Majority of our healthcare provider working in Emergency Department has good knowledge, attitude & practice level in standard precaution. In fact, we found that (78.4%) were compliance to standard precaution practice. There were 43 participants who did not compliance to standard precaution practice, 14 were medical officer (32.6%), 14 were assistant medical officer (32.6%), 2 were staff nurses (4.7%), 3 were assistant nurse/community nurse (7.0%) and 10 were health attendants (23.3%). Most participants gave lack of time is the main reason for poor compliance with 38.5%, followed by interfering with their work with 29.2%, lack of equipment with 21.5% and other reason such as laziness, forgotten, not comfortable with standard precaution, lack of staff and very busy (10.8%).

The early detection of acute blood loss is becoming more important for diagnostic purpose especially with the development of newer portable ultrasound device. Use of the ultrasound in the detection of acute blood loss via measuring the IVC diameter is not the standard clinical practice at the current moment. Current evidence suggests that acute blood loss can be detected early in hypovolemic patient by measuring the IVC diameter. The clinical implication of this study, IVCe was a great marker to determine the volume loss through bleeding in trauma patient. The measurement of the IVC diameter was also a reliable indicator of shock in trauma or medical hypovolemic cases and may even predict it in patients who have normal blood pressure due to sympathetic activity.

Trauma is one of the commonest causes for emergency room attendance and inability to protect the cervical spine in unconscious patient during primary assessment will cause significant morbidity and mortality in cervical spine injured patient. Mismanagement should be prevented at the first presentation. The emergency department residents frequently interpret plain radiograph without the presence of radiologist.The author would like to highlight that the emergency medicine trainees' ability to interpret the cervical spine radiograph in trauma is as accurate as radiologist. As a result hopefully it will give a strong impact towards improving Emergency Medicine services in future. Emergency physician has great responsibility to provide training and to teach their junior doctors working in their department.

Early and correct diagnosis of patients admitted to the hospital with symptoms suggestive of acute myocardial infarction (AMI) is paramount to ensure appropriate therapy is given to minimize myocardial injury and improve clinical outcome. The urgency in recognizing and treating patients with an AMI as early as possible has been repeatedly stressed and reiterated in various guidelines that lead to the well-known phrase of 'Time loss is myocardium loss'. As a consequence, the patient's prognosis will deteriorate.In situation like these, cardiac biomarkers may be invaluable in establishing a diagnosis of AMI in the ED setting. A number of established cardiac biomarkers have been available in the market and several new promising assays with better sensitivity have been discovered. A recent potential cardiac biomarker that shows release kinetics similar to myoglobin is heart-type fatty acid-binding protein (H-FABP). We believe that this diagnostic kit that detects H-FABP at the bedside, still needs further evaluation especially to assess its performance and practicality to detect AMI in patients presenting with chest pain in the ED setting.

Pain is one of the most challenging problems in medicine and biology. It is a challenge to the sufferer who must often learn to live with pain for which no therapy has been found. It is a challenge to the physician who seeks every possible means to help the suffering patient. Acute pain assessment and management in Emergency Department is still grossly inadequate and more research should be encouraged in this particular field. Awareness from all health care providers about appropriate acute pain management will help to improve the quality of care to our patient attending the emergency room. Based on our study, we need to critically reassess our present acute pain management practice and a better and efficient protocol should be established which is applicable to our need and setting. Secondly, patient education and understanding regarding acute pain management should be made available extensively so that the overall management is a two way process. Finally, the same issue of inadequate attention to acute pain management should be widely criticized the health care delivery system which will improve our emergency health care delivery.

As acute breathlessness has been recognized as an important medical problem, multiple attempts has been made to improve the management of such a condition. Several researches have been done to show the correlation between ETCO2 and PaCO2 especially in intubated patients. For more than 40 years since it was first used, several attempts has been made to recognize the utility and accuracy of capnometry use in patients with respiratory conditions. Microstream capnometer has a potential to predict PaCO2 level especially in the case of pure acidosis and hypocapnia. It can be a potential form of non invasive cardiopulmonary monitoring in non-intubated acute breathlessness patient. However the use of ETCO2 to predict PaCO2 should be done with caution especially in cases that involve pulmonary disorders and acid base imbalance.