The Medical journal of Malaysia
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Lemierre syndrome is an uncommon disease which commonly arise from acute bacterial oropharyngeal infection. This disease was first described in 1900 by Courmont and Cade Lemierre. It is commonly caused by Fusobacterium necrophorum. ⋯ It is characterized by an oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein with embolization to the lungs and other organs. The incidence has become relatively rare at present and is usually only diagnosed when unsuspected culture results are available. We report a case of Lemierre syndrome which was recently diagnosed in our centre.
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This was a prospective observational study done to evaluate the role of a repeat head CT in patients with mild traumatic brain injury. The aim was to evaluate wether the repeat head CT were useful in providing information that leads to any neurosurgical intervention. 279 adult patients with a mild head injury (GCS 13-15) were enrolled, and these comprised of patients with an initial traumatic intracranial haemorrhage not warranting any surgical intervention. All patients were subjected to a repeat head CT within 48 hours of admission and these showed no change or improvements of the brain lesion in 217 patients (79.2%) and worsening in 62 patients (20.8%). ⋯ This includes age of 65 years or older, GCS score of less than 15 and multiple traumatic intracranial lesion on initial head CT. As a conclusion, we recommend that, in patients with a MTBI and a normal neurological examination, a repeat cranial CT is not indicated, as it resulted in no change in management or neurosurgical intervention. Close monitoring is warranted in a subset of patients with risk factors for a worsening repeat head CT.
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Cardiopulmonary resuscitation (CPR) has been standard treatment for all cardiac arrest patients that arrive at the Emergency Department. However it is unclear whether prolonging resuscitation among the elderly victims will provide any benefit or improve outcome. This study is to evaluate factors that can influence outcome of CPR among the elderly, such as time of arrest, duration of CPR, lactate levels and age (among elderly age groups). 89 patients fit the inclusion criteria from January 2007 to January 2009, and all underwent CPR. ⋯ The mean lactate levels among the dead were 9.84 mmol/L. The mean length of CPR among the survivors was 5.42 minutes and for the non-survivors, 19.28 minutes. This study reports certain factors such as duration of resuscitation and initial lactate levels that can be valuable tools in decision making when resuscitating an elderly.
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Case Reports
The use of dental drill in removing entrapped finger by metal ring in emergency department.
Ring removal is indicated in a number of clinical circumstances to manage or prevent tourniquet effect of the digit. A ring made from hardened metal may defy commonly known methods of removal. We reported a case of unusual difficulty in removing a ring of hardened metal composition using a dental drill. We believed the unusual circumstances of this case is likely to be repeated in some other clinical practice and this instrument is an appropriate option to consider in such cases.
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In this study, we sought to determine whether laboratory and physiological parameters can be useful in predicting mortality in patients with sepsis-induced hypotension and septic shock. ⋯ Our results support blood lactate level as a promising risk stratification tool when compared with leukocytes counts and other physiological parameters. The multivariate analysis showed that for every increment of lactate value of 1 mmol/L, the hazards of dying are expected to increase by 1.5 times (p < 0.001).