Malaysian Journal of Medical Research (MJMR)

Emergency Front of Neck Surgical Airway in the Emergency Department: Lessons Learnt

Gurjeet Singh a/l Harvendhar Singh — 2025-04-30

Securing the airway is a fundamental principle in the resuscitation of critically ill patients, as it directly influences the patient's ability to breathe and sustain life. Various national and international guidelines emphasise that airway management should take precedence over both breathing and circulation in a single-rescuer scenario, underscoring the critical nature of this step-in emergency care. In this article, it presents a case involving a patient who faced a challenging airway scenario. Despite attempts at conventional intubation, including video-assisted intubation and bronchoscopy, these methods failed to secure the airway. This prompted the need to pursue a more advanced, interventional approach: the surgical airway. This procedure, while more invasive, proved essential for ensuring the patient’s survival. Through this case, it aims to highlight the importance of preparedness and flexibility in airway management, particularly in high-risk environments like the emergency department. The lessons learned from this scenario reinforce the need for healthcare providers to be well-trained in both basic and advanced airway management techniques. Additionally, it underscores the significance of timely decision-making and the ability to adapt when standard methods are not effective. By sharing this case, that hope to contribute to a broader understanding of the critical role that surgical airways can play in emergency care and enhance the collective knowledge and preparedness of emergency medical teams.

Emergency Point of Care ultrasound for early detection of Atypical Presentation of Pleural Effusion

Gurjeet Singh a/l Harvendhar Singh — 2025-04-30

Ultrasound has become an indispensable tool in modern emergency departments, significantly enhancing diagnostic accuracy, reducing patient waiting times, and facilitating the identification and treatment of life-threatening conditions. Point-of-care ultrasound (POCUS), which involves using ultrasound directly at the patient's bedside, has revolutionized the approach to emergency medicine. By using specific POCUS protocols for different organ systems, clinicians can deliver swift and accurate diagnoses, ensuring timely interventions. Among these protocols, the BLUE (Bedside Lung Ultrasound in Emergency) protocol is particularly effective in diagnosing lung-related conditions, such as pleural effusion. This case study highlights the critical role of POCUS in detecting atypical presentations of pleural effusion, a condition that can sometimes present in unconventional ways, complicating timely diagnosis. By recognizing specific signs during a lung ultrasound, clinicians can achieve an early and accurate diagnosis, ultimately leading to more effective interventions during resuscitation. Early detection of pleural effusion using the BLUE protocol can greatly improve patient outcomes, allowing for life-saving measures to be taken swiftly within the emergency department setting. We present a case where the identification of a particular sign during POCUS led to the early diagnosis of pleural effusion, enabling rapid intervention in a resuscitation scenario. This case underscores the significance of incorporating POCUS into emergency practice, as it enhances diagnostic capabilities and expedites treatment for critical conditions. The use of POCUS has the potential to save lives, particularly in high-stakes situations where time is of the essence.

Analysis of the Treatment Plan for Q-T Interval Prolongation Caused by Moxifloxacin in One Case

Tao Wen — 2025-04-30

This case report presents the clinical treatment process of a 65-year-old female patient who experienced Q-T interval prolongation following the administration of moxifloxacin for a pulmonary infection. Upon hospital admission, the patient was initially treated with a combination of moxifloxacin and ceftazidime as part of an empirical anti-infective regimen. However, shortly after treatment commenced, the patient developed a skin rash accompanied by a significant prolongation of the Q-T interval as observed on the electrocardiogram (ECG), raising concerns about potential cardiac risks. In response, the clinical pharmacist conducted a timely medication review and recommended discontinuing both moxifloxacin and ceftazidime due to their possible adverse effects. Based on the pharmacist’s recommendation, the medical team revised the anti-infective regimen and substituted biapenem, a carbapenem antibiotic with a lower risk of cardiac side effects. Supportive symptomatic treatments were also provided to address the patient's condition holistically. As a result of these adjustments, the patient's rash gradually subsided, her Q-T interval normalised, and her overall symptoms significantly improved. She was eventually discharged in stable condition. This case highlights the potential cardiac risks associated with fluoroquinolone antibiotics like moxifloxacin, particularly in elderly patients who may be more susceptible to adverse drug reactions. Moreover, it underscores the essential role of clinical pharmacists in ensuring medication safety and optimising individualised treatment plans through active participation in multidisciplinary care teams.

The Role of Paediatric Nurse to Enhance Atraumatic Care for Hospitalised Children: Literature Review

Etik Pratiwi — 2025-04-30

Introduction: Children are a gift from God and will become the foundation and future of the nation. Currently, sick children in Indonesia suffer from a wide range of both acute and chronic illnesses. This literature review aims to analyse the role of paediatric nurses in providing atraumatic care for hospitalised children. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) scheme was used in this study to describe the search strategy. The researcher conducted a search using electronic databases, including Google Scholar, PubMed, Scopus, and DOAJ. The PICO format was utilised in the literature search process, incorporating terminology such as “Hospitalised Children”, “Children”, “Paediatric Patients”, “Atraumatic Care”, “Atraumatic Care Therapy”, “Atraumatic Approach”, led by “Paediatric Nurse”, “Nurse Paediatric”, “Reduce Pain”, “Reduce Anxiety”, “Comfort”, and “Reduce Stress”. The search was conducted based on inclusion criteria comprising: 1. The role of paediatric nurses; 2. Atraumatic care in sick children; 3. Hospitalised sick children; 4. Journal articles and manuscripts. The exclusion criteria included: 1. Articles published before 2020; 2. Articles not in English. Results: In the process of finding journals in search engines, approximately 983 research journals related to the theme were identified. The author categorised several themes for further discussion, including psychosocial care (the role of paediatric nurses), hospitalised children, family support management, and atraumatic care management. It is hoped that paediatric nurses can enhance the parenting model for hospitalised children. In both primary and secondary care, the biopsychosocial model was incorporated. In primary care, local child health teams consisting of general practitioners, paediatricians, and paediatric nurses coordinated care with community paediatricians, health visitors, school health services, social workers, and mental health services. Additionally, nurses play a role in providing therapeutic play, which can reduce anxiety levels in children. The use of Trace Image and Colouring for Kids-Book (TICK-B), AI-based technology, particularly Virtual Reality, as well as both passive and active ventriloquist nursing interventions, are also alternative choices in providing nursing care. Conclusion: Nurses play a crucial role in integrated care services provided to hospitalised children.

Accuracy Assessment of an Android-Based Pharmacokinetic Application for Amikacin Using Mean Absolute Percentage Error (MAPE)

Triswanto Sentat — 2025-04-30

Background: This study evaluates the accuracy of an Android-based pharmacokinetic application, the "Indonesia Pharmacokinetic Calculator" (Kalkulator Farmakokinetik Indonesia - KFI), developed to calculate individual pharmacokinetic parameters in patients receiving amikacin, a narrow therapeutic index drug. Objective: To assess the accuracy of the KFI application in calculating pharmacokinetic and pharmacokinetic/pharmacodynamic parameters and to compare its performance with MS Excel. Methods: The KFI application incorporates pharmacokinetic algorithms to calculate patient-specific parameters (e.g., k, t½, Vd, CL, AUC, Cpss, and time to reach Cpss) and pharmacokinetic/pharmacodynamic parameters (e.g., Cpmax/MIC Ratio, AUC0-24h/MIC Ratio). The application allows the input of patient data, including two post-dose drug concentration measurements. Accuracy was assessed by comparing the KFI outputs with those obtained from MS Excel using identical formulas. The Mean Absolute Percentage Error (MAPE) was used to quantify differences between the two methods. Results: The KFI application demonstrated high accuracy in calculating pharmacokinetic parameters, with an average MAPE of 0.04% and a standard deviation of 0.13%. Most parameters exhibited an APE of 0.00%, indicating near-perfect agreement with MS Excel calculations. Minor differences were observed for clearance (CL) and minimum steady-state concentration (Cpss min), with APE values of 0.05% and 0.50%, respectively. These differences were considered clinically acceptable. Conclusion: The Android-based pharmacokinetic application has been shown to provide a reliable and accurate tool for calculating pharmacokinetic and pharmacokinetic/pharmacodynamic parameters for amikacin, offering significant potential for clinical decision-making and optimising therapy.

Assessing HIV/AIDS Knowledge and Stigmatising Attitudes among Clinical Medical Students at IMU University, Malaysia

Eudocia Tan Shu Yi — 2025-04-30

Introduction: Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continue to be significant global public health issues, affecting millions of people worldwide. Despite ongoing efforts in education and awareness, misconceptions and stigmatising attitudes toward individuals living with HIV/AIDS persist in many communities, including among future healthcare professionals. This study was designed to evaluate both the level of HIV/AIDS-related knowledge and the extent of stigmatising attitudes among clinical medical students enrolled at the IMU University in Malaysia. Methods: A cross-sectional study was carried out using stratified random sampling at a private higher education institution, IMU University Malaysia. The study population consisted of clinical-year medical students from semesters 6, 7, 8, and 9. After stratifying the students by semester, simple random sampling was used to select participants from each group. Data collection was conducted using self-administered questionnaires that included sections on sociodemographic information, a set of items designed to assess knowledge and misconceptions related to HIV/AIDS, and a separate set of items aimed at evaluating attitudes and stigma toward people living with HIV/AIDS. Results: The study achieved a high response rate of 96%, with a total of 180 participants. Statistical analysis revealed there is no significant association between students’ semester level and their HIV/AIDS knowledge score (p value = 0.39), nor between semester level and HIV stigma score (p value = 0.17). Furthermore, there was no significant correlation between HIV/AIDS knowledge and stigmatising attitudes (p value = 0.85), with a Pearson correlation coefficient of r = -0.129. Conclusion: The findings suggest that HIV/AIDS stigma is influenced by multiple factors beyond knowledge, emphasising the need for comprehensive public health interventions.

The Impact of Active and Passive Use of Social Media on Loneliness, Anxiety and Depression in Adolescents

Guo Jinghua — 2025-04-30

Introduction: The social media has become an integral part of contemporary adolescents' daily routines. However, the psychological outcomes of social media use vary significantly depending on how it is used. This paper investigates the mental health impacts of active use (e.g., engaging interaction and content creation) versus passive use (e.g., browsing and aimless scrolling) among adolescents. Method: This study is based on a comprehensive review of existing literature and empirical research studies that examine the relationship between different patterns of social media use and indicators of mental health, including depression, anxiety, and loneliness. The study conducted within 100 aadolescents. Results: Findings suggest that active use of social media is generally associated with improved mental health outcomes, such as reduced anxiety and depression and enhanced social connectedness. In contrast, passive use tends to correlate with increased levels of negative emotions, including heightened feelings of loneliness and social isolation. Conclusion: To support adolescent mental health, it is crucial to encourage more active and meaningful engagement with social media platforms while minimising passive consumption. The paper concludes with practical recommendations aimed at optimizing social media usage patterns among adolescents.