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A Rare Case of Pseudomembranous Tracheitis Presenting as Acute Stridor in a Patient after Extubation

Ong HY, Ng JJ, Nadhrah MN, Shaariyah MM, Shashi G

Turk Arch Otorhinolaryngol, 2020 Jun;58(2):130-132.
PMID: 32783042 DOI: 10.5152/tao.2020.5095

Pseudomembranous tracheitis is a rare life-threatening complication of endotracheal intubation. The exact mechanism of its formation is not well known, and it could mimic crusting or retained secretions in the trachea. We encountered a patient with history of recent intubation, presenting with acute stridor requiring emergency airway stabilization, and was eventually found to have pseudomembranous tracheitis.

Matched MeSH terms: Emergency Service, Hospital
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
Fulltext The risk factors of workplace violence among healthcare workers in public hospital

Nursyafiqah Zainal, Irniza Rasdi, Suhainizam Muhamad Saliluddin

Malaysian Journal of Medicine and Health Sciences, 2018;14(102):1-8.
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
The prevalence of hypersensitivity reactions to snake antivenoms administered in sultanah nur zahirah hospital from 2013 to 2016

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
Fulltext The 28-day mortality prediction in sepsis patients using static lactate concentration and early lactate clearance: an observational study

Noor Asmidar, A., Tan, T.L., Ong, W.J., Ahmad Fuad Fahmi, M.N., Chieng, Z.L., Noor Akmal, S.I.

Medicine & Health, 2014;9(2):124-133.
MyJurnal

Sepsis causes high mortality and morbidity. Static lactate concentration and early lactate clearance are cited to be a predictor for sepsis survival. This study examined the clinical utility of static lactate concentration and early lactate clearance within the first six hours of admission in Emergency Department (ED) to predict 28-day mortality rate in sepsis patients. Patients who presented with sepsis, severe sepsis or septic shock and admitted to ED of Universiti Kebangsaan Malaysia Medical Centre were recruited. Blood lactate concentrations were measured upon admission (H0), at 1st hour (H1) and 6th hour (H6), respectively. Either standard treatment of sepsis or early goal directed therapy was initiated according to sepsis severity. A follow-up report was conducted at 28 days via telephone call, e-mail or case notes. Patients were later classified into survivor and non-survivor as final outcome. Static lactate concentration appeared to be significantly higher for non-survivor as compared to the survival group at H0, H1 and H6 (p

Matched MeSH terms: Emergency Service, Hospital
Fulltext Work place violence (WPV) against healthcare workers in Africa: A systematic review

Njaka S, Edeogu OC, Oko CC, Goni MD, Nkadi N

Heliyon, 2020 Sep;6(9):e04800.
PMID: 32964153 DOI: 10.1016/j.heliyon.2020.e04800

Background: WPV amongst healthcare workers has been reported as a public health challenge across the countries of the world, with more in the developing countries where condition of care and service is very poor.
Objectives: We aimed to systematically produce empirical evidence on the WPV against health care workers in Africa through the review of relevant literature.
Method: We sourced for evidence through the following databases: PubMed, Science direct and Scopus from 30th November to 31st December 2019 as well as the reference list of the studies included. A total of 22 peer reviewed articles were included in the review (8065 respondents). Quality appraisal of the included studies was assessed using critical appraisal tools for cross-sectional studies.
Result: Across the studies, diverse but high prevalence of WPV ranging from 9% to 100% was reported with the highest in South Africa (54%-100%) and Egypt (59.7%-86.1%). The common types were verbal, physical, sexual harassment and psychological violence. The correlates of WPV reported were gender, age, shift duty, emergency unit, psychiatric unit, nursing, marital status and others. Various impacts were reported including psychological impacts and desire to quit nursing. Patients and their relatives, the coworkers and supervisors were the mostly reported perpetrators of violence. Doctors were mostly implicated in the sexual violence against nurses. Policy on violence and management strategies were non-existent across the studies.
Conclusion: High prevalence of WPV against healthcare workers exists in Africa but there is still paucity of research on the subject matter. However, urgent measures like policy formulation and others must be taken to address the WPV as to avert the impact on the healthcare system.

Matched MeSH terms: Emergency Service, Hospital
Fulltext An audit on the assessment and management of acute bronchial asthma in the accident and emergency department of a district hospital

Nivedita N

Med J Malaysia, 1996 Mar;51(1):89-92.
PMID: 10967985

A study was undertaken to determine the assessment and management of adult asthmatic patients presenting to the Accident and Emergency department. The records of 50 consecutive adult asthmatic patients presenting to A & E with acute bronchial asthma between June 1993 to April 1994 were reviewed. Patients were also interviewed on their subsequent visit to hospital. Observations and measurements used to assess the severity of asthma were recorded with variable frequency--cyanosis 8%, inability to speak 2%, chest auscultation 64%, heart rate 10%, blood pressure 6%, respiratory rate 4%. The failure to record more objective measurements of severity of asthma and in particular extent of airflow obstruction is cause for concern. The drugs used to treat acute asthma in order of frequency were Beta agonists by nebuliser, 49 patients; intravenous aminophylline, 8 patients; and intravenous corticosteroids, 6 patients. 15 patients were admitted to the medical ward. The decision to admit patients appeared to be due to a lack of symptomatic improvement after treatment. Of the 35 patients who were discharged from A & E, 13 (37%) had an acute relapse within 10 days. None of the patients on discharge from A & E were given a short course of oral steroids or were advised an increase in steroid inhaler therapy. There was therefore a gross underuse of corticosteroids.
Study site: Emergency department, Hospital Muar, Johor, Malaysia

Matched MeSH terms: Emergency Service, Hospital*
Fulltext Factors associated with severity of motorcyclist inqiuries seen in Hospital University Sains Malaysia (HUSM), Kelantan

Nik Rosmawati, N.H., Manaf, A.H., Ahmad Zaki, I., Naing, L.

Malaysian Journal of Public Health Medicine, 2004;4(2):45-53.
MyJurnal

All road users are at risk of being involved in motor vehicle crashes (MVCs). Approximately 52.2% of all fatalities and 70.9% of all casualties related to MVCs in Kelantan were motorcycle riders and pilliori riders. A number of risk factors have been established in the relationship between traffic accidents and road-user, the vehicle as well as road and traffic conditions. The study was a cross-sectional study to identify factors associated with the severity of injury sustained by motorcyclist accident patients admitted to the Emergency Department, Hospital Universiti Sains Malaysia (HUSM), assessed through face to face interview based questionnaire and, at the same time the severity of injury was determined through Revised Trauma Score. Data analysis was done using simple and multiple logistic regressions. The study revealed that age more than 5O years, no motorcycle license, no stressful condition and crashes on two·way road showed higher risk of sustaining a more severe injury. However, sleep time of six to less than nine hours per day, crash on a straight roadway and wet road surface were associated with less severe injury. We recommend that public education, licensing and enforcement on accident prevention and safety riding should be given a priority.

Matched MeSH terms: Emergency Service, Hospital
Fulltext Effectiveness of ultrasound as a triage tool in ruling out fractures among non-critical emergency department patients

Nik Muhamad, N.A., anesan Murthi, J., Nik Ismail, N.A.

Medicine & Health, 2015;10(2):103-111.
MyJurnal

The popularity of ultrasound for acute diagnosis of fractures in the Emergency Department (ED) has increased over the recent years. This present study aimed to determine the sensitivity and specificity of ultrasound use for detection of fractures in a different environment, which is at the triage area of the ED. We compared the results of bedside ultrasound in detecting non-critical fractures to the current gold standard of X-rays in the triage area. The design was a single centered crosssectional study. From August 2014 till November 2014, a total of 46 patients were recruited, creating 75 image pairs. Following consent, a bedside ultrasound was performed and subsequently compared with X-ray reporting regarding the presence or absence of fractures. SPSS analysis was used to determine the sensitivity and specificity of ultrasound in diagnosing fracture as compared to X-rays. Ultrasound had a sensitivity of 72% (95% CI, 50.6% - 87.9%) and a specificity of 80% (95%CI: 66.3 - 90%) when compared to X-rays in fracture diagnosis. The kappa analyses showed moderate inter observer agreement (0.5) between ultrasound and X-rays in diagnosing fractures. This study suggests that the use of ultrasound as a triage tool yet has unacceptable sensitivity and needs further evaluation and consideration.

Matched MeSH terms: Emergency Service, Hospital
Fulltext Adverse drug reaction with midazolam use in emergency department

Nik Muhamad, N.A., Ismail, A.K., Kaharuddin, H., Miao Ching, H., Qamarul Ariffin, S., Syazwani Azwa, S., et al.

Medicine & Health, 2016;11(1):2-10.
MyJurnal

Midazolam is one of the most commonly used drugs for sedation in Emergency Department (ED). This was a retrospective study conducted on 380 patients from December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The objective was to elicit the frequency of side effects and correlation to various factors i.e. socio-demography, co-morbidities, age groups and underlying illnesses. Out of 380 patients, 35 patients experienced side effects (20 patients with midazolam alone, 15 patients with combination of drugs). The average age was 42 years and the average dose of midazolam was 3.5mg. The most common other drug combined was fentanyl. The overall complication rate for midazolam was 5.3%. The most common side effect recorded was excessive somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting (0.8%), headache (0.8%) and hypotension (0.5%). There was no significant association between the socio-demographic factors and drugs combination with the side effects of midazolam on patients. It was concluded that midazolam was a safe drug due to absence of any life-threatening side effects. There are possibilities that most side effects recorded could be caused by other comfounding factors e.g. underlying injuries or disease and combination with other drugs.

Matched MeSH terms: Emergency Service, Hospital
Fulltext Factors associated with emergency department revisits and hospitalization following discharged acute asthma exarcerbation

Nik Muhamad NA, Kwong LJ

Medicine & Health, 2016;11(1):22-28.
MyJurnal

The objectives were to identify factors associated with early revisit of adult patients with acute asthma exarcebation discharged from the Emergency Department (ED). It was a retrospective cohort study with patients aged 12 years or more within a period of 1 month and who were treated for acute asthma and discharged from the ED of Sarawak General Hospital. A total of 397 patients fulfilled sampling criteria and out of this number, 13.9% had revisit to the ED within 2 weeks. In all of these revisit cases, 9.1% were actually admitted. Prescription rate of oral corticosteroid was found to be low (24.9%) and abscond rate was high (25.1%). Patients who absconded from the ED and their concurrent infection were associated with early ED revisit.

Matched MeSH terms: Emergency Service, Hospital
Fulltext The use of laboratory and physiological parameters in predicting mortality in sepsis induced hypotension and septic shock patients attending the emergency department

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
Fulltext Management of Emergency Department Overcrowding (EDOC) in a teaching hospital

Nik Azlan, N.M., Ismail, M.S.

Medicine & Health, 2013;8(1):0-0.
MyJurnal

Emergency Department Overcrowding (EDOC) has been a longstanding problem. It is defined as a situation where the demand for emergency services exceeds the ability of an Emergency Department (ED) to provide quality care within appropriate time frames. Hospital beds closure or access block to ward admission is one of the most important cause of Emergency s e.g. disaster. A surge response entails even greater responses including implementing Department overcrowding. This could be compounded further in events of a patient surge eg affirmative measurement in order to mitigate the issue in tackling the situation. The steps in managing EDOC were: 1. Recognizing EDOC, 2. Initiating action, 3. Maintaining patient flow, 4. Setting clinical goals and 5. Deploying a Surge Team for Advance Triage or Fast Tract.

Matched MeSH terms: Emergency Service, Hospital
Fulltext The pattern of death related to trauma cases presented to the emergency department of a tertiary university hospital

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*
Fulltext Randomised controlled trial on the effectiveness of audible timed reminders for simulated serial pain score documentation in an emergency department

Ng, V.H., Ahmad Khaldun, I., Siti Sarah, M.Z., Ida Zarina, Z.

Medicine & Health, 2018;13(2):114-121.
MyJurnal

Pain is one of commonest presentations at Emergency Department (ED). Previous studies showed inadequate pain control in ED. However, few have addressed specific, practical methods of improving the timeliness and frequency of pain control in emergency setting. This study was a randomized controlled trial in a simulated environment of an actual functioning ED using a timer device to remind care personnel to assess pain and provide analgesia at set intervals versus a “standard therapy” group without visual/audio aids. The mean documentation performance scores between timer and control groups were 94.45% + 5.85 vs 72.22% + 17.57 (p

Matched MeSH terms: Emergency Service, Hospital
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
Fulltext Needlestick injury among medical personnel in Accident and Emergency Department of two teaching hospitals

Ng YW, Hassim IN

Med J Malaysia, 2007 Mar;62(1):9-12.
PMID: 17682562

Needlestick injury has been recognized as one of the occupational hazards which results in transmission of bloodborne pathogens. A cross-sectional study was carried out among 136 health care workers in the Accident and Emergency Department of two teaching hospitals from August to November 2003 to determine the prevalence of cases and episodes of needlestick injury. In addition, this study also assessed the level of knowledge of blood-borne diseases and Universal Precautions, risk perception on the practice of Universal Precautions and to find out factors contributing to needlestick injury. Prevalence of needlestick injury among the health care workers in the two hospitals were found to be 31.6% (N = 43) and 52.9% (N = 87) respectively. Among different job categories, medical assistants appeared to face the highest risk of needlestick injury. Factors associated with needlestick injury included shorter tenure in one's job (p < 0.05). Findings of this study support the hypothesis that health care workers are at risk of needlestick injury while performing procedures on patients. Therefore, comprehensive infection control strategies should be applied to effectively reduce the risk of needlestick injury.

Matched MeSH terms: Emergency Service, Hospital*
An unusual neurological complication from a garden-variety organism: post-melioidosis parkinsonism

Ng CS, Azmin S, Law ZK, Sahathevan R, Wan Yahya WN, Remli R, et al.

Med J Aust, 2015 Apr 06;202(6):333-4.
PMID: 25832163
Matched MeSH terms: Emergency Service, Hospital
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
Fulltext Ectopic pregnancy following levonorgesterol-only emergency contraception: the first Malaysian case report

Natasha MN, Khoo HW, Sulaiman AS, Nur Azurah AG, Md Dali AZH, Jamil MA

Medicine & Health, 2012;7(2):107-111.
MyJurnal

Levonorgestrel (LNG) is a well-known safe and efficacious emergency contraception (EC). However, ectopic pregnancy following the failure of LNG-only EC has been reported. The exact incidence of ectopic pregnancy has been hindered by lack of data due to the fact that LNG-only EC is accessible at pharmacies without a prescription. We describe a case of ectopic pregnancy in an 18 year-old single woman who took LNG-only EC within 48 hours of unprotected sexual intercourse. She presented to the emergency department at 8 weeks period of amenorrhoea with an acute abdomen and hypovolaemic shock. Laparotomy confirmed a ruptured right tubal pregnancy and salpingectomy was performed. The patient was discharged well after 2 days. We aim to highlight this potential adverse effect and to discuss the plausible causality of ectopic pregnancy following administration of LNG-only EC.

Matched MeSH terms: Emergency Service, Hospital

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