Warfarin is an anticoagulant that is commonly used as thrombo-prophylaxis in patients at risk of thrombo-embolic events. However, the use of warfarin is known to cause hemorrhage due to its anticoagulation effect. Although the common sites of hemorrhage are gastrointestinal and genitourinary tract, it can also occur in the least expected location. We report a rare case of spinal cord compression secondary to intraspinal epidural hematoma as a result of overwarfarinization in a patient who had undergone liver transplant. The patient underwent emergency decompression laminectomy of spinal cord and hematoma evacuation after the reversal of overwarfarinization to normal levels.
Altered mental status in the setting of polytrauma poses a challenge to the emergency team managing the patient. The tendency to miss positive findings in these circumstances increases several folds due to multiple factors such as depressed mental status/intoxication, presence of distracting injuries and concurrent life-threatening injuries that require more urgent attention. In view of this, NEXUS (National Emergency X-Radiography Utilization Study) criteria of clearing the cervical spine was adopted and used worldwide. Consensus on clearance of the other parts of spine is still lacking. This case reports highlights the findings in a 18-yrs-old male who presented with altered mental status, facial pain and abrasion, following a motor vehicle accident. Facial bone fracture was diagnosed and he was discharged. Three days later, he came with severe epigastric pain. Tenderness on palpation was noted at the spine and Computed Tomography (CT) scan was done. Multiple thoracic vertebra fractures were seen. As a conclusion, thorough primary and secondary survey should be done in patients who have regained full consciousness prior to discharge in order to avoid overlooking other serious injuries.
Keywords: altered, CT scan, fracture, mental status, thoracic vertebra
Infective endocarditis (IE) is a potentially life-threatening disease which carries high risk of morbidity and mortality. The variability of clinical presentation of infective IE remains a diagnostic challenge for the Emergency Physicians. The clinical manifestation may present as an acute, rapidly progressive infection with the absence of classical immunological vascular phenomenon or as subacute or chronic disease with vague constitutional symptoms that may mislead initial assessment and mimic other conditions. Symptoms may also manifest as a result of systemic embolization which can be catastrophic and life-threatening especially if it ends up in the cerebral circulation. IE complicated by cerebral mycotic aneurysm (CMA) is the worst neurological sequalae and can be misdiagnosed as a primary intracranial infection such as meningoencephalitis. Here, we report a case of neurological emergency secondary to systemic embolization of IE with a devastating diagnosis of CMA. History of prolonged fever associated with headache and focal neurological deficit led to the initial diagnosis of meningoencephalitis due to a low clinical suspicion of the disease in the Emergency Department. In emergency setting, a combination of high degree of clinical suspicion together with thorough history, physical examination and diagnostic imaging are crucial in order to guide and establish the diagnosis of this potentially devastating disease. Early recognition and initiation of aggressive treatment is crucial to provide better prognosis and higher survival rate for patients with CMA.
Bystander rate of cardiopulmonary resuscitation (CPR) is still low worldwide because of inadequate skills and knowledge. Training the public on CPR is one of the methods to increase the bystander CPR rate. This study aimed to compare the efficacy in acquiring and retaining CPR skills and knowledge among secondary school students in Klang Valley trained by school teachers and medical students. We recruited five school teachers and five medical students as trainers. They were trained in several sessions by American Heart Association (AHA)-certified instructors using the video-assisted CPR training module. The recipients were 44 secondary school students divided between the teacher’s group and the medical student’s group. We compared knowledge and psychomotor skills between these two groups prior, immediately after and at three months after CPR training. Students in the teacher’s group showed a higher increase in knowledge comparable to the medical student’s group (median score difference 3 vs 2, p>0.05) and in psychomotor skill (median score difference 5 vs. 7, p
Pendidikan kemahiran resusitasi kardiopulmonari (CPR) kepada orang awam sangat penting dalam merendahkan kadar kematian serangan jantung. American Heart Association mencadangkan kemahiran tersebut harus dimasukkan ke dalam kurikulum sekolah. Pelatih rakan sebaya adalah kaedah yang berkos rendah dan berkesan dalam mencapai objektif ini. Objektif kajian terkawal 3 bulan ini adalah untuk membandingkan keberkesanan pengajaran kompresi CPR antara rakan sebaya dan jurulatih Basic Life Support (BLS) kepada pelajar sekolah menengah. Peningkatan pengetahuan dan kemahiran psikomotor pemampatan CPR adalah hasil utama yang dinilai. Dua belas pelatih rakan sebaya berusia 16 tahun dan dua belas pelatih BLS telah direkrut dalam kajian ini. Kompresi CPR diajarkan kepada 36 pelajar sekolah menengah secara rawak oleh pelatih rakan sebaya (Kumpulan P) atau pelatih BLS (Kumpulan B). Pra-ujian, pasca ujian serta ujian pengekalan 3 bulan mengenai pengetahuan dan kemahiran psikomotor telah dijalankan. Tidak terdapat perbezaan yang signifikan secara statistik dalam skor min pengetahuan dan psikomotor pada pra-ujian, pasca ujian serta ujian pengekalan 3 bulan antara Kumpulan P dan Kumpulan B. Terdapat peningkatan skor pengetahuan yang signifikan antara pra-ujian dan pasca ujian dalam Kumpulan P (perbezaan min 5.8+2.7, p