ABSTRACT
@#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<0.05). The level of knowledge and skills decreased after 3 months but remained significantly higher than at baseline for both groups. In conclusion, teachers could provide CPR training to their students as effective and retainable as medical students. This study aims to create an opportunity to teach CPR to the public in a larger scale.
ABSTRACT
Hemichorea-hemiballismus (HC-HB) is a movement disorder characterized by involuntary movements involving limbs on one side of the body. Many etiological factors were identified and these included stroke, infection, and neoplasm. However, acute hyperglycemia-induced HC-HB is less well known. We present two cases of non-ketotic hyperglycemia-induced HC-HB. The cases depicted here Illustrate that HC-HB can be the sole presentation from among a variety of neurological manifestations of poorly controlled diabetes which can be easily reversed when hyperglycemia is corrected.
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The Morel-Lavallee lesion is a rare soft tissue injury that occurs due to traumatic shearing force on skin surface causing separation of skin and subcutaneous tissue resulting in hematoma. This case report depicts a 22-year-old gentleman who was involved in a motor vehicle accident. He complained of pain and swelling over lower back. He was treated for soft tissue injury and admitted for pain control. One day post-trauma, he complained of increased swelling over the back. His hemoglobin dropped from 12.2g/dL to 10.7g/dL. Diagnosis of Morel-Lavallae lesion was made. Initially no surgical intervention was planned. However, in view of worsening of swelling, bedside aspiration was performed and subsequently a pigtail catheter was inserted to drain the hematoma. In total, 2.05 litre of liquefied hematoma was drained. Thus, Morel-Lavallee lesion is an uncommon soft tissue injury that can cause significant bleeding following trauma.
ABSTRACT
Mild hyperkalaemia does not typically cause cardiac symptoms. However, for an elderly patient on atrio-ventricular (AV) nodal blocker, even mild hyperkalaemia may result in disastrous outcome. We report a case of persistent bradyarrythmia caused by iatrogenic hyperkalaemia in a patient who had concomitant use of AV nodal medication. An 81-year-old lady with multiple comorbidities and a long list of medications presented with symptomatic bradyarrhythmia. She, in fact, had two AV nodal blockers in her prescription, a beta-blocker and amiodarone. Her potassium level was found to be mildly elevated due to acute renal failure. She remained bradycardic despite initial treatment and was subsequently dependant on intravenous isoproterenol until her renal function improved. This case highlights the different threshold for manifestation of hyperkalaemic symptoms in a growing group of patients: elderly patients with multiple comorbidities and polypharmacy.
ABSTRACT
Open tracheal injury is rare but can lead to disastrous consequences such as massive bleeding, airway obstruction or failure and aspiration of blood. We present a case of open tracheal injury of a man who tried to attempt suicide using a knife. In this case, the initial management was securing the airway by attempting orotracheal intubation. However, it was unsuccessful when the tube came out from the laceration wound. Intubation was then re-attempted through the distal cut-end of the trachea in the face of airway failure. A quick initial assessment and anticipation of a failed airway should always be the top priority in any emergency physician managing these cases. Direct intubation through the laceration wound might be the only option when all else fail and your patient is crashing.
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Stridor in infants with subglottic cyst is rare. Mismanagement of such cases may lead to respiratory compromise with a potentially serious and fatal outcome. The diversity of the clinical presentations throws a great challenge in the diagnosis of subglottic cysts. Manifestations vary as they depend on the size and location of the cysts. We report the case of a 6-month-old girl who had a subglottic cyst but managed as moderate croup till she developed worsening respiratory acidosis which difficult intubation. Any case of premature infants with previous history of neonatal intubation presenting with stridor should prompt clinicians to look for possible cysts in the larynx. This is important because once the diagnosis is made,appropriate treatment may be given and unnecessary morbidity and mortality may be avoided.
Subject(s)
Intubation, IntratrachealABSTRACT
Cardiac concussion is a sudden, direct blunt trauma cause to the chest which led to death. However, there are patients who did not completely fulfil this definition. We report two cases which did not fit into the definition domain. Two male patients presented to Emergency Department with moderate anterior chest pain after motor vehicle crash showed transient anterior ST segment elevation at chest lead V2 and V3 with raised creatine kinase and normal troponin T. The electrocardiogram changes fully resolved after 24 hours. Both patients were discharged uneventfully after 24 hours monitoring in Emergency Department short-stay ward. Conventional definition of cardiac concussion (commotion cordis) and cardiac contusion may be unsuitable to describe these cases. Therefore, we propose the diagnosis of focal cardiac concussion. We also highlighted the ability of Emergency Department to manage these patients in short-stay ward.
Subject(s)
Commotio CordisABSTRACT
Sepsis causes high mortality and morbidity. Static lactate concentration and early lactate clearance are cited to be a predictor for sepsis survival. This study examined the clinical utility of static lactate concentration and early lactate clearance within the first six hours of admission in Emergency Department (ED) to predict 28-day mortality rate in sepsis patients. Patients who presented with sepsis, severe sepsis or septic shock and admitted to ED of Universiti Kebangsaan Malaysia Medical Centre were recruited. Blood lactate concentrations were measured upon admission (H0), at 1st hour (H1) and 6th hour (H6), respectively. Either standard treatment of sepsis or early goal directed therapy was initiated according to sepsis severity. A follow-up report was conducted at 28 days via telephone call, e-mail or case notes. Patients were later classified into survivor and non-survivor as final outcome. Static lactate concentration appeared to be significantly higher for non-survivor as compared to the survival group at H0, H1 and H6 (p<0.05). The lactate clearance trend reflects no relationship between early lactate clearance and 28-day mortality. Static lactate concentration showed a superior predictor for sepsis over early lactate clearance. Although early lactate clearance was unable to prove its ability to predict 28-day mortality, our findings suggest it can be a useful tool to gauge the resuscitation outcome.
Subject(s)
SepsisABSTRACT
The nu(12) band of trans-d(2)-ethylene (trans-C(2)H(2)D(2)) has been recorded with an unapodized resolution of 0.0024 cm(-1) in the frequency range of 1240-1360 cm(-1) by Fourier transform infrared (FTIR) spectroscopy. This band was found to be relatively free from any local frequency perturbations. By fitting a total of 1185 infrared transitions of nu(12) with a standard deviation of 0.00043 cm(-1) using a Watson's A-reduced Hamiltonian in the I(r) representation, a set of accurate rovibrational constants for v(12) = 1 state was derived. The nu(12) band is A type with a band center at 1298.03797 +/- 0.00004 cm(-1). Copyright 2000 Academic Press.
ABSTRACT
The infrared spectrum of the nu(12) fundamental band of ethylene (C(2)H(4)) has been measured with an unapodized resolution of 0.004 cm(-1) in the frequency range of 1380-1500 cm(-1) using the Fourier transform technique. By assigning and fitting a total of 1387 infrared transitions using a Watson's A-reduced Hamiltonian in the I(r) representation, rovibrational constants for the upper state (v(12) = 1) up to five quartic and three sextic centrifugal distortions terms were derived. They represent the most accurate constants for the band so far. The rms deviation of the fit was 0.00033 cm(-1). The A-type nu(12) band with a band center at 1442.44299 +/- 0.00003 cm(-1) was found to be relatively free from local frequency perturbations. The inertial defect Delta(12) was found to be 0.24201 +/- 0.00002 u Å(2). Copyright 2000 Academic Press.
ABSTRACT
The Fourier transform infrared (FTIR) spectrum of the nu(6) band of formic acid (HCOOH) has been recorded with a resolution of 0.0024 cm(-1) in the spectral range 1050-1160 cm(-1). The nu(6) band was found to be strongly perturbed by the nearby nu(8) band centered at about 1033.5 cm(-1). Using a Watson's A-reduced Hamiltonian in the I(r) representation, and with the inclusion of a-type Coriolis coupling constant, a simultaneous fit of nu(6) and nu(8) was performed. A total of 2485 infrared transitions including about 700 perturbed transitions of nu(6) and 19 transitions of nu(8) was fitted with an rms uncertainty of 0.0006 cm(-1). Accurate rovibrational constants up to sextic order for both nu(6) and nu(8) were obtained. The nu(6) band was analyzed to be a type AB hybrid with a band center at 1104.852109 +/- 0.000050 cm(-1). The band center for nu(8) was found to be 1033.4647 +/- 0.0021 cm(-1). Copyright 2000 Academic Press.
ABSTRACT
The spectrum of the nu(9) fundamental band of ethylene-d(4) (C(2)D(4)) has been measured with an unapodized resolution of 0.004 cm(-1) in the frequency range of 2300-2400 cm(-1) using a Fourier transform infrared spectrometer. A total of 549 transitions have been assigned and fitted using a Watson's A-reduced Hamiltonian in the I(r) representation to derive rovibrational constants for the upper state (v(9) = 1) up to five quartic terms with a standard deviation of 0.00087 cm(-1). They represent the most accurate rovibrational constants for the nu(9) band so far. About 30 transitions of K(a)(') = 0, one transition of nu(9) which were identified to be perturbed possibly by the nearby nu(11) and nu(2) + nu(12) transitions, were not included in the final fit. The nu(9) band of C(2)D(4) was found to be basically B-type with an unperturbed band center at 2341.836 94 +/- 0.000 13 cm(-1). Copyright 2000 Academic Press.
ABSTRACT
The infrared spectrum of the nu(7) and nu(9) bands of methylene fluoride-d(2) (CD(2)F(2)) has been recorded with an unapodized resolution of 0.0024 cm(-1) in the frequency range of 940-1030 cm(-1) using the Fourier transform technique. A weak b-type Coriolis interaction term was found to couple these two vibrational states with band centers about 42 cm(-1) apart. By fitting a total of 1031 infrared transitions of both nu(7) and nu(9) with a standard deviation of 0.0011 cm(-1) using a Watson's A-reduced Hamiltonian in the I(r) representation with the inclusion of a b-type Coriolis resonance term, two sets of rovibrational constants for nu(7) = 1 and nu(9) = 1 states up to sextic order were derived. The nu(7) band is C type, while the nu(9) band is A type with band centers at 961.8958 +/- 0.0005 and 1003.7421 +/- 0.0001 cm(-1), respectively. Copyright 2000 Academic Press.
ABSTRACT
Fourier transform infrared spectra of the nu(1) bands of DO(79)Br and DO(81)Br have been recorded with a resolution of 0.0055 cm(-1) in the frequency range of 2510-2800 cm(-1). A total of 1901 lines of the A/B hybrid-type bands of both isotopic species have been assigned and fitted to upper state rovibrational constants employing a Watson's S-reduced Hamiltonian up to sextic terms. The K(a) >/= 4 subband transitions were found to be perturbed and were not included in the fit. The unperturbed band centers for nu(1) of DO(79)Br and DO(81)Br are 2668.79211 +/- 0.00006 and 2668.78842 +/- 0.00005 cm(-1), respectively. The ratio of the vibrational dipole transition moments (µ(a):µ(b)) was found to be 1.30 +/- 0.04 for the band. Copyright 2000 Academic Press.
ABSTRACT
The Fourier transform infrared spectrum of the nu(6) and 2nu(9) bands of deuterated formic acid (HCOOD) was recorded with an apodized resolution of 0.004 cm(-1) in the frequency range of 930-1040 cm(-1). These two bands with band centers 40 cm(-1) apart were mutually coupled by Coriolis and Fermi interactions. By fitting a total of 1076 infrared transitions of both nu(6) and 2nu(9) with a standard deviation of 0.00075 cm(-1) using a Watson's A-reduced Hamiltonian in the I(r) representation with the inclusion of c-type Coriolis and a Fermi-resonance term, two sets of rovibrational constants for v(6) = 1, and v(9) = 2 states were derived for the first time. Both nu(6) and 2nu(9) bands are A type with band centers at 972.8520 +/- 0.0001 and 1011.6766 +/- 0.0001 cm(-1), respectively. Copyright 1999 Academic Press.
ABSTRACT
The infrared absorption spectrum of the nu(2) band of deuterated formic acid (DCOOH) was recorded using a Bomem DA3.002 Fourier transform spectrometer in the wavenumber region 2130-2300 cm(-1) with an apodized resolution of 0.004 cm(-1). A total of 1024 transitions were assigned to this band which is hybrid type A and B, centered at 2219.6896 +/- 0.0002 cm(-1). As expected, the nu(2) band is coupled to 2nu(5) by a c-type Coriolis interaction. Both perturbed and unperturbed transitions were assigned and fitted to give seven rovibrational constants for the nu(2) = 1 state with a standard deviation of 0.00094 cm(-1) using Watson's A-reduced Hamiltonian in the I(r) representation. A c-type Coriolis interaction term between nu(2) and 2nu(5) was derived from the rovibrational analysis. The ratio of the transition moments, ||µ(b)/µ(a) ||, was found to be 1.42 +/- 0.10 for the hybrid band. Copyright 1999 Academic Press.
ABSTRACT
The FTIR spectrum of the nu4 band of deuterated formic acid (DCOOD) has been measured with a resolution of 0.004 cm-1 in the frequency range of 1120 to 1220 cm-1. A total of 1866 assigned transitions have been analyzed and fitted using a Watson's A-reduced Hamiltonian in the Ir representation to derive rovibrational constants for the upper state (v4 = 1) with a standard deviation of 0.00036 cm-1. In the course of the analysis, the constants for the ground state were improved by a simultaneous fit of microwave frequencies and combination differences from the infrared measurements. Due to the relatively unperturbed nature of the band, the constants can be used to accurately calculate the infrared line positions for the whole band. Although the band is a hybrid type A and B, only a-type transitions were strong enough to be observed. The band center is at 1170.79980 +/- 0.00002 cm-1. Copyright 1999 Academic Press.
ABSTRACT
The high-resolution Fourier transform infrared spectrum of HCOOD has been measured in the nu5 region between 1120 and 1220 cm-1 with a resolution of 0.004 cm-1. As expected for an in-plane vibrational fundamental mode, the nu5 band is a hybrid band consisting of both a-type and b-type transitions. Using the Watson's A-reduced Hamiltonian in the Ir representation, 1943 infrared transitions have been assigned and fitted to give 12 rovibrational constants for the v5 = 1 state. The nu5 band is primarily A type with a band center at 1177.09378 +/- 0.00002 cm-1. It is found that nu5 is slightly perturbed by the nearby 2nu7. About 90 perturbed transitions were identified. Copyright 1998 Academic Press.
ABSTRACT
The Fourier transform infrared spectrum of the nu5 band of deuterated formic acid (DCOOH) has been measured with a resolution of 0.004 cm-1 in the frequency range of 1090-1180 cm-1. Using a Watson's A-reduced Hamiltonian in the Ir representation, a total of 1731 assigned unperturbed transitions have been analyzed to provide rovibrational constants for the upper state (v5 = 1) with a standard deviation of 0.000363 cm-1. The band is A type with an unperturbed band center at 1142.31075 +/- 0.00002 cm-1. The band is expected to be perturbed by a nearby nu4 band through a Fermi resonance term and possibly a Coriolis term. The resonance is particularly noticeable for Ka = 10, and 11, at high J values. About 215 perturbed lines were identified but they were not included in the final fit. Copyright 1998 Academic Press.
