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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 Ambulance response time at three selected tertiary hospitals in Malaysia: performance of hospital-based ambulance equipped with computerized call centre system

Hussin, K., Hassan, M.R., Hamzah, M.L., Fadzli, A., Nik Mohamad, N.A., Nik Him, N.A.S.

Malaysian Journal of Applied Sciences, 2018;3(1):42-50.
MyJurnal

The importance of rapid ambulance response to emergency medical crises is undeniable. An early
access to advanced care is crucial to saving a life. Modern computerised call centre and the hospitalbased ambulance services are believed to enhance the quality of service delivery. However, whether
it will further reduce the ambulance response time is still debatable. A cross-sectional study was
conducted in June 2012 until July 2012 at three selected tertiary hospitals in Malaysia. The
ambulance response time was expressed in a median and interquartile range (IQR) and MannWhitney U test was used to determine the associations between types of ambulance and
computerised call centre system versus voice only. Wilcoxon Rank Sign Test was used to assess
the significance of means difference. A hospital-based ambulance had the median time of 0.19
minutes while community-based ambulance had the median time of 0.20 minutes (The Z score -
0.916, p-value - 0.360). The hospital with computer call centre had the median time of 0.19 minutes
while hospital without computer call centre had the median of 0.20 minutes (The Z score - 0.816, P
value - 0.414).The response time of hospital-based ambulance equipped with computerised call
centre system was comparable in three selected tertiary hospitals in Malaysia.

Matched MeSH terms: Emergencies
Scrotal emergencies: An imaging perspective

Ong CYG, Low HM, Chinchure D

Med J Malaysia, 2018 12;73(6):445-451.
PMID: 30647231

Acute scrotal pain is a common complaint in emergency or primary care practice. A myriad of pathologies need to be considered, and while the clinical history often leads the clinician to the correct diagnosis, radiologists are often called upon to provide further diagnostic information through ultrasonography. Here, we present the sonographic features of various scrotal emergencies, as well as a few pitfalls. Through this, we explore the breadth of urgent pathologies that may be encountered, both traumatic and non-traumatic. For the clinician who performs point-of-care ultrasound, whether in clinic or in the emergency department, we hope that this pictorial article will lay a good foundation for confident and accurate image interpretation.

Matched MeSH terms: Emergencies
Fulltext I-Tag: Patients stretcher innovation as a solution to injured patients mobilization

Kim Sooi Law, Noor Khairiah A. Karim, Noor Khairiah A. Karim, Nor Samsinar Abu Talib, Norhaliza Abd Hamid, Nur Arzuar Abdul Rahim, et al.

Jurnal Inovasi Malaysia, 2020;3(2):100-107.
MyJurnal

The paramedic team of Advanced Medical and Dental Institute (IPPT), Universiti Sains Malaysia (USM) is often involved in providing medical assistance for various activities organised by the university such as during PIMPIN siswa outdoor training and sport events. Paramedics often faced difficulty in saving injured patients as the current stretcher is rather heavy (5.8 kg) and is not able to be folded to a smaller size. To overcome this problem, i-TAG, a stretcher made of durable two-layer canvas cloth with the size of 170.0 cm x 74.0 cm and equipped with 10 user-friendly rubber handle, has been invented. The upper part of the stretcher has a zip to insert the spinal board if the victim has spinal and head injuries. The i-TAG is also very light with only 1.2 kg in weight, easy to be folded and stored in emergency bags, and can be easily carried by paramedics. The i-TAG innovative product has a positive impact on health and safety services. Using i-TAG, the task to carry patients or injured victims becomes easier, faster, saves energy and subsequently increases the efficacy of the rescue and medical aid tasks by paramedics.

Matched MeSH terms: Emergencies
Fulltext Diabetic ketoacidosis in end stage renal failure patient on maintenance dialysis – key challenges in management

Xue Meng Lim, Christopher Thiam Seong Lim

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):345-347.
MyJurnal

Diabetic ketoacidosis (DKA) is a medical emergency which requires prompt management to prevent mortality. Treat- ment is complicated in end stage renal failure (ESRF) patients due to their altered physiology in sugar metabolism and fluid haemodynamics. To date, there are only a few case reports illustrating the presentation and management of DKA in ESRF patients and a definite guideline on treatment of DKA in ESRF is seriously lacking. We report here a case of an ESRF patient on maintenance haemodialysis, who develops DKA due to missed insulin, and outline our successful treatment plan. We hope our reported case report research can further contribute to the knowledge of DKA management in ESRF.

Matched MeSH terms: Emergencies
Fulltext Knowledge and attitude of teachers in selected Malaysian primary school towards dental injuries

Syazwani Hassan, Nur Nabila Zulkifly, Venkiteswaran, Annapurny, Rohaida Abdul Halim

Scientific Research Journal, 2018;15(2):51-66.
MyJurnal

To ascertain the level of knowledge among primary school teachers towards the management of traumatic dental injuries (TDIs) in school and to determine the preference among teachers regarding the education tools that can be used to increase awareness and knowledge among them. A total of 150 teachers from primary schools in three different districts were included in the study and they were given self-administered questionnaires to be filled. The validated questionnaire was distributed randomly in the selected schools. The questionnaire included two scenarios comprising of tooth fracture and avulsion. Questions regarding awareness and management of these scenarios were asked. All 150 participants answered the questionnaire; of these 74% were females 26% were males. 64% of the participants had received tertiary education. Although 70% of teachers had obtained first aid training, only 9.3% of them had received training regrading dental injuries. About 53% of participants knew the correct answer for the appropriate response to fractured tooth and only 35.3% managed to correctly answer the question related to appropriate response to an avulsed tooth. Only 38.7% knew about appropriate rinsing solution and a mere 4.7% were familiar with proper storage media. Even though the teachers have poor knowledge regarding management of dental injuries, it is reassuring to know that 93% of them are keen on further training and awareness. More educational programmes need to be introduced to empower the teachers with the relevant knowledge required to deal with dental emergencies.

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
Fulltext A rare discovery of Spigelian-cryptorchidism syndrome in adult

Gurung R, Ali AA, Lee FY, Mra A, Hayati F

Urol Case Rep, 2021 Sep;38:101687.
PMID: 33996498 DOI: 10.1016/j.eucr.2021.101687

Spigelian hernia (SH) occurs due to the protrusion through a congenital or acquired defect or weakness in the Spigelian aponeurosis. SH accounts for only 0.1-0.4% of occurrence and a 17-24% risk of strangulation. We hereby report a case of a 34-year-old gentleman presented with concomitant incarceration of the omentum with small intestine and testis in Spigelian hernia sac. We have successfully operated on this patient via a transperitoneal approach with a small incision over the hernia site. This incision could be an alternative to midline laparotomy as a safe and effective method in managing incarcerated SH in an emergency setting.

Matched MeSH terms: Emergencies
Fulltext Characteristics of photo-luminescent (PL) powder applied with polyester resin as glow-in-the-dark emergency signage

Siti Khadijah Che Osm, Munikanan, Vikneswaran, Hapsa Husen, Zuliziana Suif, Maidiana Othman, Nordila Ahmad, et al.

ZULFAQAR International Journal of Defence Science, Engineering & Technology, 2020;3(1):32-38.
MyJurnal

During a disaster, the rescuer must reach the disaster area within the fastest time with the help of navigation tools. However, there might be some obstacles during the night time that make the evacuation of the victims difficult especially due to the bad weather. Hence, an attempt to produce glow-in-the-dark emergency signage to ease the evacuation process and to enhance visibility during night time is necessary. In this present study, particular emphasis is given to investigate the characteristic of photo-luminescent (PL)powder applied with polyester resin as glow-in-the-dark emergency signage. Five samples of signage were fabricated with different percentage of PL powder, i.e. 20%, 40%. 60%, 80% and 100% and mixed with 150g polyester resin. Three types of luminance test were performed to check the workability of the samples. The tests are physical appearance, one-hours illuminance test and afterglow duration tests. The result showed that the maximum lux meter reading was recorded in Sample 5 with 6 lux luminosity and provided the longest glow duration of the sample before completely off after 12-hours. Results proved that the highest percentage of the PL powder content, the longer the afterglow duration will be achieved. It also noted that the polyester resin could be a good binder of PL powder for producing the glow-in-the-dark emergency signage.

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 response programme in a petrochemical company in Malaysia

Jefferelli Shamsul Bahrin, Mohamad Husain Sajahan, Mohd. Nazri Hamad

Journal of Occupational Safety and Health, 2004;1(1):3-8.
MyJurnal

Malaysia is blessed with oil and gas resources, which form raw materials for the petrochemical industry. The petrochemical industry creates added value to this resource and is an important contributor to the national economy. The petrochemical industry however also creates hazards of which fire or explosions and chemical release are of special concern. These hazards pose a risk not only to workers but also to the surrounding population and environment. To ensure industry is prepared to cope with emergencies, a comprehensive emergency response programme is necessary. This is inline with both the Malaysian Occupational Safety and Health (Control of Industrial Major Accident Hazards) Regulations 1996 and the Responsible Care initiative of the chemical industry. This paper describes elements to be considered in an emergency response programme for industry such as the concept of emergency management, organisation, duties and responsibilities, emergency system, training and mutual aid plans and agreements. We shall provide related examples based on a multinational petrochemical company practice.

Matched MeSH terms: Emergencies
Fulltext The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, et al.

World J Emerg Surg, 2017;12:29.
PMID: 28702076 DOI: 10.1186/s13017-017-0141-6

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

Matched MeSH terms: Emergencies
Fulltext Egress modeling in performance based fire engineering design–fire safety study at NIOSH Tower

Hari Krishnan Tamil Selvan, Raemy Md Zein, Mohd Abd Muiz Che Abd Aziz, Noorul Azreen Azis

Journal of Occupational Safety and Health, 2015;12(1):41-44.
MyJurnal

Evacuation profile systems in high rise building are important to determine the safety level during any fire
emergency. In relation to this, the study was conducted with its objective to develop the evacuation profile for
NIOSH Tower. Evacnet-4 software was used to develop models for building evacuations using the building network
descriptions and the initial content of the occupant at the beginning of the evacuation. The results show that it
requires 390 seconds to evacuate NIOSH tower, with the highest number of bottlenecks recorded for the Third Floor.
Identification of bottleneck is important to determine the evacuation periods. The information gained from the model
may be used for the emergency response planning and for support material. The model should be tested in real time
to have its reliability verified.

Matched MeSH terms: Emergencies
Evaluation of workshop for training house-officers and medical officers on medical emergencies using simulation for workplace preparedness

Thiruselvi Subramaniam, Ann Jee Tan

International e-Journal of Science, Medicine & Education, 2017;11(1):33-38.
MyJurnal

Background: House-officers and medical officers are at
the forefront during medical emergencies in the ward
and casualty which impose cognitive, communication,
social and system challenges and yet, training in this
area is commonly lacking. A workshop was conducted
using simulation to provide training on some acute
medical emergencies like cord prolapse, post- partum
haemorrhage with collapse, poly-trauma and acute
exacerbation of asthma.

Objective: To determine the effectiveness of simulation
in developing competency in managing selected clinical
emergencies.

Methodology: There were 22 participants consisting
of house-officers, junior medical officers and nursing
clinical instructors. Only doctors were included in
the study. Four medical emergencies were chosen viz.:
Cord prolapse; post- partum haemorrhage with collapse;
poly-trauma and acute exacerbation of asthma. The
simulated sessions were conducted using high fidelity
manikins and simulated patients. Simulated patients
were trained and moulage was applied accordingly. The
skills stations were on airway equipment and techniques
of application, latest cardiac life support algorithm and
hands on chest compression using manikins.

Results: A 5 point Likert scale used to rate the
sessions. The skills station had 65% (n=13) rating as
excellent and 35% (n=7) good. The skills simulation
was rated excellent by 75% (n=15) and good by 25%
(n=5) of participants. Verbal feedback was that it was
very refreshing, informative, and helpful in terms of
improving their skills.

Conclusion: The simulated skills training for the junior
doctors was very well received and maybe beneficial for
work preparedness and in the long run address patient
safety.

Matched MeSH terms: Emergencies
Anaesthesia for emergency operations

Hopkin DAB

Journal of the Malaya Branch of the British Medical Association, 1939;3:315-25.

Matched MeSH terms: Emergencies
Risk stratification in acute myocardial ischaemia: potential use of a rapid bedside tropinin T assay

Goh EML, Chow SK, Lang CC

JUMMEC, 2002;7:132-134.

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.

Matched MeSH terms: Emergencies
Risk stratification in acute myocardial ischaemia: potential use of a rapid bedside troponin T assay

Goh EML, Chow SK, Lang CC

JUMMEC, 2002;7:132-134.

Matched MeSH terms: Emergencies
Fulltext Outcome of emergency colorectal cancer admissions is determined primarily by physical status

Mohamad Yunus A, Mohd Dun S

JUMMEC, 1996;1:29-32.

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%,15.2Â°/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

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
Validity and Reliability of Emergency Severity Index and Conventional Three-Tier Triage System in the Emergency Department, Hospital Universiti Sains Malaysia

Lim BJV, Wahab SFA, Kueh YC

Malays J Med Sci, 2020 Mar;27(2):90-100.
PMID: 32788845 DOI: 10.21315/mjms2020.27.2.10

Background: The study aimed to examine the reliability and validity of the existing three-tier triaging system and a new five-level emergency triaging system, emergency severity index (ESI), in the Emergency Department (ED) of Hospital Universiti Sains Malaysia (HUSM).
Methods: This study was conducted in HUSM's ED over two study periods. In the first three months, 300 patients were triaged under the three-tier triaging system, and, in the subsequent three months, 280 patients were triaged under the ESI. The patients were triaged by junior paramedics and the triage records were retained and later re-triaged by senior paramedics. The inter-rater reliability was evaluated using Cohen's Kappa statistics. The acuity ratings of the junior paramedics were compared with those of the expert panel to determine the sensitivity and specificity of each acuity level for both the ESI and the three-tier triaging system. The over-triage rate, under-triage rate, amount of resources used, admission rate and discharge rate were also determined.
Results: The inter-rater agreement for the three-tier triaging system was 0.81 while that of the ESI was 0.75. The ESI had a higher average sensitivity of 74.3% and a specificity of 94.4% while the three-tier system's average sensitivity was 68.5% and its specificity 87.0%. The average under-triage and over-triage rates for the ESI were 10.7% and 6.2%, respectively, which were lower than the three-tier system's average under-triage rate of 13.1% and over-triage rate of 17.1%. The urgency levels of both the ESI and the three-tier system were associated with increased admission rates and resources used in the ED.
Conclusion: The ESI's inter-rater reliability was comparable to the three-tier triaging system and it demonstrated better validity than the existing three-tier system.

Matched MeSH terms: Emergencies

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