1.A case of missed blunt traumatic aortic injury (BTAI)
Nik Azlan Nik Muhamad ; Rossman Hawari
The Medical Journal of Malaysia 2017;72(3):193-194
We are reporting a case of missed blunt traumatic aortic
injury (BTAI). A 28 year male presented with chest pain
following a motor vehicle accident. He was discharged
following normal clinical signs and chest radiograph. The
following day he complained of lower limb weakness.
Traumatic aortic dissection was revealed via computer
tomography (CT) of the thorax. BTAI cannot be ruled out
with normal clinical signs and chest radiograph alone. CT
thorax is mandatory to rule out BTAI in high impact chest
injury.
2.A case report of aluminium phosphide poisoning
Nik Azlan Nik Muhamad ; Rossman Hawari ; Hidayah Shafie
The Medical Journal of Malaysia 2016;71(4):213-214
Aluminium phosphide (ALP) is highly toxic and poisoning
can result in high mortality rates. A 26-year-old female who
allegedly ingested a toxic dose of ALP presented with
vomiting and diarrhoea. She developed cardiac arrest with
refractory pulseless ventricular tachycardia. Despite
aggressive resuscitation, she succumbed to death seven
hours following ingestion. In cases like this, a better
outcome can be achieved with early arrival, prompt
diagnosis, aggressive resuscitation and intensive
monitoring.
3.Internal Jugular Vein Height and Inferior Vena Cava Diameter Measurement using Ultrasound to Determine Central Venous Pressure: A Correlation Study
Nik Azlan Nik Muhamad ; Ruth Sabrina Saffer ; Colin Earnest Robertson
The Medical Journal of Malaysia 2015;70(2):63-66
Objective: To determine the correlation between central
venous pressure (CVP) measured by conventional central
venous access and ultrasonographic measurement of
internal jugular vein (IJV) height and inferior vena cava (IVC)
diameter. Methods: A prospective, cross-sectional,
convenience sampling observational study. Results: 25
patients from the Emergency Department (ED) Universiti
Kebangsaan Malaysia Medical Centre (UKMMC) were
studied between 1st March and 30th April 2013. The median
age was 63 years (95% CI 54-67). There was a significant
correlation between IJV height and CVP using central
venous access (r=0.64 p<0.001). Correlation between IVC
diameter in end expiration and CVP was 0.74 (p<0.001). An
IJV height measurement >8cm predicted a CVP >8cm H2O
(sensitivity 71.4%, specificity of 83.3%). Conclusion:
Measurement of IJV height and IVC diameter by
ultrasonography correlates well with invasive CVP and is
useful for the assessment of volume status in critically ill
patients in the ED.
Central Venous Pressure
4.Evaluation of door to operation theatre time following activation of trauma team
Nik Azlan Nik Muhamad ; Ong Sheue Fen
The Medical Journal of Malaysia 2019;74(2):116-120
Introduction: This study evaluates factors that influence
door to operation theatre (OT) time in a tertiary referral
centre following activation of trauma team. Specific factors
observed in this study were association of the injury
severity score (ISS), activation of trauma team and the
number of referred specialty to door to operation theatre
time.
Methods: Retrospective chart review that evaluates all
trauma patients which required immediate operative
intervention from January 2011 to December 2015. Trauma
patients were selected from the resuscitation log book and
data were collected by chart review of selected patients.
Results: Only 5 out of 279 patients (1.8%) achieved optimal
door to OT time. (<60 minutes) Mean door to OT time was
299.27 minutes (95% CI: 280.52, 318.52). Trauma team
activation has shown significant improvement in door to OT
time (p=0.047). Time of multiple team referrals (p=0.023) and
time of operative decision (p<0.001) both had significant
impact on door to OT time. Other factors included were
demographics, ISS score, Glasgow Coma Scale (GCS),
mechanism of injury and systolic blood pressure on arrival
all which showed no significance.
5.The Impact of 2013 Haze on Emergency Department Utilizations for Acute Respiratory Diseases: A Retrospective Study
Mohd Azim Ab Manap ; Shamsuriani Md Jamal ; Hilwani Kaharuddin ; Husyairi Harunarasid ; Mazrura Sahani ; Talib Bin Latif ; Nik Azlan Nik Muhamad
International Journal of Public Health Research 2024;14(no.1):1817-1822
Introduction:
Haze imposes a substantial health burden especially in Southeast Asia where occurrences are frequent. Reduction in air quality levels has resulted in an increase in healthcare utilization, especially to the front door of healthcare, the emergency department (ED). Data on ED utilization during haze period is lacking.
Methods:
This is a retrospective study aimed to determine the association between haze and ED utilization of haze-related acute respiratory illnesses between April 2013 to September 2013. The study period was divided into haze/ non-haze period. Clinical data was collected from the registration book and patients’ case notes. Environmental data was obtained from Institute of Environment and Development Universiti Kebangsaan Malaysia.
Results:
Total number of patients presented to ED during the study was 32,661. Fifteen percent (n= 5177) presented with acute respiratory symptoms. Total Emergency Department visits during haze period reduced due to emergency declaration, hence reducing non-emergency visits. However, there was a significant increase in hospital admission (p=0.0015) and infective respiratory illnesses (p=0.001) during haze which correlates with increase air pollutant. Patients with chronic respiratory illnesses were more affected by haze (p = 0.001). PM10 and ozone were the main pollutant during the haze period.
Conclusion
Increasing pollutant levels from the haze significantly increases ED hospital admission. Evidence from this study can influence policymakers to prepare and allocate resources to hospitals in response to haze-related illnesses.