tag:blogger.com,1999:blog-32985089Wed, 22 Apr 2026 20:19:26 +0000ICEM 2010emergency medicine in malaysiaECGSTEMImyocardial infarctionpediatricBasic Life SupportBiomedical ethicssepsisAdvanced Cardiac Life SupportCPGInfluenza A(H1N1)MMed program (emergency medicine)acute abdomenfirst aidmedical student guidesCT scanGuidelines 2010MMed programResearchResuscitationabdominal radiographsacute coronary syndromeasthmacommunication skilldoctor-patient relationshiphead traumainferior MIpre-hospital careradiographysurgeryCOPDCPREmergency medicine postingMedical BlogOSCCSgarbossa's criteriaSilver Sulphadiazine (SSD) in burnWellens' Syndromeacute respiratory distress syndrome (ARDS)airway managementanalgesiaanterior MIartificial intelligenceautomated external defibrillatorblogsbook reviewbreaking bad newsburnchest compressionchest radiographcompression-only CPRcreativen commonsdengueflipped learninggeriatric emergency medicinehemorrhagehypertonic salineinternetmedical educationministry of health malaysiamuscle relaxantsnon-invasive ventilationpitfallpurpuraraperule of six for drug infusionsevere sepsisshocksnake bitessoftwarespinal cord injurythermal burntoxicologytraumaventilation"googleable"999A-a gradientAdult SupervisionAlltop.comBenign Paroxysmal Positional VertigoBolam TestBolitho TestBrugada syndromeCARS. CHAOSCHADS2 scoreCK-MBCS gasCURB-65Chain of SurvivalChatGPTCritical appraisalDNAR orderDix–Hallpike TestDomestic Violence Act 1994Drive-Thru MedicineED visitEGDTEP InternationalETHANEEpley maneuverFAST HUGFOAMFibrinolytic therapyGrey-Turner signGuidelines 2015Haddon matrixHealth factsHenoch-Schönlein purpuraHippocratic OathHypernatremia correctionInformed ConsentJones CriteriaKFQKendrick Extrication Device (KED)LBBBLund-Browder ChartMalaysian Emergency and Rescue ServicesMedical mnemonicsMinnesota CodeN95 RespiratorNCVDNSAIDsNSTEMINursing EducationOC gasOne NationOne NumberPSIParacetamolPrimary PCIQuick caveatsR/S ratioRBBBRVHRed CrescentRheumatic FeverSIRSSMART-COPSPIKES strategyST DepressionST ElevationST ScoreSocial mediaSymbicortT inversionUniversiti Sains MalaysiaUnstable anginaWallace's Rule of NineWindows PCabdominal aortic aneurysm (AAA)acid-base balanceacute lung injuryacute pulmonary edemaadrenalineanalogyanaphylaxisanesthesiaantipyreticsarticle processing feeatrial fibrilationbenzodiazepinebeta blockerbiphasic defibrillationblended learningbowel obstructioncancer biologycardiac arrestcardiac troponinscardiometaboliccardiovascular emergenciescbrnecellulitiscerebral abscesscervical collarchest painclinical examinationcocainecommunity acquired pneumoniacopyrightcoronary angiographycreatine kinase (CK)current emergency medicinedecision makingdiabetic ketoacidosisdiagnostic testdigital technologydiluting salty soupdisasterdomestic violencedopaminedrug abusesduke criteriae-bookecchymosesectopic pregnancyelderly abuseelectronic health recordetomidateexercise stress testfebrile seizurefish bone diagramfishhook removalformula derivationfraction exhaled nitric oxidegastrointestinal emergenciesglycemic controlguy kawasakihealthcare professionalsheat exhaustionheat related illnesseshyperkalemiahyponatremiahypopyoni-gelinduction agentinfective endocarditisinsect biteintensive careintracranial hematomajaneway lesionsklialeadershipleptospirosislife expectancylikelihood ratiosludwig's anginamagnesium sulphatemannitolmaxillofacial injuriesmedical studentsmedicinemeningococcal septicemiaminor burnmolecular medicinemorphinemp3myasthenia gravisnecrotizing fasciitisnesiritideneurogenic shockneurosurgeryobstetricsodontogenic infectionsogilvie syndromeoncogeneopen acessosler's nodesoxygen therapyp53. tumor suppressor genepediatric airwaypenetrating abdominal injuriespepper spraypetechiaeposterior MIpower point slidespredatory journalprehospital carepriapismproblem based learningprocalcitoninprofessionalismpublic speakingpulmonary embolismquotationrabies post-exposure prophylaxisrandom pearls seriesrelative bradycardiarespiratory failurering enhancement lesionsriot control agentsroth spotsalicylate poisoningscientific wriitngscreen capturesea-gull sign on ultrasoundsedative agentssensitivityspecificityspinal immobilizationspinal shockstatisticsstrokesupracondylar fracturesurgical maskterrorismthrombocytopeniatoxoplasmosistyphoidultrasonographyvaccinationvasculitiswarfarinwater deficit calculationweapon of mass destructionhttp://emergencymedic.blogspot.com/noreply@blogger.com (cksheng74)Blogger174125tag:blogger.com,1999:blog-32985089.post-8470482315739465737Tue, 04 Apr 2023 03:19:00 +00002023-04-04T11:19:07.360+08:00analogydiluting salty soupformula derivationhealthcare professionalsHypernatremia correctionmedical studentswater deficit calculationDo you find it difficult to grasp the concept of hypernatremia correction and how to calculate the amount of water deficit in patients? This video breaks down the formula using a simple and relatable analogy – diluting a bowl of salty soup! Just as diluting a bowl of overly salty soup with water helps make it more palatable, correcting hypernatremia involves adjusting the body's water http://emergencymedic.blogspot.com/2023/04/formula-for-hypernatremia-correction.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-5623021170505633049Sat, 18 Mar 2023 06:00:00 +00002023-03-18T14:01:17.444+08:00leadership Image from pexels.com Leadership is a skill that anyone can learn. It's not something that people are born with, but rather something that can be developed through the right mindset and observable behaviors that lead to measurable outcomes. Unfortunately, a significant number of American workers report that their boss is toxic, and dealing with their manager is the most stressful http://emergencymedic.blogspot.com/2023/03/building-effective-healthcare.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-1226240723849267589Sat, 18 Mar 2023 03:48:00 +00002023-03-18T11:48:34.195+08:00artificial intelligencesnake bites Photo by Pixabay: https://www.pexels.com/photo/blue-bright-lights-373543/ Photo from pexels.comArtificial intelligence (AI) is revolutionizing various industries, including healthcare. The use of AI capabilities, such as natural-language generation, computer vision, and robotic process automation, is growing exponentially. In a recent McKinsey report for example, it has been shownhttp://emergencymedic.blogspot.com/2023/03/ai-and-snake-envenomation-game-changer.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-5710920843885713880Fri, 03 Mar 2023 13:23:00 +00002023-03-03T21:45:40.865+08:00artificial intelligenceChatGPTResearchBefore deep diving into the specific prompts that can be used to enhance research proposal writing,  let me start this post by repeatingly remind each other as acdemicians and professionals, to use ChatGPT responsibly and ethically. Whilst ChatGPT can be very useful in many aspects of research proposal writing, the onus still falls on the researchers to evaluate and verify the accuracy of http://emergencymedic.blogspot.com/2023/03/chatgpt-prompts-to-enhance-research.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-8766413362097031834Sat, 25 May 2019 17:54:00 +00002019-05-26T01:54:04.991+08:00   1. Unable to recognize ventricular fibrillation or ventricular tachycardia There are some students who cannot differentiate VF from PEA.  This is a potentially fatal mistake because for VF, the one intervention besides CPR that is proven to increase survival to hospital discharge is defibrillation (but not for PEA). AHA CPR Guideline 2015: In addition to high-quality CPR, http://emergencymedic.blogspot.com/2019/05/top-five-mistakes-made-by-medical.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-6411788031870999306Thu, 11 Oct 2018 07:19:00 +00002018-10-11T15:37:16.089+08:00article processing feecreativen commonsopen acesspredatory journal Predatory journals from Chew Keng Sheng This slide set is the presentation that I gave at the Faculty of Medicine and Health Sciences of Universiti Malaysia Sarawak on the issue of predatory or potentially predatory journals. “Predatory journals” refers to entities that prey on academicians for financial profit via article processing charges (APC) for open access articles, without http://emergencymedic.blogspot.com/2018/10/beware-of-predatory-or-potentially.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-2221815272186256925Wed, 15 Nov 2017 08:14:00 +00002017-11-15T16:14:17.601+08:00Biomedical ethicsHippocratic Oath One of the oldest professional oaths is the Hippocratic Oath, which is now as old as 2400 years old. The practice pledging this oath begans at the University of Wittenberg in Germany in 1508. The contents of the oath are still relevant, although pledging in the name of long forgotten medieval Greek gods is probably what makes it out-dated. A new modern version of the oath, known as ‘The http://emergencymedic.blogspot.com/2017/11/the-modern-physcians-pledge-to-replace.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-4545940897846196961Mon, 09 Oct 2017 01:54:00 +00002017-10-09T10:01:08.296+08:00breaking bad newscommunication skill The slide deck of a short sharing I gave to a group of first year medical students of Universiti Malaysia Sarawak (UNIMAS). It is indeed a good move to talk about doctor-patient communication early in their medical studies, to expose them to the intricacies, the skill and the art of communicating with patients, including how to break bad news. Doctor-Patient Communication Skill from Chewhttp://emergencymedic.blogspot.com/2017/10/doctor-patient-communication.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-7224180117941010631Sun, 28 Aug 2016 17:08:00 +00002016-08-29T08:47:27.142+08:00hyperkalemiahypertonic salinehyponatremia Slide deck (in pdf) for the above presentation: Life threatening electrolyte abnormalities from Chew Keng Sheng Perhaps one thing which I did not make clear in the video and the slide is the use of 3% hypertonic saline: As 1g of Na = 17 mmol therefore,  3% NaCl means 3 g in 100 ml or  30 g in 1000 ml (1 L) = (30 * 17) mmol in 1 L     [since 1 http://emergencymedic.blogspot.com/2016/08/life-threatening-electrolytes.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-3276143376287907108Tue, 26 Jul 2016 16:23:00 +00002016-07-27T00:24:28.224+08:00Biomedical ethics We often discuss bioethical principles using Beauchamp and Childress (2008)'s four bioethical principles (some people would say that there are more than four) but seldom do we teach or guide students through some of these bioethical dilemma (which we often face in real clinical practice) using the various ethical or moral theories in philosophy. This short video starts with a case http://emergencymedic.blogspot.com/2016/07/discussion-on-dilemma-in-bioethics.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-1313312727731278441Tue, 03 May 2016 03:37:00 +00002016-05-03T11:37:59.294+08:00cervical collarprehospital carespinal immobilization Spinal immobilization including cervical immobilization is no longer widely recommended for ALL trauma patients. In fact, the American College of Emergency Physicians (ACEP) has come out with a new statement that is against the use of long backboards by EMS (click here to access): “Backboards should not be used as a therapeutic intervention or as a precautionary measure either inside or http://emergencymedic.blogspot.com/2016/05/spinal-immobilization-including.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-9046477731672864034Mon, 25 Jan 2016 10:42:00 +00002016-01-25T18:43:57.478+08:00likelihood ratiossensitivityspecificity A short tutorial on sensitivity, specificty and likelihood ratios. A few good tutorials in YouTube are linked below as well. Sensitivity, specificity and likelihood ratios from Chew Keng Sheng A good series of 6 short videos on sensitivity, specificity, ROC curve and the concept of the trade-off between sensitivity and specificity: A short tutorial on likelihood ratios: http://emergencymedic.blogspot.com/2016/01/sensitivity-specificity-and-likelihood.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-2997184438833018514Sun, 17 Jan 2016 15:19:00 +00002016-03-03T12:10:25.881+08:00 Damage control resuscitation (DCR) Historically, first described by Rotondo et al in 1993. In that study, although no significant differences were identified between the 22 patients with definitive laparotomy (DL) vs 24 damage control surgery (DC) (with actual survival rates were similar, ~ 55% DC vs. 58% DL), in a subset of 22 patients with major vascular injury and two or more visceral http://emergencymedic.blogspot.com/2016/01/damage-control-resuscitation.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-2720070617605678756Sat, 21 Nov 2015 16:06:00 +00002015-11-22T11:46:09.302+08:00Advanced Cardiac Life SupportBasic Life SupportGuidelines 2015Resuscitation A talk that I presented during the Kelantan Resuscitation Updates 2015 (22 Nov 2015) based on the new AHA/ILCOR guidelines. However, I have put in some emphasis on certain aspects which are relevant in the Malaysian setting (for both major referral hospitals as well as smaller, lesser-equipped hospitals/clinics). Basically however, there are no major changes in this year 2015 updates. If you http://emergencymedic.blogspot.com/2015/11/bls-and-acls-updates-2015-malaysian.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-6579887601661825077Sat, 26 Sep 2015 16:35:00 +00002015-09-27T00:38:33.687+08:00acute respiratory distress syndrome (ARDS)asthmaventilation This post is created using padlet. Padlet is like a huge digital notice board where the owner as well as other collaborators can "pin" up notes by simply clicking on the board. Created with Padlet http://emergencymedic.blogspot.com/2015/09/mechanical-ventilation-in-ed-practical.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-226762359573725519Mon, 21 Sep 2015 00:06:00 +00002015-09-21T08:06:55.587+08:00acute coronary syndromechest painpulmonary embolism Another set of my learning materials developed using storify - a platform that allows me to curate contents (almost always the free ones) by simply drag and drop that content into the story timeline. The good thing about storify is that as all contents belong to their respective owners, I simply do not own them, just linking them here. All copyrights belong to the respective original authors. http://emergencymedic.blogspot.com/2015/09/an-approach-to-chest-pain-in-emergency.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-8429943745576957266Tue, 15 Sep 2015 01:10:00 +00002015-09-15T09:10:48.553+08:00CARS. CHAOSsepsissevere sepsisSIRS My learning materials developed for first year postgraduate emergency medicine candidates on the concept in the pathophysiology of sepsis using storify.com. [View the story "Pathophysiology of sepsis" on Storify] http://emergencymedic.blogspot.com/2015/09/pathophysiology-of-sepsis.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-7479142823002327644Wed, 09 Sep 2015 05:13:00 +00002015-09-21T21:37:21.308+08:00dengueleptospirosisrelative bradycardiatyphoid Two of the buzzwords in typhoid that are oft-mentioned in clinical setting as well as in many literature are 1) relative bradycardia and 2) constipation. Relative bradycardia (Faget sign): But what exactly is relative bradycardia? Cunha (2000) commented that this term has been vaguely described in a variety of literature and by many healthcare professionals leading to confusion. http://emergencymedic.blogspot.com/2015/09/relative-bradycardia-and-constipation.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-4458356709403284960Sat, 05 Sep 2015 14:09:00 +00002015-09-05T22:12:32.170+08:00Adult Supervisionflipped learningmedical education Note: This post is published simultaneously in the Malaysian College of Emergency Physicians website A REPORT ON FLIPPED LEARNING IN ADULT SUPERVISION WORKSHOP  Date: 01 SEPTEMBER 2015 Venue: Trauma and Emergency Medicine Building, School of Medical Sciences, Universiti Sains Malaysia The workshop started off with Prof Abd Karim bin Alias explaining the relevance of flipped http://emergencymedic.blogspot.com/2015/09/flipped-learning-in-adult-supervision.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-8026531819157818989Sun, 16 Aug 2015 03:47:00 +00002015-09-21T16:08:16.504+08:00asthmamagnesium sulphatenon-invasive ventilationventilation My talk on Life Threatening Asthma talk in 2nd NECCS Ipoh Life Threatening Asthma - Some Pearls and Pitfalls from Chew Keng Sheng Some may not agree with the ventilation strategy I borrowed from Scott Weingart's, i.e., a PEEP of 0 or zEEP.  I guess if you are familiar on how to play around with the PEEP in severe airway obstruction without causing a disaster in barotrauma, thenhttp://emergencymedic.blogspot.com/2015/08/life-threatening-asthma-some-pearls-and_16.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-3946516807828875696Sat, 08 Aug 2015 07:08:00 +00002015-08-08T15:18:04.186+08:00 My presentation (contra-argument) during the "debate" with Prof Dr. Rashidi Ahmad from UMMC during the 2nd National Emergency and Critical Care Symposium 2015 in Ipoh (08 August 2015)   New or Presumed New LBBB To Be Treated As a STEMI Equivalent? A Debate from Chew Keng Sheng The 6-page companion notes below can also be downloaded at: http://tinyurl.com/pern38t OR at the http://emergencymedic.blogspot.com/2015/08/five-compelling-reasons-why-new-or.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-5070082821944005880Tue, 16 Jun 2015 02:38:00 +00002015-06-16T10:42:12.765+08:00COPDoxygen therapy Effects of hypoxia in COPD The most dangerous effects of hypoxia in COPD are sudden cardiac arrest and irreversible damage to the vital organs. Significant hypoxia for more than 4 - 6 minutes is already enough to cause sudden cardiac arrest. (Murphy et al, 2001) A number of studies recommend keeping a PaO2 of 50 mmHg in COPD to prevent sudden death of hypoxia (Hutchison et al, 1964; Smith et http://emergencymedic.blogspot.com/2015/06/giving-oxygen-in-copd-goldilocks.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-6009154218983410746Thu, 14 May 2015 04:55:00 +00002015-05-14T12:55:24.445+08:00blended learningflipped learningFOAMinternetmedical educationmedical student guides Recommended resources from Chew Keng Sheng In today's hyper-connected world, content is almost a non-issue. When we click on the web, tons of educational resources can be found in websites, blogs, YouTube and in medical education, a recent crowd-sourcing, crowd-sharing concept has emerged - FOAM (Free Online Access Meducation). In recent years, I've got caught up with the FOAM virus http://emergencymedic.blogspot.com/2015/05/recommended-web-educational-resources.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-1741517134596451065Thu, 30 Apr 2015 01:08:00 +00002015-04-30T09:08:05.256+08:00adrenalineanaphylaxis IM vs SC - which is preferred? According to the AHA 2005 on CPR & ERC, it says:"Absorption and subsequent achievement of maximum plasma concentration after subcutaneous administration is slower and may be significantly delayed with shock. Thus, intramuscular (IM) administration is favored."Thus, although it does not mention that SC route cannot be used, this is not the preferred route.IV http://emergencymedic.blogspot.com/2015/04/the-use-of-adrenaline-in-anaphylaxis.htmlnoreply@blogger.com (cksheng74)0tag:blogger.com,1999:blog-32985089.post-6692669422058809767Wed, 22 Apr 2015 07:09:00 +00002015-04-22T16:23:17.097+08:00 There are two types of CPR devices: 1. Load-distributing band CPR devices (LDB) Provide circumferential thoracic compression 2. Piston-driven CPR device (PD) Provide sternal compressions In preclinical settings, CPR devices improve coronary perfusion, cardiac output, ROSC. But how effective are these in real-life clinical settings? What’s the evidence so far? Let's look at three latest http://emergencymedic.blogspot.com/2015/04/mechanical-cpr-devices-what-is.htmlnoreply@blogger.com (cksheng74)0