MyMedR

Fulltext Using acute hypervolaemic haemodilution as blood conservation technique in a Jehovah's witness patient undergoing an emergency transphenoidal surgery: a Sabah experience

Yeap TB, Teah MK, Zenian S

BMJ Case Rep, 2021 Mar 04;14(3).

PMID: 33664045 DOI: 10.1136/bcr-2021-241916

Jehovah's Witnesses (JW) is a branch of Christianity which was founded in 1872. However, their beliefs differ from other Christians in many ways. Majority of JW believe that it is against the teaching of God should they receive blood transfusion, while minority think receiving own blood or others is acceptable. These vast beliefs should always be respected by all medical practitioners to avoid medicolegal implications. The differing beliefs about blood transfusion is certainly a huge challenge to the surgeons and anesthesiologists, especially dealing with major surgeries. Thus, effective surgical and anaesthetic techniques are focused to minimise blood loss to avoid unnecessary blood transfusion. We report a JW patient who successfully underwent an emergency endoscopic transsphenoidal surgery secondary to pituitary apoplexy; highlighting our intraoperative acute hypervolaemic haemodilution technique to reduce blood loss.

Matched MeSH terms: Emergencies

Fulltext Comparative audit of abdominal aortic aneurysm repairs using POSSUM scores

Yii MK

Asian J Surg, 2003 Jul;26(3):149-53.

PMID: 12925289 DOI: 10.1016/S1015-9584(09)60374-2

Abdominal aortic aneurysm (AAA) repairs represent a significant workload in vascular surgery in Asia. This study aimed to audit AAA surgery and evaluate the application of the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) in an Asian vascular unit for standard of care. Eighty-five consecutive surgical patients with AAA from a prospective vascular database from July 1996 to December 2001 in Sarawak were available for analysis. Comparisons between predicted deaths by P-POSSUM and observed deaths in both urgency of surgery categories (elective, urgent, emergency ruptures) and risk range groups (0-5%, >5-15%, >15-50%, >50-100%) were made. No significant difference was found between the predicted and observed rates of death for elective, urgent and emergency AAA repairs. The observed mortality rates were 5%, 18% and 30%, respectively. The observed rates of death were also comparable to P-POSSUM predicted rates of death in the various risk range groups. The POSSUM score used with the P-POSSUM mortality equation is easy to use and applicable as a comparative vascular auditing tool in Asia.

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 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 Neurosurgical Services in the Northern Zone of Sarawak in Malaysia: The Way Forward Amid the COVID-19 Pandemic

Low PH, Mangat MS, Liew DNS, Wong ASH

World Neurosurg, 2020 12;144:e710-e713.

PMID: 32949798 DOI: 10.1016/j.wneu.2020.09.045

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has set a huge challenge to the delivery of neurosurgical services, including the transfer of patients. We aimed to share our strategy in handling neurosurgical emergencies at a remote center in Borneo island. Our objectives included discussing the logistic and geographic challenges faced during the COVID-19 pandemic.

METHODS: Miri General Hospital is a remote center in Sarawak, Malaysia, serving a population with difficult access to neurosurgical services. Two neurosurgeons were stationed here on a rotational basis every fortnight during the pandemic to handle neurosurgical cases. Patients were triaged depending on their urgent needs for surgery or transfer to a neurosurgical center and managed accordingly. All patients were screened for potential risk of contracting COVID-19 prior to the surgery. Based on this, the level of personal protective equipment required for the health care workers involved was determined.

RESULTS: During the initial 6 weeks of the Movement Control Order in Malaysia, there were 50 urgent neurosurgical consultations. Twenty patients (40%) required emergency surgery or intervention. There were 9 vascular (45%), 5 trauma (25%), 4 tumor (20%), and 2 hydrocephalus cases (10%). Eighteen patients were operated at Miri General Hospital, among whom 17 (94.4%) survived. Ninety percent of anticipated transfers were avoided. None of the medical staff acquired COVID-19.

CONCLUSIONS: This framework allowed timely intervention for neurosurgical emergencies (within a safe limit), minimized transfer, and enabled uninterrupted neurosurgical services at a remote center with difficult access to neurosurgical care during a pandemic.

Matched MeSH terms: Emergencies*

Mapping timely access to emergency and essential surgical services: The Malaysian experience

Hoh SM, Wahab MYA, Hisham AN, Guest GD, Watters DAK

ANZ J Surg, 2021 Jun 01.

PMID: 34075677 DOI: 10.1111/ans.16986

BACKGROUND: Surgical conditions form a significant proportion of the global burden of disease. Since the 2015 World Health Assembly resolution A68.15, there is recognition that the provision of essential surgical care is an integral part of universal access to health care. The Lancet Commission on Global Surgery proposed its first surgical indicator to measure a population's access to the Bellwether procedures (laparotomy, caesarean section and treatment of open fracture) within two hours. Bellwether access is a proxy for emergency and essential surgical care. This project aims to map essential surgical access to the Bellwether procedures in Malaysia.

METHODS: The location and capability of hospitals to perform the Bellwether procedures was obtained from the Ministry of Health (MoH) and MoH hospital specific websites. The Malaysian population data were retrieved from the national department of statistics. Times for patients to travel to hospital were calculated by combining manual contouring and geospatial mapping.

RESULTS: There were 49 Bellwether-capable MoH hospitals serving a national population of 32.5 million. Overall 94% of Malaysia's population have access to the Bellwethers within two hours. This coverage is universal in West (Peninsular) Malaysia, but there is only 73% coverage in East Malaysia, with 1.8 million residents of Sabah and Sarawak not having timely access. Malaysia's Bellwether capacity compares well with other countries in World Health Organisation's Western Pacific region.

CONCLUSION: There is good access to essential and emergency surgical services in Malaysia. The incomplete access for 1.8 million people in East Malaysia will inform national surgical planning.

Matched MeSH terms: Emergencies

Fulltext Stonefish envenomation of hand with impending compartment syndrome

Tay TK, Chan HZ, Ahmad TS, Teh KK, Low TH, Wahab NA

J Occup Med Toxicol, 2016;11:23.

PMID: 27168760 DOI: 10.1186/s12995-016-0112-y

BACKGROUND: Marine stings and envenomation are fairly common in Malaysia. Possible contact to various marine life occurs during diving, fishing and food handling. Even though majority of fish stings are benign, there are several venomous species such as puffer fish, scorpion fish, lionfish, stingray and stonefish that require urgent medical treatment. Stonefish is one of the most venomous fish in the world with potential fatal local and systemic toxicity effects to human.

CASE PRESENTATION: We reported a case of stonefish sting complicated with impending compartment syndrome.

CONCLUSIONS: Medical staff should be alert about the possibility of this potential emergency in standard management of stonefish stings.

Matched MeSH terms: Emergencies

Gynaecological emergencies masquerading as ruptured ectopic pregnancy

Sivalingam N, Thavarasah AS

Family Practitioner, 1988;11:65-67.

Matched MeSH terms: Emergencies

Fulltext Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: a randomised trial

Raheem IA, Saaid R, Omar SZ, Tan PC

BJOG, 2012 Jan;119(1):78-85.

PMID: 21985500 DOI: 10.1111/j.1471-0528.2011.03151.x

To compare oral nifedipine with intravenous labetalol in their rapidity to control hypertensive emergencies of pregnancy.

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

Pitfalls in the management of gynaecological emergencies

Tan FEH

Family Practitioner, 1977;2:20-24.

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

Central retinal artery occlusion following haemorrhage

Vijendran M, Suppiah K

Med J Malaysia, 1977 Sep;32(1):37-40.

PMID: 609341

Matched MeSH terms: Emergencies

Fulltext Irreducible rectal prolapse: emergency surgical management of eight cases and a review of the literature

Seenivasagam T, Gerald H, Ghassan N, Vivek T, Bedi AS, Suneet S

Med J Malaysia, 2011 Jun;66(2):105-7.

PMID: 22106687 MyJurnal

The management of irreducible rectal prolapse is controversial. Surgeons may attempt conservative management by application of sugar. When surgery becomes inevitable the choice of procedure varies. We reviewed eight cases and noted the clinical findings and the results of conservative and surgical management. In four cases sugar was applied first, and failed. Emergency surgery always gave good outcomes. The procedures included simple reduction, rectopexy, laparotomy with resection, Delorme's repair, and perineal resection. Our experience and review of the literature indicate that surgery should be performed early in irreducible prolapse. Perineal resection may be the most suitable emergency procedure.

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

Eye emergencies

Subramaniam SC

Family Physician, 1989;1:24-26.

Matched MeSH terms: Emergencies

Fulltext Chikungunya in Southeast Asia: understanding the emergence and finding solutions

Pulmanausahakul R, Roytrakul S, Auewarakul P, Smith DR

Int J Infect Dis, 2011 Oct;15(10):e671-6.

PMID: 21775183 DOI: 10.1016/j.ijid.2011.06.002

In the last few years, chikungunya has become a major problem in Southeast Asia, with large numbers of cases being reported in Singapore, Malaysia, and Thailand. Much of the current epidemic of chikungunya in Southeast Asia is being driven by the emergence of a strain of chikungunya virus that originated in Africa and spread to islands in the Indian Ocean, as well as to India and Sri Lanka, and then onwards to Southeast Asia. There is currently no specific treatment for chikungunya and no vaccine is available for this disease. This review seeks to provide a short update on the reemergence of chikungunya in Southeast Asia and the prospects for control of this disease.

Matched MeSH terms: Emergencies/epidemiology

Fulltext The role of prophylactic antibiotics in caesarean section--a randomised trial

Ng NK, Sivalingam N

Med J Malaysia, 1992 Dec;47(4):273-9.

PMID: 1303479

A prospective randomised controlled study was conducted over a 6 month period on the value of administering prophylactic antibiotics in patients undergoing emergency caesarean section at the Ipoh General Hospital. A total of 222 patients were randomised to receive 24 hours of ampicillin (500 mg per dose), cefoperazone (1 gm per dose) or no antibiotics. In all parameters of patient morbidity, the group receiving cefoperazone showed significantly better results as compared to the group not receiving antibiotics. The ampicillin group also had favourable results but generally not achieving statistical significance. Prophylactic antibiotics appear to be beneficial and consideration should be given to make it a routine in all emergency caesarean sections.

Matched MeSH terms: Emergencies

Fulltext The brunt of intensive simulation airway management training programme on the final year nursing in one of health training institutions in Sabah

Mazlinda Musa, Fidelia Ferderik Anis, Hamidah Hassan, Syed Sharizman Syed Abdul Rahim, Siti Fatimah Saat

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):18-0.

MyJurnal

Introduction: Airway management is one of the most important steps in emergency patient care, and it is part of the core content of emergency training programme in nursing. Besides, learning in the real clinical area on artificial air- way management is almost impossible due to the complexity of clinical conditions and non-uniform treatment algo- rithms that make the training strategies even more difficult to develop. This study was to evaluate the effectiveness of the simulation airway management training programme developed for the final year nursing students. Methods: This was a quasi-experimental with convenience sampling technique approach used. Students were exposed with the Intensive simulation of airway management technique which includes BLS, oropharyngeal measure and insertion, high flow O2 administration, interpret ECG, use of defib and understanding role of arrest team during emergency. The questionnaire on confident level was given before and after the simulation of airway management. Results: The results showed significant different in the mean score of pre-tests and post-tests (CI95% (-0.53414, -0.09586), t= -3.009, df = 19, p

Matched MeSH terms: Emergencies

Massive epistaxis from traumatic aneurysm of the internal carotid artery

Saim L, Rejab E, Hamzah M, Sakijan S, Selvapragasam T

Aust N Z J Surg, 1993 Nov;63(11):906-10.

PMID: 8216074

Intracavernous carotid artery aneurysm following head injury is a rare occurrence. Two such cases presenting with delayed but massive and repeated epistaxis are reported and the literature reviewed. The first case required a trapping procedure while the second case had only cervical carotid ligation to control the bleeding. Both resulted in no neurological sequelae.

Matched MeSH terms: Emergencies

Displaying publications 1 - 20 of 118 in total