Dr. Ashim's Emergency and General Practice

24/04/2026

For my students and juniors

How many of you know this fruit and its effect??

We get a lot in our emergency.

This is the first time the patient party brought the fruits to emergency.
Awareness do work.

23/04/2026

देशलाई माया गरौ, नेपालमा धेरै कुरा दुबई को भन्दा राम्रो छ।।
तलब र आम्दानी बाहेक।।

धन्यवाद बालन सरकार🙏 दुबईमा भन्दा नेपालमा उपचार सस्तो र राम्रो😍 दुबईमा बस्दै आएका टिकटक स्टार कृष्ण भट्टराई उपचारको महँगो खर्चका कारण अन्ततः नेपाल फर्किएका छन्। उनलाई मूत्र नलीमा अड्किएको पत्थरी निकाल्न दुबईमै प्रयास गरिएको थियो। तर, बीमा कम्पनीले उपचार खर्च कभर नगरेपछि उनले आफ्नै खर्चमा शल्यक्रिया गर्ने सोच बनाए। दुबईको अस्पतालले उक्त अपरेसनका लागि ३० हजार दिराम (करिब १२ लाख रुपैयाँभन्दा बढी) खर्च लाग्ने बताएपछि उनी अचम्ममा परे।

त्यति ठूलो रकम तिर्नुभन्दा नेपालमै सस्तो र सहज रूपमा उपचार गर्न सकिने निष्कर्षमा पुग्दै उनी स्वदेश फर्किएका हुन्। उनका अनुसार त्यही रकमले नेपालमा चार वटा अपरेसन गर्न सकिन्छ। सामाजिक सञ्जालमार्फत उनले विदेशको महँगो उपचार प्रणालीप्रति असन्तुष्टि व्यक्त गर्दै नेपाल फर्किने निर्णय सुनाएका छन्। यो घटनाले विदेशभन्दा नेपालमै उपचार सस्तो र प्रभावकारी हुन सक्ने सन्देश दिएको छ।😍🥰❤️

23/04/2026

New update on our previous case
CT report for the followers

Was your diagnosis correct??

🩺 केस हिस्ट्री

४० वर्षे पुरुषलाई आज बिहानै माथिल्लो घान्द्रुक क्षेत्रबाट साथीले हाम्रो अस्पतालमा ल्याए।
साथीले दिएको इतिहास अनुसार:

बिरामी पेशाले गाइड हुन्, कोरियाली पर्यटकलाई अन्नपूर्णतर्फ लैजाँदै थिए।

तीन दिनदेखि बिरामीलाई असह्य टाउको दुखाइ (intractable headache) भइरहेको थियो।

आज बिहान अचानक बेडबाट खसे, त्यसपछि उनी असंगठित (disoriented), बोल्न नसक्ने (mute), र स्तब्ध (stuporous) अवस्थामा देखिए।

❓ प्रश्न:
माथिको इतिहास मात्र हेर्दा, तपाईंको provisional diagnosis के हुन सक्छ?

👉 कृपया आफ्नो विचार कमेन्टमा लेख्नुहोस्।

21/04/2026

21/04/2026

OP poisoning GI Wash

Use saline and suction

Don't wait for charcoal if not available in your hospital

GI wash within 1-2 hours can give good outcome
Depending on the poison..

21/04/2026

Today I was thanked which is rare and something that rarely exists in my life..

21/04/2026

3 years so fast, dedicated to Miracle man
Learning for our young doctors
To have dedication to work, Miracle can happen

🌌 Annapurna Survival Story – From Crevasse to Heartbeat

Mountaineer Anurag Maloo fell nearly 300 meters into a crevasse on Mount Annapurna in April 2023.
His rescue was nothing short of miraculous:

👉 Rescue Team on the Mountain:

Adam Bielecki (Polish climber)

Mariusz Hatala (Polish climber)

Tashi Sherpa (Nepali rescuer)

Other Nepali Sherpas who risked their lives to pull him out of the ice

After 72 hours trapped, they brought him — but in hypothermic cardiac arrest.

🩺 Resuscitation Team at Manipal Teaching Hospital, Pokhara:
Dr. Ashim Subedi ( GPEM ), Incharge Emergency
Dr. Sujana Poudel, Medical Officer
Dr. Anil Bhusal ( Intern ) and others
Dr. Rajan Basnet ( Anaesthesia and critical care )
Nursing Team ( ER Incharge Mina, Anu, Rajani, Laxmi )
Two electives from UK

Our dedicated nurses

For us, it was the highest pressure situation of our careers.

We fought for 4 hours of continuous CPR.

At one point, we were ready to stop — but his brother insisted: “Give him 5 hours.”

That insistence, along with the ABG report confirming hypothermic arrest, kept us moving.

⏱ After 4.5 hours, we saw a heartbeat.
Even then, doubts remained — could it sustain without further CPR?

👉 With courage and teamwork, I and Intern Dr. Anil Bhusal transferred him to Mediciti Hospital, where he was treated for around 2 weeks.
Later, he was moved to AIIMS Delhi, where he remained for around 6 months before finally returning home.

🌍 Why This Story Matters

It shows the heroism of Polish climbers and Nepali Sherpas who risked their lives in the ice.

It shows the determination of a brother who refused to give up.

It shows the discipline and teamwork of doctors, interns, and nurses who fought against time and science.

❓ Reflection for all of us:
In such extreme circumstances — hypothermic cardiac arrest, prolonged CPR, fragile hope — what gives us the strength to keep going?

👉 Can we save a patient when science says “no,” but humanity says “try”?

21/04/2026

3 years so fast, dedicated to Miracle man
Learning for our young doctors
To have dedication to work, Miracle can happen

🌌 Annapurna Survival Story – From Crevasse to Heartbeat

Mountaineer Anurag Maloo fell nearly 300 meters into a crevasse on Mount Annapurna in April 2023.
His rescue was nothing short of miraculous:

👉 Rescue Team on the Mountain:

Adam Bielecki (Polish climber)

Mariusz Hatala (Polish climber)

Tashi Sherpa (Nepali rescuer)

Other Nepali Sherpas who risked their lives to pull him out of the ice

After 72 hours trapped, they brought him — but in hypothermic cardiac arrest.

🩺 Resuscitation Team at Manipal Teaching Hospital, Pokhara:
Dr. Ashim Subedi ( GPEM ), Incharge Emergency
Dr. Anil Bhusal ( Intern ) and others
Dr. Rajan Basnet ( Anaesthesia and critical care )
Nursing Team ( ER Incharge Mina, Anu, Rajani, Laxmi )
Two electives from UK

Our dedicated nurses

For us, it was the highest pressure situation of our careers.

We fought for 4 hours of continuous CPR.

At one point, we were ready to stop — but his brother insisted: “Give him 5 hours.”

That insistence, along with the ABG report confirming hypothermic arrest, kept us moving.

⏱ After 4.5 hours, we saw a heartbeat.
Even then, doubts remained — could it sustain without further CPR?

👉 With courage and teamwork, I and Intern Dr. Anil Bhusal transferred him to Mediciti Hospital, where he was treated for around 2 weeks.
Later, he was moved to AIIMS Delhi, where he remained for around 6 months before finally returning home.

🌍 Why This Story Matters

It shows the heroism of Polish climbers and Nepali Sherpas who risked their lives in the ice.

It shows the determination of a brother who refused to give up.

It shows the discipline and teamwork of doctors, interns, and nurses who fought against time and science.

❓ Reflection for all of us:
In such extreme circumstances — hypothermic cardiac arrest, prolonged CPR, fragile hope — what gives us the strength to keep going?

👉 Can we save a patient when science says “no,” but humanity says “try”?

20/04/2026

🩺 Case Story

४० वर्षे पुरुषलाई हाम्रो Emergency Department मा रिफर गरियो।

इतिहास अनुसार:

बिरामीलाई मासिभ मेलिना (कालो दिसा) भइरहेको थियो।

तर बान्ता वा रगतको वाकवाकी (hematemesis) थिएन।

अस्पतालमा ल्याउँदा बिरामी अत्यन्तै फिका (pale) देखिन्थे।

Blood Pressure: 80/40 mmHg

Pulse: 128/min (tachycardia)

👉 Clinical Examination:

बिरामी कमजोर (frail) देखिन्थे। केही मिनेटमै उनी अल्छी (drowsy) हुँदै गए, GCS घट्दै गयो।
१५–२० मिनेट भित्रै उनी छिटो‑छिटो सास फेर्न थाले (RR 40–50/min), उत्तेजित (agitated) भए, अनि अन्ततः flaccid भए।

❓ प्रश्न:
यो अवस्थासम्म आइपुग्दा, बिरामीलाई बचाउन के उपचारको बाटो रोज्न सकिन्छ?

👉 Massive GI bleed, hypovolemic shock, respiratory failure — Can we save this patient?

20/04/2026

नेपाल मणिपाल शिक्षण असपतालको Red Area

जहाँ सबैभन्दा सिकिस्त बिरामी को ज्यान बचाउने कोशिश हुन्छ।।

यो Area संबेदनसिल हुन्छ
कृपया याहा भिड र वैमनस्यता ननिम्त्याउन अनुरोध छ।।

याहा ज्यान जोगाउन कार्य हुनेगर्छ।।

याहा कार्यरत स्वास्थकर्मीलाई (डाक्टर अथवा नर्स ) हरुलाइ

रिपोर्ट के भयो, हाम्रो के भैरहेछ, यता आउनुस त, ओ डाक्टर , ओ नर्स भन्दै नबोलाइदिनुहोला please
याहा काम हुँदा तनाबमा र pressure मा काम हुन्छ।।
कहिले काहीं एउटा बिरामीलाई मात्र समय दिनुपर्ने अवस्था हुन्छ।।

यो बुझेमा इमर्जेन्सी मा ढिलो र चाडोको कुरो हुदैन।।

कृपया यो सबै माझ पुराइदिनुहोला।।

20/04/2026

Typical pathognomonic sign in a case of 41 years old alchololic male with severe epigastric pain and loss of appetite with nausea.

Please mention the signs and your diagnosis??

You don't have to be right everytime..
But try..

20/04/2026

🧠 बालबालिकामा टाउको चोट भएपछि CT Scan कहिले गर्नुपर्छ?

बालबालिका खेलकुदमा सक्रिय हुन्छन्, सामान्यतया लडाइ वा ठोक्काइ हुन्छ।

तर गम्भीर चोटमा CT Scan जीवनरक्षक हुन सक्छ।

CT Scan केवल आवश्यक अवस्थामा मात्र प्रयोग गर्नुपर्छ किनकि यसमा रेडिएशन हुन्छ।

CT Scan गर्नुपर्ने अवस्था:

बच्चा बेहोस भएको वा चेतनाको स्तर घटेको छ भने,
बारम्बार वाकवाकी वा तीव्र टाउको दुखाइ भएको छ भने,
दौरा आएको छ वा असामान्य निद्रा,
अलमल वा व्यवहार परिवर्तन भएको छ भने,
गम्भीर दुर्घटना भएको छ जस्तै मोटर वाहन दुर्घटना वा ३ फिट भन्दा माथिबाट खस्नु,
खोपडी फ्र्याक्चरको शंका छ भने,
शरीरको एकातिर कमजोरी वा दृष्टि-श्रवण गुमेको छ भने,
CSF shunt भएको बच्चामा समस्या शंका भएमा वा intracranial pressure बढेको शंका भएमा तुरुन्त CT Scan गर्नुपर्छ।

CT Scan नगर्ने अवस्था: हल्का concussion वा सामान्य लडाइमा प्रायः CT आवश्यक हुँदैन।
अनावश्यक CT स्क्यानले दीर्घकालीन रेडिएशन जोखिम बढाउँछ।

रेडिएशनबाट बच्ने उपाय:
चिकित्सकको निगरानीमा बच्चालाई केही घण्टा अवलोकनमा राख्न सकिन्छ।

Clinical decision rules (जस्तै PECARN वा NICE guideline) प्रयोग गरेर CT गर्ने वा नगर्ने निर्णय गर्न सकिन्छ।
आवश्यक भएमा low-dose CT protocol प्रयोग गर्न सकिन्छ।
MRI वा cranial ultrasound केही अवस्थामा विकल्प हुन सक्छ।

सन्देश:
बालबालिकामा टाउको चोट भएमा CT Scan केवल गम्भीर लक्षण वा जोखिमपूर्ण दुर्घटनामा मात्र गर्नुपर्छ।
हल्का चोटमा चिकित्सकको निगरानी र सावधानी पर्याप्त हुन्छ।
छिटो निर्णयले जीवन बचाउन सक्छ।