Singap Med J
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There has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for care of the terminally ill and dying. There have also been calls by certain groups to actually legalize voluntary euthanasia and physician-assisted suicide for patients who meet certain conditions, some of which are as follows: that the patient be of a sound mind, suffering from an incurable or terminal illness, experiencing unbearable suffering and uncontrollable pain. The rationale for legalizing euthanasia is based on the principle of the patient's right of self-determination and the duty of doctors to relieve pain and suffering at all times. ⋯ Some even went as far as to suggest that euthanasia and palliative care be part of the continuum of care for terminally ill patients. When palliative medicine fails to fully control pain and suffering for the patient, euthanasia can be the logical next step in the continuum of care. This article seeks to discuss why the rationale for legalizing euthanasia is flawed, why euthanasia goes against the fundamental principles of Medicine in general and why it is incompatible with the practice of palliative medicine.
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Many patients with diabetes can lead a full life without developing diabetic lesions in their feet. This is because these patients have avoided the precipitating factors of which the most important is mechanical trauma and infections. We present five cases of diabetic patients who, out of ignorance, listened to bad advice by using hot therapy to treat their peripheral neuropathy. ⋯ All of them required large surgical debridement and prolonged costly hospital stay to treat their condition. Fortunately, none of them required amputation. This paper hopes to highlight the dangers of self treatment and medication in diabetic foot lesions.
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Phenytoin toxicity is an uncommon problem seen in clinical practice. The predisposing factors for toxicity are hypoalbuminemia, chronic renal failure, hepatic dysfunction and drugs which interfere with phenytoin metabolism. Common manifestations of toxicity, like confusion and ataxia, are well known. ⋯ It may or may not be accompanied by other features of toxicity. We present three patients with paradoxical seizures; their serum phenytoin levels were 43.5 mcg/mL, 46.5 mcg/mL and 38.3 mcg/mL. In all cases, seizures were controlled by withdrawal of phenytoin and reduction of drug levels.
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A patient had general anaesthesia for laparoscopic surgery. She bit on and occluded her endotracheal tube during recovery from anaesthesia. ⋯ The pulmonary oedema resolved within 24 hours. Use of an oropharyngeal airway as a bite block could have prevented this complication.
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Resuscitation of collapsed cardiac patients is often a not-too-successful affair. It has been repeatedly emphasised that the most important aspect of cardiac resuscitation is early access, early recognition of ventricular fibrillation and early defibrillation in patients with ventricular fibrillation. ⋯ In this report, we describe a case of successful prolonged cardiac resuscitation with emphasis on the organisation of resuscitation as well as early defibrillation. We would also like to emphasise that all procedures that were done were performed correctly and their effects on the monitored patient were assessed frequently so as to maximise efficiency, myocardial salvage and patient survival.