Most spider species in Malaysia are considered harmless and spider bites are rarely reported. This is partly due to the mild effects from the bite and victims do not seek medical treatment in the hospital. To date, there are few well-documented cases of medically significant bites from indigenous spider species in Malaysia. Here, we report the presentation, clinical management and outcome of two patients following a bite by the yet to be described ‘Black & Gold’ Huntsman spider from the genus Thelcticopis in Malaysia. The first case involved a 42-year-old man who was bitten on the tip of the distal phalanx of his right middle finger and presented with severe pain and local swelling. He was treated symptomatically and was discharged well. The second case involved a 57-year-old woman, who was bitten on the proximal phalanx of her right little finger and presented with severe throbbing pain and progressive swelling. She was treated symptomatically and was discharged after 24 hours observation in the medical ward. However, she noted moderate neck and generalized joints pains especially affecting the hips and knees, one day prior to discharge. She was treated with oral analgesia and symptoms resolved within two days.
Patients who self-discharge against medical advice (DAMA) are susceptible to life-threatening consequences. By understanding the factors associated with DAMA, healthcare centres can build strategies to assist patients to receive optimal medical care and prevent unfavourable outcome. The objective of this study was to determine the factors associated with DAMA from the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a prospective unmatched case control study conducted over a 4-month period. For every DAMA episode, two patients who were admitted on the same day were randomly selected as control. Following patient consent, data was collected using a standardized questionnaire. Patients were contacted by the investigator for information regarding hospitalization within two weeks of DAMA. Ninety three patients were recruited; 31 DAMA patients and 62 admitted patients. Payment method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01). The likelihood of self-paying patients to take DAMA was three times higher than those who had a guarantor letter from their employer or insurance provider. Other factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09-15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6% DAMA patients were admitted to hospital within two weeks of the DAMA episode. Payment method significantly influences DAMA. Payment planning, social welfare services, non-governmental organization funds and the introduction of a national health policy scheme may aid hospital payment, alleviate financial limitation of patients and reduce DAMA episodes.
Out-of-hospital cardiac arrest (OHCA) patients require immediate cardiopulmonary
resuscitation (CPR). Early initiation of CPR and defibrillation before arrival at
Emergency Department (ED) increases the chance of survival from sudden cardiac
arrest. The main objective of this study was to identify the factors that influenced
the outcome of early cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac
arrest (OHCA) patients managed at the ED of Universiti Kebangsaan Malaysia
Medical Centre (UKMMC). The second objective was to determine the incidence
of CPR initiated by the public prior to ambulance arrival. The present study was a
one-year cross-sectional study. The OHCA patients were identified from the ED
resuscitation logbook. Patients’ medical records were used to obtain details of the
resuscitation. Factors recorded included: aetiology of arrest, initiation of on-scene
CPR, use of automated external defibrillators (AEDs), mode of transportation and
the incidence of return of spontaneous circulation (ROSC) in the ED. Categorical
data was analysed using chi-square and Fisher exact tests. Nine patients out of 98
had early CPR. Three patients achieved ROSC. Gender was significantly associated
with ROSC (p-value=0.015). More patients who received early CPR achieved ROSC
compared to those who received late CPR. The provision of early CPR and usage
of AEDs by the public is still low. Female gender had a positive influence on ROSC.
Efforts are required to increase the awareness and involvement of the public in
initiating early CPR prior to the arrival of ambulance service.
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.