MyMedR

Usage of airway ultrasound as an assessment and prediction tool of a difficult airway management

Adi O, Fong CP, Sum KM, Ahmad AH

Am J Emerg Med, 2021 04;42:263.e1-263.e4.

PMID: 32994082 DOI: 10.1016/j.ajem.2020.09.011

Airway assessment is important in emergency airway management. A difficult airway can lead to life-threatening complications. A perfect airway assessment tool does not exist and unanticipated difficulty will remain unforeseen. Current bedside clinical predictors of the difficult airway are unreliable but airway ultrasound can be used as an adjunct to predict difficult laryngoscopy. We report a case of a 60-year-old man presenting to the emergency department with shortness of breath, hoarseness of voice and stridor. Airway ultrasound revealed a large laryngeal mass narrowing the upper airway, extending to bilateral vocal cords with heterogenous echogenicity. In view of impending complete upper airway obstruction, acute respiratory distress and airway ultrasound findings, urgent emergency tracheostomy was chosen as definitive airway over endotracheal intubation or surgical cricothyroidotomy. Point of care ultrasound (POCUS) was used to evaluate this patient with severe upper airway obstruction. A laryngeal mass was detected by ultrasound and this pointed towards the presence of a difficult airway. POCUS was a good non-invasive tool used for airway assessment in this uncooperative and unstable patient. Ultrasound predictors of the difficult airway include the inability to visualize the hyoid bone, short hyomental distance ratio, high pretracheal anterior neck thickness and large tongue size. Besides airway assessment, ultrasound can also help to predict endotracheal tube size, confirm intubation and guide emergency airway procedures such as cricothyroidotomy and tracheostomy. Point of care ultrasound of the upper airway can be used in airway assessment to identify distorted airway anatomy, pathological lesions and guide treatment decisions.

Matched MeSH terms: Emergencies

Fulltext A Cross-Sectional Study of Neutrophil-to-Lymphocyte Ratio in Diagnosing Acute Appendicitis in Hospital Melaka

Ahmad KA, Ideris N, Aziz SHSA

Malays J Med Sci, 2019 Nov;26(6):55-66.

PMID: 31908587 DOI: 10.21315/mjms2019.26.6.6

Background: Acute appendicitis is one of the most common surgical emergencies. However, its proper diagnosis is complicated. This study aims to evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to diagnose acute appendicitis in pre-operative state.

Methods: Histopathological examination of appendicectomies conducted between 2016 and 2017 in Melaka Hospital, Malaysia were traced and categorised into three groups: i) G1 (normal appendix), ii) G2 (acute appendicitis) and iii) G3 (perforated appendicitis). The reports were randomised and a total of 338 samples were collected. NLR values were compared between the three different groups and analysed.

Results: The median values of NLR for G1, G2 and G3 were 2.37, 5.25 and 9.27, respectively. We found a statistically significant difference in NLR between G1 and G2 (P < 0.001), and G2 and G3 (P < 0.001). The diagnostic values of NLR for acute appendicitis and perforated appendicitis were 3.11 (sensitivity: 75.23%, specificity: 68.70%) and 6.17 (sensitivity: 76.32%, specificity: 58.72%), respectively. There was a substantial correlation between NLR and disease severity, and a moderate correlation between NLR and duration of admission.

Conclusion: NLR, with a sensitivity of 75.23% and specificity of 68.70%, is a useful and reliable adjunct in diagnosing acute appendicitis. Hence, it will help in reducing the rate of negative appendicectomies.

Matched MeSH terms: Emergencies

Fulltext Transphyseal fracture-separation of the femoral capital epiphysis: a true SCFE of traumatic origin

Aminudin CA, Suhail A, Shukur MH, Yeap JK

Med J Malaysia, 2006 Feb;61 Suppl A:94-6.

PMID: 17042240

Acute traumatic transphyseal fracture of the capital femoral epiphysis is a rare but serious injury. The injury is typically inflicted by a severe trauma. Because of the vulnerability and predisposed anatomy of the femoral epiphysis in relation to its blood supply, the fracture has been designated to have poor prognosis with inevitable osteonecrosis and eventual deformity of the hip. We report a case of such fracture in a 13-year-old child in view to highlight some of the anticipated problems in the management of such injury.

Matched MeSH terms: Emergencies

Fulltext Sequelae of neglected senile cataract

Azhany Y, Hemalatha C, Nani D, Rosediani M, Liza-Sharmini A

Malays Fam Physician, 2013;8(1):33-7.

PMID: 25606266 MyJurnal

Cataract is the most common cause of blindness in the world. An attack of phacolytic and phacomorphic glaucoma as a result of neglected cataract constitutes a medical emergency that must be addressed immediately. Ocular emergencies such as these is challenging for the surgeon with guarded or poor prognosis. We describe the presentation, management and prognosis of three cases of phacomorphic and phacolytic glaucoma. All three patients underwent aggressive management of intraocular pressure. Despite successful cataract operation with implantation of intraocular lens, there was only mild improvement of the vision. Optic nerve and pupil functions were permanently affected following the insult. Phacomorphic and phacolytic glaucoma present a very challenging problem to the surgeon with poor visual outcome. Public health education and awareness are important and health workers should encourage patients with cataract to seek early treatment for better prognosis.

Matched MeSH terms: Emergencies

Fulltext Paramedics’ knowledge on intraosseous cannulation

Balakrishnian, M., Johar, M.J., Ismail, M.S., Ahmad Khaldun, I., Hamidah, Y.

Medicine & Health, 2013;8(2):81-84.

MyJurnal

Access to an intravenous (IV) route is very crucial in emergency patients under resuscitation. The difficulty to access and administer fluid and drugs through intravenous will influence the outcome of patient. In case of unavailable of intravenous route, the alternative is intraosseous access. To date, there is no data available on the prevalence and pattern of intraosseous cannulation knowledge among emergency paramedics in the published literature from our country, even though the use of intraosseous cannulation for emergency patients is being practices. Therefore, the purpose of the present study was to determine the level of knowledge regarding intraosseous cannulation among emergency paramedics. The knowledge related to intraosseous cannulation among emergency paramedics was assessed through structured validated test questions. Fifteen paramedics participated in this study. Majorities of participants were male (86.6%). The age group ranged from 22 – 45 old years. The working experiences were from two to thirteen years. There was only 1 out of 15 participants who had scored 75%. The majority (10) scored 40% to 50%. This suggests that necessity in teaching of intraosseous cannulation among emergency paramedics needs to be emphasised.

Matched MeSH terms: Emergencies

Emergency management of the coronary patient

Catterall RA

Family Practitioner, 1977;2(6):5-7.

Matched MeSH terms: Emergencies

Emergency medicine in general practice

Catterall RA

Family Practitioner, 1977;2:78-79.

Matched MeSH terms: Emergencies

Psychiatric emergencies

Chan BTM

Family Physician, 1992;4:16-18.

Matched MeSH terms: Emergencies

Fulltext Management of patients on antithrombotic agents undergoing emergency and elective endoscopy: joint Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) practice guidelines

Chan FKL, Goh KL, Reddy N, Fujimoto K, Ho KY, Hokimoto S, et al.

Gut, 2018 03;67(3):405-417.

PMID: 29331946 DOI: 10.1136/gutjnl-2017-315131

This Guideline is a joint official statement of the Asian Pacific Association of Gastroenterology (APAGE) and the Asian Pacific Society for Digestive Endoscopy (APSDE). It was developed in response to the increasing use of antithrombotic agents (antiplatelet agents and anticoagulants) in patients undergoing gastrointestinal (GI) endoscopy in Asia. After reviewing current practice guidelines in Europe and the USA, the joint committee identified unmet needs, noticed inconsistencies, raised doubts about certain recommendations and recognised significant discrepancies in clinical practice between different regions. We developed this joint official statement based on a systematic review of the literature, critical appraisal of existing guidelines and expert consensus using a two-stage modified Delphi process. This joint APAGE-APSDE Practice Guideline is intended to be an educational tool that assists clinicians in improving care for patients on antithrombotics who require emergency or elective GI endoscopy in the Asian Pacific region.

Matched MeSH terms: Emergencies

Some medical conditions in relation to dentistry

Chan YF

Dent J Malaysia Singapore, 1972 May;12(1):35-8.

PMID: 4507355

Matched MeSH terms: Emergencies

Fulltext A one month review of the types of medical emergencies and their treatment outcomes at two urban public health clinics

Chew BH, Than TL, Chew KS, Jamaludin NK, Hassan H

Med J Malaysia, 2012 Dec;67(6):571-6.

PMID: 23770947 MyJurnal

INTRODUCTION: Our study was to examine prevalence and treatment outcomes of medical emergencies at two urban public health clinics in the Petaling district, Selangor, Malaysia.
METHODS: A prospective universal sampling was employed to recruit all emergencies over one month period (12 April to 11 May 2011). A structured case record form was used to capture demographic data, whether the index case was selfpresenting or decided by health care workers as a medical emergency, presenting complaints, diagnoses, concurrent chronic diseases and their treatment outcomes at the clinic level. Emergency presentations and diagnoses were classified according to the International Classification of Primary Care, revised second edition (ICPC-2-R).
RESULTS: A total of 125 medical emergencies with 276 presenting complaints were recorded. The mean age was 30.7 years old (SD 19.9). The prevalence of medical emergency was 0.56% (125/22,320). Chief complaints were mainly from ICPC-2-R chapter R (respiratory system) and chapter A (general and unspecified), 40.0% and 28.0% respectively. The most common diagnosis was acute exacerbation of bronchial asthma (34.6%). Forty percent were referred to hospitals. After adjusting for age and gender, patients who presented with painful emergency (OR 4.9 95% CI 2.0 to 11.7), cardiovascular emergency (OR 63.4 95% CI 12.9 to 310.4) and non-respiratory emergency were predictors of hospital referral (OR 4.6 95% CI 1.1 to 19.1).
CONCLUSION: There was about one medical emergency for every 200 patients presenting to these urban public polyclinics which were mainly acute asthma. More than half were discharged well and given a follow-up.
Study site: Klinik Kesihatan Seri Kembangan and Klinik Kesihatan Puchong, Selangor, Malaysia

Matched MeSH terms: Emergencies*

Fulltext Delirium acutum -- an uncommon life-threatening psychiatric emergency

Chew PH, Leong LC, Yao SK

Med J Malaysia, 1982 Dec;37(4):370-2.

PMID: 7167091

Matched MeSH terms: Emergencies

Fulltext A systematic review: public health policies on Zika infection surveillance for Malaysia

Chin Mun Wong, Rozita Hod, Mohd Rohaizat Hassan, Sazaly Abu Bakar

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):3-3.

MyJurnal

Introduction: Zika infection was declared as Public Health Emergency of International Concern since year 2015. Despite of no new reported case via National Surveillance System for flavivirus, an underestimated seroprevalence might occur as the country contributes to the Asian lineage of the virus. Methods: Systematic literature search using PICO framework and PRISMA checklist across four databases for articles published from year 2013-2018 yielded 189 results, 37 articles accepted by titles following criteria were subjected to abstract screening, leaving 8 articles with clear risk proceed to full text analysis using Cochrane checklist and GRADE assessment. Results: There were four high quality articles and four low quality articles based on biases in studies. Blood product management and vac-cination are strategies strongly recommended to be implemented as Zika response while vector control and family planning are public health measures to be proposed as policy if feasible. Successful factors to improve Zika surveil-lance and management includes developing algorithm for blood product management, anti-Zika vaccine research, algorithm for new-born screening, participation of policy makers, healthcare capacity building, raising healthcare and public awareness on the infection, international funding, utilization of technology in data management and bio-logical control of vector. Conclusion: Implementation of Zika response as policy is timely, should be evidence-based and follow guidelines from WHO / CDC / FDA US after cost-effectiveness evaluation for Malaysia setting.

Matched MeSH terms: Emergencies

Malrotated Subhepatic Caecum with Subhepatic Appendicitis: Diagnosis and Management

Chong HC, Chai FY, Balakrishnan D, Asilah SM, Adila IN, Syibrah KZ

Case Rep Surg, 2016;2016:6067374.

PMID: 27648337

Subhepatically located caecum and appendix is a very rare entity. It occurs due to the anomaly in fetal gut rotation that results in an incomplete rotation and fixation of the intestine. Appendicitis, which is a common surgical emergency, in combination with the abnormal subhepatic location, presents a great challenge in its diagnosis and management. Here, we describe a 42-year-old male with chronic dyspepsia who presented with sepsis and severe pain at his right hypochondriac and epigastric region. The final diagnosis was acute appendicitis of the subhepatic appendix. Our discussion focuses on the diagnostic approach and clinical and surgical management. We hope that our report will increase the awareness among the clinicians and hasten the management of such rare condition to avoid complications.

Matched MeSH terms: Emergencies

Fulltext Paediatric Palliative Care during the COVID-19 Pandemic: A Malaysian Perspective

Chong LA, Khoo EJ, Kamar AA, Tan HS

Asian Bioeth Rev, 2020 Aug 13.

PMID: 32837563 DOI: 10.1007/s41649-020-00142-2

Malaysia had its first four patients with COVID-19 on 25 January 2020. In the same week, the World Health Organization declared it as a public health emergency of international concern. The pandemic has since challenged the ethics and practice of medicine. There is palpable tension from the conflict of interest between public health initiatives and individual's rights. Ensuring equitable care and distribution of health resources for patients with and without COVID-19 is a recurring ethical challenge for clinicians. Palliative care aims to mitigate suffering caused by a life-limiting illness, and this crisis has led to the awareness and urgency to ensure it reaches all who needs it. We share here the palliative care perspectives and ethical challenges during the COVID-19 pandemic in Malaysia.

Matched MeSH terms: Emergencies

Gynaecological emergencies

Chow SY

Family Physician, 1989;1:19-23.

Matched MeSH terms: Emergencies

Acute and emergency care

Chua WT

Family Physician, 1989;1(3):6-15.

Matched MeSH terms: Emergencies

Fulltext Night calls at a doctor's residence

Chua WT

Family Practitioner, 1987;10(2):36-41.

Night calls at the doctor's residence are part of the family physician's service to the community. not all night calls are emergencies. Many of the cases can be managed at home if they keep simple remedies at home or they are properly instructed by the doctor. But because some of the calls are medical, surgical or gynaecolofical emergencies, the doctor must respond to all night calls. Some common illnesses necessitating night calls are identified and a list of drugs either to be stocked in the house clinic or in the doctor's emergency bad are identified. Reduction in night calls can be achieved by educating our patients regarding self-management of minor illnesses, use of hospital emergency services, setting up of group practices, a private hospital with emergency service or a community night clinic.

Matched MeSH terms: Emergencies

Psychiatric emergencies and their management

Deva MP

Family Physician, 1989;1:16-18.

Matched MeSH terms: Emergencies

Case report: A case of pericardial effusion presenting to primary care

Devaraj NK

Med J Malaysia, 2017 08;72(4):252-253.

PMID: 28889141 MyJurnal

This is a rare but interesting case of Mr. MZ who had a lifethreatening pericardial effusion presenting to the primary care clinic. Through great clinical acumen and prudent targeted investigations, diagnosis of this rare condition was reached and urgent referral made to the cardiology team which performed an emergency pericardiocentesis which proved to be life -saving. However, the hovering poor prognosis of Mr. MZ may prompt for a referral to the palliative care team to provide quality end of life care for this unfortunate patient.

Matched MeSH terms: Emergencies

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