Singap Med J
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The initiation of extracorporeal membrane oxygenation (ECMO) in the emergency department (ED) is a rare event. Herein, we report a case of acute fulminant myocarditis in a nine-year-old girl who was successfully resuscitated by early initiation of ECMO support in the paediatric ED of KK Women's and Children's Hospital, Singapore. ⋯ The patient recovered well with normal neurocognitive function. The initiation of ECMO in the ED is potentially life-saving in the resuscitation of children with witnessed in-hospital cardiac arrest due to a reversible cause.
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Acute respiratory infections are prevalent and pose a constant threat to society. While the use of facemasks has proven to be an effective barrier to curb the aerosol spread of such diseases, its use in the local community is uncommon, resulting in doubts being cast on its effectiveness in preventing airborne infections during epidemics. We thus aimed to conduct a literature review to determine the factors that influence the use of facemasks as a primary preventive health measure in the community. ⋯ Complex interventions that use multipronged approaches targeting the five components of the Health Belief Model, especially perceived susceptibility, are needed to increase the use of facemasks in the community. Further studies are required to evaluate the effectiveness of implemented interventions.
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Case Reports
Bilateral rectus sheath blocks as the single anaesthetic technique for an open infraumbilical hernia repair.
We present a case of an open surgical repair of an infraumbilical hernia, which was performed on a 45-year-old man categorised as American Society of Anesthesiologists class 4; he weighed 107 kg, and had a body mass index of 34.2 kg/m2 and nonischaemic cardiomyopathy (left ventricular ejection fraction of 20%). Due to the patient's significant perioperative risks, the surgery was performed with the patient under ultrasonography-guided bilateral rectus sheath blocks; 15 mL of 1% lignocaine and 10 mL of 0.5% bupivacaine were deposited in the space between the rectus abdominis and posterior rectus sheath. ⋯ Rectus sheath block is a useful regional technique for periumbilical surgery, allowing surgery in highrisk patients while avoiding general anaesthesia and central neuraxial blockade. The use of real-time ultrasonographic guidance may reduce risks of peritoneal puncture, bleeding and visceral injury, while potentially increasing the rate of success.
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Out-of-hospital cardiopulmonary arrest (CPA) in children is rare but significant, with poor survival rates and high morbidity. Asystole is the most common dysrhythmia, and cardiopulmonary resuscitation (CPR) is of great importance in such cases. We aimed to survey the knowledge, attitudes and perceptions of parents in Singapore regarding infant basic life support (IBLS). ⋯ IBLS training, as part of basic cardiac life support training, is important given that CPR can significantly alter the outcome in children with CPA. Our survey revealed knowledge gaps that could be bridged through formal training. Refresher courses to regularly update parents' knowledge are recommended.