Monday, December 30, 2013

Hematocolpos mimicking acute urinary retention in Emergency Department

Lower abdominal pain with lower urinary tracts symptoms in young girls presented to Emergency
Department (ED) is urinary tract infection (UTI) until proven otherwise. We reported a case of classic UTI
presentation with unusual finding of hematocolpos. We believed the unusual circumstance of this case is
likely to be repeated in some other clinical practice and such differential diagnoses should be considered. click here

Monday, December 23, 2013

Subtalar Dislocation Reduction with Regional Block in Emergency Department

Pain is one of the common presentation in ED. It is a stressful event and has an impact psychologically and  emotionally. It is important for the ED physician to control the pain first before asking further question. I'd still remember one of the lecturer always quote the word ' give me morphine, then we talk' when dealing with patient in pain. There are many methods available nowadays to control the pain in ED, one of that is regional block. The knowledge of regional block is very useful. We can help alleviate the patient pain while doing a procedure.This case report shows one of the technique using regional here

Wednesday, June 12, 2013


Assalamualaikum & Dear all..

It has been a long time not updating my blog, and I think it's almost 6 months. Not to say I'm busy, but rather common excuse used by others. In this post I would like to share about NIV[noninvasive ventilation] in ED.Some students still confuse about the terminology and setting used in NIV. For example, CPAP [continuous positive airway pressure] which is class 1 evidence in APO. Some ventilator already has CPAP mode, but some don't.Actually you can use BPAP mode to become CPAP. We understand that, in BPAP there will be IPAP,EPAP and RATE, if you put IPAP=0,RATE=0 [spontaneous mode] and you set EPAP=10, it's automatically become CPAP.Hope this can clear the cloud in our minds...Cheers

Sunday, August 26, 2012

ED = Exhausted Doctor

An interesting article to read. click here

Sunday, August 12, 2012





P-Pontine Hemorrhage / Phenothiazine / Pilocarpine
O- Organophosphorus poisoning / Opiod poisoning
N-Neostigmine Poisoning
N-Narcotics drugs e.g. Morphine
E-Elevated temperature / Eye- Horner's syndrome

Wednesday, August 8, 2012

A Twist in The Tale of A Body Packer: Some Lessons Learned

Patient who is a drug trafficker can present to emergency department as a variety presentation ranging from acute abdomen to abnormal behavior. A high index of suspicion is the only clue to diagnosed drug trafficker. A 21-year-old oversea female with no known medical illness, was brought in by police officer to the ED of Hospital XX after receiving a public complaint of displaying indecent behavior in the public. Further history from the police reveals that she was naked in the Chow Kit area and behaving aggressively. 
On examination, she looked calm with no aggressive behavior. She was talking coherently, and she complained of mild colicky abdominal pain. Denying of behaving abnormally as well as denying of taking any substance abuse, she said that she had just arrived in Kuala Lumpur by flight yesterday. Otherwise, her physical examination was uneventful and her vital signs were normal. Urine for amphetamine was positive and abdominal radiograph showed multiple oval to elongated radioopaque foreign bodies in the small and large bowels (Figure 1). Upon probing further, she admitted to swallowing 80 packets of amphetamine for transportation (Figure 2). The diagnosis of drug body packing with concomitant substance abuse was made. She was to the ED observation ward for 5 days, during which, a total of 60 packets of amphetamine were passed out after using adequate laxatives. She was discharged well back to the police custody on day 5 after admission.

In the ED, cases of missed diagnosis of body packing may occur due to hectic activities, lack of manpower as well as lack of experience, especially among junior doctors. Therefore, it is vitally important for junior doctors to be aware of the clinical manifestations of body packer syndrome so that early recognition and diagnosis can be made. Recent increase in the number of drug trafficking in the United States and around the world have led to increase security measures beefed up at national borders. This leads to increasing cases of drug smugglers using children as couriers, including using them as "body packers".

In conclusion, doctors may miss this type of gastrointestinal foreign body if they are not aware of the “body packer syndrome”. Body packing should be suspected in anyone with signs of drug-induced toxic following recent arrival at city terminals or when there is denial of recent history of recreational drug use.

                                                                       FIGURE 1
                                                                       FIGURE 2