Emergency Medicine Blog

Elderly Abuse in Malaysia

2012-02-14T23:56:00.001+08:00

The official visit by the undergraduate students and their lecturers from Tzu Chi University from Taiwan ended a week ago. During that visit, I talked about elderly care and abuse, particularly within the Malaysian context because I feel this is one area which is not very much talked about, not easily detected, and in fact, what we know is probably the tip of the iceberg only. This forum

Heuristics and Cognitive Biases in Decision Making During Clinical Emergencies

2012-01-18T00:43:00.000+08:00

When faced with a potential clinical emergency situation, physicians are often expected to make diagnostic decisions within a limited time frame. A delayed decision, albeit an accurate one, is a futile decision if the patient deteriorates. Therefore, as almost always, such urgent decisions have to be made with some degree of uncertainty. This is especially so in an environment like the emergency

Severe Sepsis Talk by Emmanuel Rivers (Originally posted in EMCrit Blog)

2011-09-04T14:06:00.007+08:00

Early goal directed therapy (EGDT) is a series of targeted treatment measures directed aggressively and as early as possible for the first 6 hours for patients with severe sepsis and septic shock. The EGDT was first conceptualized by Emmanuel Rivers. The EGDT was well known through a landmark paper published in NEJM (looking back, this paper is already 10 years old!): Rivers E., Nguyen B.,

Prehospital Care in Malaysia and Kendrick Extrication Device

2011-08-14T22:05:00.012+08:00

Prehospital care in Malaysia - Issues and Challenges View more presentations from Chew Keng Sheng This talk was the first lecturer that I gave during the Prehospital Care course that I conducted for the Red Crescent volunteers of Penang Branch Malaysia. This slide was prepared based on a commentary journal article that I wrote together with Dr. Hiang Chuan Chan from Kuching Sarawak. Red

Some Lessons Learned From ACEM 2011 Bangkok - Emerging Drugs of Abuse in Asia and Riot Control Agents

2011-07-14T00:39:00.022+08:00

In every conference that I attended, I tried to learn at least one or two things, if not, more. In ACEM 2011, I find that the toxicology track was particularly interesting. Two specific topics are of particular interest to me (since they are relatively new stuffs to me):Emerging Drugs of Abuse in AsiaRiot Control Agents In this blog post, I will share some of the things I learned from

Hypopyon

2011-06-25T12:02:00.003+08:00

A hypopyon is a pus collection within the anterior chamber of the eye.Patients will present with pain, irritation, itchiness of affected eye. Some may have decreased visual acuity or photophobia. This patient did not have decreased visual acuity or photophobia other than the limited visual field besides the pain and irritation.It is not a disease per se, but a presentation of diseases. It can

The Rule of Six in Infusion Part 2 - The Pros and Cons

2011-06-24T19:16:00.006+08:00

For the last one week, there has been some interesting discussion in my group on the use of the rule of six for infusion. I have previously written a blog post on this.According to an article (click here to access), the rule of six is not optimal for patient safety - which I sincerely agree. Some of the points raised in that article:1. the rule of 6 is not followed consistently. Some

3rd Malaysian International MMA Medical Students Conference on Trauma

2011-06-05T12:54:00.005+08:00

The 3rd Malaysian International MMA Medical Students conference held at Melaka-Manipal college has just concluded (2nd - 5th June 2011). I must say that it was a huge success given the limited resources they have, especially since the committee members themselves are busy medical students, many of whom are clinical students. I wish that more medical students from Universiti Sains Malaysia could

First Aid: Principles and Practice (Updated According to AHA Guidelines 2010)

2011-04-11T19:30:00.002+08:00

This is the set of slide that I used during my recent lecture The Principles and Practice of First Aid for First Year Medical/Dental Students in early January 2011. First aid 2011 View more presentations from Chew Keng Sheng

Recommended Website: Life in The Fast Lane

2011-03-22T01:13:00.003+08:00

Life In The Fast Lane is, as it describe itself, is "a medical blog and website dedicated to providing online emergency medicine and critical care insights and education for everyone, everywhere... usually with a healthy dose of good humour, and always with endless enthusiasm".There are many great resources over there, but one particular feature that may especially interest candidates sitting for

Lecture Slides On Toxic Gases and An Introduction To CBRNE Weapons

2011-03-18T21:52:00.005+08:00

Toxic gasesView more presentations from Chew Keng Sheng.CBRNE - An IntroductionView more presentations from Chew Keng Sheng.Overview of CBRNEChemical agentsBlood agentsNerve agentsBlistering agents1. Blood agentsCyanide groups2. Nerve agentsG series and V seriesG series - made in Germany (that's why it is called G)GA Tabun, GB (Sarin - used in Aum Shinrikyo 1995 attack), GD (Soman)V series e.g.

Book Review: Enchantment: The Art of Changing Hearts, Minds, and Actions by Guy Kawasaki

2011-03-12T22:35:00.029+08:00

Product Information:Name: Enchantment: The Art of Changing Hearts, Minds, and ActionsPage count: 224Year of first printing: 2011ISBN: 9781591843795Although this book is not directly related to emergency medicine, but Enchantment: The Art of Changing Hearts, Minds, and Actions by management guru, Guy Kawasaki, has a lot to teach us, doctors in ER, on the one of the very important aspect of

Chain of Survival AHA Resuscitation Guidelines 2010

2011-02-06T12:00:00.004+08:00

Image link: http://circ.ahajournals.org/content/vol122/18_suppl_3/images/large/zhc1431087430001.jpeg (AHA Website)To increase the chance of successful resuscitation following cardiac arrest, this requires an integrated set of coordinated, sequential actions represented by a chain of links. This is known as the Chain of Survival.The links include the following:Immediate recognition of cardiac

Book Review: Connected for Health: Using Electronic Health Records to Transform Care Delivery

2011-01-24T06:14:00.016+08:00

Product Information:Hardcover: 272 pagesPublisher: Jossey-Bass; 1 edition (May 17, 2010)Language: EnglishISBN-10: 0470639377ISBN-13: 978-0470639375Product Dimensions: 9.2 x 7 x 0.9 inches Connected for Health: Using Electronic Health Records to Transform Care edited by Louise L. Liang is an account that chronicles the implementation of electronic health record (EHR) by Kaiser Permanente (KP).

First Aid Recommendations Updates

2011-01-23T14:17:00.022+08:00

The American Heart Association (AHA) together with the American Red Cross have published a series of updates in conjunction with the 2010 AHA and Emergency Cardiac Care (ECC) Guidelines on Basic Life Support and Advanced Life Support.Download the pdf file of this 2010 AHA first aid updates here.NB: Please note that all the recommendations by AHA and American Red Cross stated below are for first

Etomidate Versus.....

2011-01-04T16:29:00.004+08:00

Widely used as an induction agent, etomidate is an ideal agent for emergency endotracheal intubation because:of its predictability in dosingreliable hypnotic effectrapid onset short duration of actionit has no effect on histamine release, which contributes to its hemodynamic stability.Unfortunately, since the early 1980s, there has been concerns about the use of etomidate in critically ill

Blogs Recommendations

2011-01-04T09:58:00.003+08:00

EM.Crit Blog has listed 12 of his favorite emergency medicine/critical care blogs. You may want to follow them. Click here.In fact, EMCrit itself is an excellent blog worth following. The blog includes podcast in free mp3 downloads. You can subscribe their RSS. Click here.

Scientific Writing - Challenges Within The Malaysian Context

2011-01-03T15:45:00.002+08:00

Below is my presentation slide during the 1st National Symposium in Emergency and Acute Care held in Universiti Sains Malaysia. Feel free to download by clicking here.Scientific writingView more presentations from Chew Keng Sheng.

Bowel Obstruction

2010-11-15T09:30:00.002+08:00

Matric No MCQ Grade OSCE Grade 85192

Traumatic Hemorrhagic Shock - An Update

2009-09-01T08:15:00.000+08:00

Traumatic Hemorrhagic Shock - An Update View more documents from cksheng74. Files link: 1. Kwan, I., Bunn, F. & Roberts, I. (2003). Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev, (3), CD002245. URL: http://www.cochrane.org/reviews/en/ab002245.html This Cochrane review shows that to date, there is a lack of uniformity in terms of study designs

Supracondylar fracture

2009-08-27T16:13:00.002+08:00

This 8-year old girl who was allegedly fell down from bicycle at about 1 pm on the day of admission, complained of pain, swelling and deformity. No external wound seen.She sustained a closed left supracondylar fracture with no neurological deficit and good radial pulse volume on the affected side.

Malaysia's National Trauma Database (NTrD)

2009-08-17T23:59:00.007+08:00

The Malaysian National Trauma Database contains information and statistics on trauma injuries pooled from selected Malaysian hospitals from May 2006 - April 2007 (First report).The National Trauma Database (NTrD) is a service initiated supported by the Ministry of Health (MOH) to collect information about trauma in Malaysia, which will enable us to know the incidence of trauma, and to evaluate

Penetrating Abdominal Trauma

2009-08-16T23:15:00.007+08:00

A good case for discussion with the medical students. This man was apparently stabbed by a knife - looked as if it were quite deep in, as only the knife handle was left visible. A quick ultrasound scan showed that the spleen and kidney on that side (left) were still viable and intact. However, the bowels were floating in free intra-abdominal fluid - the echogenicity suggestive of blood.Note:

Monoarthritis As A Presenting Feature in Acute Rheumatic Fever

2009-08-16T10:54:00.006+08:00

This case report had been presented as a free paper in the 3rd National Scientific Meeting in Emergency Medicine in Kota Kinabalu, Sabah 23rd - 25th April 2009.A Case of Knee Swelling - Don't forget to bring your stethoscope!View more documents from cksheng74.MONOARTHRITIS AS A PRESENTING FEATURE IN ACUTE RHEUMATIC FEVER: A CASE PRESENTATIONHamizah K, Chew K SEmergency Medicine Department,School

Basic and Advanced Cardiac Life Support Lecture

2009-08-11T10:10:00.003+08:00

Basic and Advanced Life SupportView more documents from cksheng74.

SkillStat Learning

2009-07-19T12:03:00.002+08:00

SkillStat Learning Inc. was created to fulfill a vision: to deliver efficient, effective and engaging training modules to busy healthcare professionals.Under the "Tool" section, several learning tools are developed by SkillStat and are freely available. For example, the ECG Simulator and the ACLS STAT tools are favorites! Click here to access.Free e-books on ECG and managing cardiac emergencies

Influenza A(H1N1)

2009-07-19T00:04:00.006+08:00

Picture above is linked from the Jabatan Perkhidmatan Haiwan Perak website. Great site! Informative. Click here.The Ministry of Health Malaysia has a new webpage just to address the issues of Influenza A(H1N1).Click here to access. URL: http://h1n1.moh.gov.my/Few salient points from the webpage regarding management during the mitigation phase:*Note: Mitigation phase of the Influenza A pandemic is

Ludwig's Angina

2009-07-18T19:04:00.012+08:00

This man came to the A&E with complaint of pain in the floor of the mouth, difficulty and painful swallowing as well as loss of voice. He had history of tooth extraction three days prior to the day of admission.On examination, there was a tender induration over the floor of the mouth; his voice was muffled; febrile with stable vital signs. Tonsils were injected.Working diagnosis: Ludwig's

Current Issues in Emergency Medicine - A Selected Update

2009-04-29T20:03:00.001+08:00

Current Issues In Emergency Medicine - A Selected UpdateView more presentations from cksheng74.

Tutorial in Basic ECG For Medical Students

2009-04-05T14:57:00.002+08:00

Tutorial in Basic ECG for Medical StudentsView more presentations from cksheng74.This is the lecture notes that I have been giving to the medical students (2nd, 3rd, final year) for the last two years (updated 2008)

Ethics in Resuscitation

2009-03-15T16:07:00.012+08:00

Ethics in ResuscitationView more presentations from cksheng74.Other Important Points Not Covered in the Lecture:The Concept of Patient Autonomy“Every human being of adult years and sound mind has the right to determine what shall be done with his own body, and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable”- Justice Cardozo in

Emergency Telephone Number 999 in Malaysia

2009-01-18T16:52:00.007+08:00

Many Malaysians would probably be aware that the Malaysian emergency telephone number has now been integrated to a single number, 999.Previously before October 2007,999 - Police and Ambulance994 - Fire Rescue991 - Civil Defence112 - Mobile phone dailingThe number one problem with the emergency and rescue telephone number is prank calls. Below is the statistics of prank calls in year 2006 before

Alveolar-arterial Partial Pressure Oxygen Gradient (A-a O2 gradient)

2009-01-12T11:56:00.009+08:00

Alveolar-arterial gradient (A-a gradient) is a measurement of the difference between the alveolar concentration of oxygen and the arterial concentration of oxygen.It can be used in diagnosing the source of hypoxemia.For example, in conditions of high altitude or hypoventilation in which the lung parenchyma is normal, the A-a gradient should be within normal limits.In contrast, in persons with

Peripheral signs of infective endocarditis

2008-11-01T09:59:00.006+08:00

I was recently asked by a student to explain on the pathogenesis of the peripheral signs of infective endocarditis.I don't think anyone could adequately explain the exact pathogenetic mechanisms of these signs - many of which, the exact mechanisms remain unclear.I found this particular article useful:http://turner-white.com/pdf/hp_may00_endocard.pdfAnd I have attempted to summarize the gist of

An Interesting Finding!

2008-09-16T00:37:00.004+08:00

I found this interesting study concerning the effects of smoking on the anti-platelet activity of clopidogrel and it was found that in smoker, the anti-platelet activities of clopidogrel is enhanced!! Reference:Bliden KP et al. The association of cigarette smoking with enhanced platelet inhibition by clopidogrel. J Am Coll Cardiol 2008 Aug 12; 52:531.The association of cigarette smoking with

Emergency Medicine Digest

2008-08-23T10:12:00.005+08:00

A new pneumonia severity assessment tool? SMART-COPExisting severity assessment tools, such as the pneumonia severity index (PSI) and CURB-65 (tool based on confusion, urea level, respiratory rate, blood pressure, and age >or=65 years), predict 30-day mortality in community-acquired pneumonia (CAP) and have limited ability to predict which patients will require intensive respiratory or

Use of Bedside Ultrasound in Emergency Department for Detection of Abdominal Aortic Aneurysm (AAA)

2008-08-22T22:20:00.008+08:00

Ultrasonography is a relatively easy to use, sensitive and specific bedside test in emergency department for the detection of AAA.The main disadvantage is that a leaking or ruptured aneurysm can be difficult to distinguish from an enlarged but non ruptured aneurysm.A leaking or ruptured AAA classically presents in patients- who are older than 60 years- have a history of hypertension- and

Emergency Medicine Digest

2008-07-26T18:41:00.004+08:00

1. Prolonged QTc in diabetic ketoacidosis in childrenQTc was shown to be prolonged in up to 47% of diabetic ketoacidosis in children and tend to resolves when the ketosis clears (only 13% still with prolonged QTc after recovery).Implication: Probably monitoring of QT interval in diabetic ketoacidosis in children can be used as a measure of the disease progression?Reference:Kuppermann N et al.

The changing trend of US Emergency Department (ED) visit (More Older Age Groups to the ED) - What about in Malaysia?

2008-07-26T17:05:00.009+08:00

A study based on the US National Hospital Ambulatory Medical Care Survey showed ED visits for patients aged 65 to 74 has increased 34% from 1993 to 2003.The authors conclude that if these trends continue, ED visits in US for this group (65-year to 74-year-old) could nearly double from 6.4 million visits to 11.7 million visits by 2013.Implication: As stated by Richard D. Zane in a commentary in