Subcutaneous emphysema can occur after a breach to the air-containing space. The classical condition will be ruptured alveolus in chronic lung disease. A disruption of the upper airway such as trauma to the laryngotracheal framework may lead to similar presentation. The amount of air leak varies depending on site and size of the breach. We report a case of blunt neck trauma after a fall from bicycle, which ended with massive subcutaneous emphysema, pneumothorax and pneumomediastinum requiring intubation.
This case illustrates the difficulty in diagnosing TAA from an uncommon symptom of haemoptysis, especially in a patient with recent cardiac eventandthe possibility of having a lung malignancy as he is anex-smoker. It appears that CT Angiography is the modality of choice here.
Background:The rise in global popularity of triathlon competition requires the medicalteam to be familiar with variousendurance sport related injuries that may sustain throughout the race period. However, there have been very few published studies on the injury profiles of triathlon events heldlocally.
Objective: To describethe injury rate, the pattern of injuries, andtime of presentation for medical treatment among injured athletes at theultra-distancetriathlonevent held in Malaysiain year 2014.
Methodology:This cross-sectional studyanalyseddata from allathletes who sustained the injury that required treatment or assessment by the medical personnelduring or immediately after the triathlon race. Data on injured athletes were retrieved from Medical Encounter Form used during the race. All physical injurieswere documented based on body part affected, type of injury sustained and time of medical treatment sought.
Results: Approximately 30.7% (329/1073) of the athletes in our study population presented to the medical team for treatment during or immediately after the event, with 539 injuriesidentified among them. Injuries were more commonly seen among male, age group of 30–39 years old, and Asian athletes. The injuries more commonly sustained during the running discipline. Muscle cramps, sprains, and nausea and/or vomiting were the most common type of injury across all race disciplines. There was an apparent increasedin athlete presentation from 15:00 hours, and it remained high until 23:00 hours.
Conclusion: There was a wide range of injuries encountered by the competitors. Our resultswill add to the growing body of knowledge on local triathlon injuriesand helps the medicalteampreparation for future triathlon events.
Future healthcare providers are facing the threat of needle stick injuries (NSIs) with the consequent risk of acquiring blood borne diseases. A cross sectional study was conducted from May 2017 to September 2017 among 327 students including medical, nursing and paramedic students from Faculty of Medicine UKM. This study aimed to determine the level of knowledge and awareness among students during their clinical years. A validated questionnaire was delivered via convenience sampling. Data was analyzed using SPSS 23 software and one sample t-test was used to compare with the standard setting value. The mean age of respondents was 23.32±2.37. The knowledge and awareness were significantly higher in both paramedic (knowledge (10.71 ± 1.64, p<0.001), awareness (5.50 ± 0.86, p<0.001), and nursing (knowledge (9.94 ± 1.38, p<0.001), awareness (5.35 ± 1.07, p<0.001) students as compared to standard setting, respectively. Meanwhile for medical students there was no significant difference in knowledge (9.95 ± 1.39, p=0.589) but significant difference in awareness (5.87 ± 1.03, p<0.001) compared to standard setting. The prevalence of NSIs was 8.3% with majority having at least one incident (85.2%) and main exposure is during medical posting (77.8%) during procedure needle recapping (70.4%) using hollow needle (63%). Incident of NSIs were mostly not reported (74.1%). Despite a significant good result on knowledge and awareness, the incidence of NSIs is alarming. Therefore, preventive steps need to be taken by the university to avoid the occurrence.
Keyword: Knowledge, Awareness, Students, Needle Stick Injury (NSI), Cross-sectional study
Study site: Universiti Kebangsaan Malaysia (UKM)
Flying feather is a traditional street weapon, which is believed to be originated from Philippine. It is a famous weapon in Tawau, Sabah, shot within short distance and being used with the aim to debilitate the victims. Some may even apply poison at the tip of the weapon. We report two cases of severe chest injuries in resulting from flying feathers. Case 1, a 25-year old man sustained left sided hemothorax with anterior right ventricle injury. He underwent thoracotomy and was discharged well. Case 2, a 40-year old man, presented to emergency department with no signs of life, sustained penetrating injury to the left second intercostal muscle, the pericardium and the anterior wall of the right ventricle adjacent to the interventricular septum. These cases highlight the severity spectrum of cardiac injury resulting from flying feathers.
FascicularVentricular Tachycardia (VT) is a uniqueclinical syndrome, rarelyencountered by physicians.It isalso known as BelhassenSyndrome, named after a physician who reported the case in 1981. The condition,accounts for 10-15% of total idiopathic VTand the rhythm is sensitive tocalcium channel blocker. First described in 1979, the diagnosis of thissyndromeremains challenging,as the electrocardiogram (ECG) changes may be incorrectly diagnosed as Supraventricular Tachycardia (SVT) with aberrant conductions. We describeda patient whopresented to Emergency Department with palpitation. The difficulty in diagnosis and management is illustrated in the reportas he was initially misdiagnosed as SVT with resistance to initial standard treatment.This case report alsodescribedwide complex tachycardia algorithms to assist physician in daily clinicalpractice. Therapeutic options inmanaging this rare syndrome werealso discussed.
Introduction:Clinical characteristics to differentiate stroke subtype may be helpful to make sound decisionin managing blood pressure in clinically stroke patients. This is more important while en route patient to tertiary centre forneuroimaging facility and neurosciences services. The objective of this study is to determine the distinction between ischaemic and haemorrhagic stroke based on the clinical characteristics. Time of presentation was also calculated to determine the feasibility of thrombolytic therapy among stroke patients in Malaysia.
Methods:A cross-sectional observational study of all stroke patients presented to Hospital Kuala Lumpur from January 2005 to May 2005. All patients were subjected to brain CT. Clinical characteristics –age, gender, loss of consciousness (LOC), headache, vomiting, Glasgow coma scale (GCS), systolic blood pressure and diastolic blood pressure –were assessed. Time of presentation was also determined. Multiple logistic regression analyses with the stroke types as the outcome (ischaemic=1 vs haemorrhagic stroke=0) were performed.
Results:A total of 143 patients (88 male and 55 female) were included. The mean age for haemorrhagic stroke was 51.1 (± 14.9) years oldand mean age for ischaemic stroke was 56.8 (± 9.7) years old.Our logistic model shows five clinical characteristics were associated with types of stroke–age, GCS, sex, headache and LOC. Male (adj. OR 0.18, 95% CI 0.05-0.59), headache (adj.OR 0.16, 95% CI 0.06-0.47), LOC (adj.OR 0.20, 95% CI 0.06-0.66), age in years (adj OR 1.06, 95% CI 1.01-1.11) and GCS (adj.OR 1.44, 95% CI 1.14-1.82)wereall significant (p-value < 0.05) in our model. Only 4.9% patients presented less than 3 hours and most of them (64.3%) presented more than 6 hours.
Conclusion:Male patients, having LOCandheadache were the clinical characteristics predictive of lower chance of having ischaemic stroke. But, increasing age and higher GCS were more likely to associate with ischaemic stroke. BP in clinically stroke patients that have higher odds for haemorrhagic stroke should be lowered with a target of SBP ≥ 140mmHg. There was significant delayed of presentation for stroke patients. Many factors need to be improved to reduce the time of presentation in the future.
Background: Diving related illness has become a public health concern, as there isan increasing number of diversworldwide. However, the incidence of Decompression Illness (DCI), a medical disorder as a result of sudden reduction of ambient pressure, remainsgenerallylow. This paper describes the patternsof decompression illness treated in a military hospital-based recompression chamber facility in Peninsular Malaysiafrom year 2000 until 2010.Objective:The objective ofthis study is to determine the patternsof decompression illnesspatientstreated withHyperbaric Oxygen Therapy(HBOT)in a military hospital-based recompression chamber facility inPeninsular Malaysia.
Methodology:A retrospective descriptive study was carried out to utilizesecondary data from Hospital Angkatan Tentera Lumut, Perakfrom 1stJanuary 2000 to 31stDecember 2010. A total of 96 caseswere included in thisstudy.
Results:Most of the patients were male (94.8%), recreational divers (43.0%), non-smokers (56.3%),with no previous medical illness(85.4%), who had dived with compressed air (78.0%), had lessthan 5years divingexperience (56.3%), were non-instructors(75.0%),and had body mass index between 18.5 to 24.9kg/m2(59.4%). Interestingly,25% of the patients developing DCI dived to less than 10 meters depth, 35.4% of them went for a single dive and 71.9% performed safety stops.The majority of the patients had symptoms startingwithin 12 hours after surfacing (85.4%),mainly within the first 3 hours and many had neurological manifestation (61.5%).Only 16.7% of the patients treated withHBOThad therapycommenced within 6 hours from the onset of symptomsand 93.8% from this group had complete recovery. Overall,76.0% of patients had fullrecovery after HBOT.
Conclusion:Diving activities must be closely monitored. Medical surveillance as well as legislations related to diving activities in Malaysia areessential to improve SCUBA discipline and to reduce mortality and morbidity ofDCI in the future.
Severe acutepoisoning of cypermethrin is rare. We reportedthiscase about a47-year old man who was brought to the Emergency Departmentwith drowsiness and drooling of saliva after intentional self-harm with 2.25gram of cypermethrin.His initial condition was stable. However, nine hours after admission, he developed seizures and reduced conscious level. He was ventilated overnight for airway protection. Management of acute severe poisoning is discussed in this case report.
Diagnosis of pulmonary embolism (PE) remains a challenge in clinical practice, especially in emergency setting despite availability of various diagnostic tools. It is desirable to have a rapid and accurate bedside test to rule out PE.The aim of this study is to evaluate the diagnostic accuracyof CUEPED, a novel method of ruling out pulmonary embolism using a combination of end-tidal CO2(ETCO2), Compression Ultrasonography (CUS) and Transthoracic Echocardiography (TTE).In this pilot study, patients who presented to the Emergency Department at Univers it y Malaya Medical Centre with suspected acute PE from December 2013 to October 2014,who fulfilled the inclusion and exclusion criteria, were assessed using CUEPED. CUEPED was considered positive if the measured ETCO2 was less than 35 mmHg, or if there was presence of venous incompressibility in lower limb ultrasonography orif tricuspid annular plane systolic excursion (TAPSE) in transthoracic echocardiography was less than 1.6. All patients received a computed tomography pulmonary angiography (CTPA) for confirmation of diagnosis. Data obtained was analyzed to determine if a negative CUEPED has the potential to accurately rule out a PE. 30 patients (mean age = 48 years [SD = 13.6]) were involved with an equal distribut io nbetween gender. The incidence of PE was 56.7%. CUEPED had a sensitivity of 100% for PE. Negative CUEPED ruled out PE with a negative predictive value of 100%. Positive CUEPED ruled in PE with a low specificity of 53.8% and moderate positive predictive value of 73.9%. This diagnostic study showedthat a negative CUEPED is potentially accurate in ruling out PE.
This study is a descriptive epidemiology on the frequency of injuries, characteristics, and type of injuries incurred during the 16th National SilatChampionships 2012 competitions. This was a retrospective study by using a Pre Hospital Care Emergency Medicine PPUKM Form. All injuries sustained during the competition days were documented. The total number of participants involved in this tournament was 158 (114 males and 44 females). 51.6% participants sustained various injuries during the competition. The common sites of injuries involved the upper and lower extremities. The injuries sustained consist of swelling, fracture, dislocation, muscle sprain, strain and others. Most of the injuries were minor and did not require hospitalization. This study identified that soft tissue injuries due to blunt trauma were common among the silatparticipants. Strict observation of the tournament regulations, vigorous training and protective measures or equipments may contribute to the absence of severe or serious injury.