BackgroundAirway management is an important part of the management of the critically ill and injured patients in the Emergency Department (ED). Numerous studies from developed countries have demonstrated the competency of emergency doctors in intubation. To date there have been no published data on intubations performed in EDs in Malaysia.MethodsData on intubations from 7 August 2007 till 28 August 2008 were prospectively collected.ResultsThere were 228 intubations included in the study period. Cardiopulmonary arrest was the main indication for intubation (35.5%). The other indications were head injury (18.4%), respiratory failure (15.4%), polytrauma (9.6%) and cerebrovascular accident (7.0%). All of the 228 patients were successfully intubated. Rapid sequence intubation (RSI) was the most frequent method (49.6%) of intubation. A total of 223 (97.8%) intubations were done by ED personnel. In 79.8% of the cases, intubations were successfully performed on the first attempt. Midazolam was the most common induction agent used (97 patients), while suxamethonium was the muscle relaxant of choice (109 patients). There were 34 patients (14.9%) with 38 reported immediate complications. The most common complication was oesophageal intubation.ConclusionEmergency Department UKMMC personnel have a high competency level in intubation with an acceptable complication rate. RSI was the most common method for intubation.
Background/aim: Regional anesthesia for surgery is associated with increased anxiety for patients. This study aimed to compare the effect of propofol and dexmedetomidine infusion on perioperative anxiety during regional anesthesia.Materials and methods: Eighty-four patients were randomly divided into two groups receiving either study drug infusion. Anxiety score, level of sedation using the Bispectral Index and Observer's Assessment of Alertness and Sedation, hemodynamic stability, and overall patient's feedback on anxiolysis were assessed.Results: Both groups showed a significant drop in mean anxiety score at 10 and 30 min after starting surgery. Difference in median anxiety scores showed a significant reduction in anxiety score at the end of the surgery in the dexmedetomidine group compared to the propofol group. Dexmedetomidine and propofol showed a significant drop in mean arterial pressure in the first 30 min and first 10 min respectively. Both drugs demonstrated a significant drop in heart rate in the first 20 min from baseline after starting the drug infusion. Patients in the dexmedetomidine group (76.20%) expressed statistically excellent feedback on anxiolysis compared to patients in the propofol group (45.20%). Conclusion:Dexmedetomidine infusion was found to significantly reduce anxiety levels at the end of surgery compared to propofol during regional anesthesia.
Ludwig Angina' adalah penyakit yang merbahaya. Sekiranya penyakit tersebut tidak dikesan dari peringkat awal ataupun dirawat, kadar kematian adalah sebanyak 50%. Kami ingin memaparkan satu kes klinikal yang melibatkan seorang pesakit lelaki yang berumur 43 tahun yang mempunyai simptom dan tanda-tanda 'Ludwig angina' selama dua hari. Beliau telah menjalani prosedur cabutan gigi sebelum itu. Walaupun pesakit menunjukkan simptom dan tanda-tanda yang klasik untuk 'Ludwig angina', diagnosa tersebut tidak dapat dikesan pada rawatan yang pertama. Penyakit 'Ludwig angina' hanya boleh dikesan sekiranya doktor mempunyai indeks kecurigaan yang tinggi terhadap penyakit tersebut. Penangguhan dalam pengesanan penyakit tersebut akan menyebabkan saluran pernafasan tersumbat kerana kebengkakan pada saluran pernafasan.
Introduction: The study’s objective was to validate a Malay language translated questionnaire on end-of-life care to be used among nurses practicing in critical care areas. Methods: The English language questionnaire underwent forward and backward translations by four experts. The translated Malay language questionnaire was pilot tested on 30 subjects and revised accordingly. The validation of the revised questionnaire was carried out on 250 nurses. The reliability of the translated questionnaire was checked. Cronbach alpha value of at least 0.70 suggests adequate internal consistency. The validity of the questionnaire was explored using Confirmatory Factor Analysis (CFA) and model fit tests were run to achieve fit test specific cut off values. The CFAs were run repeatedly with iterative item reductions until acceptable goodness of fit for the model was achieved. Results: All domains of the translated questionnaire showed reasonable to excellent reliability (Cronbach Alpha 0.687 to 0.922). Multiple CFAs were run and 13 out of 46 items were excluded, and the final model fit improved substantially with the indices were within the acceptable threshold of good or reasonably fit, cut off values are in brackets [Chi-Square statistics 1.635 (≤ 2.0), Root Mean Square Error of Approximation 0.050 (< 0.05), Standardised Root Mean Square Residual 0.059 (≤ 0.08), Comparative Fit Index 0.911 (0.90-0.94), Tucker Lewis Index 0.900 (0.90-0.94), Akaike Information Criteria 13024, Bayesian Information Criteria 13334]. Conclusion: The psychometric properties of the final model indicated the Malay language translated questionnaire is reliable and valid to investigate nurses’ perspective and involvement in end-of-life care.
INTRODUCTION: Laryngoscopy and endotracheal intubation is known to cause tachycardia and increase in blood pressure during general anaesthesia. This study was designed to assess if auricular acupressure has beneficial effects in attenuating the haemodynamic changes during laryngoscopy and intubation. Secondly, this study aimed to evaluate the effectiveness of auricular acupressure in reducing preoperative anxiety. MATERIALS AND METHODS: Eighty patients who were scheduled for surgery under general anaesthesia were randomised to receive either active auricular acupressure over bilateral Shen Men (Group A) or sham auricular acupressure (Group B). A total of three stimulations of auricular acupressure with ten minutes interval were performed before induction of anaesthesia. Haemodynamic parameters (heart rate and blood pressure) were recorded ten minutes after each stimulation, during laryngoscopy and intubation and every minute for ten minutes after intubation. Visual analogue scale for anxiety was documented before and at 30 minutes post first stimulation. RESULTS: The heart rate and mean arterial pressure were statistically higher in Group B comparing to Group A during intubation (p=0.043 and p=0.049 respectively). There was statistically significant reduction in blood pressure after intubation in both groups as compared to baseline (p<0.003 respectively). However, there was no significant difference when comparing both groups (p>0.05). There was no significant reduction of preoperative anxiety level in both groups after auricular acupressure (p=0.879). CONCLUSION: Auricular acupressure over bilateral Shen Men helped to attenuate the haemodynamic changes during intubation. However, it did not reduce preoperative anxiety.
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