Snakebite envenomation remains a significant cause of morbidity and mortality in Southeast Asia. Accurate identification of the snake species or even confirming biting incident can be challenging, especially in children. This case report discussed the essential considerations for a suspected snakebite in a paediatric patient who presented to the emergency department with progressive neurological signs consistent with envenomation, necessitating empiric antivenom administration and mechanical ventilation. It highlights the diagnostic and therapeutic challenges encountered, emphasising the critical need for prompt identification of envenomation, judicious use of empirical antivenom therapy, and comprehensive supportive critical care. Urgent and effective interventions, including ventilatory support have been demonstrated to enhance outcomes in severe neurotoxic envenomation cases

Case Report Open Access 15 Methaemoglobinaemia is a rare but potentially life -threatening cause of hypoxemia that may be overlooked in emergency settings. We report a case of acquired methaemoglobinaemia in a 36 - year-old man following inhalation of an alkyl nitrite –containing recreational product (“Super Rush ”). The patient presented with cyanosis and hypoxemia on pulse oximetry despite minimal symptoms and preserved arterial oxygen tension. Diagnosis was confirmed by co -oximetry demonstrating elevated methaemoglobin levels. Prompt treatment with intravenous methylene blue led to rapid clinical and biochemical improvement. This case highlights the importance of suspecting and recognising recreational inhalants as a cause of methaemoglobinaemia and the utility of co -oximetry in patients with unexplained cyanosis and a saturation gap

Snakebite envenomation remains a significant cause of morbidity and mortality in Southeast Asia. Accurate identification of the snake species or even confirming biting incident can be challenging, especially in children. This case report discussed the essential considerations for a suspected snakebite in a paediatric patient who presented to the emergency department with progressive neurological signs consistent with envenomation, necessitating empiric antivenom administration and mechanical ventilation. It highlights the diagnostic and therapeutic challenges encountered, emphasising the critical need for prompt identification of envenomation, judicious use of empirical antivenom therapy, and comprehensive supportive critical care. Urgent and effective interventions, including ventilatory support have been demonstrated to enhance outcomes in severe neurotoxic envenomation cases

Case Report Open Access 15 Methaemoglobinaemia is a rare but potentially life -threatening cause of hypoxemia that may be overlooked in emergency settings. We report a case of acquired methaemoglobinaemia in a 36 - year-old man following inhalation of an alkyl nitrite –containing recreational product (“Super Rush ”). The patient presented with cyanosis and hypoxemia on pulse oximetry despite minimal symptoms and preserved arterial oxygen tension. Diagnosis was confirmed by co -oximetry demonstrating elevated methaemoglobin levels. Prompt treatment with intravenous methylene blue led to rapid clinical and biochemical improvement. This case highlights the importance of suspecting and recognising recreational inhalants as a cause of methaemoglobinaemia and the utility of co -oximetry in patients with unexplained cyanosis and a saturation gap

Introduction: A thorough medical history ensures safe dental practice. A good medical history guides clinicians in risk stratification to avoid medical emergencies and improve preparedness to prevent patient morbidity and mortality. This clinical audit aims to analyse the medical history taken by the dental students in patients with hypertension and/or diabetes mellitus (DM) and subsequently, recommend improvements in history-taking components in the dental practice. Methods: Hundred and two patients’ folders from the Faculty of Dentistry were examined by two independent auditors using a validated history-taking evaluation form. Six components of the medical history were classified as good or bad practices. Sociodemographic factors and distribution of the American Society of Anesthesiologists (ASA status) were described. The level of completeness of medical history records with years of study was assessed using the Chi-square test. Results: None of the students met 100% of the components required in medical history taking. Year three undergraduates performed poorly in the completeness of diagnosis and control of the medical condition whereby none of them had a good level of practice. The completeness of records did not differ between years of study except for diagnosis (p=0.026), control (p<0.001) and updating medical history (p=0.009) whereby the postgraduates had the best practice. Conclusion: This study highlighted marked deficiencies in taking a thorough medical history. Adaptation of the European Medical Risk Related History (EMRRH) form is recommended to be implemented in dental schools.

Introduction: The importance of early recognition and treatment of sepsis and its effects on short-term survival outcome have long been recognized. Having reliable indicators and markers that would help prognosticate the survival of these patients is invaluable and would subsequently assist in the course of effective dynamic triaging and goal directed management. Study Objectives: To determine the prognosticative value of Shock Index (SI), taken upon arrival to the emergency department and after 2 hours of resuscitation on the shortterm outcome of severe sepsis and septic shock patients. Methodology: This is a retrospective observational study involving 50 patients admitted to the University of Malaya Medical Centre between June 2009 and June 2010 who have been diagnosed with either severe sepsis or septic shock. Patients were identified retrospectively from the details recorded in the registration book of the resuscitation room. 50 patients were selected for this pilot study. The population comprised 19 males (38%) and 31 females (62%). The median (min, max) age was 54.5 (17.0, 84.0) years. The number of severe sepsis and septic shock cases were 31 (62%), and 19 (38%) respectively. There were 17 (34%) cases of pneumonias, 13 (26%) cases of urological sepsis, 8 (16%) cases of gastro intestinal tract related infections and 12 (24%) cases of other infections. There were a total of 23 (46%) survivors and 27 (54%) deaths. The value of the shock index is defined as systolic blood pressure divided by heart rate was calculated. Shock Index on presentation to ED (SI 1) and after 2 hours of resuscitation in the ED (SI 2). The median, minimum and maximum variables were tested using Mann-Whitney U and Chi square analysis. The significant parameters were re-evaluated for sensitivity, specificity and cut-off points. ROC curves and AUC values were generated among these variables to assess prognostic utility for outcome. Results: Amongst all 7 variables tested, 2 were tested to be significant (p: < 0.05). From the sensitivity, specificity and ROC analysis, the best predictor for death was (SI 2) with a sensitivity of 80.8%, specificity of 79.2%, AUC value of 0.8894 [CI95 0.8052, 0.9736] at a cut-off point of ≥1.0. Conclusion: (SI 2) may potentially be utilized as a reliable predictor for death in patients presenting with septic shock and severe sepsis in an emergency department. This parameters should be further analyzed in a larger scale prospective study to determine its validity.