Motor Vehicle Accident.. in 2011 from Local Papers

Another 3 lives lost in horrific accident (From Borneo Bulletin dated Monday December 19th,2011)

By James Kon & Siti Hajar

The number of road fatalities has increased yet again following a tragic accident that took place an hour-and-a-half past midnight yesterday, claiming the lives of three people - two passengers of a saloon vehicle and a motorcyclist.

Less than 24 hours prior to this incident, a 20-year-old male succumbed to multiple injuries in another accident that occurred at 2.24am on Saturday.

According the Royal Brunei Police Force (RBPF), the deceased were passengers of a saloon car - a 19-year-old male youth and a 31-year-old woman - who were part of a group of four individuals travelling along a bridge within the vicinity of Ban 6 in Kampong Kilanas on their way to Jerudong from Limau Manis. It was during this commute that their vehicle veered off the road into oncoming traffic and struck a 33-year-old motorcyclist who was killed upon impact.

It is believed that the driver of the vehicle, who at press time was fighting for his life at RIPAS Hospital, was driving under the influence of alcohol, according to the police.

Shortly after, the vehicle slammed into a stationary vehicle at a junction. Fortunately, the driver of the vehicle parked at the junction escaped with only minor injuries.

The last nine days has seen the deaths of five individuals, three of whom were youths between the ages of 18 and 20, at three separate locations, including the Rimba and Hassanal Bolkiah highways. Between January and October 2011, of the 37 deaths recorded then, almost 50 per cent of them were youths between the ages of 18 and 28.

With the latest fatalities, Brunei's road deaths for 2011 has jumped to 45, making it the second highest number of road-related deaths in recent memory. In 2007, 56 people died as a result of road-related accidents.

In the Sunday Bulletin news report, "RBPF Calls On Driving Schools To Help Curb Road Accident", which was published yesterday, the RBPF reminded the public to be on alert when driving especially during heavy rain and to strictly obey the country's traffic acts and laws.

What was also highlighted by the RBPF was the need for driving schools to play a more in-depth role in educating its students of not just the standard modules that are taught but also to teach would-be drivers the importance of driving carefully, being courteous to other road users and be patient.

"It should be reminded that preserving road safety should not just be concentrated on related agencies, but it should also become a social responsibility of all road users," the RBPF had highlighted.

Human error has been marked as the main cause of road accidents, while driving during bad weather such as heavy rain has also been considered a major contributor to this growing problem.

Fines and imprisonment are typical penalties for road violators and these range from $1,000 to $20,000, and a jail term ranging from six months to three years, depending on the severity of the crimes committed.

According to the RBPF, those found guilty of causing death as a result of driving under Chapter 27 (1), Road Traffic Act (RTA) Paragraph 68 would be fined $20,000, jailed for seven years, and suspended from driving for a period of three years. Meanwhile, those found guilty of driving whilst intoxicated or under the influence of drugs would be fined $10,000, jailed for two years, and barred from driving for three years under Chapter 26 (1) of the RTA Paragraph 26.

Those found guilty of dangerous driving will be fined $10,000, jailed for two years and suspended from driving for three years under Chapter 28 (1) of the RTA Chapter 26, whereas those who are found guilty of reckless or inconsiderate driving would be fined $5,000 and jailed for a year under Chapter 29 (1) of the RTA Paragraph 68.

Those found guilty of using a mobile phone whilst driving could be slapped with a $1,000 fine and/or jailed for six months. Repeat offenders will be fined $2,000 and/or jailed for a year under Chapter 29A (1) of the RTA Paragraph 68.

Sutures

Image taken by verbal permission from individual...

Image taken by verbal permission from individual..

Suturing requires expertise and experience which normally done by nurses in Brunei, if you can see these are samples of sutures (usually done with interrupted technique), are done by nurses in Brunei. Regular advice to individual resulted a free of infection, thus, cleanliness of the wound could be meet.

2011......

it has been awhile i haven't post an issue or case or anything in this blog. Well, i am back!

Nursing practice has changed over the years.

For this matter, sooner or later, i will be making this as my blog. Due to inactiveness of the community i intended to change for the sake of keeping this blog alive..

Nursing Care for Seizures

this is a link where i obtained the following article....

http://nursingpub.com/nursing-care-for-seizures

What is a seizure?

A seizure is an episode of abnormal electrical activity in the brain. A seizure, just like headache, is a symptom rather than a disease.

What is epilepsy?

Epilepsy is a diagnosis given when a person has two or more unprovoked seizures.

Difference between seizure and epilepsy:

All people with epilepsy have seizures but not all people with seizures have epilepsy. A seizure is a symptom of an underlying condition. Epilepsy is a clinical diagnosis assigned to a patient having more than two unprovoked seizures.

Types of Seizures:

There are two main categories of seizures: -

1. Generalized Seizures

a. Tonic Clonic Seizures (Grand mal)

b. Absence Seizures (Petit mal)

2. Partial Seizures.

a. Simple partial

b. Complex partial

Tonic Clonic Seizures (Grand mal)

Signs and symptoms:

1. Sudden loss of consciousness

2. Muscle rigidity and stiffening

3. Jerking movements

4. Shrill cry

5. Incontinence

6. Apnea (pt may turn blue)

7. Dilated Pupils

Absence seizures

Signs and symptoms

1. Sudden behavioral arrest

2. Staring

3. Unresponsiveness

4. Only last for 1-15 seconds

Simple partial seizures:

Signs and symptoms

1. No alteration or loss of consciousness

2. There could subjective symptoms reported by the patients in absence of objective signs (smell, sound, taste or visual perception)

3. Pt remains awake and aware, sometimes unable to communicate until the seizure is over

Complex Partial Seizures:

Signs and symptoms

1. Alteration of consciousness (Not complete loss of consciousness)

2. Automatisms: Simple repetitive uncontrollable actions performed during the seizure.

a. Lip smacking

b. Chewing

c. Picking at clothes, etc

3. Patient has no awareness of what they are doing

4. Patient cannot remember what happened

5. This is the most common seizure by those diagnosed with epilepsy.

Causes of seizures:

1. Trauma

2. Drug overdose

3. Alcohol or drug withdrawal

4. Non-compliance of anti-epileptic medications

5. Stroke

6. Febrile

7. Intracranial processes and increase in intracranial pressure. E.g. tumors. A seizure occurring in an adult without any obvious underlying cause like alcohol, etc should be evaluated for brain cancer.

8. Infections. E.g. Meningitis

9. Metabolic and electrolyte imbalance. E.g. Uremia and Hyponatremia

Nursing Responsibilities and Priorities During Seizures.

What Do I do?

1. Remain calm. This is your strength during any medical emergency. Make it an active process and tell your self: “I need to remain calm to help the situation and avoid causing errors, accidents or downright malpractice”.

2. Mark the seizure start time.

3. If a patient is standing, lay them to the ground and roll them to the side

4. If the patient is in bed, roll them to the side;

5. The patient can never swallow their tongue. Never place anything in patient mouth or try to open their mouth. This can compromise the airway or cause more harm to the patient.

6. Never hold the patient down or try to stop their movements. This can cause injury to the patient. Instead, protect the patient from hitting hard surfaces with soft puddings like pillows.

Priorities

ABC assessments

1. By rolling the patient to the sides, you may achieve a patent airway.

2. Administer 100% oxygen

3. Check oxygen saturation. It may be below 90 due to apnea. The patient may turn blue on the lips and fingers. Do not panic!

4. Patient will have oral secretions. Suction at bedside to keep the airway patent.

5. If help is available, establish an IV- line for possible IV medication administration if the seizure continues for a long time (Status epilepticus). You do not have to have a physician order to start an IV line in this case.

All about Tetanus......

Reference - Department of Health (March, 2010), South Australia, Tetanus
http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=303&id=1659

Tetanus is a serious illness, which can be fatal. It is caused by the tetanus bacteria (germs) getting into a wound or cut and producing a toxin (poison) which affects the nervous system.

Spores of these bacteria are in the soil world wide. Few people in Australia get tetanus because of the protection given by immunisation but tetanus kills many hundreds of thousands of people world wide every year, many of them very young babies.

ALERT!
Deep cuts and bites are likely places for tetanus bacteria to grow but they can grow in a small clean wound. If a child or adult has an injury which cuts the skin, it is important to check as soon as possible whether the person is fully immunised against tetanus.

Who is at risk?

• Any person who has NOT been immunised against tetanus is at risk.
• In Australia, adults are affected by tetanus more often than children either because they have not been immunised or because the protection they originally had from immunisation has decreased as they have grown older. Approximately 10 adults per year are diagnosed with tetanus in Australia.
• Newborn babies can get tetanus if the mother has not been immunised, often after unsterile treatment of the umbilical cord stump.

What you can do

• Make sure that all family members are fully immunised and get a booster if a person has a deep or dirty wound.
• A person with tetanus will need hospital treatment.
• The person will be watched closely for any breathing problems and given medicine to control the spasms. The person will often need to be in hospital, in intensive care, for several months.

Protecting your family from tetanus

• Immunisation works! In World War 2 all Australian Servicemen were immunised against tetanus and none developed tetanus (unlike previous wars).
• Because tetanus germs can grow in even small wounds, the only protection is a full course of immunisation for all the family.
• The first 3 doses (the "primary course") are given at 2, 4 and 6 months with the whooping cough (pertussis) and diphtheria vaccines.
• Booster immunisations are needed to keep up immunity - boosters are recommended for children before they start school (4-5 years) then around 15 years of age. If the person has had a full course of immunisations, one extra booster around 50 years of age is recommended unless the person has had a booster dose in the previous 5 years.
• Any adult who has not had 5 doses of the vaccine should have the vaccine at any age.
• Adults born in other countries may not be fully immunised. They should be encouraged to be immunised. Adults as well as children need protection against tetanus.

Issues on HIV in Brunei (from Borneo Bullettin dated June 9th, 2010 Wednesday)

HIV cases still a concern in Brunei

By Siti Hajar

Even though government bodies as well as private institutions have taken steps in promoting awareness against promiscuous activities, cases of HIV/AIDS are still being recorded, with high chances that other members of the general population may unknowingly get infected with the deadly disease.

Ever since the establishment of surveillance in 1986, 56 local cases have been recorded by the end of 2009 with an additional three cases this year.

"You're talking about human nature," said Dr Hajah Ramlah, Director-General of Health Services, when taking into consideration that the Sultanate highly values conservative practices.

"A big majority of the cases know that HIV/AIDS is the result of indulging in high-risk behaviour," she added.

"We can give so much information (on HIV/AIDS) but it is up to the individual to practise it."

A number of the cases have succumbed to the deadly virus and only 20 carriers of the virus are still being monitored and treated by the Ministry of Health.

Meanwhile, according to Dr Ahmad Fakhri, a medical officer under the Disease Control Division, the concentrated age range for HIV/AIDS is between 20 and 29 years. Some cases have also seen senior citizens as well as newborn babies who have contracted the virus from either or both parents during pregnancy.

"This is probably just the tip of the iceberg," he said referring to the number of cases and urged those who have placed themselves at risk to get tested. He also added that most cases are not aware that they were carriers of the disease until they were screened for HIV/AIDS or after they consulted a medical practitioner when they fell ill.

HIV, or 'Human Immunodeficiency Virus', infects cells of the human immune sys tem and destroys or impairs their function. Infections due the virus results in the progressive deterioration of the immune system, thus leading to 'Acquired Immunodeficiency Syndrome' or AIDS, leaving the individual more susceptible to a wide range of infections.

An estimated 33.4 million people worldwide were recorded living with the disease with an approximate two million deaths by the end of 2008.

Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial.

BMJ (2008)

Alastair D Hay, consultant senior lecturer in primary health care,1 Ce´ire Costelloe, trial coordinator,1
Niamh M Redmond, trial coordinator,1 Alan A Montgomery, senior lecturer in primary care research,1
Margaret Fletcher, reader in children’s nursing,2 Sandra Hollinghurst, senior lecturer in health economics,1
Tim J Peters, professor of primary care health services research1


ABSTRACT
Objective To investigate whether paracetamol
(acetaminophen) plus ibuprofen are superior to either
drug alone for increasing time without fever and the relief
of fever associated discomfort in febrile children managed
at home.

Design Individually randomised, blinded, three arm trial.
Setting Primary care and households in England.
Participants Children aged between 6 months and 6 years
with axillary temperatures of at least 37.8°C and up to
41.0°C.

Intervention Advice on physical measures to reduce
temperature and the provision of, and advice to give,
paracetamol plus ibuprofen, paracetamol alone, or
ibuprofen alone.

Main outcome measures Primary outcomes were the time
without fever (<37.2°C) in the first four hours after the first
dose was given and the proportion of children reported as
being normal on the discomfort scale at 48 hours.
Secondary outcomes were time to first occurrence of
normal temperature (fever clearance), time without fever
over 24 hours, fever associated symptoms, and adverse
effects.

Results On an intention to treat basis, paracetamol plus
ibuprofen were superior to paracetamol for less time with
fever in the first four hours (adjusted difference
55 minutes, 95% confidence interval 33 to 77; P<0.001)
and may have been as good as ibuprofen (16 minutes, −7
to 39; P=0.2). For less time with fever over 24 hours,
paracetamol plus ibuprofen were superior to paracetamol
(4.4 hours, 2.4 to 6.3; P<0.001) and to ibuprofen (2.5
hours, 0.6 to 4.4; P=0.008). Combined therapy cleared
fever 23 minutes (2 to 45; P=0.025) faster than
paracetamol alone but no faster than ibuprofen alone
(−3 minutes, 18 to −24; P=0.8). No benefit was found for
discomfort or other symptoms, although power was low
for these outcomes. Adverse effects did not differ between
groups.

Conclusion Parents, nurses, pharmacists, and doctors
wanting to use medicines to supplement physical
measures to maximise the time that children spend
without fever should use ibuprofen first and consider the
relative benefits and risks of using paracetamol plus
ibuprofen over 24 hours.
Trial registration Current Controlled Trials
ISRCTN26362730.