MATERIALS AND METHODS: This is a prospective cross-sectional study on the data obtained from Hospital Universiti Sains Malaysia (Hospital USM) from Jun 2018 until May 2019. Blood samples were taken via a single prick from venous blood and sent separately using 1ml heparinised syringe and were analysed immediately in ED using BGA (Radiometer, ABL800 FLEX, Denmark) and another sample was sent to the central laboratory of Hospital USM and analysed by BCA (Architect, C8000, USA). Only patients who had potassium levels ≥5.0mmol/L on blood gas results were included. A total of 173 sample pairs were included. The correlation and agreement were evaluated using Passing and Bablok regression, Linear Regression and Bland-Altman test.
RESULT: Of the 173 sample pairs, the median of potassium level based on BGA and BCA were 5.50mmol/L (IQR: 1.00) and 5.90mmol/L (IQR: 0.95) respectively. There was significant correlation between two measurements (p<0.001, r: 0.36). The agreement between the two measurements showed within acceptable mean difference which was 0.27 mmol/L with 95% limit of agreement were 1.21mmol/L to 1.73mmol/L.
CONCLUSION: The result of blood gas can be used as a guide for initial treatment of hyperkalaemia in critical cases where time is of the essence. However, BCA result is still the definitive value.
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.
METHODS: This is a clinical audit involving all patients admitted to our institution from January 2008 to June 2018 of those who had undergone revascularization surgery for lower limb trauma.
RESULTS: Fifty-nine patients were in this study with a mean age of 28.1 years. Most of the patients were motorcyclist involved in road traffic accidents with cars (n=30, 50.8%). The popliteal artery was most commonly seen injury (n=41, 69.5%). The mean duration of ischaemia was 14.1 hours. The limb salvage rate was 89.8%.
CONCLUSION: Lower extremity vascular injury caused by RTA treated in our institution predominantly involved young patients aged between 18-30 years associated with long bone fractures causing contusion and thrombosis of the popliteal artery.
METHODS: In this retrospective cohort study, medical records of all general surgical operations in a public hospital were reviewed for the period 1st January 2017 to 31st December 2017. Data on patient demographics, operative workload, case mix, time of surgery and outcomes were analysed.
RESULTS: Of the 2960 general surgical operations that were performed in 2017, 1720 (58.1%) of the procedures were performed as emergencies. The mean age for the patients undergoing emergency general surgical procedures was 37.9 years (Standard Deviation, ±21.0), with male preponderance (57.5%). Appendicitis was the most frequent diagnosis for the emergency procedures (43%) followed by infections of the skin and soft tissues (31.6%). Disorders of the colon and rectum ranked as the third most common condition, accounting for 6.7% of the emergency procedures. Majority of emergency surgery (59.3%) took place after office hours and on weekends. Post-operative deaths and admissions to critical care facilities increased during EGS when compared to elective surgery, p<0.01.
CONCLUSIONS: EGS constitutes a major part of the workload of general surgeons and it is associated significant risk for death and post-operative complications. The burden of EGS must be recognised and patient care systems must evolve to make surgery safe and efficient.
METHODS: This pre-post, single-arm, quasi-experimental study randomly sampled 140 healthcare providers working in the Emergency Department of Hospital Ampang, Malaysia. Parameters of CPR quality, namely chest compression rate and depth were compared among participants when they performed CPR with and without an AV CPR feedback device. The efficacy of the AV CPR feedback device was assessed using the Chi-square test and Generalised Estimating Equations (GEE) models.
RESULTS: The use of an AV CPR feedback device increased the proportion of healthcare providers achieving recommended depth of chest compressions from 38.6% (95% Confidence Interval, 95%CI: 30.5, 47.2) to 85.0% (95%CI: 78.0, 90.5). A similar significant improvement from 39.3% (95%CI: 31.1, 47.9) to 86.4% (95%CI: 79.6, 91.6) in the recommended rate of chest compressions was also observed. Use of the AV CPR device significantly increased the likelihood of a CPR provider achieving recommended depth of chest compressions (Odds Ratio, OR=13.01; 95%CI: 7.12, 24.01) and rate of chest compressions (OR=13.00; 95%CI: 7.21, 23.44).
CONCLUSION: The use of an AV CPR feedback device significantly improved the delivered rate and depth of chest compressions closer to American Heart Association (AHA) recommendations. Usage of such devices within real-life settings may help in improving the quality of CPR for patients receiving CPR.
METHOD: Categorisation was a surgical judgment call after thorough clinical assessment. There were 4 levels of urgency with their respective TTT; Red (2 hours), Yellow (8 hours), Green (24 hours), Blue (72 hours). Caesarean cases were excluded in colour coding due to pre - existing classification. The data for mean TTT was collected 4 weeks before the implementation (Stage 1), and another 4 weeks after implementation (Stage II). As there was a violation in the assumption for parametric test, Mann Whitney U test was used to compare the means between these two groups. Using logarithmic (Ln) transformation for TTT, Analysis of Covariance (ANCOVA) was conducted for multivariate analysis to adjust the effect of various departments. The mean TTT for each colour coding classification was also calculated.
RESULTS: The mean TTT was reduced from 13 hours 48 min to 10 hours, although more cases were completed in Stage II (428 vs 481 cases). Based on Mann-Whitney U test, the difference in TTT for Stage I (Median=6.0, /IQR=18.9) and Stage II (Median=4.2, IQR=11.5) was significantly different (p=0.023). The result remained significant (p=0.039) even after controlled for various department in the analysis. The mean/median TTT after colour coding was Red- 2h 24min/1h, Yellow- 8h 26min/3h 45 min, Green- 15h 8min/8h 15min, and Blue- 13h 46min/13h 5min.
CONCLUSION: Colour coding classification in emergency Operation (OT) was effective in reducing TTT of patients for non-caesarean section cases.
METHODOLOGY: This was a cross-sectional observational study done from November 2017 until December 2017 at ED Hospital Sultan Abdul Halim (HSAH), a 650-bedded tertiary hospital in the state of Kedah. All patients that were triaged to red zone, age 18 years and above, and involved in intra-hospital transfer to critical coronary unit, intensive care unit and wards were included. All cases were documented in proforma by the accompanying staff.
RESULTS: Among the 170 critically ill patients, only 29 patients (17.1%) experienced adverse events during intra-hospital transfer. The adverse events seen were hypotension (12.4%), desaturation (3.5%) and dislodged peripheral line (2.4%). Cardiorespiratory related diagnosis was the commonest presentation. Intra-hospital transfer during morning shift and evening shift has 79.5% (b=-1.59, OR=0.21, 95% CI: 0.06, 0.69, p=0.011) and 75.6% ((b=-1.41, OR=0.24, 95% CI: 0.08, 0.73, p=0.012) lesser odds of experiencing adverse events compare to night shift. Patients with vasopressor/inotropes had 9 times higher odds of experiencing adverse events during transportation, compared to patients with no vasopressor/inotropes (b=2.27, OR=9.70, 95% CI: 3.39, 27.72, p<0.001).
CONCLUSIONS: Critical care patients who are involved in intrahospital transfer were at risk of adverse events such as hypotension, desaturation and dislodge peripheral line. Risk identification and maintaining level of care is important to minimize the adverse events during transfer. Patients had higher rates of adverse events if they were transferred during night shifts and on inotropic/vasopressor support.
MATERIALS AND METHODS: We analysed retrospective data of chest pain patients presenting to ED HUSM from 1st June 2020 till 31st January 2021 based on the patient's history, ECG findings, risk factors, age and troponin level. The patients were stratified as low risk (MHS and HEAR score of 0-3), intermediate risk (MHS and HEAR score of 4-6), and high risk (MHS of 7-10 and HEAR score of 7-8). The association of the MHS and HEAR score with MACE at 6 weeks' time was evaluated using simple logistic regression.
RESULTS: This study included 147 patients in the MHS analysis and 71 patients in HEAR score analysis. The incident rate of MACE in low, intermediate and high risk was 0%,16.3%, and 34.7%, in the MHS group, and 0%, 3.22%, and 6.66% in HEAR score group. The mean difference between MACE and non-MACE in MHS and HEAR score groups was -2.29 (CI: -3.13,1.44, p<0.001) and -2.51(CI: -5.23, 0.21, p=0.070), respectively. There was no significant association between the incidence rate of MACE with modified HEART score (MHS) and HEAR score groups (p>0.95).
CONCLUSION: HEAR score is not feasible to be used as a risk stratification tool for chest pain patients presenting to ED HUSM in comparison to MHS. Further studies are required to validate the results.
MATERIAL AND METHODS: This is a retrospective observational study done in Hospital Sg Buloh (HSB), a tertiary referral centre in an urban area located north of Kuala Lumpur, Malaysia's capital city, from January until December 2018, involving 289 patients. All cases with CPR and a sustained return of spontaneous circulation (ROSC) were included in the study and followed up until discharged or died in the hospital.
RESULTS: Out of 236 patients recruited, 25.8% achieved ROSC, 15.7% survived on admission, and 4.2% of patients were discharged alive. Of 74.1% of witnessed OHCA, only 17.5% received bystander CPR. Factors with favourable outcomes include CA in ED (p<0.001), the initial rhythm of ventricular fibrillation (p=0.003), defibrillation (p=0.024), OHCA witnessed by emergency medical services (EMS) (p=0.024) and intravenous adrenaline administration (p=0.001). When using multivariate regression analysis, positive outcomes were associated with the cardiac and respiratory cause of CA (Adjusted Odd Ratio (AOR) 3.66; 95% Confidence Intervals, 95%CI: 2.52 - 12.61 and AOR 8.76; 95%CI: 5.76- 15.46, respectively) as well as OHCA witnessed by EMS (AOR 10.81; 95%CI: 1.84- 19.52).
CONCLUSIONS: Despite being an upper-middle-income country and having advancements in the healthcare system, a relatively lower STD rate among survivors of CA in the ED was observed in this study. There was underutilization of the EMS among patients with CA. The bystander CPR rate among patients with CA in Malaysia is also worryingly low. Aggressive community participation in cardiac arrest awareness programmes is much required. Additionally, in achieving better outcomes, implementing standardized post-resuscitation care protocols with existing resources will be a challenge for physicians managing cardiac arrest cases.