

SHOCK

🔹Definition
Circulatory Insufficiency (tissue/cell) that create imbalance btw O2 supply and O2 demand.

✔️RUSH (Rapid Ultrasound Shock)

A) Pump🌸

1. Look for pericardial Effusion/ Tamponade
2. Look for LV Contractility
3. Right Ventricle Strain : Dilated RV and D Shape RV

😎 Tank 🌸
⁃ Assesment of effective intravascular volume

Hypovoluemic
(Rapid Fluid Loss)

🔹Haemorrhagic
⁃ Trauma
⁃ Triple A

🔹Non Haemorrhagic
⁃ Vomiting
⁃ Loose stool
⁃ Dehydration
⁃ Burn

🔹Fullness of the tank :
⁃ IVC Variation
⁃ IVC distensibility index
⁃ If IVC 50%
⁃ If clinically hypovolumic, IVC distended, look for heart, look for RV Failure.

🔹Leakiness of the tank - Fluid in abdomen/thorax/ lung

🔹 Compromise of Tank - Tension Pneumothorax

Normal lung : Sea shore sign
Pneumothorax : Barcode sign

3. Pipe :🌸 - assess arterial and venous system
⁃ Rupture of pipe : Aortic Aneurysm + Dissection

Aorta : Abdominal aorta > 3 cm (aneurym)

✔️Iliac Artery > 1.5 cm ( Disection)

✔️Aortic root

⁃ Obstruction of pipe (Deep Vein Thrombosis)

✔️DVT : Non compressible deep veins (femoral and popleteal)

❤️Cardiogenic
(Pump Problem)

🔺Cause
⁃ Ischemia
⁃ Arrythmia
⁃ Infarction
⁃ Congenital Heart Disease/Valvular

Treatment
⁃ Inotrope/ Vasopressor

To differentiate cardiogenic shock with obstructive shock

▪️Do echo : Any reduce contractility

▪️Cardiac Enzyme & ECG to confirm Dx

❤️Obstructive

1. Diastolic Filling : Cardiac Temponade | Tension Pneumothorax
⁃ Reduce venous return

2. Excessive Afterload : Massive Pulm Embolism / pulmonary HPT

Tx :
1. Fluid Support
2. Treat underlying cause

❤️Distributive Shock
⁃ Sepsis : vasodilation

❤️Anapylactic :

⁃ Of not shock, give IM Adrenaline (1st line) ,antihistamine/ steroid (2nd line) if shock, inotrope support

▪️IM adrenaline : 0.5mg (1: 1,000)
Up to 3 times (every 5 min - reasses)
▪️If no response : IVI Adrenaline (for vasoconstriction)

❤️Neurogenic :

Spinal cord injury ; impairment to sympatetic innervation > vasodilation > reduce Venous Filling > reduce preload > reduce stroke volume

20/09/2022

Mohon doa semua.

Pukul 12 PM sekej*p lagi akan dibuka sistem pemilihan untuk penempatan baru.

3000 lebih doktor akan berebut memilih negeri yang diingini. Siapa cepat dia dapat, gitu lebih kurang.

Ingat lagi betapa debarnya masa mula nak kerja 4 Tahun lepas, berperang berebut penempatan dalam sistem, siap booking Cybercafe lagi, nak internet paling laju. Rezeki, dapat HUSM, dekat dengan rumah, ketika Houseman. Banyak belajar di situ.

***

Doakan dapat ‘negeri’ tempat kerja baru, yang terbaik untuk dunia, akhirat dan agama serta keluarga saya. Kalau boleh nak dekat dengan keluarga/ mertua, senang nak berkhidmat untuk ibu bapa.

Dah 2 Tahun ulang alik balik kampung, 4 jam perjalanan, banyak habis masa cuti di jalanan sahaja. Biasa sempat sehari je di rumah. Duk Gua Musang, tempat orang paling tak nak, terutama kalau rumah keluarga jauh. Ramai yang PJJ.

Semuanya Allah dah tetapkan sebelum kita memilih lagi. Semoga diberi ‘Redha’ akan apa jua keputusannya nanti.
Bismillah.

Dengar khabar, boleh pilih negeri sahaja, bukan specific hospital atau klinik kesihatan.

Tapi j*p nak imagine negeri yang nak dulu.

Kelantan.
Kelantan.
Kelantan.
Kelantan.
Kelantan.
Kelantan.

Semoga ada ‘kosong’ untuk saya.
Ya Allah, jika Kelantan adalah penempatan terbaik untuk dunia akhirat saya, permudahkanlah…

28/08/2022

Kalau anda sejenis tak berapa pandai simpan duit macam saya... sejenis tak boleh tengok duit, rasa gatal tangan je nak membeli ini dan itu…

Simpanlah duit dalam bentuk emas.
Highly recommended. 1 gram sebulan.

Andai satu gram tu RM250, kita simpan sebulan 1 keping selama 3 Tahun, iaitu 36 bulan....

Berapa dah dapat simpan?

Rm9,000.

Kalau 2 gram?

Rm18,000.

Kalau 2 gram 5 tahun?

RM30,000 sahaja gaisss!!!😱😱

Nada insaf,

“Rugi tak beli emas ketika 2018, harga 1 gram emas ketika itu hanya RM 180”

Hari ni?

1 gram = RM277

Untung hampir seratus setiap gram yang dibeli.

Ada orang, celik kewangan awal-awal lagi.

Setiap kali dapat duit raya anak, tukarkan dalam bentuk emas, untuk simpanan mereka pada masa akan datang.

Tips ni untuk bagi yang tak berapa pandai simpan duit, kalau simpan pun, tak lama kemudian, ia bocor entah ke mana.... bolehlah cuba!

Nanti boleh guna untuk pergi Umrah, atau buat bayar deposit untuk rumah 😱

Hanya tukarkan duit, menjadi aset yang tak mudah bocor. Kita rasa kita membeli, sebenarnya kita sedang menyimpan.

Begitulah!

Saya bersyukur belajar simpan sejak mula kerja, sedikit demi sedikit. Masa zaman covid hari tu, sempat grab gambar limited edition DG Dr Hisham, buat kenangan…😉

Kini anda boleh menyimpan emas SERENDAH R.M 1OO!

Wasap SEKARANG!

Wasap.my/60129046065/SimpanEmasRm100
Wasap.my/60129046065/SimpanEmasRm100
Wasap.my/60129046065/SimpanEmasRm100

22/08/2022

Advanced Trauma Life Support (ATLS) 10th edition

Fb : Afiq Fahimy

[Part 1 sharing]

Chapter 1 : Initial Assessment & Management

1. Primary survey:
A - Airway + Restriction of cervical spine motion
B- Breathing + Ventilation
C - Circulation + Hemorrhage Control
D- Disability
E- Exposure & Environment control

Adjuncts to primary survey:
a. pulse oxometry/ capnopgraphy
b. ABG
c. urinary catheter
d. gastric catheter for decompression
e xray (CXR and pelvic cray)
f. FAST/ extended - FAST (eFAST) scan
g. ECG

* transurethral catheter contraindict in suspected urethral injury. How to suspect?
- blood at urethral meatus
- perineal ecchymosis/ swelling

2. Secondary survey
(i) History : A.M.P.L.E. history
A - Allergies
M- Medications
P- past illness/pregnancy
L- last meal
E- events/ environment related to injuries

(ii) head - to - toe examinations

Adjuncts to secondary survery: specific diagnostic test

Chapter 2: Airway Management and Ventilation

1.Objective sign of airway obstruction
(a) agitated (suggesting hypoxia)
(b) obtunded (suggesting hypercarbia)
(c) cyanosis
(d) retraction/ use of accessory muscle
(e) abnormal sounds/ noisy breathing
(f) abusive

2. Signs of laryngeal trauma:
- hoarseness of voice
- subcutaneous emphysema
- palpable fracture

3. Objective sign of inadequate ventilation
(a)Asymmetrical chest rise
(b)Decrease/ absent of breath sound
(c)Use of capnography in intubated patient to check ventilation

4.Predicting difficult airway management:
(a)C- spine injury
(b)Severe arthritis of C-spine
(c)Significant maxilofacial/ mandibular trauma
(d)Limited mouth opening
(e)Obesity
(f) Anatomical variation
(g)Paediatric patient

5 .L.E.M.O.N assessment of difficult airway:
L - look externally
E - Evaluate 3-2-2 rule
3 FB - in between incisor’s teeth
2 FB - from hyoid bone to chin
2 FB - from thyroid notch to floor of mouth
M - Mallapati’s score
O - obstruction
N - neck mobility

6.Airway maintainance technique:
(I) chin lift
(ii) Jaw thrust
(iii) nasopharyngeal airway - contraindicated in cribiform plate fracture
(iv) oropharyngeal airway
(v) extraglottic/supraglottic device (LMA, laryngeal tube airway, multilumen esophageal airway)

7.Definitive airway:
(a) orotracheal tube
(b) nasotracheal tube
(c) surgical airway ( cricothyroidectomy, tracheostomy)

8.Criteria establishing for definitive airwawy
(a) inability to maintain patent airway with impending or potential airway compromise
(b) inability to maintain adequate oxygenation / presence of apnea
(c) obstunded/combasiveness resulting from cerebral hypoperfusion
(d) obstunded indicating presence of head injury (GCS less or equal 8 or sustained seizure.

Chapter 3: Shock

A.Initial management of Hemorrhagic shock
1 . Follow ABCDE
2.Obtain vascular access:
- minimum of 18 gauge caliber
- short large peripheral IV line is preferred (Poiseuille’s law: The rate of flow is proportional to the foourth power of the radius of the cannula and inversely related to it’s length)

3.Initiating fluid theraphy:
- 1L bolus of crystalloid (warm) for adult ; 20mls/kg for paediatric (< 40kg)
- assess pt respond to fluid:
(a) rapid responder
(b) transient responder
(c) minimal or no response
- balancing goal of organ perfusion + tissue oxygenation + avoidance of rebleeding (permissive hypotension)
4.Prevention of hypothermia
5.Prevention of coagulopathy
- Role of tranxemic acid within 3 hours of injury ( 1st dose given for 10min then 1g over 8 hours)

* massive transfusion:
Definition: > 10 units of pRBC within 1st 24 hours of admission OR > 4units of pRBC transfused over 1 hour
- administration of pRBC, FFP, Plt in balanced ratio (1:1:1) may improve survical (damage control resuscitation)

* special consideration:
1.Adv age :
- deficit receptor response to cathecholamines
- cardiac compliance reduce with age
- artherosclerotic vasscular disease make vital organ more sensitive in slight reduction in blood flow
- reduced pulmonary compliance, reduce diffusion cpacity + generalised weakness of respiratory muscles limits ability to cope with increase demand of gas exchanges

2.Athelete :
- have remarkable ability to compesate blood loss, may not manifest the usual response to hypovolaemia

3.Pregnancy - hypovolaemia might be reflected in decrease in fetal perfusion

4.Pacemaker - unable to response to blood loss as expected (HR remain as device’s set rate)

Chapter 4: Thoracic Trauma

1.Primary survey life threatening injuries:
A.Airway obstruction
B.Tracheobronchial injury
C.Tension pneumothorax
D.Open pneumothorax
E.Massive hemothorax
F.Cardiac tamponade

2.Secondary survey potential life threatening injuries
A.Simple pneumothorax
B.Hemothorax
C.Flail chest
D.Pulmonary Contusion
E.Blunt cardiac injury
F.Traumatic Aortic disruption
G.Traumatic diaphragmatic injury
H.Blune esophageal rupture

A.Trancheobronchial injury
- majority occurs within 1 inch (2.54cm) from carina
- signs & symptoms:
(I) Hemoptysis
(II)Cervical subcutaneous emphysema
(III)Tension pneumothorax
(IV)Cyanosis
(V) Continous air leak after placement of chest tube
- Confirmational dx: Bronchoscopy
- Immediate treatment: definitive airway if indicated (advanced airway skill might require due to anatomical disruption)
- Operative intervention is indicated

B.Tension pneumothorax
- Do not delay treatment to obtain radiological confirmation
- Symptoms and signs:
i)Hypotension
ii) tracheal deviation from affected side
iii) neck vein distension
iv) unilateral absence of breath sound
v) respiratory distess
vi) tachycardic
vii) chest pain
viii) air hunger
ix) elevated hemithorax with respiratory movement
x) cyanosis (late signs)

- immediate treatment: needle decompression (5th ICS slightly anterior to mid-axillary line)
- definitive rx: chest tube

C.Open pneumothorax
- occurs whenopening of chest wall approximate 2/3 of diameter of trachea
- immediate Rx: sterile occlusive dressing (secured tape at 3 edges)
- definitive Rx: chest tube insertion

D.Massive Hemothora
- Definition: (i) initial output of more than 1500ml
(ii) continous blood loss of 200ml/hr for 2-4 hours
- immediate Rx; chest tube
- if blood loss as per mentioned above - thoracotomy is indicated
- chest wound medial to ni**le line or posterior wound medial to scap**a, have to suspect great vessl injury and have to keep an eye for thoracotomy

E.Cardiac tamponade
- Beck’s triad : muffled heart sound, hypotension and distended neck vein - may not be present/not easily to detect
- FAST scan rapid and accurate to detect the problem
- Rx : emergency thoracotomy/sternotomy, if surgical intervention not possible - to proceed with pericardiocentesis

F.Flail chest & Pulmonary Contusion
- Flail chest : two or more consecutive ipsilateral rib fratures
- Pulmonary contusion : bruising of lung cause by thoracic trauma
- Rx: (I) adequate analgesia
(ii) adequate ventilation/O2 supplementation
(iii) cautious fluid resuscitation

G.Blunt cardiac injury
- can result in myocardial muscle contusion, cardiac chamber rupture (will cause cardiac tamponade), coronary artery dissection, valvular disruption
- presence of cardiac troponins can be of myocardial infarction
- - typical symptoms : chest discomfort
- patient with blunt injury to heard diagnose by conduction abnormalities are at risk fo dysarythymia - should be monitor for first 24 hours

H.Traumatic aortic disruption
- Radiographic sign (high index of suspcious:
(a)Widened mediastinum
(b)obliteration of aortic k**b
(c)Deviation of trachea to right
(d)Depression of left mainstem bronchus
(e)Elevation of right mainstem bronchus
(f)Obliteration of aortopulmonary window
(g)Deviation of esophagus to right
(h)Widened paratracheal stripe
(i)Widened paraspinal interfaces
(j)Presence of pleural or apical cap
(k)Left hemothorax
(l)Fracture of 1st/2nd/scap**a

- CT scan prove as accurate screening
- TEE appear useful as non invasive tools
- HR + BP control can reduced likelihood of rupture
- Rx: open or endovascular repair

I.Traumatic diaphragmatic injury
- common on right side
- Rx: endoscopic (laparoscopic or thoracoscopy) with direct repair of the defect

J.Blunt esophageal rupture
- may present with Left pneumo/hemothorax without a rib fracture who has received severe blow over sternu,/epigastrium
- presence of mediastinal air
- Rx: direct repair

(Kalau salah, mohon betulkan ya)

To be continue..

Wallahua'lam

22/08/2022

REFER NEPHRO?

Muhammad Hilmi Kamaruddin

-Living a life as Peri 'Nephric' MO rotation as part of MMed journey requirement- 😊

Long list of referrals. Non stop phone call. Catheter. And so on so on.

So, I would like to share some tips for HO before making referral to Nephrology.
I'm not the best teacher nor the best MO in UMMC BUT at least, with this tips, it can guide HO what to highlight to us prior to make referral.
It is win win situation. Will make me happy, U happy and save my time.
(As some of u know, I'm not the type of 'marah-marah' one).

1) AKI (Acute Kidney Injury)

- This is the number 1 in my referral list. Always when I got call for this, some of them said " I want to refer for AKI with Urea 25 and Creatinine 300". Then the conversation like krik krik there. And I need to prompt them to search for the numbers which may consume my time. BUT I never reject ur referrals. Assume it is a learning curve for HO.

- I just need to know few numbers. No need to highlight all the cerita nenek moyang of the patient.

- The thing u need to highlight as below

i) Urea and Creatinine - If possible, give few days trend and during admission. And of course the most important thing is the Baseline renal function test which may give me rough idea regarding the chronicity of the renal impairment.

ii) PH and HCO3 - Also the trend.

iii) Potassium

iv) Urine output - This is very important for us to determine fluid balance in the body. Bonus to us if u could provide the Cumulative fluid balance for the past 3 days and Urine out how many mls/hour.

v) BP? Inotropic support? Hydration status; How many IV Drip given?

vi) Any Contrasted CT scan done during admission? Nephrotoxic medication?

- And the most important thing, If you think the patient has severe Uremia > 25, Acidosis, Refractory Hyperkalemia and Minimal or Nil urine output, please refer in the morning so that I can anticipate catheter insertion early.

2) HD support for End stage kidney disease (N0 2 most in the list)
- This is more easier. I just need to know few things only.

i) Why is the patient currently admitted under ur team? Plan for operation?

ii) What type of dialysis used? (Peritoneal dialysis / Hemodialysis).

iii) Day of dialysis? (1,3,5 VS 2,4,6) an when was the last HD.
- 1,3,5 = Dialysis on Monday, Wednesday and Friday
- 2,4,6 = Dialysis on Tuesday, Thursday and Saturday.

iv) Vascular access for dialysis? Using fistula? TCC? Temporary Femoral or IJC catheter?

v) Bonus for me to know the Dry weight of the patient (Most of the patient will able to tell u their dry weight).

Thats all. Then I will happily come to see ur patient and give HD regime Less than 1 minute conversation.

Usually I will not ask the Creatinine as the kidney already damage what. And if need Contrast CT, just perform if the benefit outweigh the risk (There are no words to describe the end of the End stage kidney disease. Endgame? Avengers? End of the world?)

I think that was the 2 most common referrals in Nephrology. Of course there are few case of Nephrotic syndrome, CRBSI, CKD for Contrast-induced AKI prevention etc etc.

I hope HO can use this template as a guide prior to Nephrology consult.

Cheers
I'm also still learning.

- Hilmi -
- 7/1/2022 -

* Azrul Fahmi Jaharudin (He is my partner in crime as Peri Nephric MO at the moment)

22/08/2022

Nak Buka Klinik?

Hasnor Safwan

Ramai doktor kontrak yang tidak mendapat kerja tetap di KKM dan sedang mencari alternatif bagi kelangsungan hidup. Ada doktor-doktor muda yang saya tahu membuat ‘personal loan’ bagi membuka klinik swasta.

Mungkin mereka sudah ada rancangan rapi, cuma saya rasa perlu dinilai risiko yang akan datang dengan keadaan inflasi dan kemelesetan ekonomi yang mungkin berlaku.

Untuk menanggung hutang jika bisnes gagal dan kemungkinan s**ar mendapat kerja tetap dikala ekonomi merundum nanti adalah beban yang sangat berat. Statistik muflis dikalangan orang muda juga tinggi, antaranya disebabkan membuat pinjaman bagi urusan perniagaan.

Jika anda berminat bekerja sendiri, ini nasihat saya :

1. Jika boleh, elak dahulu daripada buat sebarang jenis loan.
Lebih-lebih lagi jika bisnes itu masih di fasa idea dan belum terbukti akan berjaya.

2.Mulakan idea anda dengan duit sedia ada.
Jika tidak cukup modal, mulalah menyimpan sebelum resign. Ajak kawan rapat untuk join atau pulun lah locum dahulu untuk kumpul duit. Bersedia untuk duit terbakar di fasa-fasa awal perniagaan. Jika idea anda sangat menarik, boleh juga cuba dapatkan pelabur. Namun, mengikut pengalaman saya, jarang orang nak melabur pada mereka yang belum punya kejayaan bisnes yang terbukti. Dulu nak ajak otai-otai bisnes berjumpa pun ramai yang tak sudi.

3. Mulakan dengan kecil.
Boleh buat kerjasama beberapa pihak atau individu. Bahagi keuntungan berdasarkan hasil. Cari individu berpengalaman untuk guide anda. Paling penting jangan buat seorang diri.

4. Seeloknya ada gaji tetap ketika fasa awal ‘resign’ dari government.
Untuk mendapat ‘feel’ bekerja sendiri ini mengambil masa. Kena faham dahulu sepak terajang kehidupan diluar. Secure ‘permanent locum’ dahulu pun dah okay. Sambil-sambil to work on your business.

5. Jangan habiskan duit pergi kelas bisnes mahal-mahal.
Menuntut dulu dengan orang sekeliling anda. Akaun, pemasaran, jualan, belajar menulis dan merangka plan. Banyak ilmu-ilmu percuma di youtube atau boleh join kursus-kursus online yang mampu milik.

6. Elakkan bersaing dengan bisnes lain.
Kalau buat perniagaan kesihatan selain membuka klinik swasta pun lebih baik. Sudah terlalu banyak persaingan di kalangan klinik swasta. Anda bukan bersaing dengan klinik berdekatan sahaja, anda juga bersaing dengan platform-platform online lain yang tumbuh bagai cendawan kapitalis.

7. Jangan rasa diri tahu banyak benda.
Banyakkan belajar dengan orang sekeliling. Bos kedai runcit, bos-bos syarikat kecil. Mereka ini s**a bercakap dan kongsi ilmu. Tadah lah mana yang boleh. Yang tak faham boleh google dan kemudian tanya lagi.

8. Be flexible. Survival itu penting.
Kadang-kadang anda merancang nak buat benda lain, tapi feedback market lagi s**a benda lain. Jangan risau untuk ubah. Survival di awal ini lebih penting.

9. Kurangkan komitmen kewangan.
Untuk ketenteraman hati, ini anda kena korbankan. Lebihkan enjoy perkara-perkara kecil. Sunset, view dari atas bukit, ambil angin tepi pantai. Alam semula jadi tidak pernah menghampakan. Percuma p**a tu.

Itu dulu saja kot nak kongsikan. Terlebih panjang p**a. Nanti sambung kalau ada yang minat.

*Gambar kenangan bermandi peluh ketika bulan puasa 2 tahun lalu ketika awal-awal wabak melanda. Masa ini baru setahun resign dari kerja government dan tidak sangka betapa mencabarnya hidup di luar. Segala jenis cara digunakan bagi memastikan kelangsungan hidup 3 entiti bisnes dan membayar gaji mereka yang bernaung dibawah bisnes tersebut.

Alhamdulillah kesemua bisnes survive.

20/08/2022

Ada kawan saya, dia nak jadi doktor,
Ketika asasi, tak dapat.

Akhirnya dia menjadi doktor gigi, mengambil course science biochem. Ambil course sekian-sekian, menjadi hebat.

Dia bersyukur tak dapat jadi doktor.

Ada kawan, dia dapat tawaran pergigian, akhirnya ketika asasi, dibuka tawaran untuk masuk asasi perubatan, akhirnya dia menjadi doktor.

Ada kawan, dia tak dapat tawaran perubatan, dia pergi sendiri ke Mesir, UK dan sebagainya, bayar sendiri guna duit parents, akhirnya jadi doktor.

Ada orang, dia tak minat pun nak jadi doctor, rasa tak layak, selalu fail exam, akhirnya dipermudahkan untuk dia jadi doktor, kemudian dia jadi minat.

Ada orang, keluar dari jadi doktor; ketika houseman. Dia ambil master kaunseling.

Ada orang, berusaha habiskan houseman, kerja setahun MO, quit KKM, sebab rasa tak mampu jadi doktor di hospital. Nak buat locum sahaja di klinik, ada kebebasan masa.

Ada orang, dicampak ke sabah sarawak, bertahan kerja setahun sebagai MO, akhirnya tak boleh jauh dari keluarga, dia keluar KKM. Lebih bahagia.

Ada orang, buka klinik.
Ada orang, jadi MO Resident klinik.
Ada orang, jadi Locum di klinik swasta.

Ada orang, kalau boleh dia nak quit KKM, dia harap dia tak dapat permanent post, supaya mungkin lebih senang untuk dapat pengurangan denda JPA, iaitu kena bayar RM250 ribu jadi berkurang… tup-tup dia dapat tawaran tetap. Jadi semakin s**ar untuk dia berhenti…

‘Alah, pergi interview tu untuk cukupkan syarat je… buat tak perfect, sijil pun tak cop, jawab pun sembang je… kenapa dapat permanent p**a? Huhu; susah dah la nak quit…”

Saya belajar sesuatu melalui kawan-kawan saya ni.

Yakin akan rencana Allah.
Ada sebab Allah tak bagi kita tetap.
Ada sebab kenapa Allah bagi kita jawatan tetap.
Ada sebab Allah mudahkan atau s**arkan kita untuk jadi doktor, sebab Allah tahu kelak ada hikmah di bahagian lain itu.

Sekarang.
Rasa sedih.
Rasa down.
Rasa kenapa tak dapat apa yang aku nak?

Sematkan keyakinan.
Allah tahu; ini yang terbaik buatku.

Teruskan keyakinan.
Teruskan berbuat baik.
Teruskan asah soft skill.
Teruskan menjadi manusia bermanfaat.

Kerana orang baik ni, tercampaklah di mana-mana pun, ia akan dis**ai ramai.

Apabila kita dis**ai ramai,
Itulah kunci rezeki kita.
Jangan memilih untuk buat baik pada bos je, marah dan tengking sekian orang.

Baiki hati.
Berbisik pada diri.
Ya Allah, tempatkanlah aku di tempat yang terbaik untuk diriku, kebaikan untuk duniaku dan akhiratku. Kau tahu banyak, kami tahu sedikit.

Allah Ya Razzaq, mudahkan lah rezeki kami.

S**a kata Prof Muhaya.

“Nak tahu apa yang bakal kita dapat? Tengoklah apa value yang kita beri pada dunia! Jadi manusia bermanfaat, rezeki akan datang melalui itu…”

“Tengok Steve Job, Mark Zukerberg, Bill Gates… dia dapat banyak, sebab memberi value pada manusia lain…”

Hikmah itu tak nampak dalam sehari dua.
Suatu hari nanti kita akan berkata,

“Ya Allah, terima kasih 5-10 tahun lepas uji aku begini dan begitu…”

Tambahkan keyakinan pada Allah.
Jangan berputus asa dari rahmat Allah.

Ingat!
Allah sayang kita, lebih dari mak kita, sayang pada kita.

Kita berusaha dan buat ini dan itu, berdoa bagai, itu sebagai amalan soleh.

Dapat begini atau begitu, adalah mengikut RENCANA dan RAHMAT Allah.

19/08/2022

“Amalina, kenapa tak buat nota ni masa saya houseman? Best sangat! Senang nak baca…” - MO

“The best notes ever! Precise, help me to understand more cases in ward”

“Amalina, nak restock buku ni 200” - Dr Iliana, Medicorp.

Alhamdulillah,
2000 copy terjual.

Help many medical student, houseman, junior MO to revise some knowledge during O&G, Medical, Orthopaedic, Paediatric, Medical and Emergency Department.

Included commonly asked question for every major posting.

Limited Edition.

Amalina’s Notes✨✨✨

Tekan wassap untuk dapatkan sample PERCUMA👇🏻👇🏻👇🏻