Shake till you break – bilateral neck of humerus fracture post seizure

Fractures may occur after an episode of seizures. Although rare, with a high index of suspicion and proper physical examination, delay of diagnosis and treatment can be avoided. We report a case of near missed bilateral proximal humerus fracture after an episode of generalized tonic-clonic seizure. A 58-year-old lady with a background history of epilepsy complained of generalized body ache after a generalized tonic-clonic seizure which happened few hours before presentation to our Emergency Department. On assessment, she was in pain and unable to move all four limbs. After given analgesia, patient was reassessed whereby she complained of bilateral shoulder stiffness and pain. Examination of the upper limbs revealed restricted range of movement in all directions with no shoulder squaring. X-ray showed bilateral proximal humerus fracture. Proximal humeral fractures rarely occur by itself following seizures; they are almost always associated with dislocation of the glenohumeral joint

Intraspinal epidural hematoma in a warfarinized patient presenting with back pain : a case report

Warfarin is an anticoagulant that is commonly used as thrombo-prophylaxis in patients at risk of thrombo-embolic events. However, the use of warfarin is known to cause hemorrhage due to its anticoagulation effect. Although the common sites of hemorrhage are gastrointestinal and genitourinary tract, it can also occur in the least expected location. We report a rare case of spinal cord compression secondary to intraspinal epidural hematoma as a result of overwarfarinization in a patient who had undergone liver transplant. The patient underwent emergency decompression laminectomy of spinal cord and hematoma evacuation after the reversal of overwarfarinization to normal levels

Peer trainers compared with basic life support trainers in delivering effective cardiopulmonary resuscitation training to secondary school students

Teaching cardiopulmonary resuscitation (CPR) skills to the public is essential in improving cardiac arrest survival. American Heart Association suggested to incorporate it into the school curriculum. Peer trainers is a low cost and effective method in achieving this. The objective of this 3 months prospective controlled study was to compare the effectiveness of teaching compression only CPR between peers and certified basic life support (BLS) trainers to secondary school students. Improvement in knowledge and psychomotor skills of CPR compression were the primary outcome evaluated. Twelve peer trainers aged 16-years-old and twelve certified BLS trainers were recruited into the study. Compression only CPR was taught to 36 randomized secondary school students by either peer trainers (Group P) or BLS trainers (Group B). A pre-test, immediate post-test and 3 months retention test on knowledge and psychomotor skill were conducted. There was no statistically a significant difference in the mean scores of knowledge and psychomotor at pre-test, post-test and 3 months retention between Group P and Group B. There was significant increase of knowledge score between pre-test and post-test in Group P (mean difference 5.8+2.7, p<0.001) and in Group B (mean difference 4.7+2.7, p<0.001). Psychomotor score was significantly increased between pre-test and post -test in Group P (mean difference 7.11+1.49, p<0.001) and Group B (mean difference 7.22+1.5, p<0.001). Peer trainers is non-inferior to BLS trainers in teaching CPR to secondary school students as both groups showed significant improvement at post-test

Do no harm, stay current: immersive trauma continuous medical education for emergency medicine postgraduate trainees

Continuous medical education (CME) is an essential component of postgraduate education to improve trainees’ competencies level to be at par with the current clinical practice thereby improving overall quality of patient healthcare delivery. As a postgraduate trainee in addition to being a part of hospital workforce, providing a compact CME session is essential albeit the learning challenges. Therefore, a framework for the trauma CME program was developed to integrate trainee-led immersive active learning (AL) activities based on our emergency medicine postgraduate training curriculum. It comprised of three components which were miniconferences on trauma management principles updates; hands-on skill stations session utilizing pre-prepared learning packages, simulated scenarios, manikins and phantoms; and immersive trauma simulation on prehospital response, radio communication and patient resuscitation combined with formative assessments and debriefing session. Google Form platform was used to gather the trainees’ self-appraisals of the learning experience. Feedbacks from the trainees revealed that the sessions were engaging and appropriate to their level of training. In conclusion, by incorporating AL activities into immersive trauma CME, it promotes trainees’ engagement towards teaching and learning activities thus consolidating their knowledge and skills on handling trauma patients

A qualitative study on emergency health care worker (EHCW) prception towards COVID-ACLS simulation training in resuscitating suspected COVID-19 patients

The emergence of COVID-19 pandemic has caused difficulty to emergency-HCW (EHCW) in resuscitating high-risk patients. We set out to explore EHCW’s perception after undergoing COVID-ACLS resuscitation training and address their anxiety of working in this pandemic. A qualitative case study using focused group discussion was conducted among EHCW who have undergone COVID-ACLS training. Five semi-structured questions exploring respondent’s confidence level, anxiety factors, areas of improvement for COVID-ACLS and if this COVID-ACLS training is sufficient. Inductive and deductive thematic analysis approach was done to analyse the result. 20 EHCW participated in this study. Out of 4 themes, 11 subthemes were identified based on the respondents. They were acquired new knowledge, self-precaution, method of delivery, concerns of self and family members, stigmatisation, insufficient protective methods, underappreciation, regular training sessions, other modalities for learning, course duration; and unsatisfactory reading material. New knowledge and self-precaution were noted to be an important aspect that boosts confidence among EHCW. The main factor that increased anxiety was safety issues and disease spreading to family members, colleagues, and society. In conclusion, COVID-ACLS training is able to boost EHCW confidence in resuscitating high-risk patients. Factors leading to anxiety among EHCW should also be addressed during this pandemic to ensure psychological welfare and mental health are not affected. Regular training and utilisation of other teaching modalities such as video are perceived as a helpful adjunct in boosting their confidence. The utilisation of new training approach should be explored in enhancing EHCW’s knowledge and confidence

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