Displaying publications 1 - 20 of 24 in total

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  1. Head injuries
    Monro JK
    Journal of the Malaya Branch of the British Medical Association, 1939;3:294-96.
    Matched MeSH terms: Emergency Treatment
  2. Fulltext Medical Standby: An Experience at the 4(th) National Youth Camping and Motivation Program Organized by Maksak Malaysia
    Zakaria MI, Isa RM, Shah Che Hamzah MS, Ayob NA
    Malays J Med Sci, 2006 Jan;13(1):43-51.
    PMID: 22589590
    Medical standby is the provision of emergency medical care and first aid for participants and/or spectators in a pre-planned event. This article describes the framework and the demographics of a medical standby at the 4(th) National Youth Camping and Motivation Program in Pasir Puteh, Kelantan from 30(th) July until the 3(rd) August 2004. The framework of the medical team is described based on the work process of any medical stand by. A medical encounter form was created for the medical standby defining the type of case seen (medical or trauma), name, age, race and diagnosis of the patient. We concluded that interagency collaboration during the initial planning and during the event itself is needed to ensure the smooth running of the medical standby. Most of the medical encounters were minor illnesses which are similar to previous studies and there was no case transferred to the hospital during that period.
    Matched MeSH terms: Emergency Treatment
  3. Video clip transfer of radiological images using a mobile telephone in emergency neurosurgical consultations (3G Multi-Media Messaging Service)
    Waran V, Bahuri NF, Narayanan V, Ganesan D, Kadir KA
    Br J Neurosurg, 2012 Apr;26(2):199-201.
    PMID: 21970777 DOI: 10.3109/02688697.2011.605482
    The purpose of this study was to validate and assess the accuracy and usefulness of sending short video clips in 3gp file format of an entire scan series of patients, using mobile telephones running on 3G-MMS technology, to enable consultation between junior doctors in a neurosurgical unit and the consultants on-call after office hours.
    Matched MeSH terms: Emergency Treatment/instrumentation*; Emergency Treatment/methods
  4. Does guideline knowledge affect treatment compliance among emergency doctors?
    Aftab RA, Khan AH, Syed Sulaiman SA, Ali I, Khan K
    Am J Med Sci, 2014 Nov;348(5):357-61.
    PMID: 25118657 DOI: 10.1097/MAJ.0000000000000269
    BACKGROUND: The insufficient adoption of internationally accepted clinical guidelines may lead to less than adequate patient care of patients with asthma.
    OBJECTIVE: To evaluate the knowledge and treatment compliance with Global Initiative of Asthma (GINA, 2011) asthma treatment guidelines among emergency physicians (EPs) at a referral hospital in northern Malaysia.
    METHODS: A cross-sectional study was designed in the territory-level referral hospital in northern Malaysia. Twenty-seven EPs were asked to complete an asthma guideline questionnaire to assess their knowledge regarding GINA 2011 asthma treatment guidelines. A total of 810 patients were enrolled, and 30 patients were selected per physician. The authors evaluated the physicians' compliance with GINA 2011 asthma treatment guidelines.
    RESULTS: Of 27 EPs, 20 (74.1%) had adequate knowledge of GINA 2011 asthma treatment guidelines. A total of 615 (75.9%) patients received guideline-recommended emergency treatment. Shortness of breath (n = 436, 53.8%) was the most frequently reported chief complaint. Furthermore, there was a significant but weak association between knowledge of the guideline and treatment compliance among emergency doctors (P = 0.003, φ = 0.110). Moreover, there was no significant change in therapy for patients with comorbid conditions. The mean age of respondents was 27.3 years.
    CONCLUSIONS: Overall, a fair level of guideline knowledge and treatment compliance was noted among EPs. Doctors with adequate guideline knowledge were more likely to comply with GINA 2011 asthma treatment guidelines.
    Matched MeSH terms: Emergency Treatment/methods; Emergency Treatment/standards*
  5. Fulltext The brunt of intensive simulation airway management training programme on the final year nursing in one of health training institutions in Sabah
    Mazlinda Musa, Fidelia Ferderik Anis, Hamidah Hassan, Syed Sharizman Syed Abdul Rahim, Siti Fatimah Saat
    Malaysian Journal of Medicine and Health Sciences, 2020;16(105):18-0.
    MyJurnal
    Introduction: Airway management is one of the most important steps in emergency patient care, and it is part of the core content of emergency training programme in nursing. Besides, learning in the real clinical area on artificial air- way management is almost impossible due to the complexity of clinical conditions and non-uniform treatment algo- rithms that make the training strategies even more difficult to develop. This study was to evaluate the effectiveness of the simulation airway management training programme developed for the final year nursing students. Methods: This was a quasi-experimental with convenience sampling technique approach used. Students were exposed with the Intensive simulation of airway management technique which includes BLS, oropharyngeal measure and insertion, high flow O2 administration, interpret ECG, use of defib and understanding role of arrest team during emergency. The questionnaire on confident level was given before and after the simulation of airway management. Results: The results showed significant different in the mean score of pre-tests and post-tests (CI95% (-0.53414, -0.09586), t= -3.009, df = 19, p
    Matched MeSH terms: Emergency Treatment
  6. The treatment of wounds
    Cameron JAP
    Journal of the Malaya Branch of the British Medical Association, 1939;3:297-304.
    Matched MeSH terms: Emergency Treatment
  7. Fulltext Mason on a surgical mission
    Utpal DE, Dhritiman M, Mukhopadhyay M
    Med J Malaysia, 2012 Jun;67(3):331-2.
    PMID: 23082429
    Matched MeSH terms: Emergency Treatment/methods*
  8. Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia
    Awang R, Al-Sohaim SI, Zyoud SH, Khan HR, Hashim S
    Intern Emerg Med, 2011 Oct;6(5):441-8.
    PMID: 21750875 DOI: 10.1007/s11739-011-0662-z
    Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.
    Matched MeSH terms: Emergency Treatment
  9. Fulltext A Study of Patients’ Satisfaction with the Emergency Department (ED) of Hospital Universiti Kebangsaan Malaysia (HUKM)
    Isamil Saiboon, Ho, Siew Eng, Krishnan, Bala, Siti Norraini Ali, Noorafindi Murad, Pathnathan, Audrey, et al.
    Medicine & Health, 2008;3(1):7-13.
    MyJurnal
    Patients’ satisfaction is of critical interest to all healthcare providers. Satisfied patients are more likely to seek health care and to comply with prescribed treatment regimes. The objective of the study was to identify factors that influence patient satisfaction with Emergency Department HUKM (ED HUKM). This study was conducted at ED HUKM from January 2007 till March 2007. A convenience sample of 100 participants was recruited from triage 4. The Davis Consumer Emergency Care Satisfaction Scale (CECSS) was adopted and modified. It consists of 19 questions; used a 5 point, Likert type scale of 1 to 5 (1= completely disagree and 5= completely agree) to measure patient satisfaction with triage, health care providers caring behaviours and health teaching. Results showed that 75 participants (75%) were satisfied. There were no significant difference found between male and female patients with total CESCC scores (t=0.308, p values >0.05). Pearson product moment correlation coefficients showed a positive relationship between total and subscale patient satisfaction scores, caring scores (r=0.905, p value
    Matched MeSH terms: Emergency Treatment
  10. Fulltext The Assessment, Evaluation, and Management of the Critically Ill Child When Resources are Limited-Southeast Asian Perspective
    Tang SF, Lum L
    J Pediatr Intensive Care, 2017 Mar;6(1):6-11.
    PMID: 31073420 DOI: 10.1055/s-0036-1584672
    The Southeast Asia region comprises 10 independent countries with highly divergent health systems and health status. The heterogeneity in infant and child mortality rates suggests that there is still scope for improvement in the care of critically ill children. There is, however, a paucity of published data on outcomes and processes of care that could affect planning and implementation of intervention programs. Significant challenges in the delivery of care for the critically ill child remain, especially in pre-hospital and in-hospital triaging and emergency care and inpatient hospital care. Potential areas for continued improvement include strengthening of health systems through sustained commitment by local governments, capacity building, and sharing of research output. Simple, low cost, locally available, and effective solutions should be sought. The introduction of standards and auditing tools can assist in determining effectiveness and outcomes of intervention packages that are adapted to local settings. Recognition and acknowledgment of shortfalls between expectations and outcomes is a first step to overcoming some of these obstacles necessary to achieve a seamless interface among pre-hospital, emergency, inpatient, and critical care delivery processes that would improve survival of critically ill children in this region.
    Matched MeSH terms: Emergency Treatment
  11. Fulltext The use of preserved bovine pericardium for emergency temporizing graft in corneal perforation
    Koay AC, Yew YH, Ngo CT, Loo VP, Intan G, Chua CN
    Med J Malaysia, 2008 Dec;63(5):421-2.
    PMID: 19803308 MyJurnal
    Corneal perforation is an ocular emergency that requires early intervention to avoid permanent visual loss from endophthalmitis or irreversible structural changes. Although tectonic keratoplasty is the best choice for patching a large perforation, a donor cornea is not always immediately available. Consequently, an alternative material is required while awaiting a donor cornea. We report the use of preserved bovine pericardium as a temporizing graft to maintain the ocular integrity in two patients with corneal perforation.
    Matched MeSH terms: Emergency Treatment/methods
  12. Fulltext Outcome of surgically treated Lisfranc injury: a review of 34 cases
    Miswan MF, Singh VA, Yasin NF
    Ulus Travma Acil Cerrahi Derg, 2011 Nov;17(6):504-8.
    PMID: 22290002 DOI: 10.5505/tjtes.2011.04809
    We reviewed cases with Lisfranc injuries who presented to our center in order to study the adequacy of the treatment method and their final functional outcome.
    Matched MeSH terms: Emergency Treatment/statistics & numerical data
  13. Which mild head injured patients should have follow-up after discharge from an accident and emergency ward? A study in a university hospital setting in Kelantan, Malaysia
    Chan HC, Adnan WA, Jaalam K, Abdullah MR, Abdullah J
    Southeast Asian J. Trop. Med. Public Health, 2005 Jul;36(4):982-93.
    PMID: 16295557
    Mild head injury (MHI) is a common presentation to many hospitals in both rural and urban settings in Southeast Asia, but it is not well studied. We studied 330 patients that presented to Hospital Universiti Sains Malaysia Emergency Department with possible MHI, with the intentions to identify prognostic factors that may improve the diagnosis of MHI in the emergency setting as well as to determine which patients would need follow-up. Patients' one-year outcomes were classified as discharged well (DW) for patients without post-traumatic signs and symptoms and discharged with long term follow-up (DFU) for patients with such signs and symptoms. Four patients died and 82 were DFU. An abnormal skull X ray was associated with mode of accident and type of transportation, older age, presence of vomiting, confusion, bleeding from ear, nose or throat, abnormal pupil size on the right side associated with orbital trauma, unequal pupillary reflexes, absence of loss of consciousness (LOC), a lower Glasgow Coma Scale (GCS) score, multiple clinical presentations, and DFU. An abnormal CT scan was associated with older age, multiple clinical presentation, skull X-ray findings, and DFU. A similar analysis on outcomes revealed that mode of accident, older age, vomiting, confusion, headache, bleeding from ear, nose and throat, neurological deficits, absence of LOC, pupil size, multiple presentation, abnormal skull X ray, CT scan of the brain, and a GCS of 13 was associated with DFU. In conclusion, all patients involved in motor vehicle accidents (MVAs), especially motorcycles, aged over 30 years of age, with multiple clinical presentations, including a lower GCS, and with abnormal radiological findings should have a longer follow-up due to persistent post-traumatic symptomatology.
    Matched MeSH terms: Emergency Treatment*
  14. Evaluate the impact of hospital types on the availability of antidotes for the management of acute toxic exposures and poisonings in Malaysia
    Al-Sohaim SI, Awang R, Zyoud SH, Rashid SM, Hashim S
    Hum Exp Toxicol, 2012 Mar;31(3):274-81.
    PMID: 21478291 DOI: 10.1177/0960327111405861
    The availability of antidotes may be considered essential and lifesaving in the management of certain poisonings. Surveys carried out in a number of countries have demonstrated inadequate availability of a variety of poisoning antidotes.
    Matched MeSH terms: Emergency Treatment
  15. Carbetocin compared to oxytocin in emergency cesarean section: a randomized trial
    Razali N, Md Latar IL, Chan YK, Omar SZ, Tan PC
    Eur J Obstet Gynecol Reprod Biol, 2016 Mar;198:35-39.
    PMID: 26773246 DOI: 10.1016/j.ejogrb.2015.12.017
    OBJECTIVE: To evaluate the uterotonic effect of carbetocin compared with oxytocin in emergency cesarean delivery.

    STUDY DESIGN: Participants were randomized to intravenous bolus injection of 100mcg carbetocin or 10IU oxytocin after cesarean delivery of the baby. The primary outcome is any additional uterotonic which may be administered by the blinded provider for perceived inadequate uterine tone with or without hemorrhage in the first 24hours after delivery. Secondary outcomes include operating time, perioperative blood loss, change in hemoglobin and hematocrit levels, blood transfusion and reoperation for postpartum hemorrhage.

    RESULTS: Additional uterotonic rates were 107/276 (38.8%) vs. 155/271 (57.2%) [RR 0.68 95% CI 0.57-0.81 p<0.001; NNTb 6 95% CI 3.8-9.8], mean operating time 45.9±16.0 vs. 44.5±13.1minutes p=0.26, mean blood loss 458±258 vs. 446±281ml p=0.6, severe postpartum hemorrhage (≥1000ml) rates 15/276 (5.4%) vs. 10/271 (3.7%) p=0.33 and blood transfusion rates 6/276 (2.2%) vs. 10/271 (3.7%); p=0.30 for carbetocin and oxytocin arms respectively. There was only one case of re-operation (oxytocin arm). In the cases that needed additional uterotonic 98% (257/262) was started intraoperatively and in 89% (234/262) the only additional uterotonic administered was an oxytocin infusion over 6hours.

    CONCLUSION: Fewer women in the carbetocin arm needed additional uterotonics but perioperative blood loss, severe postpartum hemorrhage, blood transfusion and operating time were not different.

    Matched MeSH terms: Emergency Treatment
  16. Management of laryngeal foreign bodies in children
    Sharma HS, Sharma S
    J Accid Emerg Med, 1999 Mar;16(2):150-3.
    PMID: 10191459
    Foreign body aspiration is one of the leading causes of accidental death in children. Food items are the most common items aspirated in infants and toddlers, whereas older children are more likely to aspirate non-food items. Laryngeal impaction of a foreign body is very rare as most aspirated foreign bodies pass through the laryngeal inlet and get lodged lower down in the airway. Two rare cases of foreign body aspiration with subglottic impaction in very young children (under 2 years of age) are described. In both the cases subglottic impaction occurred consequent to attempted removal of foreign body by blind finger sweeping. The clinical presentation, investigations, and management of these rare cases are discussed.
    Matched MeSH terms: Emergency Treatment
  17. Fulltext Endoscopic retrieval of an accidentally ingested bur during a dental procedure: a case report
    Kunaparaju K, Shetty K, Jathanna V, Nath K, M R
    Patient Saf Surg, 2021 Jan 05;15(1):1.
    PMID: 33402200 DOI: 10.1186/s13037-020-00273-3
    BACKGROUND: Accidental ingestion of a dental bur during the dental procedure is a rare, but a potentially serious complication. Early recognition and foreign body retrieval is essential to prevent adverse patient outcomes.

    CASE PRESENTATION: A 76-year old male patient, presented to the department with a chief complaint of sensitivity in his upper right back tooth due to attrition. After assessing the pulp status, root canal therapy was planned for the tooth. During the procedure, it was noticed that the dental bur slipped out of the hand piece and the patient had accidentally ingested it. The patient was conscious and had no trouble while breathing at the time of ingestion of the bur although he had mild cough which lasted for a short duration. The dental procedure was aborted immediately and the patient was taken to the hospital for emergency care. The presence and location of the dental bur was confirmed using chest and abdominal x-rays and it was subsequently retrieved by esophagogastroduodenoscopy (EGD) procedure under general anaesthesia on the same day as a part of the emergency procedure. The analysis of this case reaffirms the importance of the use of physical barriers such as rubber dams and gauze screens as precautionary measures to prevent such incidents from occurring.

    CONCLUSION: Ingestion of instruments are uncertain and hazardous complications to encounter during a dental procedure. The need for physical barrier like rubber dam is mandatory for all dental procedures. However, the dentist should be well trained to handle such medical emergencies and reassure the patient by taking them into confidence. Each incident encountered should be thoroughly documented to supply adequate guidance for treatment aspects. This would fulfil the professional responsibilities of the dentist/ clinician and may help avoid possible legal and ethical issues. This case report emphasizes on the need for the usage of physical barriers during dental procedures in order to avoid medical emergencies.

    Matched MeSH terms: Emergency Treatment
  18. Fulltext Critical adjustments and trauma surgery trends in adaptation to COVID-19 pandemic in Malaysia
    Tan Chor Lip H, Huei TJ, Mohamad Y, Alwi RI, Tuan Mat TNA
    Chin J Traumatol, 2020 Aug;23(4):207-210.
    PMID: 32653358 DOI: 10.1016/j.cjtee.2020.05.007
    Malaysia has one of the highest total numbers of COVID-19 infections amongst the Southeast Asian nations, which led to the enforcements of the Malaysian "Movement Control Order" to prohibit disease transmission. The overwhelming increasing amount of infections has led to a major strain on major healthcare services. This leads to shortages in hospital beds, ventilators and critical personnel protective equipment. This article focuses on the critical adaptations from a general surgery department in Malaysia which is part of a Malaysian tertiary hospital that treats COVID-19 cases. The core highlights of these strategies enforced during this pandemic are: (1) surgery ward and clinic decongestions; (2) deferment of elective surgeries; (3) restructuring of medical personnel work force; (4) utilization of online applications for tele-communication; (5) operating room (OR) adjustments and patient screening; and (6) continuing medical education and updating practices in context to COVID-19. These adaptations were important for the continuation of emergency surgery services, preventing transmission of COVID-19 amongst healthcare workers and optimization of medical personnel work force in times of a global pandemic. In addition, an early analysis on the impact of COVID-19 pandemic and lockdown measures in Malaysia towards the reduction in total number of elective/emergent/trauma surgeries performed is described in this article.
    Matched MeSH terms: Emergency Treatment
  19. Fulltext Challenges in managing uncontrolled hypertension cases at relief centre in Kota Tinggi District, Johore
    Hanihaselah, M.S., Norasikin, M.
    Malaysian Journal of Community Health, 2009;15(3):24-34.
    MyJurnal
    Background : The management of chronic disease during flood seems to be one of the main challenges to the health care service. Chronic disease becomes worst during flood. Poor condition at the relief centres, loss of assets, fear, and lack of functional health facilities contribute to the morbidity and mortality during and after flood. Poor chronic disease management, especially on severe and uncontrolled hypertension, may threaten lives of victims during flood. In addition, comprehensive treatment cannot be delivered due to destroyed infrastructure, shortage of doctors on duty and delay in getting drug supply. Therefore, all aspects of chronic disease management shall be reviewed and included in the disaster preparedness in order to control and prevent acute incidence and complications of the chronic diseases. Previous Action Plan did not address this issue effectively which had caused many patients not getting their treatment adequately. The aim of this writing is to share experiences in managing chronic disease patients particularly hypertensive patients.
    Methodology : A retrospective study based on data collection by health personnel while conducting health screening, clinical examination and giving treatment to flood victims at the relief centres. Hypertensive patients were identified when the victims came for treatment and while the medical team conducting medical rounds. New hypertensive cases as well as uncontrolled cases with no complication were treated and monitored at the relief centres.
    Result : It was found that 34,530 cases of non communicable disease (11.1% of the total number of the flood victims) including hypertension and diabetes mellitus were reported in Johor. Kota Tinggi reported a total number of 5,317 cases of chronic disease. There was no data collection on specific chronic diseases collected at the state level during the floods thus the findings representing Kota Tinggi cases only. In retrospective search of 150 flood victims with hypertension in Kota Tinggi, only 95 cases had complete data. Among them 71.6% (68 cases) were hypertensive cases already on treatment and 28.4% (27 cases) were new cases. Also it has been found that 67.4% (64 cases) were uncontrolled hypertension and 32.6% (31 cases) were controlled hypertension. Four cases had been found diagnosed as uncontrolled hypertension with complications and have been referred to hospital.
    Conclusion : Comprehensive health strategy for flood victims shall not be focused only on saving lives and giving emergency treatment to patients but also to update and strengthen an overall chronic disease management. Many factors contributed to increase in blood pressure during flooding. Good hypertensive treatment at the relief centres is needed to minimise morbidity and mortality. Information on care and treatment received by flood victims having chronic disease is vital in assessing their health needs during disaster and in formulating disaster preparedness in the future.
    Matched MeSH terms: Emergency Treatment
  20. Fulltext Cross-sectional descriptive study of management modalities and quality of life of surgical patients in a palliative care unit
    Amjad, N.M., Karim, K.A., Naing Soe, Y.
    International Medical Journal Malaysia, 2016;15(1):35-43.
    MyJurnal
    Introduction: The goal of palliative care is the provision of the best quality of life (QOL) for terminally ill
    and dying patients. Advances in medical treatment has seen an increase in overall survival of all stages of
    malignant diseases. This includes advanced and/or inoperable malignancies where management is mainly
    palliative involving different modalities. Methods: We designed a cross-sectional descriptive study of
    surgical patients in a palliative care unit in a 1000-bedded teaching hospital in Kuantan, Malaysia.
    Objectives of this study are: to study the demographic characteristics and indications for admission of
    surgical patients in palliative care unit, to study the options of treatment modalities and their
    complications, to identify the barriers in decision making in surgical treatment and finally to objectively
    assess the quality of life of these patients by utilizing QUALITY OF LIFE (WHOQOL) –BREF –questionnaire.
    Results: One hundred and one eligible patients (53%) male, (47%) female of mean age of 54yrs, majority
    Malay and Chinese patients were included in the study. All patients had malignancies and they were Breast
    (30%), Lower gastrointestinal (GI) (24%), (18%) upper GI, (15%) hepato-biliary, and (7%) pancreatic cancers.
    Thirty two percents of patients had emergency treatment while the rest had supportive treatment. Barriers
    to decision making were mainly due to patient factors in 71%, while 12% was due to the disease presenting
    at an advanced stage and 15% due to limitation of care. The final results of overall quality of life rating
    were shown as poor (1%), neither poor nor good (42%), good (52%) and very good (2%). Conclusions:
    Palliative care and end of life decision making from surgical point of view is a delicate issue. Like all other
    fields in medicine, palliative care must be evidence-based with specific goal directed therapy. Our study
    shows that we are able to positively impact the quality of life in more than two thirds of our patients. Our
    aim is to achieve 100% success. As such, it is imperative to inculcate the goal of palliative care to all grades
    of health care personnel. ‘To cure sometimes, To relieve often, To comfort always’ should not be mere
    words.
    Matched MeSH terms: Emergency Treatment
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