Displaying publications 21 - 40 of 276 in total

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  1. Peta D, Day A, Lugari WS, Gorman V, Ahayalimudin N, Pajo VMT
    J Emerg Nurs, 2023 Nov;49(6):814-825.
    PMID: 37925222 DOI: 10.1016/j.jen.2023.08.004
    Triage is a process by which patients are assessed, classified, and sorted based on their presenting complaint and clinical urgency, providing assurance for timely access to emergency care. The goal is to get the right person to the right place, in the right amount of time, for the right reason, and within the context of resource availability. In many countries, a standardized triage system, underpinned through the use of guidelines, is used to provide clinicians with support and guidance. Triage is a globally adopted principle, and although triage guidelines are used in many countries, no single system has been internationally adopted. This paper discusses the importance of how triage process standardization improves patient care, resource management, and benchmarking at local, national, and international levels by applying 5 internationally recognized triage systems to fictional case studies. Evaluation of similarities and differences in severity scores, with a gap analysis, occurs.
    Matched MeSH terms: Emergency Service, Hospital
  2. Mandhane PJ, Paredes Zambrano de Silbernagel P, Aung YN, Williamson J, Lee BE, Spier S, et al.
    PLoS One, 2017;12(8):e0182411.
    PMID: 28771627 DOI: 10.1371/journal.pone.0182411
    BACKGROUND: Antibiotics are frequently used to treat wheezing children. Macrolides may be effective in treating bronchiolitis and asthma.

    METHOD: We completed a prospective, double-blinded, randomized placebo-control trial of azithromycin among pre-school children (12 to 60 months of age) presenting to the emergency department with wheeze. Patients were randomized to receive either five days of azithromycin or placebo. Primary outcome was time to resolution of respiratory symptoms after treatment initiation. Secondary outcomes included the number of days children used a Short-Acting Beta-Agonists during the 21 day follow-up and time to disease exacerbation during the following six months (unscheduled health care visit or treatment with an oral corticosteroid for acute respiratory symptoms).

    RESULTS: Of the 300 wheezing children recruited, 222 and 169 were analyzed for the primary and secondary outcomes, respectively. The treatment groups had similar demographics and clinical parameters at baseline. Median time to resolution of respiratory symptoms was four days for both treatment arms (interquartile range (IQR) 3,6; p = 0.28). Median number of days of Short-Acting Beta-Agonist use among those who received azithromycin was four and a half days (IQR 2, 7) and five days (IQR 2, 9; p = 0.22) among those who received placebo. Participants who received azithromycin had a 0.91 hazard ratio for time to six-month exacerbation compared to placebo (95% CI 0.61, 1.36, p = 0.65). A pre-determined subgroup analysis showed no differences in outcomes for children with their first or repeat episode of wheezing. There was no significant difference in the proportion of participants experiencing an adverse event.

    CONCLUSION: Azithromycin neither reduced duration of respiratory symptoms nor time to respiratory exacerbation in the following six months after treatment among wheezing preschool children presenting to an emergency department. There was no significant effect among children with either first-time or prior wheezing.

    Matched MeSH terms: Emergency Service, Hospital
  3. Flaherty GT, Walden LM, Townend M
    J Travel Med, 2016 May;23(5).
    PMID: 27279126 DOI: 10.1093/jtm/taw036
    Few studies have examined emergency self treatment (EST) antimalarial prescribing patterns. 110 physician-members of the Travel Medicine Society of Ireland and British Global and Travel Health Association participated in this study. There was a trend towards the prescription of EST for travel to remote low-risk malaria areas; for long-term residents living in low-risk areas; and for frequent travellers to low-risk areas. This study provides insights into the use of EST in travellers' malaria.
    Matched MeSH terms: Emergency Service, Hospital/statistics & numerical data*
  4. Rafidah Bahari, Muhammad N Mohamad Alwi, Muhammad R Ahmad, Ismail Mohd Saiboon
    ASEAN Journal of Psychiatry, 2015;16(2):203-211.
    MyJurnal
    There are a number of validated questionnaires available for the screening of Post-Traumatic Stress Disorder (PTSD), and the PTSD Checklist for Civilians is one of them. However, none was translated into the Malay Language and validated for use in the Malaysian population. The aim of this study is to translate and validate the Malay PTSD Checklist for Civilians (MPCL-C). Methods: The PCL-C was translated into the Malay Language and back-translated. The reliability and validity of the MPCL-C were then determined by administering them to those who presented at the emergency department for motor vehicle accident at least one month before. Results: The MPCL-C has good face and content validity. In terms of reliability, it is also good, with Chronbach’s alpha values of 0.90, 0.77, 0.75 and 0.74 for the full scale, re-experiencing, avoidance and arousal domains respectively. Conclusions: The MPCL-C is a valid and reliable instrument to screen for PTSD in motor vehicle accident victims for the studied population.
    Matched MeSH terms: Emergency Service, Hospital
  5. Osman A, Fong CP, Wahab SFA, Panebianco N, Teran F
    J Emerg Med, 2020 Sep;59(3):418-423.
    PMID: 32591302 DOI: 10.1016/j.jemermed.2020.05.003
    BACKGROUND: Although surface sonography has become an essential diagnostic tool in the evaluation of trauma patients, important limitations of this modality include the evaluation of retroperitoneal hemorrhage and mediastinal pathology, such as blunt traumatic aortic injuries (BTAI). As in other emergency applications where surface sonography can't provide the information needed, focused transesophageal echocardiography (TEE) may represent a valuable diagnostic tool in the evaluation of hemodynamically unstable trauma patients with suspected thoracic pathology such as BTAI.

    CASE SERIES: We present a series of five cases that illustrate the diagnostic value of emergency physician-performed resuscitative TEE in the diagnosis of BTAI in patients presenting with blunt thoracic trauma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As the use of point-of-care TEE during resuscitation continues to expand in emergency medicine, the evaluation of patients with BTAI represents a novel application where this emerging modality can allow early diagnosis of these injuries in hemodynamically unstable patients.

    Matched MeSH terms: Emergency Service, Hospital
  6. Mohamad N, Abd Halim NN, Ahmad R, Baharuddin KA
    Malays J Med Sci, 2009 Apr;16(2):33-7.
    PMID: 22589656 MyJurnal
    Theophylline toxicity is a life-threatening toxidrome that can present to an emergency department. To ascertain an immediate provisional diagnosis in toxicology at the emergency department is very challenging, especially when the patient presents with altered mental status, because the clinical features of several toxidromes overlap. We report a case of survival of undiagnosed theophylline toxicity that required intubation for two days in the intensive care unit. This was the first case to have been reported from our department. Accurate diagnosis of a toxidrome by gaining adequate history and conducting a thorough physical examination and early serum toxicology screening, coupled with good knowledge of toxicology, will lead to better patient outcomes.
    Matched MeSH terms: Emergency Service, Hospital
  7. Rahman NH, Hashim A
    Emerg Med J, 2011 Oct;28(10):861-5.
    PMID: 21098799 DOI: 10.1136/emj.2009.085019
    This study aimed to determine the effectiveness of propofol as an alternative agent for procedural sedation and analgesia (PSA) in the emergency department (ED) and to make a comparison between two different sedative (propofol vs midazolam) drugs used in combination with fentanyl.
    Matched MeSH terms: Emergency Service, Hospital/statistics & numerical data
  8. Nik Hisamuddin NAR, Azlan K
    Med J Malaysia, 2012 Jun;67(3):259-64.
    PMID: 23082413 MyJurnal
    In this study, we sought to determine whether laboratory and physiological parameters can be useful in predicting mortality in patients with sepsis-induced hypotension and septic shock.
    Matched MeSH terms: Emergency Service, Hospital
  9. Kheng CP, Rahman NH
    Int J Emerg Med, 2012;5(1):31.
    PMID: 22828152 DOI: 10.1186/1865-1380-5-31
    BACKGROUND: The aim of this study was to determine the usefulness of end tidal carbon dioxide (ETCO2) monitoring in hypotensive shock patients presenting to the ED.
    METHODS: This was a prospective observational study in a tertiary ED. One hundred three adults in shock with hypotension presenting to the ED were recruited into the study. They were grouped according to different types of shock, hypovolemic, cardiogenic, septic and others. Vital signs and ETCO2 were measured on presentation and at 30-min intervals up to 120 min. Blood gases and serum lactate levels were obtained on arrival. All patients were managed according to standard protocols and treatment regimes. Patient survival up to hospital admission and at 30 days was recorded.
    RESULTS: Mean ETCO2 for all patients on arrival was 29.07 ± 9.96 mmHg. Average ETCO2 for patients in hypovolemic, cardiogenic and septic shock was 29.64 ± 11.49, 28.60 ± 9.87 and 27.81 ± 7.39 mmHg, respectively. ETCO2 on arrival was positively correlated with systolic and diastolic BP, MAP, bicarbonate, base excess and lactate when analyzed in all shock patients. Early ETCO2 measurements were found to be significantly lower in patients who did not survive to hospital admission (p = 0.005). All patients who had ETCO2 ≤ 12mmHg died in the ED. However, normal ETCO2 does not ensure patient survival.
    CONCLUSION: The use of ETCO2 in the ED has great potential to be used as a method of non-invasive monitoring of patients in shock.
    Study site: Emergency department, Hospital Universiti Sains Malaysia
    Matched MeSH terms: Emergency Service, Hospital
  10. Howe TA, Jaalam K, Ahmad R, Sheng CK, Nik Ab Rahman NH
    J Emerg Med, 2011 Dec;41(6):581-9.
    PMID: 19272745 DOI: 10.1016/j.jemermed.2008.10.017
    STUDY OBJECTIVE: To determine if the slope of Phase II and Phase III, and the alpha angle of the expiratory capnographic waveform, as measured via computer-recognizable algorithms, can reflect changes in bronchospasm in acute asthmatic non-intubated patients presenting to the emergency department (ED).
    METHODS: In this prospective study carried out in a university hospital ED, 30 patients with acute asthma were monitored with clinical severity scoring and peak flow measurements, and then had a nasal cannula attached for sidestream sampling of expired carbon dioxide. The capnographic waveform was recorded onto a personal computer card for analysis. The patients were treated according to departmental protocols. After treatment, when they had improved enough for discharge, a second set of results was obtained for capnographic waveform recording. The pre-treatment and post-treatment results were then compared with paired-samples t-test analysis.
    RESULTS: On the capnographic waveform pre- and post-treatment, there was a significant difference in the slope of Phase III (p < 0.001) and alpha angle (p < 0.001), but not in the Phase II slope (p = 0.35). There was significant change in peak flow meter reading, but it was poorly correlated with all the capnographic indices.
    CONCLUSION: The study provides some preliminary data showing that capnographic waveform indices can indicate improvement in airway diameter in acute asthmatics in the ED. Capnographic waveform analysis presents several advantages in that it is effort-independent, and provides continuous monitoring of normal tidal respiration. With further refined studies, it may serve as a new method of monitoring non-intubated asthmatics in the ED.
    Study site: Emergency department, Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kelantan, Malaysia
    Matched MeSH terms: Emergency Service, Hospital; Emergency Service, Hospital*
  11. Cheah PK, Steven EM, Ng KK, Hashim MI, Abdul Kadir MH, Roder NP
    Int J Emerg Med, 2021 May 07;14(1):30.
    PMID: 33962581 DOI: 10.1186/s12245-021-00354-9
    Sabah in Malaysian Borneo is among the Malaysian states which reported a high number of detected COVID-19 cases during the current pandemic. Due to geographical challenges and limited resources, clinicians developed novel strategies for managing patients. The use of a dual oxygen concentrator system for mechanical ventilation is one of the innovations developed by retrieval team members from the Emergency Department (ED) of the Sabah Women and Children's Hospital. Due to conditions requiring isolation of patients suspected of or positive for COVID-19, high-risk patients were treated in an ED extension area that lacked central wall oxygen. Direct access to oxygen tanks became the only viable option, but ensuring a continuous supply was laborious. The novel setup described within this paper has been used on intubated patients in the ED extension area with moderate to high ventilator settings successfully. This simple setup, designed to meet the limited resources within a pandemic environment, needed only a turbine-driven ventilator, two oxygen concentrators, a 3-way connector, and three oxygen tubing. The application of this setup could potentially save more critically ill patients who are being managed in resource-limited conditions such as in smaller district hospitals or out in the field.
    Matched MeSH terms: Emergency Service, Hospital
  12. Shamsuddin SR, Hashim AA, Nazer B, Hashairi F, Shaik Farid AW, Abu Yazid MN
    Med J Malaysia, 2012 Jun;67(3):349-50.
    PMID: 23082436 MyJurnal
    Ring removal is indicated in a number of clinical circumstances to manage or prevent tourniquet effect of the digit. A ring made from hardened metal may defy commonly known methods of removal. We reported a case of unusual difficulty in removing a ring of hardened metal composition using a dental drill. We believed the unusual circumstances of this case is likely to be repeated in some other clinical practice and this instrument is an appropriate option to consider in such cases.
    Matched MeSH terms: Emergency Service, Hospital
  13. Maheswaran M, Adnan WA, Ahmad R, Ab Rahman NH, Naing NN, Abdullah J
    PMID: 18613557
    Non-traumatic Altered States of Consciousness (ASC) are a non-specific consequence of various etiologies, and are normally monitored by Glasgow Coma Scale (GCS). The GCS gives varriable results among untrained emergency medicine personel in developing countries where English is not the first language. An In House Scoring System (IHSS) scale was made by the first author for the purpose of triaging so as to quickly asses patients when seen by medical personel. This IHSS scale was compared to the GCS to determine it's specificity and sensitivity in the accident and emergency department (ED) of Hospital University Sains Malaysia (HUSM). All patients with non-traumatic ASC were selected by purposive sampling according to pre-determined criteria. Patients were evaluated by the two systems, IHSS and GCS, by emergency physicians who were on call. Patient demographics, clinical features, investigations, treatment given and outcomes were collected and followed for a period of 14 days. A total of 221 patients with non-traumatic ASC were studied, 54.3% were males. The mean age of the patients was 56 years old. The mean overall GCS score on presentation to the ED was 10.3. The mean duration of ASC was 11.6 hours. One hundred thirty patients (58.8%) experienced ASC secondary to general or focal cerebral disorders. The mortality rate was 40.3% 2 weeks after the ED visit. Fifty-four point three percent of the patients were awake and considered to have good outcomes while 45.7% of the patients had poor outcomes (comatose or dead) 2 weeks after the ED visit. The mean overall GCS score, verbal and motor subscores as well as the IHSS had significantly decreased (worsened) after treatment in the ED. A poor IHSS scale, hypertension, current smoking, abnormal pupillary reflexes and acidosis were associated with a worse 2-week outcome. The mean age and WBC count was lower and the mean overall GCS score and eye, verbal and motor subscores were higher as well as those having a lower IHSS scale for the good outcome category. Multivariate analysis revealed that smokers and hypertensives were at higher risk for a poor outcome. Higher eye scores on the GCS were associated fewer poor outcomes. There was significant agreement between the IHSS scale and GCS scores in the assessment of non-traumatic ASC. The sensitivity and specificity of the IHSS score versus GCS were 71.9% and 100.0%, respectively.
    Matched MeSH terms: Emergency Service, Hospital
  14. Nasarudin NM, Mohd Saiboon I, Ismail AK
    Eur J Emerg Med, 2013 Oct;20(5):335-8.
    PMID: 22976462 DOI: 10.1097/MEJ.0b013e328358fa40
    Dengue fever is endemic in Malaysia and poses a significant problem to the national health system. Because of its nonspecific clinical features, it creates clinical and administrative uncertainties. We evaluated the role of an emergency department short-stay ward (EDSSW) in the management of dengue fever in the Universiti Kebangsaan Malaysia Medical Centre (UKMMC).
    Matched MeSH terms: Emergency Service, Hospital/organization & administration*
  15. Nursyafiqah Zainal, Irniza Rasdi, Suhainizam Muhamad Saliluddin
    MyJurnal
    Workplace violence become a global concern and perceived as a very serious safety and health hazard especially in healthcare setting. The aim of this study was to determine the prevalence of workplace violence and its associated risk factors among healthcare workers in public hospital. Methods: This was a cross-sectional study which involved 136 randomly selected respondents among doctors and nurses in a public hospital in Kuala Lumpur. Data was gathered through a self-administered questionnaire consisted of two standardized questionnaire; Workplace Violence (WPV) and Job Content Questionnaire (JCQ-27). Results: The response rate was 91%. The prevalence of reported WPV was 71.3% where nurses (73.2%) had slightly higher prevalence than doctors (69.2%). The most common forms of WPV was verbal abuse (70.6%), followed by bullying/mobbing (29.4%), physical violence (11.0%), and sexual harassment (6.6%). The perpetrators were mostly among relatives of patients and visitors followed by the patients. Multiple logistic regression shows that respondents working in Accident and Emergency (A&E) Department was 17 times more likely to report workplace violence than those working in Pediatric Department. Also, for every 1 year younger, respondents were 5 times more likely to experience workplace violence controlling for other factors. Conclusion: The prevalence of workplace violent among respondents were high and most common among young workers, especially nurses and those working in A&E Department. Hence, further assessment should be carried out to reduce the identified risk factors and to find ways of solving this issue.
    Matched MeSH terms: Emergency Service, Hospital
  16. Ahmad, K.I., Shamsul, A.S., Ismail, M.S.
    MyJurnal
    Acute appendicitis is one of the most common differential diagnoses for acute abdominal pain made by emergency doctors. Suspected cases require surgical referral for observation or definitive intervention to prevent complications. A high index of suspicion and good clinical skills with the aid of scoring systems allows early decision making, which includes optimal pain control. The objective of this study was to identify the pain score and is relationship to the cut-off points of the Alvarado scoring system so that justifies early surgical referral or discharge for suspected acute appendicitis from the Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a cross sectional study of acute abdominal pain from June 2007 to September 2008. All patients who fulfilled the criteria and consented to the study were assessed for Alvarado score, verbal numerical pain score (VNRS) and their subsequent management. Patients with an Alvarado score of ≥7 were likely to have acute appendicitis (80.1% sensitivity and 52.63% specificity) and those with the score of ≤3 were unlikely to have acute appendicitis. The median pain score was 7.00 (IQR: 5.00-8.50) but 72.5% did not receive any analgesia. There was no direct relationship between the pain score with Alvarado score. Oligoanalgesia in patients with acute appendicitis still exist in Emergency Department of UKMMC.
    Matched MeSH terms: Emergency Service, Hospital
  17. Seak CJ, Hsu KH, Wong YC, Ng CJ, Yen DH, Seak JC, et al.
    Am J Emerg Med, 2014 Sep;32(9):972-5.
    PMID: 25043627 DOI: 10.1016/j.ajem.2014.05.016
    This study aimed to investigate the prognostic factors of adult patients with hepatic portal venous gas (HPVG) in the emergency department (ED) to facilitate clinical decision making by emergency physicians.
    Matched MeSH terms: Emergency Service, Hospital
  18. Nur AS, Hamid F, Mohd Shahezwan AW, Mohd Zaki FS, Ahmad KI
    Med J Malaysia, 2020 05;75(3):216-220.
    PMID: 32467535
    INTRODUCTION: Snakebite is an important medical emergency. Antivenoms remain the only proven treatment for snake envenoming. However, the use of antivenom is associated with hypersensitivity reactions. The aims of this study were to determine the prevalence and types of hypersensitivity reactions and types and outcomes of pharmacological and non-pharmacological treatments for antivenom reactions among snakebite patients that received antivenoms.

    METHODS: This was a 4-year cross-sectional study of snakebite patients from January 2013 to December 2016 in Hospital Sultanah Nur Zahirah (HSNZ), Terengganu. Data was extracted from the Pharmacy Record on the usage of antivenom and patients of snakebites treated with antivenom were identified. Data of patients were then obtained from the electronic medical records.' Demographic details, clinical features and characteristics of antivenom reactions of patients were recorded in standardized data collection forms and analyzed using chi-square or Mann- Whitney U tests.

    RESULTS: Of the 44 patients who received antivenom, 24 (54.5%) developed hypersensitivity reaction. All patients developed reaction early. No patient developed delayed (serum-sickness) reaction. Of the 24 patients, 14 (58.3%) had moderate to severe hypersensitivity reaction and 9 (37.5%) patients had mild reactions. Only one (4.2%) patient presented with bradycardia.

    CONCLUSION: The prevalence of early hypersensitivity reaction to snake antivenom in HSNZ was relatively high. Healthcare providers should be aware of the appropriate method of preparing and administering antivenom, and the management for acute hypersensitivity reactions. This will optimize the management of snakebite and ensure patient safety.

    Matched MeSH terms: Emergency Service, Hospital
  19. Subramaniam T, Loo RCN, Poovaneswaran S
    MyJurnal
    Background: This cross sectional study was done to identify the areas of lack of knowledge, practice and awareness of students about the effective use of personal protective equipment (PPE).
    Methods: A total of 40 students were selected when they were posted to the accident and emergency unit (A&E) in Seremban Hospital; all of them answered a questionnaire and were observed unaware on the effective use of PPE in the A&E.
    Results: We found that 17.5% of students were unaware of the right technique of removing the gloves after a procedure and 25% of students were unaware of safety of hand washing. During invasive procedures, 12.5 % of students did not wash their hands before invasive procedures, 65% did not wear aprons and 57.5% did not wear masks. During non- invasive procedures more than 25% of students did not wash hands before or after the procedures.
    Conclusion: There is still significant lack of knowledge in students about the effective use of PPE that needs to be addressed.
    Keywords: PPE, Personal protective equipment, effective practice of PPE, A&E
    Matched MeSH terms: Emergency Service, Hospital
  20. Nik Ab Rahman NH, Mohd Hussain H
    Med J Malaysia, 2013 Apr;68(2):148-52.
    PMID: 23629562 MyJurnal
    Trauma is an ever increasing problem and it is the leading cause of morbidity and mortality in the under 40s age group. The main purpose of this study is to determine the pattern of death related to trauma cases presenting to the emergency department (ED) of a university hospital. This was a retrospective analysis of 75 consecutive trauma case records at a university hospital for a one year period. The most common cause of deaths is motor vehicle crashes. The mean score for the injury severity score (ISS) and revised trauma score (RTS) on arrival to the ED among the succumbed patients were 27.8 (s.d 8.6) and 5.7 (s.d 1.1) respectively. 58.7% of deaths occurred within 48 hours after the admission. Less than 50% of studied patients were still alive beyond 45 hours post admission and less than 10% still alive beyond 11 days. Our analysis also showed that 28% (n=21) and 56% (n=41) of the studied sample had a probability of survival between 50% to 75% and more than 75% respectively upon arrival based on the initial vital signs in the ED and the trauma and injury severity score (TRISS) methodology. Overall, we observed similar injury mechanisms, demographics and causes of death compare to other studies. The figures from this study, mandate further exploration of preventive issues and management improvements that should be applied not only to the current trauma system, but also to the health care system in general.
    Matched MeSH terms: Emergency Service, Hospital*
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