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Fulltext Surgical Challenges in Management of Transected Pancreatic Duct in Blunt Trauma

Fahmi I, Zailani M, Nik H

IIUM Medical Journal Malaysia, 2019;18(101):16-0.
MyJurnal

Isolated blunt pancreatic injury with ductal involvement is rare following a motor vehicle collision, but correlates with significant morbidity and mortality. We reported a15-year-old male who presented to emergency department after sustained motor vehicle collision. Post trauma, he appeared drowsy but hemodynamically stable. Abdominal examination was unremarkable but FAST scan was positive and he was subjected for CECT abdomen and showed pancreatic laceration at the body with suspicious of pancreatic ductinjury. He was planned for emergency exploratory laparotomy and intra-operatively noted pancreatic head laceration with transected pancreatic duct. The case proceeded with ligation of pancreatic duct cephalic stump, and distal pancreaticogastrostomy. Postoperatively, the patient recovered well and he was discharged home on day 6 post operatively. Upon follow up visit, he was asymptomatic with repeated ultrasonography of abdomen showed no evidence of intra-abdominal collection. Discussion: Pancreatic injuries with ductal disruption are of special significance. Apart from bleeding, the leak of enzyme rich of pancreatic juice incites vigorous inflammatory cascade that lead to catastrophic changes in patient metabolism and its sequelae including pancreatic necrosis, peripancreatic abscess, pseudocyst, enteric fistulae and organ failures. In a hemodynamically stable patient, CECT abdomen is the investigation of choice to detect pancreatic duct involvement. Pancreatic injury with ductal involvement require surgical management to prevent the complication of pancreatic enzyme leak. Non operative measure is found to be useful in selected patient. The criteria for non-operative group are stable hemodynamically, a controlled leak wall off like pseudocyst, absent associated injury or pancreatic necrosis. Non-operative strategy requires multidisciplinary involvement with excellent nutritional support, expert endoscopist and interventional radiologist.
A randomized controlled trial of patient-controlled analgesia compared with boluses of analgesia for the control of acute traumatic pain in the emergency department

Rahman NH, DeSilva T

J Emerg Med, 2012 Dec;43(6):951-7.
PMID: 23068783 DOI: 10.1016/j.jemermed.2012.02.069

The use of patient-controlled analgesia (PCA) has been reported to provide effective pain relief, often resulting in less opioid consumption, and is associated with greater patient satisfaction when it is compared to other techniques of analgesia delivery.
The use of propofol for procedural sedation and analgesia in the emergency department: a comparison with midazolam

Rahman NH, Hashim A

Emerg Med J, 2011 Oct;28(10):861-5.
PMID: 21098799 DOI: 10.1136/emj.2009.085019

This study aimed to determine the effectiveness of propofol as an alternative agent for procedural sedation and analgesia (PSA) in the emergency department (ED) and to make a comparison between two different sedative (propofol vs midazolam) drugs used in combination with fentanyl.
Doping in sports among Malaysian universities athlete: survey of the knowledge, beliefs, and perception during Malaysian universities games in Kuala Lumpur 2014

Jaafar Z, Wan Hamat NH

J Sports Med Phys Fitness, 2020 May;60(5):794-799.
PMID: 32037780 DOI: 10.23736/S0022-4707.20.09623-1

BACKGROUND: Doping in young athletes at present is on escalation. A few doping cases involving athletes from South East Asia (SEA) countries have been reported. The objective of this study is to determine current perceived doping and antidoping climate in Malaysia through an exploration of doping-related knowledge, perception and beliefs among the university athletes.
METHODS: A survey was conducted during the Malaysian Universities Games in Kuala Lumpur 2014. A total of 614 athletes completed the questionnaires on perception, specific knowledge, environment, behavior and beliefs towards doping.
RESULTS: From this survey, we found that their knowledge about doping and antidoping was poor, they have misguided beliefs and perception about doping, and their environment seems to be favorable for performance enhancing substances usage in the future. We grouped the athletes based on their doping's environment into ultraclean, potential and high-risk group; and the results showed that they have a significant relationship with their knowledge, beliefs and perception about doping in sports, P<0.001. About 1.5-1.8% of the studied athletes have positive behavior towards doping practice; doping use, χ2 =24.6(2) P<0.001 and doping willingness, χ2 =17.15(2) P<0.001.
CONCLUSIONS: Doping behavior and doping risks in this region are still under-studied. Hence, we recommended that every South East Asia countries would identify the potential risks of doping among their young athletes, and collectively collaborating in managing doping issues involving this region. Special attention should be given to doping environment as it has negative influences on athletes behavior towards doping.
Fulltext The use of end-tidal carbon dioxide monitoring in patients with hypotension in the emergency department

Kheng CP, Rahman NH

Int J Emerg Med, 2012;5(1):31.
PMID: 22828152 DOI: 10.1186/1865-1380-5-31

BACKGROUND: The aim of this study was to determine the usefulness of end tidal carbon dioxide (ETCO2) monitoring in hypotensive shock patients presenting to the ED.
METHODS: This was a prospective observational study in a tertiary ED. One hundred three adults in shock with hypotension presenting to the ED were recruited into the study. They were grouped according to different types of shock, hypovolemic, cardiogenic, septic and others. Vital signs and ETCO2 were measured on presentation and at 30-min intervals up to 120 min. Blood gases and serum lactate levels were obtained on arrival. All patients were managed according to standard protocols and treatment regimes. Patient survival up to hospital admission and at 30 days was recorded.
RESULTS: Mean ETCO2 for all patients on arrival was 29.07 ± 9.96 mmHg. Average ETCO2 for patients in hypovolemic, cardiogenic and septic shock was 29.64 ± 11.49, 28.60 ± 9.87 and 27.81 ± 7.39 mmHg, respectively. ETCO2 on arrival was positively correlated with systolic and diastolic BP, MAP, bicarbonate, base excess and lactate when analyzed in all shock patients. Early ETCO2 measurements were found to be significantly lower in patients who did not survive to hospital admission (p = 0.005). All patients who had ETCO2 ≤ 12mmHg died in the ED. However, normal ETCO2 does not ensure patient survival.
CONCLUSION: The use of ETCO2 in the ED has great potential to be used as a method of non-invasive monitoring of patients in shock.
Study site: Emergency department, Hospital Universiti Sains Malaysia
Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study

Tanaka H, Ong MEH, Siddiqui FJ, Ma MHM, Kaneko H, Lee KW, et al.

Ann Emerg Med, 2018 05;71(5):608-617.e15.
PMID: 28985969 DOI: 10.1016/j.annemergmed.2017.07.484

STUDY OBJECTIVE: The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai).
METHODS: This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community.
RESULTS: Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95% CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95% CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95% CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival.
CONCLUSION: In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation.