Acute aortic dissection (AAD) is rare in the paediatric and young adult population. We present a fatal case of acute aortic dissection Stanford B in a young male diagnosed with hypertension. He presented with severe acute abdominal pain with malignant hypertension. He did not have any trauma to the chest or did not have history of an illicit drug abuse. He had no features suggestive of connective tissue disease as well as other typical signs of aortic dissection. The complain of acute, severe abdominal pain which was out of proportion and required multiple doses of intravenous opioid, raised the suspicion of aortic dissection in this case. Point of care sonography (POC) was done in Emergency Department (ED). However, due to its highly operator dependability, the intimal flap was missed. Computed tomography (CT) scan of abdomen was done and confirmed the diagnosis of AAD. Unfortunately, his clinical condition rapidly deteriorated few hours later with no response to surgical intervention and succumbed within 36 hours of admission. We highlighted the importance of the early recognition of this disease as well as the point of care sonography in ED as a diagnostic tool to tackle this time-sensitive disease.
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
Junior doctors are often the "first line" doctors called to attend to patients in cardiac arrest. We performed an anonymous questionnaire study from October 2008 to December 2008 to assess the knowledge, attitude and skill of cardiopulmonary resuscitation among junior doctors in Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II. Out of the 100 questionnaire forms sent out, 70 were returned completed. The majority (85.8%) stated that they were not confident of managing a resuscitation case. There was a statistically significant (p<0.001) association between duration of clinical practice and confidence level. Up to 77.1% said that BLS should be re-certified every two years.