Local anaesthesia systemic toxicity (LAST) is an uncommon and a potentially life-threatening event that develops after peripheral nerve block. The cause may be multifactorial and may include the choice of drug, technique of block and individual patient risk factors. We report a case of a 55-year-old female who developed slurring of speech and quadriplegia after receiving a mixture of lignocaine and hydrocortisone through an intra-articular injection to the right shoulder. Neurological examination revealed hypotonia and absence of power (0/5) in all limbs. These toxic events may have resulted from an accidental intra-arterial or dural cuff injection of local anaesthesia or absorption from surrounding tissues. This case report demonstrated that an intra-articular injection in the shoulder may cause LAST and may be under-recognized as it can mimic stroke.
Hemichorea-hemiballismus (HC-HB) is a movement disorder characterized by involuntary movements involving limbs on one side of the body. Many etiological factors were identified and these included stroke, infection, and neoplasm. However, acute hyperglycemia-induced HC-HB is less well known. We present two cases of non-ketotic hyperglycemia-induced HC-HB. The cases depicted here Illustrate that HC-HB can be the sole presentation from among a variety of neurological manifestations of poorly controlled diabetes which can be easily reversed when hyperglycemia is corrected.
Cardiac concussion is a sudden, direct blunt trauma cause to the chest which led to death. However, there are patients who did not completely fulfil this definition. We report two cases which did not fit into the definition domain. Two male patients presented to Emergency Department with moderate anterior chest pain after motor vehicle crash showed transient anterior ST segment elevation at chest lead V2 and V3 with raised creatine kinase and normal troponin T. The electrocardiogram changes fully resolved after 24 hours. Both patients were discharged uneventfully after 24 hours monitoring in Emergency Department short-stay ward. Conventional definition of cardiac concussion (commotion cordis) and cardiac contusion may be unsuitable to describe these cases. Therefore, we propose the diagnosis of focal
cardiac concussion. We also highlighted the ability of Emergency Department to manage these patients in short-stay ward.
Keywords: commotio cordis, chest pain, nonpenetrating, electrocardiography
Stridor in infants with subglottic cyst is rare. Mismanagement of such cases may
lead to respiratory compromise with a potentially serious and fatal outcome. The
diversity of the clinical presentations throws a great challenge in the diagnosis of
subglottic cysts. Manifestations vary as they depend on the size and location of
the cysts. We report the case of a 6-month-old girl who had a subglottic cyst
but managed as moderate croup till she developed worsening respiratory acidosis
which difficult intubation. Any case of premature infants with previous history of
neonatal intubation presenting with stridor should prompt clinicians to look for
possible cysts in the larynx. This is important because once the diagnosis is made, appropriate treatment may be given and unnecessary morbidity and mortality may
be avoided.
Fractures may occur after an episode of seizures. Although rare, with a high index
of suspicion and proper physical examination, delay of diagnosis and treatment
can be avoided. We report a case of near missed bilateral proximal humerus
fracture after an episode of generalized tonic-clonic seizure. A 58-year-old lady
with a background history of epilepsy complained of generalized body ache after
a generalized tonic-clonic seizure which happened few hours before presentation to our Emergency Department. On assessment, she was in pain and unable to
move all four limbs. After given analgesia, patient was reassessed whereby she
complained of bilateral shoulder stiffness and pain. Examination of the upper limbs
revealed restricted range of movement in all directions with no shoulder squaring.
X-ray showed bilateral proximal humerus fracture. Proximal humeral fractures
rarely occur by itself following seizures; they are almost always associated with
dislocation of the glenohumeral joint.
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
Bystander rate of cardiopulmonary resuscitation (CPR) is still low worldwide because of inadequate skills and knowledge. Training the public on CPR is one of the methods to increase the bystander CPR rate. This study aimed to compare the efficacy in acquiring and retaining CPR skills and knowledge among secondary school students in Klang Valley trained by school teachers and medical students. We recruited five school teachers and five medical students as trainers. They were trained in several sessions by American Heart Association (AHA)-certified instructors using the video-assisted CPR training module. The recipients were 44 secondary school students divided between the teacher’s group and the medical student’s group. We compared knowledge and psychomotor skills between these two groups prior, immediately after and at three months after CPR training. Students in the teacher’s group showed a higher increase in knowledge comparable to the medical student’s group (median score difference 3 vs 2, p>0.05) and in psychomotor skill (median score difference 5 vs. 7, p
Pendidikan kemahiran resusitasi kardiopulmonari (CPR) kepada orang awam sangat penting dalam merendahkan kadar kematian serangan jantung. American Heart Association mencadangkan kemahiran tersebut harus dimasukkan ke dalam kurikulum sekolah. Pelatih rakan sebaya adalah kaedah yang berkos rendah dan berkesan dalam mencapai objektif ini. Objektif kajian terkawal 3 bulan ini adalah untuk membandingkan keberkesanan pengajaran kompresi CPR antara rakan sebaya dan jurulatih Basic Life Support (BLS) kepada pelajar sekolah menengah. Peningkatan pengetahuan dan kemahiran psikomotor pemampatan CPR adalah hasil utama yang dinilai. Dua belas pelatih rakan sebaya berusia 16 tahun dan dua belas pelatih BLS telah direkrut dalam kajian ini. Kompresi CPR diajarkan kepada 36 pelajar sekolah menengah secara rawak oleh pelatih rakan sebaya (Kumpulan P) atau pelatih BLS (Kumpulan B). Pra-ujian, pasca ujian serta ujian pengekalan 3 bulan mengenai pengetahuan dan kemahiran psikomotor telah dijalankan. Tidak terdapat perbezaan yang signifikan secara statistik dalam skor min pengetahuan dan psikomotor pada pra-ujian, pasca ujian serta ujian pengekalan 3 bulan antara Kumpulan P dan Kumpulan B. Terdapat peningkatan skor pengetahuan yang signifikan antara pra-ujian dan pasca ujian dalam Kumpulan P (perbezaan min 5.8+2.7, p