The Real 'Mat Kilau'

Do you remember the time quite a while ago when Brunei army recruits on some hill in Tutong were struck by multiple lightning strikes ? I think this was last year in March or February. Violent lightning storm it was. I was told that a few soldiers were hit directly by lightning and died on the spot. Many were 'electrified' through water or direct body contact.

About a 4-5 soldiers were admitted to ICU as there were 'bradycardic' but this was a misinterpretation of their normal physiological state. These are fit fighting soldiers hence you would expect them to have a normal low heart rate.

One of the patients there was struck by lightning directly. Note the picture of this patient's chest, right nipple on the left, and white 3^rd degree burn marks into this skin of the chest (gauze is covering the burn area) like a fingers of lightning protruding and burning into the chest. The lightning went into his chest, and somehow did NOT defibrillate his heart and went out the exit wound ie. Left thigh. Note the 3^rd degree burn on the thigh. He was intubated and observed in Surgical Intensive Care Unit for a few days.

Miraculously, this man survived with no internal organ damage. He must have had a low 'resistance' to electricity. Unfortunately, I was told that his colleagues who were next to him died instantly.

This man must be Mat Kilau.

3^rd degree burn on the thigh

patient's chest

Article contributed by Dr Doom

Finger Trauma

These are actually two different patients with what I would call 'Avoidable' trauma to their hands! The reason why we choose to post it this week is to highlight some important lessons that can be learnt from these cases.

The first picture is a 35 year old male who had this infected little finger 2 weeks before presenting to A&E RIPAS. If you were a casualty officer apart from giving him a good telling off for not coming earlier what would be your next treatment plan? By the way it's a ring on the little finger just incase some people are wondering.



This should be an easy one too. What is wrong with this hand x-ray? This is a result of someone trying to escape from the 2nd floor of a house using a rope... tsk.. tsk.. tsk.. Bad Rope!

AED for the public

About 2 months ago we posted a story of a male patient who suffered a cardiac arrest whilst performing friday prayers, but was revived because 3 doctors happened to be around and a Defibrillating machine was available in time.

AED (Automatic External Defibrillator) is a life-saver and should not just be available by the paramedics and hospital, but should also be available at all peripheral clinics and even public areas, such as the mosque, shopping malls, stadiums & popular recreational parks. You never know when this handy little machine can save someone's lives... it could be your beloved ones.

Our neighbouring countries like singapore have already taken steps to ensure this. If you've been to Singapore you may have seen this machine at the shopping malls.

AED machine in Takashimaya

AED machine in ISETAN

Swelling at the Wrist

This is an interesting case of a 64 yr old male who presented with a Four year history of swelling at his wrist. Apparently in some parts of the world this is quite a common and significant sign of a serious illness, which has gradually reduced over the years. Nevertheless if you see this in your clinic there should be 2 important diagnoses that comes to mind.. What are they? What is the name given to this particular swelling?

The above is a radiograph of the affected wrist. If you were thinking along the correct path, you probably would have asked for a chest x-ray. What do you think?

Answers will be posted next week.


ANSWERS:

1. The two commonest differential diagnosis are Tuberculosis & Rheumatoid Arthritis

2. The name given to this swelling is Compound Palmar Ganglion

'The Culprit'

Immediately post-op
Surgeon: Dr Phillip, Assisstant: Dr Herry Zul

The histopathology came back as Tuberculosis and it turns out that he actually had this swelling and cough for more than 4 years already.... suffice to say that he is currently on anti-TB medication.