Public healthcare institutions (PHIs) in Singapore have a range of policies and guidelines for the management of patients presenting to the emergency department (ED) with blunt or penetrating major trauma. “Trauma team activation” is initiated by the ED specialist through the hospital call-centre, and is a process that mobilises...

The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its negative effects include adverse impact on patient safety, medical errors and staff burnout. In addition, high volume of patients waiting to be seen (ED input)...

Dear Editor, Atrial fibrillation (AF) is frequently encountered in the emergency department (ED) and is a major risk factor for thromboembolic events. The clinical decision for anticoagulation is guided by risk scoring systems that include factors such as age, sex and comorbidities.1,2 AF can sometimes occur in patients with active...

Fatal road accidents are by no means uncommon in Singapore, a modern tropical metropolis with a population of approximately 3 million. Statistics provided by the Traffic Police Department show that, although the accident fatality rate had fallen sharply from 13.4 per 100,000 population in 1984, to 8.0 per 100,000...

The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed only seven papers on the epidemiology of poisoning since 1975 (the earliest year covered by the database) and none targeting those severe enough to require...

Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute myocardial infarction, to save those with “hearts too good to die”. This article is available only as a PDF. Please click on “Download PDF” on top...

Singapore employs more than 350,000 foreign workers currently. With this influx of foreign workers into our city-state which has limited land and resources, it is not surprising that public services like the health service feel the impact of their presence. This article is available only as a PDF. Please click...

Drowning is defined as suffocation from submersion in a liquid with death within the first twenty-four hours. Near-drowning implies that recovery has occurred, at least temporarily, or that the victim has survived over twenty-four hours. This article is available only as a PDF. Please click on “Download PDF” on top...

The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it as there are so few books of medicine written and published in Singapore. This article is available only as a PDF. Please click on “Download PDF”...

Of the approximately 15,000 deaths that occur in Singapore every year, about 25% are from cardiac causes; of which, some 30% to 40% occur suddenly, outside of a hospital. The mechanism of death is usually a fatal arrhythmia, most often ventricular tachycardia or fibrillation. This article is available only as...

Total parenteral nutrition (TPN) may contribute to good outcome in selected groups of patients. Parenteral nutrition is highly effective in reversing effects attributable to simple starvation. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Acute coronary syndrome (ACS) refers to a continuum of clinical entities ranging from unstable angina pectoris (UAP) to Q-wave myocardial infarction. Mortality rates from acute myocardial infarction (AMI) have seen a worldwide decline in recent years. This article is available only as a PDF. Please click on “Download PDF” on...

Pulmonary thromboembolism (PE) has historically been considered a rarity in the Asian population. Although well studied in the West, Asian literature on this condition has been sporadic. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Deep vein thrombosis (DVT), and its acute complication–pulmonary embolism (PE), is one of the most important preventable causes of death in hospital patients. It also contributes to significant morbidity in terms of post-phleblitic syndrome and chronic venous ulcers. This article is available only as a PDF. Please click on “Download...

It is projected that elderly persons will make up 18.4% of Singapore’s population by the year 2030. Currently, there are 5189 residents staying in nursing homes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly population above the age of 65 will rise from 7.5% in 2002 to 18.9% by the year 2030. This article is available only as a PDF....

Caesarean sections performed without medical indication, better known as maternal request caesarean sections, have generated intense debate in recent times. While uncommon in the past, a recent national audit in the United Kingdom (UK)1 revealed that 7% of all elective caesarean sections were performed for precisely this reason. This article...

Dear Editor, The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of stress will allow for more effective interventions to aid residents, while reducing attrition and its impact on pandemic response. We present our qualitative study, guided by...

Singapore has a resident population of 3.26 million and 0.53 million foreign workers. Of these half a million foreigners, 450,000 are work permit holders, typically working in lower skill industries and blue-collar sectors, e.g. construction industry. This article is available only as a PDF. Please click on “Download PDF” on...

Paracetamol overdose is one of the most common drug overdose in both children and adults in Singapore. Doses of paracetamol exceeding 150 mg/kg in a patient can be life threatening. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Earthquakes and tsunamis can cause massive destruction over large areas, affecting the lives of many in areas hit by such disasters. The local health care system often gets disrupted and the health and well-being of the survivors may depend on disaster relief organisations from within the country as well...

Haemolysis of blood samples leads to inaccurate results and often necessitates a repeat sample. Escalating workloads and finite resources are an increasing problem in many Emergency departments (EDs), where many conditions have time-dependent outcomes, and accurate and quick blood results are thus important. This article is available only as a...

Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms of its ability to achieve higher patency rates, minimise infarct size, improve left ventricular function and improve long-term survival, as well as lower rates of...

Renal infarction is a rare disease. Domanovits et al reported an incidence rate of 0.007% (17/248,842) during a study period of 45 months. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Critical limb ischaemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb to maintain reasonable metabolic requirement of the tissues at rest. Eventual loss of limb is the feared sequelae of CLI. This article is available only as a PDF....

Cardiovascular disease is a major cause of morbidity among postmenopausal women. Up to the age of 50 years, the prevalence of coronary artery disease (CAD) among women is lower than among men, but the incidence rises significantly after the menopause. This article is available only as a PDF. Please click...

We thank the authors for their interest in our study and their insightful comments. We agree that filling pressures such as the central venous pressure and pulmonary artery wedge pressures are inaccurate in predicting cardiac output or fluid responsiveness. This article is available only as a PDF. Please click on...

We would like to thank Dr Huck Chin Chew et al for sharing their findings and we are appreciative of their work, “Oesophageal Doppler Ultrasound in the Assessment of Haemodynamic Status of Patients Admitted to the Medical Intensive Care Unit with Septic Shock”. In their paper, Dr Chew and...

Snakes are present even in an industrialised country like Singapore. A bite from a venomous snake can inflict much morbidity and occasionally, it can be fatal. In many countries with a large agricultural base, it poses a significant economic burden. This article is available only as a PDF. Please click...

Out-of-hospital cardiac arrest (OHCA) is a substantial public health burden that has poor prognosis. Patients who receive “good” and “high-quality” cardio-pulmonary resuscitation (CPR) have better outcomes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Exercise-related cardiac arrest is uncommon, however it is devastating when it occurs in otherwise healthy adults. In young adults, vigorous physical exercise trigger cardiac arrest in those affected by silent congenital cardiovascular conditions. In older adults, sudden vigorous physical exercise increases the incidence of acute coronary events in those...

Multi-detector Computed Tomography (MDCT) pulmonary angiography is currently the method of choice for the detection of acute pulmonary embolism (PE), because of its convenience, speed, sensitivity, direct clot visualisation and ability to provide alternative diagnoses that mimic PE clinically. This article is available only as a PDF. Please click on...

Our tertiary hospital has a 9-bed Surgical Intensive Care Unit (SICU) that caters to all surgical disciplines except Cardio-Thoracic and Vascular Surgery (which has its own dedicated Cardio-Thoracic Intensive Care Unit). This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were constant distractions from the other things he needed to attend to quickly. The patient, Madam Sumar was referred by her family doctor for chest pain with...

Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive pathology lies anterior to the spinal cord – prolapsed intervertebral discs (PID), ossified posterior longitudinal ligament (OPLL), spondylodiscitis and retropulsion of fractured bony fragments. More...

It has been 4.5 years since the Accreditation Council for Graduate Medical Education (ACGME-I) accredited competency-based emergency medicine residency programmes were started in July 2010 in Singapore. The transit from a time-based curriculum to a competency-based curriculum, which centres on the 6 ACGME-I core competencies of ‘medical knowledge’, ‘patient...

Child sexual abuse (CSA) is a global public health issue with adverse short- and long-term repercussions. Formal definitions of CSA and the age for defining children differ around the world. In Singapore, CSA refers to any act where a child or young person below 16 years old is used...

The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during COVID-19-related lockdowns. Notably, there have been reports that patients with acute emergencies such as strokes and heart attacks are either not seeking treatment, or are...

Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work pass issued to semiskilled workers, comprise 26.0% of Singapore’s entire labour force. Two other work passes held by FWs, “S pass” and “employment pass”, are...

Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with a global incidence of 62 cases per 100,000 person-years. In addition, there are variations in the reported survival-to-hospital discharge rates among different regions in the world. In Singapore, OHCA incidence rate was 27.2 per 100,000 person-years, with...

Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and a significant public health problem globally. In Singapore, OHCA affected 11,061 adults between 2011 and 2016. Despite multiple pre-hospital and hospital-based interventions, survival rates remain low. Initiation of time-sensitive cardiopulmonary resuscitation (CPR) while waiting for emergency services arrival...

Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with minor ailments, but these observations have yet to be evaluated in Singapore. We investigated ED attendances during the coronavirus disease 2019 (COVID-19) pandemic in Singapore. This...

Emergency airway management is a keystone of emergency medicine practice and critical skill in residency training. An accredited emergency attending is expected to handle difficult airways that may present unexpectedly with expertise. Flexible bronchoscopic intubation (FBI) technique is considered an important option in the management of predicted difficult airways....

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...

Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports and road traffic injuries are common causes in school-going children. Majority of paediatric head injury cases are mild traumatic brain injuries, defined as a Glasgow...

Emergency airways often present with little warning, and the need for airway management is necessary for a successful resuscitation. This is in contrast to most intubations performed in the operating room (OR). Additionally, difficult airways are more prevalent in emergency department (ED) populations due to acute conditions such as...

Splenic artery aneurysms (SAAs) are uncommon and often asymptomatic. However, ruptured SAAs can be rapidly fatal. We reviewed the literature on SAAs and highlighted the management challenges faced in the emergency department (ED). This article is available only as a PDF. Please click on "Download PDF" on top to view...