Stridor in children: croup or something more sinister? A case of subglottic cyst

Stridor in infants with subglottic cyst is rare. Mismanagement of such cases may lead to respiratory compromise with a potentially serious and fatal outcome. The diversity of the clinical presentations throws a great challenge in the diagnosis of subglottic cysts. Manifestations vary as they depend on the size and location of the cysts. We report the case of a 6-month-old girl who had a subglottic cyst but managed as moderate croup till she developed worsening respiratory acidosis which difficult intubation. Any case of premature infants with previous history of neonatal intubation presenting with stridor should prompt clinicians to look for possible cysts in the larynx. This is important because once the diagnosis is made, appropriate treatment may be given and unnecessary morbidity and mortality may be avoided

A comparison of patient-controlled analgesia with oxycodone and morphine after total abdominal hysterectomy surgery

We compared the analgesic profile between patient-controlled analgesia (PCA) using oxycodone and morphine in post total abdominal hysterectomy patients. Eighty-four ASA I or II patients, aged 18 to 65 years who underwent total abdominal hysterectomy were recruited into this prospective, double blind, randomised controlled study. They were randomised to receive either PCA oxycodone 0.7 mg per bolus or PCA morphine 1 mg per bolus for postoperative pain relief. At the end of surgery, all patients received IV morphine 0.1 mg/kg and skin incision was infiltrated with 20 mls of bupivacaine 0.25%. Post-operative pain scores, opioids consumptions, sedation scores and side effects were assessed upon arrival and at 30 minutes after arrival to recovery area, as well as at 6 hours and 24 hours after the operation in the ward. Patients’ overall satisfaction was also assessed 24 hours postoperatively.No significant differences were observed in terms of postoperative pain scores, opioids consumption, sedation scores, side effects as well as patient’s overall satisfaction between the PCA oxycodone and PCA morphine group. Oxycodone was comparable to morphine as PCA in terms of total opioid consumption, pain scores and satisfaction level for patients undergoing total abdominal hysterectomy and therefore may be an alternative to morphine in postoperative pain management as PCA

Comparing teachers and medical students as trainers of cardiopulmonary resuscitation (CPR) among secondary school students

Bystander rate of cardiopulmonary resuscitation (CPR) is still low worldwide because of inadequate skills and knowledge. Training the public on CPR is one of the methods to increase the bystander CPR rate. This study aimed to compare the efficacy in acquiring and retaining CPR skills and knowledge among secondary school students in Klang Valley trained by school teachers and medical students. We recruited five school teachers and five medical students as trainers. They were trained in several sessions by American Heart Association (AHA)-certified instructors using the video-assisted CPR training module. The recipients were 44 secondary school students divided between the teacher’s group and the medical student’s group. We compared knowledge and psychomotor skills between these two groups prior, immediately after and at three months after CPR training. Students in the teacher’s group showed a higher increase in knowledge comparable to the medical student’s group (median score difference 3 vs 2, p>0.05) and in psychomotor skill (median score difference 5 vs. 7, p<0.05). The level of knowledge and skills decreased after 3 months but remained significantly higher than at baseline for both groups. In conclusion, teachers could provide CPR training to their students as effective and retainable as medical students. This study aims to create an opportunity to teach CPR to the public in a larger scale