Table of Contents
Association Between Assessment And Missed Pain Treatment Among Patients With Headache Pain Presenting To The Emergency Department
Gurjeet Singh, Ariff Arithra
Pain assessment and management has been widely practiced in emergency departments all over the world. As proper pain management is directly related to improvement in patient satisfaction, health care officers have to be effective in dealing with pain related chief complaints daily. A common chief complaint of patients presenting to the emergency departments all over the world including Malaysia is headache. The aim of this study is to determine the missed pain assessment and management of headache at the Emergency Department (ED) in Hospital Universiti Sains Malaysia and the factors that were influencing them. The factors associated with missed pain assessment and treatment among patients with headache presenting to the emergency department were investigated. A cross sectional retrospective observational study was performed from December 2017 to May 2018 among all patients presenting with headache to the emergency department of Hospital University Sains Malaysia (HUSM). A total of 94 patients were enrolled in this study and 77 patients met the inclusion criteria. There was a statistically significant association (p-value<0.05) between pain reassessment and triage zone (x2 =6.858) and patient’s arrival time (x2 =5.773). A significant association (p-value<0.05) between missed pain treatment and triage zone, and patient’s arrival time was noted. The chi square value (x2) for triage zone and patient arrival were 7.428 and 4.807 respectively. Whereas, there was no significant association between pain treatment and attending physician. Triage zone and arrival time of patients are the factors influencing missed assessment and management of pain among patients with headache presenting to ED. A proper action plan and more intervention studies are warranted in order to overcome the above mentioned issues and optimize pain management for headache.
Bleeding Battle In Soft Tissue Sarcoma Surgery: A Review Of Perioperative Considerations And Management
Eyrique G., Paul AG and Looi C
Bleeding is a common expected complication during surgery, but more so in advanced sarcoma resection surgery owing to the tumour’s angiogenesis. As surgery is potentially curative for primary nonmetastatic extremity soft tissue sarcoma – hence surgery is necessitated. In this case, we have a patient with significant bleeding intraoperatively requiring several methods and techniques to control the hemorrhage. The management of bleeding involves multiple assessment and strategies to ensure appropriate care for the patients. The management is perioperative involving all stages: preoperative risk identification and optimization to intraoperative surgical options and techniques to postoperative care. The objective of this review is to establish a guideline on factors and options that surgeons should to be aware, going into surgery from preoperative to postoperative management when bleeding ensues. Latest updates and recent evidence help ensure improved clinical management for sarcoma patients undergoing surgery.
A Rare Case Of Myelomatous Pleural Effusion
Chelvam Rajesvaran, Noor Laili Mokhtar, Nadira Shahrul Baharin, Leong Tze Shin
Myelomatous pleural effusion is a rare cause of pleural effusion in patients with multiple myeloma, with an incidence rate of 1-2%. The diagnosis is best appreciated on cytological examination. Visualisation of atypical and immature plasma cells in large numbers in the pleural fluid is characteristic, however may be easily missed in smears. We reported a case of a 61 years old gentleman of Malay ethnicity, with underlying refractory multiple myeloma, presented with worsening shortness of breath and found to have a left-sided pleural effusion. Pleural fluid from pleural tapping procedure was submitted for cytological examination. The pleural fluid showed singly scattered atypical plasmacytoid cells in close admixture with mesothelial cells and lymphocytes, which were more apparent on the cell block. Immunohistochemically, the plasmacytoid cells were positive for CD138 while scattered cells consistent with mesothelial cells were positive for calretinin. The patient was diagnosed with a myelomatous pleural effusion. The rarity of this finding and use of cell block to enhance the detection of the cells is highlighted.
Overweight And Obesity Leads To Dental Problems: A Mini Review
Teeth are a much neglected part of most people. They care for their whole body except teeth. In this regard, they suffer many dental problems, especially in their mixed dentition stages. After checking the teeth of the students of a Cantonment School of Bangladesh with a registered physician and medical assistant, the result showed many teeth-related problems as well as the dental cavity. In addition, their feeding habit and the education of their parents at home were observed. Proper knowledge of health, food habit and exercise should be increased in most families.
Waiting Times For Covid-19 Patients In The Emergency Department During The Pandemic: Experience From A Single Center In Malaysia.
Gurjeet Singh and Mohamed Alwi Bin Hj Abdul Rahman
Patients presenting to the emergency departments who turn out to be COVID-19 positive long length of stay is associated with more exposure to health care staff and other patients. The objective of this study was to use routinely collected daily data of patients to add to the literature on long waiting times of COVID-19 positive patients in the emergency department. An observational study and case series study was performed for a period of time observing patients presenting to the ED who turn out to be COVID-19 positive, time of exposure and waiting time for admission. The results showed that mean time of a COVID-19 patient’s stay in the emergency department is 13.88 hours. These results show that the patients waiting time for the results of COVID-19 test and waiting time for admission to the wards is long and thus poses high risk of exposure to the health care workers in the emergency department and neighboring patients in the ED.