Faculty

Chan Pei Fong

Dr. Chan Pei Fong is an emergency physician at the Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.

Education:
a. Undergraduate Degree: Bachelor of Medicine & Surgery (MBBS) University of Malaya, 2006
b. Postgraduate Degree: Masters of Emergency Medicine, University of Malaya, 2015
c. Fellowship in Emergency & Critical Care Ultrasound (WINFOCUS), 2019
d. Fellowship (Subspecialty) Training in Emergency Critical Care by Ministry of Health, Malaysia, 2020
e. Clinical Fellowship in Intensive Care Unit (Chinese University of Hong Kong), 2020

Other qualification: Certified Advanced Paediatric Life Support (UK) since 2017

Field of interest:
Emergency medicine critical care
Critical care ultrasound
Paediatric emergency medicine

Brain Dysfunction in Critical Illness

Acute brain dysfunction has 3 manifestations which can present distinctly or may have overlapping features. Disorder with arousal or consciousness give rise to coma. A problem with attention and cognition present as delirium. Catatonia is a third form of brain dysfunction due to psychomotor dysfunction.

The key features of delirium are acute with fluctuating level of symptoms, inattention and occur as a result of another medical condition. Delirium is widely heterogeneous, involving different pathophysiologies and risk factors. The first line of treatment for delirium is non-pharmacological. The ABCDEF (A2F) bundle is the best strategy to prevent and treat brain dysfunction.

Drug is the last resort if the patient is difficult to manage and become harmful. However, benzodiazepine is best avoided to prevent worsening of delirium. Sleep has been proven to improve delirium. Currently, dexmedetomidine or propofol are preferred to target light levels of sedation. But both drugs are not suitable for hemodynamically unstable patients. Antipsychotic is a reasonable alternative but the evidence did not show strong benefit.

Catatonia a syndrome of psychomotor abnormalities. It is due to the imbalance between the inhibitory GABAergic transmission which is less compare to the excitatory glutamate transmission. Therefore, the first line of treatment for catatonia is benzodiazepine. Antipychotic may give rise to extrapyramidal symptoms or neuroleptic malignant syndrome if given to catatonic patients.

80% of patients had coma and 50% developed delirium in critically ill Covid-19 patients. The challenges faced by clinicians are the unavoidable deep sedation with widespread use of benzodiazepine infusions, prolonged immobilisation, and isolation from families due to the Covid 19.

Acute brain dysfunction is common during critical illness. We need to recognize it and avoid factors that can worsen it as it can lead to long term neurocognitive impairment.

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