Displaying publications 41 - 60 of 272 in total

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  1. Fulltext Antenatal traumatic brain injury secondary to maternal motor vehicle accident
    Shamala N., Faizal, A.H.
    Medicine & Health, 2018;13(2):202-207.
    MyJurnal
    Trauma is thought to complicate 1 in 12 pregnancies. The management of trauma during pregnancy requires special consideration because pregnancy alters maternal physiology and the foetus is a potential collateral victim. The approach of these cases in the setting of the Emergency Department should not only be diagnostic for any foetal injuries but also prognostic for any future undue outcome. Antenatal traumatic brain injury is a rare but real complication of maternal blunt force trauma. Our case involves a 22-year-old primigravida who suffered a motor vehicle accident and on initial assessment revealed normal foetal assessment but subsequently after premature labour revealed a new born with traumatic brain injury. Early ultrasonographic evaluation and observational period with continuous electronic foetal monitoring may improve the detection and emergent treatment in these cases.
    Matched MeSH terms: Emergency Service, Hospital
  2. Fulltext Anterior penetrating chest injury with left ventricular thrombus
    Ruth Sabrina, S., Nik Azlan, N.M., Adi, O.
    Medicine & Health, 2013;8(1):28-32.
    MyJurnal
    Urban cities are synonym with a high incidence of penetrating chest injuries either from accidents or interpersonal violence. The outcome of penetrating chest wound can vary from immediate death to a prolonged morbidity. We here report a case of 39-year-gentleman who presented to Emergency Department Hospital Raja Permaisuri Bainun, Ipoh, Perak after being stabbed to the chest. His anterior penetrating chest wound was located at the 5th intercostal space medial to the midclavicular line. The stab wound penetrated the myocardium, causing minimal myocardial rupture. He also suffered from left haemothorax and hemopericardium. The haemothorax was drained with insertion of 32 French chest tube. The patient was admitted under the cardiothoracic team and discharged five days later without surgical intervention. He presented again to the Emergency Department with complains of shortness of breath and pleuritic pain. A left ventricular thrombus was detected via echocardiography. Unfortunately, he took his own discharge. Five days later he came again to Emergency Department with sporadic of loss of vision. The mural thrombus dislodged and embolized to the retinal artery causing amaurosis fugax. The patient was treated with aspirin 150mg and his symptoms subsequently resolved.
    Matched MeSH terms: Emergency Service, Hospital
  3. Fulltext Antimicrobial resistance among pilgrims: a retrospective study from two hospitals in Makkah, Saudi Arabia
    Haseeb A, Faidah HS, Bakhsh AR, Malki WH, Elrggal ME, Saleem F, et al.
    Int J Infect Dis, 2016 Jun;47:92-4.
    PMID: 27312582 DOI: 10.1016/j.ijid.2016.06.006
    OBJECTIVE: To identify commonly reported community-acquired organisms and antimicrobial resistance patterns exhibited by Gram-positive and Gram-negative pathogens among pilgrims visiting emergency care departments in Makkah.
    METHOD: The study was designed as a retrospective audit of all patients (pilgrims) admitted to two hospitals and residing in the city of Makkah, Saudi Arabia.
    RESULTS: Among 374 isolates, Gram-negative pathogens accounted for 280 (75%), while the remaining 94 (25%) were Gram-positive organisms. Among all isolated pathogens, the highest resistance was observed for amoxicillin-clavulanic acid. Klebsiella pneumoniae had the highest resistance to amoxicillin-clavulanic acid and ampicillin. Most of the organisms were sensitive to tobramycin except Acinetobacter baumannii (n=3, 50%), Escherichia coli (n=4, 57%), and K. pneumoniae (n=6, 46%).
    CONCLUSION: Overall, a high resistance was observed for beta-lactam antibiotics. In addition, a high resistance was noted for ceftazidime with A. baumannii species (n=16, 77%). However, for quinolones, the highest resistance to ciprofloxacin was observed for E. coli, A. baumannii, methicillin-resistant Staphylococcus aureus, and K. pneumoniae.
    KEYWORDS: Antimicrobial resistance; Community-acquired organisms; Makkah; Pilgrims
    Matched MeSH terms: Emergency Service, Hospital
  4. Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study: Rationale, design and analysis
    Kelly AM, Keijzers G, Klim S, Graham CA, Craig S, Kuan WS, et al.
    Emerg Med Australas, 2015 Jun;27(3):187-91.
    PMID: 25940885 DOI: 10.1111/1742-6723.12397
    Shortness of breath is a common reason for ED attendance. This international study aims to describe the epidemiology of dyspnoea presenting to EDs in the South East Asia-Pacific region, to compare disease patterns across regions, to understand how conditions are investigated and treated, and to assess quality of care.
    Matched MeSH terms: Emergency Service, Hospital/standards; Emergency Service, Hospital/statistics & numerical data*
  5. Fulltext Assessing and exploring the competency of prehospital emergency medical service personnel in Klang Valley, Malaysia: a mixed method approach
    Mohd Said N, Sukonthasarn A, Wangsrikhun S, Chanpransit C
    International Medical Journal Malaysia, 2014;13(2):7-20.
    MyJurnal
    Introduction: The notion of competency in pre-hospital emergency medical service (EMS) personnel is mainly focused on the professional proficiency that he/she has to provide intervention outside of hospital setting. Consequently, the effectiveness of pre-hospital EMS performance very much depends upon the capability of the personnel at the scene and as well during transport to the definitive care center. The aim of this study is to appraise and explore the competency of pre-hospital care staff and provide strategies for improvement.

    Methods: A mixed method approach combining the qualitative and quantitative study design. Of 134 staffs only 111(82.84%) returned the questionnaire. Nine semi-structured interviews and two focus group discussions were performed. The main informants were nurses/assistant medical officers, nurse/assistant medical officer administrators, and emergency physicians.

    Results: From the quantitative finding on the competency of staff handling pre-hospital EMS, all had the essential knowledge and skills. However, most of them reported not having good knowledge and skills for invasive procedures (31%-61%), include giving medications (61%-66%). The qualitative information provided insight about the issues and strategies for the personnel in regards to competency. All the relevant qualitative data were merged into 5 categories relating issues and 5 categories to strategies that could affect the competency of the personnel.

    Conclusion: Pre-hospital EMS systems need to consider that the competency of pre-hospital EMS personnel has to come along with the responsible attitude of the staff itself, the support of medical direction, clear protocol for guiding them whenever needed, and continuous professional-development courses require them to maintain their professional proficiency.
    Matched MeSH terms: Emergency Service, Hospital
  6. Fulltext Assessing patient pain scores in the emergency department
    Baharuddin KA, Mohamad N, Nik Abdul Rahman NH, Ahmad R, Nik Him NA
    Malays J Med Sci, 2010 Jan;17(1):17-22.
    PMID: 22135521 MyJurnal
    BACKGROUND: Pain management in the Emergency Department is challenging. Do we need to ask patients specifically about their pain scores, or does our observational scoring suffice? The objective of this study was to determine the inter-rater differences in pain scores between patients and emergency healthcare (EHC) providers. Pain scores upon discharge or prior to ward admission were also determined.
    METHODS: A prospective study was conducted in which patients independently rated their pain scores at primary triage; EHC providers (triagers and doctors) separately rated the patients' pain scores, based on their observations.
    RESULTS: The mean patient pain score on arrival was 6.8 ± 1.6, whereas those estimated by doctors and triagers were 5.6±1.8 and 4.3±1.9, respectively. There were significant differences among patients, triagers and doctors (P< 0.001). There were five conditions (soft tissue injury, headache, abdominal pain, fracture and abscess/cellulites) that were significantly different in pain scores between patients and EHC providers (P<0.005). The mean pain score of patients upon discharge or admission to the ward was 3.3 ± 1.9.
    CONCLUSIONS: There were significant differences in mean patient pain scores on arrival, compared to those of doctors and triagers. Thus, asking for pain scores is a very important step towards comprehensive pain management in emergency medicine.
    KEYWORDS: emergency medicine; neurosciences; pain assessment; pain management; pain score
    Study site: Emergency department, Hospital Kuala Lumpur
    Matched MeSH terms: Emergency Service, Hospital
  7. Fulltext Association between prehospital field to emergency department delta shock index and in-hospital mortality in patients with torso and extremity trauma: A multinational, observational study
    Kim DK, Jeong J, Shin SD, Song KJ, Hong KJ, Ro YS, et al.
    PLoS One, 2021;16(10):e0258811.
    PMID: 34695147 DOI: 10.1371/journal.pone.0258811
    Hemorrhage, a main cause of mortality in patients with trauma, affects vital signs such as blood pressure and heart rate. Shock index (SI), calculated as heart rate divided by systolic blood pressure, is widely used to estimate the shock status of patients with hemorrhage. The difference in SI between the emergency department and prehospital field can indirectly reflect urgency after trauma. We aimed to determine the association between delta SI (DSI) and in-hospital mortality in patients with torso or extremity trauma. Patients with DSI >0.1 are expected to be associated with high mortality. This retrospective, observational study used data from the Pan-Asian Trauma Outcomes Study. Patients aged 18-85 years with abdomen, chest, upper extremity, lower extremity, or external injury location were included. Patients from China, Indonesia, Japan, Philippines, Thailand, and Vietnam; those who were transferred from another facility; those who were transferred without the use of emergency medical service; those with prehospital cardiac arrest; those with unknown exposure and outcomes were excluded. The exposure and primary outcome were DSI and in-hospital mortality, respectively. The secondary and tertiary outcome was intensive care unit (ICU) admission and massive transfusion, respectively. Multivariate logistic regression analysis was performed to test the association between DSI and outcome. In total, 21,534 patients were enrolled according to the inclusion and exclusion criteria. There were 3,033 patients with DSI >0.1. The in-hospital mortality rate in the DSI >0.1 and ≤0.1 groups was 2.0% and 0.8%, respectively. In multivariate logistic regression analysis, the DSI ≤0.1 group was considered the reference group. The unadjusted and adjusted odds ratios of in-hospital mortality in the DSI >0.1 group were 2.54 (95% confidence interval [CI] 1.88-3.42) and 2.82 (95% CI 2.08-3.84), respectively. The urgency of traumatic hemorrhage can be determined using DSI, which can help hospital staff to provide proper trauma management, such as early trauma surgery or embolization.
    Matched MeSH terms: Emergency Service, Hospital/statistics & numerical data*
  8. Fulltext Association between prehospital time and outcome of trauma patients in 4 Asian countries: A cross-national, multicenter cohort study
    Chen CH, Shin SD, Sun JT, Jamaluddin SF, Tanaka H, Song KJ, et al.
    PLoS Med, 2020 10;17(10):e1003360.
    PMID: 33022018 DOI: 10.1371/journal.pmed.1003360
    BACKGROUND: Whether rapid transportation can benefit patients with trauma remains controversial. We determined the association between prehospital time and outcome to explore the concept of the "golden hour" for injured patients.

    METHODS AND FINDINGS: We conducted a retrospective cohort study of trauma patients transported from the scene to hospitals by emergency medical service (EMS) from January 1, 2016, to November 30, 2018, using data from the Pan-Asia Trauma Outcomes Study (PATOS) database. Prehospital time intervals were categorized into response time (RT), scene to hospital time (SH), and total prehospital time (TPT). The outcomes were 30-day mortality and functional status at hospital discharge. Multivariable logistic regression was used to investigate the association of prehospital time and outcomes to adjust for factors including age, sex, mechanism and type of injury, Injury Severity Score (ISS), Revised Trauma Score (RTS), and prehospital interventions. Overall, 24,365 patients from 4 countries (645 patients from Japan, 16,476 patients from Korea, 5,358 patients from Malaysia, and 1,886 patients from Taiwan) were included in the analysis. Among included patients, the median age was 45 years (lower quartile [Q1]-upper quartile [Q3]: 25-62), and 15,498 (63.6%) patients were male. Median (Q1-Q3) RT, SH, and TPT were 20 (Q1-Q3: 12-39), 21 (Q1-Q3: 16-29), and 47 (Q1-Q3: 32-60) minutes, respectively. In all, 280 patients (1.1%) died within 30 days after injury. Prehospital time intervals were not associated with 30-day mortality. The adjusted odds ratios (aORs) per 10 minutes of RT, SH, and TPT were 0.99 (95% CI 0.92-1.06, p = 0.740), 1.08 (95% CI 1.00-1.17, p = 0.065), and 1.03 (95% CI 0.98-1.09, p = 0.236), respectively. However, long prehospital time was detrimental to functional survival. The aORs of RT, SH, and TPT per 10-minute delay were 1.06 (95% CI 1.04-1.08, p < 0.001), 1.05 (95% CI 1.01-1.08, p = 0.007), and 1.06 (95% CI 1.04-1.08, p < 0.001), respectively. The key limitation of our study is the missing data inherent to the retrospective design. Another major limitation is the aggregate nature of the data from different countries and unaccounted confounders such as in-hospital management.

    CONCLUSIONS: Longer prehospital time was not associated with an increased risk of 30-day mortality, but it may be associated with increased risk of poor functional outcomes in injured patients. This finding supports the concept of the "golden hour" for trauma patients during prehospital care in the countries studied.

    Matched MeSH terms: Emergency Service, Hospital/organization & administration
  9. Associations between gender and cardiac arrest outcomes in Pan-Asian out-of-hospital cardiac arrest patients
    Ng YY, Wah W, Liu N, Zhou SA, Ho AF, Pek PP, et al.
    Resuscitation, 2016 May;102:116-21.
    PMID: 26970031 DOI: 10.1016/j.resuscitation.2016.03.002
    BACKGROUND: The incidence of out-of-hospital cardiac arrest (OHCA) in women is thought to be lower than that of men, with better outcomes in some Western studies.
    OBJECTIVES: This study aimed to investigate the effect of gender on OHCA outcomes in the Pan-Asian population.
    METHODOLOGY: This was a retrospective, secondary analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data between 2009 and 2012. We included OHCA cases which were presumed cardiac etiology, aged 18 years and above and resuscitation attempted by emergency medical services (EMS) systems. We used multi-level mixed-effects logistic regression models to account for the clustering effect of individuals within the country. Primary outcome was survival to hospital discharge.
    RESULTS: We included a total of 40,159 OHCA cases, 40% of which were women. We found that women were more likely to be older and have an initial non-shockable arrest rhythm; they were more likely to receive bystander cardio-pulmonary resuscitation (CPR). The univariate analysis showed that women were significantly less likely to have return of spontaneous circulation (ROSC) at scene or in the emergency department (ED), and had lower rates of survival-to-admission and discharge, and poorer overall and cerebral performance outcomes. There was however, no significant gender difference on outcomes after adjustment of other confounders. Women in the reproductive age group (age 18-44 years) were significantly more likely to have ROSC at scene or in the ED, higher rates of survival-to-admission and discharge, and have better overall and cerebral performance outcomes after adjustment for differences in baseline and pre-hospital factors. Menopausal women (age 55 years and above) were less likely to survive to admission after adjusting for other pre-hospital characteristics but not after age adjustment.
    CONCLUSION: Differences in survival outcomes between reproductive and menopausal women highlight a need for further investigations into the plausible social, pathologic or hormonal basis.
    KEYWORDS: Gender; Out-of-hospital cardiac arrest; Registry
    Matched MeSH terms: Emergency Service, Hospital
  10. Asthma among adult patients presenting with dyspnea to the emergency department: An observational study
    Kuan WS, Craig S, Kelly AM, Keijzers G, Klim S, Graham CA, et al.
    Clin Respir J, 2018 Jun;12(6):2117-2125.
    PMID: 29469993 DOI: 10.1111/crj.12782
    INTRODUCTION: Shortness of breath is a common presenting symptom to the emergency department (ED) that can arise from a myriad of possible diagnoses. Asthma is one of the major causes.

    OBJECTIVE: The aim of this study was to describe the demographic features, clinical characteristics, management and outcomes of adults with an ED diagnosis of asthma who presented to an ED in the Asia Pacific region with a principal symptom of dyspnea.

    METHODS: Planned sub-study of patients with an ED diagnosis of asthma identified in the Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study. AANZDEM was a prospective cohort study conducted in 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia over three 72 hour periods in May, August and October 2014. Primary outcomes were patient epidemiology, clinical features, treatment and outcomes (hospital length of stay (LOS) and mortality).

    RESULTS: Of the 3044 patients with dyspnea, 387 (12.7%) patients had an ED diagnosis of asthma. The median age was 45 years, 60.1% were female, 16.1% were active or recent smokers and 30.4% arrived by ambulance. Inhaled bronchodilator therapy was initiated in 88.1% of patients, and 66.9% received both inhaled bronchodilators and systemic corticosteroids. After treatment in the ED, 65.4% were discharged. No death was reported.

    CONCLUSION: Asthma is common among patients presenting with a principal symptom of dyspnea in the ED of the Asia Pacific region. There was a suboptimal adherence to international guidelines on investigations and treatments of acute asthma exacerbations presenting an opportunity to improve the efficiency of care.

    Matched MeSH terms: Emergency Service, Hospital/statistics & numerical data*
  11. Fulltext Asthma control and prior medical care of patients presenting with acute asthma at the emergency department
    Lee PY, Khoo EM
    Med J Malaysia, 2003 Oct;58(4):482-9.
    PMID: 15190622
    Seventy patients presented with acute asthma at the emergency department of the University of Malaya Medical Centre, Kuala Lumpur were recruited over a two-week period in July 2001. Fifty-one (73%) patients belonged to the poorly controlled group. Fifty-seven (81%) patients were using inhaled salbutamol but 21 (30%) were still using oral short acting salbutamol. Only 32 (46%) patients used inhaled corticosteroids. In the poorly controlled group, 22 (43.1%) patients were not on regular inhaled corticosteroids, 35 (68.6%) were not receiving "add-on" medication and 18 (35%) did not have regular follow up. The emergency department should implement a protocol for asthma management and follow up to achieve better long term patient care.
    Matched MeSH terms: Emergency Service, Hospital*
  12. Fulltext Asthma guideline knowledge, adherence and cost of treating asthma at emergency department [Abstract]
    Khan AH, Syed Sulaiman A, Hassali AA, Saleem F, Aftab RA, Ali I
    Value Health, 2014 Nov;17(7):A725.
    PMID: 27202576 DOI: 10.1016/j.jval.2014.08.050
    Conference abstract:
    Objectives: To evaluate physician’s knowledge and adherence to asthma guideline adherence (GINA 2011) at emergency department of Hospital Pulau Pinang, Malaysia and to calculate cost of adhered and non-adhered prescriptions
    Methods: A cross-sectional survey was conducted to evaluate knowledge of GINA, 2011 asthma guideline at emergency department of Hospital Pulau Pinang, Malaysia. A total of 810 patient prescriptions of 27 doctors (30 prescriptions per doctor) were viewed to asses doctor’s guideline adherence. Patients’ prescriptions were categorised in terms of asthma severity as mild, moderate and severe. Prescriptions were labelled as adhered or non-adhered in terms of doctor treatment according to patient asthma severity as recommended by CPG (GINA 2011). Cost of adhered and non-adhered was calculated according to asthma severity.
    Results: Twenty two (81.5%) doctor’s had adequate GINA, 2011 asthma guideline knowledge (Mean 16.7, SD ± 1.5). Six hundred and twenty eight (77.5%) patients received guideline (GINA 2011) adhered pharmacotherapy. Six hundred and seventy eight (83.7%) patients asthma were classified as mild asthma, 128 (15.8%) patients were classified as moderate asthma and 4 (0.5%) patients were classified as severe asthma. Pearson correlation indicated no statistical significant association between asthma guideline adherence and asthma guideline knowledge score (p=0.27). Univariate analysis indicate that patients with age group 25-35 years and with hypertension as co-morbidity received significantly better pharmacotherapy (p=0.04, p=0.03 respectively). Total cost of 628 adhered prescriptions was RM 5792.87 whereas cost of 182 non-adhered prescriptions was RM 1759.09. Cost of single mild asthma adhered prescription (RM 9.18) was less as compared to non adhered mild asthma prescription (RM 10.39).
    Conclusions: Emergency doctor’s had adequate GINA, 2011 asthma guideline knowledge. Majority of patients received GINA, 2011 asthma guideline adhered pharmacotherapy. Cost effective medication can significantly reduce socioeconomic burden related to asthma.
    Matched MeSH terms: Emergency Service, Hospital
  13. Fulltext Atypical Cavernous Sinus Thrombosis: A Diagnosis Challenge and Dilemma
    Matthew TJH, Hussein A
    Cureus, 2018 Dec 04;10(12):e3685.
    PMID: 30761237 DOI: 10.7759/cureus.3685
    Cavernous sinus thrombosis (CST) is an ocular emergency because of its devastating effect and it is prone to cause serious complications. Diagnosis of cavernous sinus thrombosis is a challenging task despite medical advancement. Efforts to promptly diagnose and initiate treatment require a high index of suspicion and a deep understanding of the disease. Unfortunately, patients suffering from CST may not always present with typical symptoms, thus making diagnosis all the more challenging. We would like to describe a 22-year-old man who presented with atypical symptoms and radiological presentations of CST. The patient was admitted and treated in our institution with full recovery demonstrated after the treatment.
    Matched MeSH terms: Emergency Service, Hospital
  14. Fulltext Atypical presentation of catastophric spontaneous mesenteric bleeding
    Ohn MH, Ng JR, Luen NP, Ohn KM
    BMJ Case Rep, 2021 Aug 13;14(8).
    PMID: 34389596 DOI: 10.1136/bcr-2021-244051
    Spontaneous mesenteric bleeding is an exceptionally rare clinical condition and potentially lethal especially among elderly patients who are taking oral anticoagulant. We present a case of a 79-year-old woman who presented to the emergency department with atypical chest pain which was radiating to the back. She developed profound hypotension with a sudden drop of haemoglobin. Contrast-enhanced CT of the aorta showed active mesenteric bleeding with mesenteric haematoma. The early diagnosis relies solely on a high index of suspicion of occult bleeding in patients with unexplained hypotension with a sudden drop of haemoglobin. Troponin can be falsely positive in mesenteric bleeding. Close monitoring to detect any sign of deterioration and early imaging in diagnosing intra-abdominal bleeding can help to avoid delay in treatment which is essential to prevent mortality and morbidity.
    Matched MeSH terms: Emergency Service, Hospital
  15. Fulltext Audit of pain management in the emergency department
    Fathil SM, Soong NS, Mustafa NM, Arith A, Ng WN, Bahrum NA, et al.
    Med J Malaysia, 2011 Jun;66(2):89-91.
    PMID: 22106683 MyJurnal
    Pain management in Malaysian Emergency Departments has not been studied well. Convenience sampling was used to recruit 402 patients who presented with acute pain over a 2-week period. The 11-point Numerical Rating Scale was used to quantify pain. Pain relieving medications were prescribed to 178 patients (44.3%) in the Emergency Department. These patients had a median pain score of 7 on arrival. Nonsteroidal anti inflammatory drugs were the most commonly prescribed class of analgesic. Pain was found to be inadequately treated.
    Matched MeSH terms: Emergency Service, Hospital*
  16. Fulltext Automated external defibrillator (AED) use among paramedics in the emergency department – what are the obstacles in using the automated external defibrillator in the pre-hospital care settings?
    Mohd Khairi, A.L., Nik Azlan, N.M., Faizal Amri, H.
    Medicine & Health, 2018;13(1):198-207.
    MyJurnal
    This study determined factors that influence usage of automated external defibrillation (AED) on out-of-hospital cardiac arrest among paramedics in Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). It was a cross sectional prospective study conducted between December 2013 and January 2014. Paramedics from Emergency Department were enrolled and assessed using the self-filled questionnaire consisting of multiple sections including knowledge assessment, training and practice. In total, 53 paramedics participated in this study. Only 62% participants used AEDs previously. Not more than 83% participants admitted that they would use it if required. A positive correlation was observed between age and work experience with knowledge on AED usage (p=0.001 and p=0.005, respectively). Government’s institute graduates possess better knowledge and higher confidence level than private institutions graduates (p
    Matched MeSH terms: Emergency Service, Hospital
  17. Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia
    Awang R, Al-Sohaim SI, Zyoud SH, Khan HR, Hashim S
    Intern Emerg Med, 2011 Oct;6(5):441-8.
    PMID: 21750875 DOI: 10.1007/s11739-011-0662-z
    Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.
    Matched MeSH terms: Emergency Service, Hospital*
  18. Fulltext Axillary Artery Injury with Intact Radial Pulse following Fracture-Dislocation of Shoulder: A Case Report
    Rajeev A, Timmons G
    Malays Orthop J, 2019 Nov;13(3):66-68.
    PMID: 31890113 DOI: 10.5704/MOJ.1911.011
    The occurrence of axillary artery injury following proximal humerus fracture dislocation in elderly patient with low velocity fall is uncommon. The patient could have diverse clinical presentations in spite of intact peripheral pulses. We report the case of an 85-year-old lady who presented to our emergency department with greater tuberosity fracture of the humerus with dislocation of the right shoulder. After closed manipulative reduction of the dislocation, it was observed that the patient had brachial plexus palsy with intact radial pulse. An expanding swelling and bruise around the shoulder was noted and a steady drop in haemoglobin level. CT angiogram revealed avulsion of the posterior circumflex artery which was then treated successfully with stenting.
    Matched MeSH terms: Emergency Service, Hospital
  19. Fulltext Bayesian network classification of gastrointestinal bleeding
    Nazziwa Aisha, Mohd Bakri Adam, Shamarina Shohaimi, Aida Mustapha
    Pertanika Journal of Science & Technology, 2014;22(2):567-575.
    MyJurnal
    The source of gastrointestinal bleeding (GIB) remains uncertain in patients presenting without hematemesis. This paper aims at studying the accuracy, specificity and sensitivity of the Naive Bayesian Classifier (NBC) in identifying the source of GIB in the absence of hematemesis. Data of 325 patients admitted via the emergency department (ED) for GIB without hematemesis and who underwent confirmatory testing were analysed. Six attributes related to demography and their presenting signs were chosen. NBC was used to calculate the conditional probability of an individual being assigned to Upper Gastrointestinal bleeding (UGIB) or Lower Gastrointestinal bleeding (LGIB). High classification accuracy (87.3 %), specificity (0.85) and sensitivity (0.88) were achieved. NBC is a useful tool to support the identification of the source of gastrointestinal bleeding in patients without hematemesis.
    Matched MeSH terms: Emergency Service, Hospital
  20. Fulltext Belhassen ventricular tachycardia-a diagnostic challenge in emergency room: case report
    Syed Farid Almufazal Syed Salim, Shamsuriani Md Jamal
    Malaysian Journal of Emergency Medicine, 2018;3(1):0-0.
    MyJurnal
    FascicularVentricular Tachycardia (VT) is a uniqueclinical syndrome, rarelyencountered by physicians.It isalso known as BelhassenSyndrome, named after a physician who reported the case in 1981. The condition,accounts for 10-15% of total idiopathic VTand the rhythm is sensitive tocalcium channel blocker. First described in 1979, the diagnosis of thissyndromeremains challenging,as the electrocardiogram (ECG) changes may be incorrectly diagnosed as Supraventricular Tachycardia (SVT) with aberrant conductions. We describeda patient whopresented to Emergency Department with palpitation. The difficulty in diagnosis and management is illustrated in the reportas he was initially misdiagnosed as SVT with resistance to initial standard treatment.This case report alsodescribedwide complex tachycardia algorithms to assist physician in daily clinicalpractice. Therapeutic options inmanaging this rare syndrome werealso discussed.
    Matched MeSH terms: Emergency Service, Hospital
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