We collected data on patients above the age of 5 years with acute bronchial asthma who presented to the emergency room of Hospital Sains Universiti Sains Malaysia during the period between 1 January to 31 March 1990. Two hundred and twelve patients (57% males and 43% females) who made a total of 271 visits were recorded. This constitutes 16.3% of all adults and paediatric medical cases seen in the emergency room during this period. The majority of patients presented between 8 pm and 6 am which contrasts with the attendance pattern due to other causes. We also recorded two peak periods of presentation (between 8 pm and 12 midnight and between 6 am and 10 am). Thirty-one (11.4%) cases resulted in admission. Of the 240 cases that were successfully treated and discharged from the emergency room, there were 59 relapses (in 45 patients). Twenty-two percent of the relapses occurred within 24 hours of the last visits. We recorded lower rates of admission as well as relapses compared to all previous studies. Our finding of bimodal pattern of presentations was also not previously reported.
Study site: Emergency department, Hospital Sains Universiti Sains Malaysia, Kelantan, Malaysia
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.
Emergency left-sided colonic resections have traditionally been dealt with by employing staged resections due to the dangers of an anastomosis in unprepared bowel. A small series of 6 patients with left-sided colonic obstruction is presented in which a single stage primary anastomosis was done after an antegrade intraoperative colonic lavage. There were no deaths, infective complications or anastomotic leaks. Major series in the last decade using intraoperative colonic lavage are reviewed as well, to confirm that the method is safe, effective and warrants wider usage locally.
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.
We reviewed the deliveries in a teaching hospital in a multiracial community over the period of one year (1988), and investigated the relationship between maternal height, ethnic origin, and the extremes of birth weight with the likelihood of emergency lower segment caesarean section (LSCS). After excluding patients with obvious indications for LSCS, 5,050 patients were entered in the study. Chi-square analysis showed that the risk of emergency LSCS is significantly higher in the Indians compared to Chinese and Malays, but does not differ significantly between the latter two groups. Logistic regression analysis showed that birth weight of less than 2,500 g or greater than 3,500 g is the most significant association with emergency LSCS rate. Conditional logistic regression showed that, provided the individuals conformed to the characteristics of the cohort in this study, risk of emergency LSCS for a 150 cm (25th centile) tall Indian pregnant lady is almost twice that of a 158 cm (75th centile) tall non-Indian).
A retrospective cohort study of 206 consecutive patients with colorectal cancer presenting to three general surgeons in the University Hospital, Kuala Lumpur over a 3-year period is reported. In all, 184 patients had an operation and are grouped according to whether their operation was within 24 hours of admission (n=16), more than 24 hours after admission (n=38), or elective (n=130). Operative mortalities for these groups were 15.9%,15.2°/o and 6.5%, respectively, significantly higher in both the emergency groups. Delayed surgery to allow complete resuscitation did not improve the operative mortality when compared with those patients having urgent surgery. Both groups of emergency patients, delayed (27%) and urgent (19%), showed poorer 5-year survival than the electively treated patients (36%), many dying of non-cancer causes. Patients who undergo emergency surgery for colorectal carcinoma are more l i k e l y to be in poorer physical condition than the patients undergoing elective surgery for the same condition. It appears that the physical status is the principal determinant of outcome after emergency colorectal surgery rather than any other factor. KEYWORDS: colorectal cancer, emergency, outcome
An antrochoanal polyp, a common clinical entity, with a rare presentation is being reported. A 12 year old boy was brought to Accident and Emergency department with an unusual sudden presentation of polypoidal mass filling the oral cavity up to his incisors as a result of which he could not swallow and speak. Prior to this episode he had no complaints of the disease. An emergency removal was planned and only during the operation could it be diagnosed as a antrochoanal polyp because of its pedicle in the lateral wall of the nose, which was confirmed by histopathological examination.
The requirement of the medical graduate, tabled in the objectives of undergraduate medical education, as envisaged by the Malaysian Medical Council, call for the all round basic doctor to be able to handle any medical emergency, as well as meet the requirements of law in examining, documenting and reporting on the common offences of the Penal Code, where medical documentation is required of law for the purposes of dispensing justice. However, in tabling the amended requirements of the undergraduate syllabus on the lines of those followed in sollie of the more developed nations, we seem to have lost this perspective. The authors discuss, based on his previous experience from another former colonial country viz. India, where the objectives of the undergraduate training is the same, and the influences 011 the legal profession bear a common origin and governance, the relevance of some of these topics, coming under the antbit of Forensic Medicine and Toxicology as an undergraduate subject, in the day-to-day practise of medicine in and out of government service. While this issue has been the frequent topic of discussion in international confereilces and symposia, where the decline in the standards of medico-legal work in the coulltries attending have been blanled on the fall in the standard of undergraduate teaching, due recognition of the pitfalls of the deletion or whittling down of the course content, independent of the overall overhauling of the syllabi of medical schools, to keep up to the trends of overseas universities, has not been accorded in the planing of the coursc revisions, resulting in a deletion of a vital aspect of daily practise of medicine. KEYWORDS: Medico-legal; Undergraduates
Epistaxis is a common clinical condition and perhaps the most common ENT cause for emergency hospital admission. Commonly epistaxis originates from the anterior septum and is easily controlled with caurterization and packing. Posterior epistaxis is less common, but more difficult to treat. It usually occurs in the elderly and is frequently associated with hypertension, artherosclerosis and conditions that decrease platelets and clotting function. In the elderly and hypertensive patient the source of bleeding is likely from the sphenopalatine area in lateral posterior nasal wall. Intractable posterior epistaxis that persists despite repeated use of nasal packing has been treated in many different ways. Conventional methods of arterial ligation in intractable epistaxis often involve surgical morbidity as well as failure due to arterial anastomosis. Embolization is most effective in hands of an experience radiologist, in patients with epistaxis refractory to arterial ligation, bleeding site difficult to reach surgically or epistaxis due to general bleeding disorder. Endoscopic ligation or clipping of sphenopalatine artery is a relatively simple and effective procedure for control of intractable posterior epistaxis.
We describe what we believe is the first reported case of a sublingual hematoma secondary to severe hypertension. The patient, a 77-year-old woman, experienced a spontaneous hematoma of the floor of the mouth, tongue, and sublingual space that eventually caused an airway obstruction. We performed an emergency tracheostomy under local anesthesia and then evacuated the hematoma through an incision along the floor of the mouth. The patient recovered uneventfully.
This study is to examine the use of a Rapid Troponin T test in patients attending the Emergency Room with complaints of chest pain. The results show a strong correlation between time to positive developmentaf the Rapid Trapanin T lest to ELISA Trapanin T. These results indicate the use of a simple to perform bedside assay of Rapid Trapanin T may be used in early risk stratification of patients presenting wilh acute coronary syndromes. KEYWORDS: Rapid Trapanin T, acule coronary syndromes, risk stratification.
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.
The morbidity patterns and demographics of patients presenting to two government health centers and four private general practice clinics were studied over one week. Results showed little difference in the morbidity patterns but a significant difference in the demographics of the patients. The commonest illnesses seen were minor ones like upper respiratory tract infection and chronic ones like hypertension and diabetes mellitus. A wide spectrum of illnesses was seen in all the clinics. Both places handled few emergencies and referred only occasionally. There was an equal percentage of patients from both sexes. Ages of the patients varied from place to place and the racial distribution was influenced by several factors, including the existing patient population and the race of the doctor.