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Background: The role of prehospital care (PHC) services in out-of-hospital cardiac arrest (OHCA) is well established in developed countries. The American Heart Association has defined PHC as the ‘chain of survival’ between public and advanced medical care. For developing countries such as Malaysia, the importance of PHC services in OHCA is evolving; however, data are lacking. Objective: This study aimed to investigate OHCA outcomes in relation to PHC services in Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia. Method: This was a prospective study conducted on OHCA cases attended by the PHC staff of Hospital Canselor Tuanku Muhriz. Independent variables were patient background, OHCA nature, and PHC interventions, while dependent variables were patient outcomes. Results: A total of 82 OHCA cases were identified. The survival rate to admission was 12.2% (n = 10), while the survival rate to discharge was 1.2% (n = 1) with cerebral performance categories of 1 or 2. The mean ambulance response time was 14.91 min. Among the variables, only OHCA location and adrenaline administration show significant association with OHCA outcome. OHCA location was significant in both outcomes (admission χ2(4) = 16.354, p < 0.03, Cramer's V = 0.447, discharge χ2(4) = 19.741, p < 0.001, Cramer's V = 0.491). However, adrenaline administration was significant only for survival to admission (χ2(1) = 3.776, p < 0.052, Cramer's V = 0.215) but not for survival to discharge (χ2(1) = 0.964, p < 0.326). Conclusion: Improvement in ambulance response time, public availability of automated external defibrillator, and public awareness of early cardiac arrest and cardiopulmonary resuscitation are required to increase the survivability of OHCA in developing countries.

ABSTRAK ABSTRACTWe report a case of a giant bullous emphysema misdiagnosed as a pneumothorax. A 18-year-old chronic smoker presented with right sided chest pain and dyspnoea. Initial respiratory rate was 35 /min, blood pressure was 136/90 mmHg, heart rate 80/min and SpO2 was 98% on room air. Clinical examination revealed reduced right air entry and left trachea deviation. Chest X-ray helped to arrive at a diagnosis of pneumothorax. Needle aspiration was then performed followed by a chest tube thoracostomy because of no improvement. Massive amount of blood was drained and patient deteriorated further. CT thorax revealed a right haemopneumothorax with multiple bullaes. Patient was rushed to OT for emergency thoracotomy for stapling of the ruptured bullae. Giant bullous emphysema can mimic pneumothorax and physician must be vigilant if draining a suspected pneumothorax.91

Prehospital notification of the stroke team in alerting incoming acute stroke patient has been practiced in several countries worldwide. Currently this is not practiced in Malaysia. This study evaluates feasibility and impact to stroke team door to review time when prehospital notification is employed. Duration of case control study was between June 2018 to January 2019. Control phase consists of conventionally activating stroke team after in-hospital assessment by emergency medical officer. This was then followed by an intervention phase where on scene activation of stroke team was done by the Prehospital Emergency Care (PHC) staff. Training of PHC staff in recognising an acute stroke was based on identification of BE-FAST (Balance, Eyes, Face, Arm and Speech Test) abnormalities. The objectives were to compare the mean between two groups for acute stroke team review time, door to computerised tomography (CT) scan and door to thrombolysis time. Thirty-nine patients were analysed (control n=29, intervention n=10). Results were insignificant (p>0.05). Mean time in minutes for control phase vs. intervention phase was as follows: Door to stroke team review time, 25.96 + 39.16 vs. 15.9 + 13.14, door to CT scan was 43.04 + 40.00 vs. 25.8 + 11.35. Only 3 patients underwent thrombolytic therapy during study period. Limitation was non-parametric data with lack of number of acute stroke cases responded during the intervention period. With continual training of pre-hospital staff in detecting acute stroke, feasibility can be improved.

penunjuk yang boleh mengurangkan kematian dan morbiditi pesakit infark miokardium beserta peningkatan ST (STEMI). Kajian ini dijalankan untuk mengenalpasti faktor-faktor yang mempengaruhi masa dari pintu ke jarum untuk STEMI dan adakah ia telah mencapai masa yang disyorkan iaitu 30 minit. Satu kajian keratan rentas dijalankan di kalangan pesakit yang telah dikenalpasti mengidap STEMI akut dan trombolisis dijalankan di ED,