Low Tidal Volume Ventilation Should be the Routine Ventilation Strategy of Choice for All Emergency Department Patients

http://www.mdconsult.com/das/article/body/354288136-3/jorg=journal&source=&sp=25474944&sid=1346999426/N/1091883/1.html?issn=0196-0644

ED = Exhausted Doctor

 
An interesting article to read. click here

CAUSES OF UNEQUAL & PINPOINT PUPILS IN ED

MNEMONIC 'HANTU' (UNEQUAL)


H-HORNER'S SYNDROME/HEAD INJURY
A-ANEURYSM OF POSTERIOR COM A.
N- NORMAL VARIANT (20-25% OF POPULATION)
T- TRAUMATIC MYDRIASIS
U-USED OF MYDRIATIC AGENT

MNEMONIC 'PONTINE' (PINPOINT PUPILS)

P-Pontine Hemorrhage / Phenothiazine / Pilocarpine
O- Organophosphorus poisoning / Opiod poisoning
N-Neostigmine Poisoning
T-Transient
I-Iritis
N-Narcotics drugs e.g. Morphine
E-Elevated temperature / Eye- Horner's syndrome

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

MNEMONIC FOR PRIMARY SURVEY DURING TRAUMA

During Primary Survey, we need to detect the life threatening condition, so call "LETHAL SIX". These life threatening conditions are "clinical diagnosis" and require prompt management by managing team.Mnemonic ATOMFC.

1. A - AIRWAY OBSTRUCTION
2. T- TENSION PNEUMOTHORAX
• present of pneumothorax with hemodynamically unstable
3. O-OPEN PNEUMOTHORAX
• the chest wound size should be 2/3 of trachea diameter size. Air will travel into path thaht less resistance.
4. M-MASSIVE HEMOTHORAX
• the amount of blood 1.5 liter during initial chest tube insertion or 200mls/h
• significant to refer cardiothoracic urgently
5. F- FLAIL CHEST
• paradoxical breathing. 3 or more ribs fracture with two points fracture each rib
6. C-CARDIAC TAMPONADE
• becks' triad but neither sensitive or specific 

An eight-year review of blood culture and susceptibility among sepsis cases in an emergency department in Northeastern Malaysia

A detailed understanding of the pathogens common to a region, including their respective antimicrobial sensitivity patterns, is extremely important for the proper management of sepsis cases by ED personnel. Our results indicate there is a growing trend among Gram-negative species encountered in the ED of increased antimicrobial resistance, particularly to those agents regularly used in an outpatient setting. Read more..

Resuscitation Not Only Science but Politics & Business

Experts of the International Liaison Committee on Resuscitation (ILCOR) have thoroughly reviewed the literature for new evidence and classified the studies according to predefined levels of evidence. That resulted in the ILCOR Consensus on Science and Treatment Recommendations (CoSTR) simultaneously published in North America1 and Europe2 and forms the scientific basis for the new guidelines published in October 2010. Resuscitation training is not only science but to a considerable extent also politics and business. Especially in Europe but also elsewhere European Resuscitation Council (ERC) and American Heart Association (AHA) training programs are in direct competition. This article compares how AHA and ERC interpret the ILCOR treatment recommendations for Basic Life Support (BLS) and Advanced Life Support (ALS) in adults and kids.Read more....

Salam Ramadhan 1433H

Salam Ramadhan & Good day to everybody...

Still not to late for me to wish all of you happy Ramadhan kareem 1433H. Hopefully this Ramadhan bring us happiness and guidance from Allah SWT and the most important is "maghfirah" from Him. It was a long time for me not updated my blog because of few reasons. But now insyaAllah i will try my best to share with all of you about life & emergency especially to my students undergraduates and also postgraduates. Hopefully this blog will benefit all of us.

The Use of Dental Drill in Removing Entrapped Finger by Metal Ring in Emergency Department

For several years many techniques have been described in the literature for the removal of a tight ring3. Most clinicians use the non-destructive methods such as the application of suture, glove, rubber band, nylon tape, ribbon gauze, and paper clips to remove the stuck ring. Usually the destructive method of removal will be reserved as the last resort. High speed dental handpiece drill offered an option to physician when encounter such difficult case during emergency situation. Click here for details