bluuebunny/crossref_metadata_2025 huggingface dataset:
Audit on Treatment and Recovery of Ankle Sprain
Authors: Lee WY
Published: December 2017

Study Objectives

The object of this study is to audit the care of ankle sprain of different severity and the functional limitations at two weeks and six weeks post injury of patients presenting to the Emergency Department of my hospital.

Methods

Over a three month period, all patients presenting with acute ankle sprain were recruited at triage (index visit). Exclusion criteria were ankle injuries more than twenty-four hours old or had already received radiological evidence of fractures. A self-administered questionnaire was used to determine the severity and treatment. At second and at sixth week post index visit, three telephone interview attempts were made respectively to ask for the functional limitations and recovery using a standard questionnaire.

Results

One hundred and thirty-nine candidates were recruited. Of these, 35.3% had mild, 19.6% had moderate and 15.2% had severe ankle sprain. Those with moderately severe ankle sprain have the least medical leave days. Only 48% were given more than 3 days of medical leave compared to 71% (mild group) and 76% (severe group). The treatment is otherwise similar across the three groups. Eighty-one patients (58%) and 70 patients (50%) were captured in the 2nd and 6th week telephone interviews respectively. Those patients with moderate severity fared worse with higher overall percentages in functional limitations and secondary consultations. This was more obvious in the 6th week telephone interview.

Conclusion

Patients with moderate severity ankle sprain fared worse compared with patients with severe or mild ankle sprain over a six-week recovery period. This may be due to insufficient rest days given to this group of patients at initial presentation.
Strengthening Links in the “Chain of Survival”: A Singapore Perspective
Authors: Charles Ra , Lateef F , Anantharaman V
Published: December 2017

Introduction

The concept of the chain of survival is widely accepted. The four links viz. early access, early cardiopulmonary resuscitation (CPR), early defibrillation and early Advanced Cardiac Life Support (ACLS) are related to survival after pre-hospital cardiac arrest. Owing to the dismal survival-to-discharge figures locally, we conducted this study to identify any weaknesses in the chain, looking in particular at bystander CPR rates and times to Basic Cardiac Life Support (BCLS) and ACLS.

Methods and materials

A retrospective cohort study was conducted in the Emergency Department of an urban tertiary 1500-bed hospital. Over a 12-month period, all cases of non-trauma out-of-hospital cardiac arrest were evaluated.

Results

A total of 142 cases of non-trauma out-of-hospital cardiac arrest were identified; the majority being Chinese (103/142, 72.5%) and male (71.8%) with a mean age of 64.3±7.8 years (range 23–89 yrs). Most patients (111/142, 78.2%) did not receive any form of life support until arrival of the ambulance crew. Mean time from collapse to arrival of the ambulance crew and initiation of BCLS and defibrillation was 9.2±3.5 minutes. Mean time from collapse to arrival in the Emergency Department (and thus ACLS) was 16.8±7.1 minutes. Three patients (2.11%) survived to discharge.

Conclusion

There is a need to (i) facilitate layperson training in bystander CPR, and (ii) enhance paramedic training to include ACLS, in order to improve the current dismal survival outcomes from out-of-hospital cardiac arrest in Singapore.
Management of Foreign Bodies in Throat: An Emergency Department's Perspective
Authors: Chiu Hs , Chung Ch
Published: December 2017

Objectives

To review the share of emergency physicians and surgeons in the removal of foreign bodies in throat, and to revisit the concept of home observation and elective endoscopic examination for this group of patients.

Design

Retrospective study for a five month period.

Setting

Public general hospital with emergency and surgical departments.

Population

All patients attending the emergency department from 1st January 1999 to 31st May 1999 with a diagnosis or chief complaint of foreign body in throat or foreign body ingestion.

Main outcome measures

Success rate of foreign body retrieval, method of removal, specialty and patient outcome.

Results

79.8% of the foreign bodies were fish bones. Eighty-nine percent foreign bodies was removed by direct laryngoscopy in the emergency department, 6.7% by emergency physicians in the endoscopy unit as outpatients and 4.3% by surgeons after admission.

Conclusion

In the absence of frank clinical or radiological sign, a short period of home observation before proceeding to elective oesophagogastro-duodenoscopy (OGD) assessment may be helpful as well as cost-effective. This policy screens out some unnecessary instrumentation, without increasing the rate of complications. As emergency physicians remove the majority of foreign bodies, their expanded involvement on an ambulatory basis is both reasonable and feasible.
Management of Acute Asthmatic Attacks in a Local Emergency Department before and after the Introduction of Guidelines
Authors: Tsui Sh , Sham Ask , Chan-Yeung M , Tong Hk
Published: December 2017

Introduction

Objective assessment and management of acute asthma is often sub-optimal in busy emergency departments. This study examined the effect of the introduction of guidelines on asthma management in the emergency department.

Materials & Methods

All patients (>2 years old) presented to the emergency department for acute asthmatic attacks over a period of 1 year were included. Guidelines for the management of acute asthma were introduced after the first quarter of the study year. Analysis was made to compare the assessment, treatment and discharge planning of patients presenting with acute asthma to the emergency department before and after the introduction of the guidelines.

Results

After the introduction of the guidelines, there was a significant increase in the measurement of peak expiratory flow rate (PEF) and oxygen saturation as part of patient assessment for asthma severity. Such an improvement did not result in a change in hospital admission rate. There was a significant increase in the proportion of patients discharged with a course of oral corticosteroids, a significant reduction in the use of oral bronchodilators in the younger age group and antibiotics in the older age group.

Conclusions

The introduction of guidelines for the management of acute asthma and education of the clinicians in the emergency department has resulted in improvement in the overall management and discharge planning for asthma patients.
Low Back Pain: Would it be Psoas Abscess?
Authors: Siu AYC , Law KL , Lo CB , Chung CH
Published: December 2017

Psoas abscess is an uncommon clinical entity. It can be a primary infection with no obvious source of infection or a secondary infection from other sites, e.g. gastrointestinal tract or spinal pathology. The triads of presentation: fever, loin pain and limitation of hip movement may not be found in all patients. The correct diagnosis can be made with a vigilant clinical examination and appropriate investigation, for example ultrasonography. We present two cases of psoas abscess. One was a primary case and the other was secondary to carcinoma of caecum. Both of them presented with recent onset of back pain. Emergency physicians consider psoas abscess as one of the differential diagnosis for patient complaining of low back pain.
Emergency Physician use of Ultrasonography to Evaluate Hypotension: A Case Report
Authors: Chan SSW
Published: December 2017

In a non-trauma patient, several conditions giving rise to hypotension and cardiovascular collapse can be immediately life-threatening. These include cardiac tamponade, ruptured abdominal aortic aneurysm, pulmonary embolism, and massive acute myocardial infarction. Prompt diagnosis is essential because correct immediate treatment and disposal decisions will affect the outcome. This is a report of a case in which the emergency physician used ultrasonography to evaluate a patient with hypotension, leading to timely intervention. Sonographic diagnosis also guided subsequent disposal and management decisions. This utility of ultrasonography in the emergency department setting is discussed.
A Case Presentation of Haemolytic Uraemic Syndrome Presenting as Gastroenteritis
Authors: Wong LN , Yeung RSD
Published: December 2017

A 62‐year‐old man presented to our department with gastroenteritis. He was found to have decreased platelets and deranged renal function. A diagnosis of haemolytic uraemic syndrome was eventually made. The disease usually presents nonspecifically with gastroenteric symptoms and systemic upset at the initial stage. Without a high index of suspicion, the diagnosis can easily be missed.
Injury Related Deaths in Singapore
Authors: Leong MKF , Mujumdar S , Raman L , Lim YH , Chao TC , Anantharaman V
Published: December 2017

Background

Injury is the commonest cause of morbidity and mortality amongst the younger age groups. Management of injuries has been identified as one of the major health issues facing our community. The study objective was to define the epidemiology of injury related deaths in Singapore.

Methods

A nationwide review of all deaths arising as a result of injury in 1995 was conducted.

Results

There were 913 cases with an injury mortality rate of 27 per 100,000 population. Ninety‐seven percent (97%) were due to blunt injury. Falls from heights from deliberate self‐harm was the commonest mechanism, followed by motor vehicle collisions (MVC). Fifty‐two percent (52%) of MVC deaths were motorcyclists or pillion riders. Sixty‐six percent (66%) of all deaths occurred in the prehospital phase. Central nervous system injury was the main cause of hospital deaths.

Conclusion

Results from this study will help our community focus on the appropriate preventive strategies to reduce mortality and the cost of injuries to our society.
A Study on Police bean Bag Injuries in a Pork Model
Authors: Chan JTS , Yeung RSD
Published: December 2017

Introduction

Currently law enforcement agencies in 10 countries have been granted approval for the use of police bean bag. The need for “less lethal” weapon to control violent suspects is under hot discussion. The manufacturer acknowledges that this weapon will only cause bruises, skin abrasions and minor injuries so as to incapacitate the violent suspect. The objective of this study was to see the degree of trauma produced by shooting police bean bag at different firing ranges.

Materials and methods

Fresh pork was chosen for this test. The pork was subjected to police bean bag challenge at two different firing ranges. A standard shotgun (Model Remington 870P) was used. In order to test the degree of trauma to different parts of the body, regions with small amount of soft tissue (pig rib) and large amount of soft tissue (pig thigh) were selected. Each region would receive challenge of police bean bag at three and five meters range shot. The above test was repeated with heavy clothing covering the pork.

Results

It was shown that all shots of police bean bag could produce injuries, ranging from minor indentation to laceration of soft tissues. The degree of trauma was greatly diminished if the target had been protected by heavy clothing. Moreover, the trauma produced on rib region was more severe than that of the thigh region. The larger volume of soft tissue, the better absorption of kinetic energy was expected and resulted in lesser degree of injuries.

Conclusion

Although police bean bag can still produce injuries, there is great potential for bean bag technology as this is an alternative to deadly force. Both suspects and law enforcement agencies can benefit from this less lethal technology as police bean bag clearly causes fewer fatal injuries and death than traditional bullets.
An Intravenous Drug Addict Presenting with ‘Shortness of Breath’: Case Report
Authors: Chung CH
Published: December 2017

A 49-year-old male intravenous drug addict attended the emergency department complaining of ‘shortness of breath’ for one day. He was discharged after evaluation and referred to the methadone clinic. He re-attended the next day complaining of neck stiffness and twitching of limbs for one day. The final diagnosis was tetanus. Although tetanus is rare in Hong Kong, high vigilance should still be maintained for its atypical presentations, especially in high-risk groups.
Ultrasound Assisted Detection and Removal of Wooden Foreign Bodies in Soft Tissue
Authors: Chung KL , Kam CW
Published: December 2017

Soft tissue foreign bodies represent a common cause for emergency department visits. Diagnosis may be difficult especially with non-radiopaque foreign bodies. Undetected wooden foreign bodies can cause significant morbidity, repeat visits, high cost, and extensive surgery. We report a case in which ultrasound was used in the Emergency Department to detect and remove wooden foreign bodies from the soft tissue. Ultrasound and other imaging modalities that may aid in the early diagnosis are discussed.
A Study of Drug Radiopacity by Plain Radiography
Authors: Chan YC , Lau FL , Chan JCS , Hon TYW
Published: December 2017

Plain abdominal X‐ray (AXR) may be helpful in the management of acute poisoning in the emergency department if the drugs involved are radiopaque. There are varying radiopacity among different medications and even for the same medication from different manufacturers. Therefore, we performed this study to detect local drug radiopacity in Hong Kong. A total of 430 drugs under the formulary of the United Christian Hospital were tested by standard AXR (75 kV, 23 mA) in a specially designed box which corresponded to the soft tissue density of the abdomen. Two different radiologists classified the drug radiopacity into three grades. Eight drugs (1.9%) were graded as definitely radiopaque (ranitidine bismuth citrate, tripotassium dicitratobismuthate, Drixoral SR, amiodarone, ferrous sulphate, sodium chloride, calcium carbonate, and Cafertamin). Another 129 drugs (30.0%) were slightly radiopaque, including slow release drugs, neuroleptics, antacids, ionic salts, beta‐blockers, tricyclic antidepressants, antibiotics and others. The remaining 293 drugs were undetectable. As a significant number of drugs (31.9%) were detectable by plain AXR in vitro and some of them were potentially lethal, we should consider AXR as an adjunct in managing a suspected poisoned patient. Further study may be needed to evaluate these drugs' radiopacity in vivo with respect to the dosage and time of ingestion to assess its clinical application.
Golf‐related Injuries: Case Series and Reports
Authors: Ng CP , Chung CH
Published: December 2017

Within the year 2002, eleven patients attended the emergency department of a public district hospital because of golf‐related injuries. This attested to the low but occasionally serious risk of this type of sport activity. As golf is becoming increasingly popular in Hong Kong, it is expected that emergency physicians will see more and more golf‐related injuries.
The Effect of Wearing a Face Mask on Body Temperature
Authors: Yip WL , Leung LP , Lau PF , Tong HK
Published: December 2017

Objective

To investigate the effect of wearing a face mask on body temperature in healthy subjects.

Methods

The study was of repeated measures design. It was conducted from July to August 2003 in two accident & emergency departments on Hong Kong Island. Staff of the two departments, who were free from any active disease at the time of measurement, were recruited. Their body temperature (oral and aural) was measured while they were not wearing a mask and at 30 minutes after they had worn a mask (either surgical mask or N95 mask). Paired t‐test was used for significance testing. Pearson product‐moment correlation coefficient was calculated to elucidate the relationship between oral and aural temperature measurement.

Results

Ninety‐three subjects were included. Oral temperature was significantly higher when a mask was worn (p=0.002, 95% CI 0.06–0.26). When considered separately, only those wearing N95 mask demonstrated such significance (p=0.005, 95% CI 0.088–0.454). The correlation coefficient for oral/aural temperature measurements was 0.219 (without mask, p=0.035) and 0.169 (with mask, p=0.104).

Conclusion

Wearing a face mask may increase the oral temperature in healthy subjects. However, the difference may not be clinically significant.
A Case of Persistent and Recurrent Ventricular Fibrillation with Successful Resuscitation and Good Neurological Outcome
Authors: Chung CH
Published: December 2017

A 49‐year‐old man suffering from chest pain collapsed on arrival at an emergency department. Ventricular fibrillation was confirmed and he survived neurologically normal after 22 defibrillation shocks. This case attests that persistent and recurrent ventricular fibrillation is still compatible with good neurological outcome. Energetic and persistent efforts should be continued in such cases. Amiodarone should be considered early in the course of refractory ventricular fibrillation.
Going to the Multidisciplinary Case Conference for Child Abuse: A Review and Guide to the Medical Practitioner
Authors: Lee ACW , Li CH , So KT
Published: December 2017

Multidisciplinary case conference is an important component in the management of suspected cases of child abuse and neglect in Hong Kong. The medical practitioner is one of the key professionals in the case conference to discuss the nature of the case, issues concerning child protection, and interventions to safeguard the child's subsequent welfare interests. Yet, specific guidance for the medical profession is lacking. In this article, the authors present an overview of the child protection case conference and practical suggestions for the medical practitioner when called to participate in the multidisciplinary case conference.
Antibiotic Prescribing for Patients with Upper Respiratory Tract Infections by Emergency Physicians in a Singapore Tertiary Hospital
Authors: Lee WY
Published: December 2017

Objective

Despite the paucity of supporting evidence, the use of antibiotics in the management of upper respiratory tract infections (URTI) remains a persistent and worrying trend worldwide. This survey study set out to examine the antibiotic prescribing profile of emergency physicians for patients diagnosed with URTI at a local tertiary hospital.

Methods

Patients seeking treatment for URTI at the emergency department in the year 2001 were identified by their ICD-9 code. The electronic medical records of a random sample of these patients were reviewed. Patients with the following documented findings were excluded: (a) a duration of more than 7 days between disease onset and date of consultation, (b) prior antibiotic usage or medical consultation, (c) presentation of purulent sputum and/or purulent nasal discharge, and (d) existing medical conditions requiring antibiotic treatment/prophylaxis. Chi-square and multivariate analyses were performed to assess the association of patient-related factors with antibiotic prescribing.

Results

Of a random sample of 488 cases of URTI, inappropriate antibiotic prescribing was observed in 24% of cases (95% CI 20%, 28%). Significant associations were observed between antibiotic prescribing and month of consultation, patients' temperature and symptom of rhinorrhoea.

Conclusion

A substantial proportion of emergency department patients with URTI received antibiotics despite the lack of evidence supporting the drugs' effectiveness. Appropriate interventions to promote evidence-based prescribing amongst emergency physicians are required to reduce the extent of inappropriate antibiotic prescribing as well as to ensure the longevity of antibiotic effectiveness.
A Snapshot of Chronic Obstructive Airways Disease in Australian Emergency Departments
Authors: Kerr D , Kelly AM
Published: December 2017

Objectives

To characterise emergency department (ED) attendances for chronic obstructive airways disease (COAD) by patient demographics and severity, to determine treatment and disposition of patients and to determine use of diagnostic tests and treatment provided to different severity groups. A secondary aim was to compare treatment given to established treatment guidelines.

Methods

Prospective, observational cohort study of patients who presented to nine Australian ED with a primary diagnosis of acute exacerbation of COAD in October 2002. Information collected included demographics, duration of symptoms, co-morbidities, assessment findings, severity, treatment, disposition, tests, in-hospital mortality and length of stay.

Results

A total of 137 patients were studied. Two-thirds (65%) of the group were male, and most (90%) were aged greater than 60 years. COAD severity was mild in 11%, moderate in 30% and severe in 59%, and 23% were receiving home oxygen therapy. As anticipated, patients with severe COAD were more likely to be admitted to hospital (mild: moderate: severe = 13%: 68%: 99%; p<0.0001) and to require ventilatory support (0%: 0%: 23%; p<0.002). There was under-utilisation of corticosteroids and antibiotics in the moderate and severe groups, and only 35% of the group had received influenza vaccination within the past year.

Conclusion

This study showed that adherence to best practice guidelines with respect to the use of corticosteroids and antibiotics for patients who presented to the ED with COAD was sub-optimal, as was the prevalence of prior influenza vaccination. Other aspects of treatment and investigation were consistent with available evidence. Efforts to address these deficiencies should be developed.
An Uncommon Shoulder Dislocation Presenting to the Emergency Department: Inferior Shoulder Dislocation
Authors: Fong CM , Li HS
Published: December 2017

Three patients presenting to the emergency department with inferior shoulder dislocation were reviewed with respect to their clinical and radiological features, initial management and final results.
Emergency Medicine in Malaysia
Authors: Rahman NHNA , Holliman CJ
Published: December 2017

The concept of emergency medical health care systems in Malaysia has existed since the 1950s. As in other countries in Asia, their functions and important contributions to the overall healthcare system have been much underestimated compared to other specialties. Historically, the concept of prehospital care management was almost non-existent and the casualty (accident & emergency department) was considered as a dumping place for under-performed medical officers. Postgraduate training in Emergency Medicine in Malaysia is still at its infancy and a lot more effort is required to improve the training program. The establishment of a structured residency training program and certified emergency physicians have revolutionized the emergency services that were neglected for so many years. Many challenges have been encountered since the start of the first program but each of the problems was tackled with great enthusiasm. It is hoped that in time Emergency Medicine and emergency health care in the country would be placed equal or even higher than any other specialty.
Pancreatic Injury: An Uncommon Cause of Abdominal Pain after Blunt Trauma
Authors: Chiu HS , Cheng SST , Chung CH
Published: December 2017

Blunt pancreatic injury is an uncommon cause of traumatic abdominal pain. Early diagnosis is difficult due to its subtle initial presentation, both clinically and on imaging study. Dilemma between a watchful expectant management and thorough initial investigation may arise. The management of a 44-year-old man presenting to the emergency department because of generalised trunk pain after blunt trauma is reported.
The Severity and Prognostic Markers of 148 Cases of Carbon Monoxide Poisoning by Burning Charcoal
Authors: Lam KK , Fung HT , Kam CW
Published: December 2017

Objective

To identify and analyse the characteristics of carbon monoxide (CO) poisoning due to burning charcoal in our locality.

Methods

This was a 3-year retrospective study. All patients presenting with CO poisoning by burning charcoal from August 1999 to December 2002 were recruited. The demographic data, initial vital signs, blood results, treatment regimens and outcomes were collected. Association between clinical outcomes and parameters were calculated.

Results

The study identified 148 patients (mean age 34.7 years) suffering from CO poisoning by burning charcoal. One hundred and forty-six cases (98.6%) were suicidal. Twenty-five patients (16.9%) were unconscious (GCS ≤ 8) on arrival. The mean initial carboxyhaemoglobin (COHb) level was 21.0%. The mortality rate was 5.4%. Fifteen cases (10.1%) required intensive care. Twelve cases (8.1%) had neurological complications and five (3.4%) suffered from delayed neurological sequelae. Initial blood results showing hyperkalemia and acidosis were associated with likelihood of unconsciousness on arrival (p = 0.007, p = 0.019 respectively). Hyperkalemia and unconsciousness on arrival were associated with longer hospital stay (p < 0.001, p < 0.001 respectively) as well as likelihood of systemic complication (p < 0.001, p < 0.001 respectively). There was no relationship between co-ingestion, age, initial COHb level, initial systolic and diastolic blood pressure with consciousness level on arrival (p = 0.188, p = 0.846, p = 0.264, p = 0.224, p = 0.755 respectively). Age, initial COHb level, acidosis, initial systolic and diastolic blood pressure did not correlate with the duration of hospital stay (p = 0.679, p = 0.176, p = 0.501, p = 0.313, p = 0.868 respectively).

Conclusion

Suicide almost accounted for all the CO poisonings by burning charcoal in our study group. It caused significant mortality and morbidity. Hyperkalemia, unconscious state and acidosis had prognostic values.
Prognostic Predictive Values of the Initial Electrocardiogram with St‐Segment Elevation Acute Myocardial Infarction in Chinese Patients
Authors: Chan KF , Ng CP , Chung CH
Published: December 2017

Objective

To study the electrocardiogram (ECG) features that predict 30‐day mortality of ST‐segment elevation acute myocardial infarction (STEMI) in Chinese patients.

Method

This was a retrospective study. Patients presenting within twelve hours after the onset of chest pain with ECG features compatible with STEMI and the diagnosis confirmed after admission were included in the study. Data taken into account included age, sex and thrombolytic therapy in the emergency department. The hospital records of the patients were later retrieved from the computer. The initial ECG performed in the emergency department were reviewed.

Results

A total of 98 patients were included in the study. There was no statistically significant relationship between 30‐day mortality and the type of myocardial infarction or the magnitude of the ST segment changes. Distortion of the terminal portion of the QRS complex and prior evidence of myocardial infarction (in another location different from the presenting one) showed statistically significant relationship with 30‐day mortality, with odds ratio 10.364 (95% CI 1.715–62.620) and 12.731 (95% CI 2.317–69.962) respectively.

Conclusion

In newly diagnosed STEMI patients, if there is evidence of terminal distortion of the QRS complex or prior ECG changes of myocardial infarction, the 30‐day mortality will be significantly higher.
Sternal and Thoracic Spinal Fractures: Case Reports of Two in One Accident
Authors: Sia JYS , Wong DYT
Published: December 2017

Two restrained back‐seat taxi passengers suffered from sternal fracture as a result of head‐on collision with another car. They were wearing shoulder‐lap seat belts at the time of the collision. Both of them also complained of upper back pain one day after admission. Computed tomography of the thorax showed fracture of the thoracic spine in both of them. We performed literature search, analysing the mechanism of sternal fracture and its association with spinal fracture. A management guideline in the emergency department is proposed to handle this injury.
A Retrospective Study on Carboxyhaemoglobin Half-Life in Acute Carbon Monoxide Poisoning in Patients Treated with Normobaric High Flow Oxygen
Authors: Li CK , Tsui KL , Hung CY , Yau HH , Kam CW
Published: December 2017

Objective

There has been a vast difference in the reported value for carboxyhaemoglobin (COHb) half-life (COHbt½) in carbon monoxide (CO) poisoning patients breathing 100% normobaric oxygen (O2). This could be due to the fact that all previous studies were performed on heterogeneous groups of patients with different aetiology. We wished to determine the COHbt½ in a homogenous group of acute CO poisoning patients who attempted suicide by burning charcoal and were treated with normobaric high flow oxygen.

Methods

It was a retrospective descriptive cohort study for a period of 60 months (January 2001 to December 2005).

Setting

Accident and Emergency Department of Tuen Mun Hospital, serving a population of 1.5 millions.

Population

We recruited all cases of CO poisoning by burning charcoal for suicidal attempt and we excluded the cases if (1) there was only one COHb measurement; (2) the patient had not received high flow O2 therapy via tightly fitting facial mask with O2 reservoir, given before the first blood sample or throughout the period until a second blood sample was taken; (3) the first COHb was <10%; (4) the second COHb was <2%; (5) there was significant co-poisoning; (6) the patient was haemodynamically unstable; or (7) the time of blood sampling was not documented. We believed that the elimination of COHb under 100% normobaric O2 was constant and followed a simple exponential decay.

Results

Forty-three (27.4%) cases met all of the selection criteria and the mean COHbt½ was 78±9 minutes.

Conclusion

We believed that our patients (i.e. CO poisoning patients who committed suicide by burning charcoal) represented a homogenous group of acute CO poisoning of unique aetiology. The estimated COHbt½ would be useful in deciding the length of normobaric oxygen therapy for this group of patients.
Work‐Related Crushing Injuries with Amputations of Digits, Hands and Forearms
Authors: Lai CH , Tsui KL , Kam CW
Published: December 2017

Objective

To review work‐related crushing injuries leading to amputation of digits, hands and forearms, by focusing on patients' demographics, and clinical outcomes.

Design

Retrospective descriptive study.

Setting

Regional hospital, Hong Kong.

Patients

Patients with work‐related crushing injuries causing amputation of digits, hands or forearms admitted to hospital for treatment from January 2003 to August 2005.

Methods

Patients' age, sex, past medical history, occupations, context of injuries including injuring objects and levels of amputation were studied. During a 9‐month follow up period, patients' need for urgent operation, length of hospital stay, duration of sick leave and change of occupational status were analysed.

Results

Eighty‐eight patients were studied. The age distribution ranged from 19 to 81 years, with 50% being less than 40 years of age. Most patients (93%) were healthy adult before the injury. Industries frequently involved were construction (24%), manufacturing (17%) and transportation (14%). Machineries and metallic tools were the most common injuring objects. Eighty‐four percent of the amputation injuries involved the finger(s), and 13% the thumb. Most patients (91%) required urgent operation. The mean length of hospital stay was 4 days. The mean duration of sick leave was 152 days. The estimated wage loss was around HK$145,000 per accident. Only 42% of the patients could fully resume working without job restriction.

Conclusion

Traumatic amputation as a severe work‐related injury is common in Hong Kong. It frequently affects the young and healthy workforce, resulting in devastating physical and psychological disabilities. The clinical, social and economical significances are enormous and far‐reaching.
Case Report of Traumatic Aortic Disruption: A Lethal Injury Requiring Rapid and Accurate Diagnosis to Lower Mortality
Authors: Mak EYL , Kam CW
Published: December 2017

Traumatic aortic disruption is an uncommon but frequently emphasised condition in trauma management in the emergency department. We report a case in which a middle aged woman was hit by a moving vehicle, sustaining multiple severe injuries. Multidetector computed tomography revealed an unexpected but potentially fatal condition – traumatic aortic disruption. A pseudoaneurysm was detected over the aortic arch. In view of the multiple trauma, she was put on conservative treatment. Traumatic aortic disruption should be borne in mind during the emergency evaluation and management of unstable trauma victims, especially those with significant trauma mechanisms. Radiological evaluation plays an important diagnostic role.
The Use of Glucagon and other Antidotes in a Case of Beta‐Blocker and Calcium Channel Blocker Overdose
Authors: Fung HT , Lai CH , Wong OF , Lam KK , Kam CW
Published: December 2017

We report a case of metoprolol and nifedipine overdose complicated by hypotension which responded to intravenous boluses of calcium chloride and glucagon. The blood pressure was subsequently stabilised by continuous glucagon infusion with the aid of an insulin‐dextrose drip. The discussion is focused on the role of antidotes and catecholamine inotropes in the management of beta‐blocker and calcium channel blocker poisoning.
A One‐Year Hospital‐Based Analysis of Sports Injuries
Authors: Tsui CT , Leung M , Chow CP , Chan KH , Lit ACH
Published: December 2017

Objectives

(1) To survey and analyse the pattern of sports injuries; (2) to make implication from the results.

Methodology

Subjects with sports injuries attending the emergency department of Princess Margaret Hospital in 2006 were retrieved via the Injury Surveillance System. The characteristics of the subjects and their injuries were evaluated.

Results

In 2006, 709 subjects had sports injuries, from which 83% were male. The median age was 19. Age below 20 accounted for 53% of the attendance. Football (35%), basketball (25%) and cycling (9%) were the three commonest sport‐injury activities. All sports injuries had the maximum AIS ≤3 and 83% had MAIS of 1 only. Overall, 39% had contusion and scrape, 36% with sprain and strain, and 18% had fracture. Nearly half (47%) had lower limb injury; 30% and 24% had upper limb injury and head injury respectively. Contusion and scrape of the head, and sprain and strain of the lower limb were the two commonest injuries in football and basketball. In cycling, two‐thirds suffered from contusion and scrape of any body region and 57% of those involved the head.

Conclusion

Sports injury surveillance with characterised patterns of injuries helped to devise prevention measures.
A Comparison between Two Different Fixed-Dose Regimens of Terazosin on the Rates of Acute Haemodynamic Complication and Successful Trial without Catheter
Authors: Tsui KL , Fung HT , Kam CW
Published: December 2017

Objectives

To compare the treatment with 2 mg or 4 mg terazosin once daily (an alpha-adrenergic receptor antagonist) on the success rate of trial without catheter (TWOC) and acute haemodynamic complication rate in patients with the first episode of acute urinary retention due to benign prostatic hyperplasia managed by catheterisation in the emergency department.

Design

Retrospective cohort study.

Setting

Emergency department of a regional hospital.

Methods

Medical records of year 2006 were reviewed. Patients taking 2 mg and 4 mg terazosin once daily were compared on the occurrence of acute haemodynamic complications (decrease in mean arterial pressure of more than 25%, orthostatic change of blood pressure of more than 20/10 mmHg or severe dizziness in the supine position) within eight hours post-treatment. The success rates of TWOC during urology follow-up (day 3 onwards) were also compared. Age and history of concurrent anti-hypertensive medication were taken as confounders and controlled. Two binary logistic regression models were applied.

Results

Sixty-eight patients were studied. The overall, 2 mg and 4 mg success TWOC rates were 55.6%, 44.4% and 60.0% respectively. Overall, 39.7% of the patients developed transient haemodynamic complication but none had significant adverse clinical outcome. The effects of drug dosage (p=0.271) and age (p=0.857) on the success rate of TWOC were not statistically significant. The effects of drug dosage (p=0.111), concurrent use of anti-hypertensive medication (p=0.996) and age (p=0.625) on the occurrence of haemodynamic complication were also not statistically significant.

Conclusion

There is no statistically significant difference between regimens of terazosin 2 mg and 4 mg once daily on the success rate of TWOC or the occurrence of acute haemodynamic complications.
Etomidate and Midazolam for Procedural Sedation in the Emergency Department of Queen Elizabeth Hospital: A Randomised Controlled Trial
Authors: Chan KKL , Ho HF
Published: December 2017

Objective

The objective of the study was to compare the effectiveness and safety of intravenous etomidate against midazolam in procedures which required sedation and analgesia in our emergency department.

Methods

The study was conducted in the emergency department of Queen Elizabeth Hospital from 1st November 2005 to 30th June 2006. Adult patients who required procedural sedation and analgesia were recruited and randomised into two groups, in which either etomidate or midazolam was used as the sedative agent. Vital parameters and depth of sedation were closely monitored until they regained full consciousness.

Results

a total of 87 patients were recruited and randomised into study and control groups, of which 78 patients completed the study and were analysed – 36 patients were in the midazolam group whereas 42 patients were in the etomidate group. There was no statistical difference in mean age, mean weight and procedures between the two groups. Mean time for onset of action was 1.8 minutes for the etomidate group versus 3.4 minutes for the midazolam group (p=0.003). There were no significant differences in total procedure time, total length of stay, pain score, satisfaction score and adverse effects.

Conclusion

Etomidate achieved adequate depth of sedation for painful procedures in significantly shorter time than midazolam. There were no differences in procedure time, length of stay, pain relief and patient's satisfaction between the two drugs.
Hazmat Emergency Preparedness in Hong Kong: What are the Dangerous Goods in Kowloon?
Authors: Walter FG , Chan JTS , Winegard B , Shirazi FM , Chase PB , Chow YY , de Boer M , Denninghoff K
Published: December 2017

Introduction

Hazmat emergency preparedness is critical, especially as Hong Kong prepares for major international events, such as the 2008 Olympic Equestrian Games. No published medical study has described the identities and quantities of dangerous goods (DG) in the Kowloon area and listed what antidotes are needed for these DG. This study describes what hazardous materials are most common in Kowloon to prioritise emergency preparedness and training.

Materials & methods

Design

A descriptive, cross‐sectional study.

Setting

The Hong Kong Special Administrative Region, specifically Kowloon.

Sample

The Hong Kong Fire Services Department (HKFSD) Dangerous Goods Database (DGD).

Interventions

Descriptive statistical analyses with Stata 9.2.

Chief outcome

Identifying and quantifying dangerous goods in the HKFSD DGD.

Results

Most DG do not have antidotes. The most common DG with recognised antidotes are carbon monoxide, methylene chloride, fluorine, fluorides, fluoroboric acid, cyanides, nitriles, methanol, nitrobenzene, nitrites, and nitrates. The most common categories of DG are substances giving off inflammable vapours, compressed gases, and corrosive and poisonous substances.

Conclusions

Hazmat emergency preparedness and training should emphasize these most common categories of DG. Disaster planning should ensure adequate antidotes for DG with recognised antidotes, i.e., oxygen for carbon monoxide and methylene chloride; calcium gluconate or calcium chloride for fluorine, fluorides, and fluoroboric acid; hydroxocobalamin for cyanides and nitriles; ethanol for methanol; and methylene blue for methaemoglobinaemia produced by nitrobenzene, nitrites, and nitrates. Supportive care is essential for patients exposed to hazardous materials because most dangerous goods do not have antidotes.
Transorbital Sonographic Evaluation of Optic Nerve Sheath Diameter in Normal Hong Kong Chinese Adults
Authors: Chan PYN , Mok KL
Published: December 2017

Objective

To establish the range of normal values of optic nerve sheath diameter (ONSD) measured by bedside ocular ultrasonography (USG) in Hong Kong Chinese adults.

Design and methods

This was a prospective study conducted between May and June 2007 in the Accident and Emergency Department (AED) of Ruttonjee and Tang Shiu Kin Hospital. Subjects without neurological and ophthalmologic complaint were recruited by convenience sampling. The ONSD of both eyes were measured 3 mm behind the globe using a 7.5 MHz linear probe on the closed eyelids of supine subjects. Repeated measurements (n=4) were carried out for every optic nerve to control the variability of this scanning procedure. Range, mean values and standard deviations were calculated.

Results

One hundred subjects were recruited to the study. The range for ONSD was from 3.7 mm to 4.7 mm with a mean of 4.05 mm and standard deviation (SD) of 0.19 mm. There were no significant differences in ONSD measurement between males and females (p=0.44), between right and left eye (p=0.83) or between volunteer AED staff and recruited patients (p=0.10). The differences among different age groups (p=0.13) and the correlation between age and ONSD with r=0.19 (p=0.05) were not significant.

Conclusion

Our results suggest that the range of ONSD in normal Hong Kong Chinese adults is between 3.7 mm and 4.7 mm which is similar to the finding in previous literatures. This study also suggests that bedside ocular USG is a convenient and useful tool in measuring ONSD and the application of this technique is acceptable by patients in our locality.
A Pilot Randomised Clinical Trial of 3-In-1 Femoral Nerve Block and Intravenous Morphine as Primary Analgesia for Patients Presenting to the Emergency Department with Fractured Hip
Authors: Graham CA , Baird K , McGuffie AC
Published: December 2017

Background

Fractured neck of femur (NOF) is a leading cause of morbidity and mortality in the elderly. Published clinical guidelines suggest early adequate analgesia as a key management aim. The femoral nerve ‘3-in-1 block’ has previously been shown to provide effective analgesia for these patients in the peri- and post-operative phase of care. The aim of this study was to examine the use of the ‘3-in-1’ femoral nerve block as primary analgesia for patients with a fractured NOF presenting to the emergency department.

Methods

This was a single centre pragmatic randomised controlled open-label trial comparing femoral nerve block (using a ‘3-in-1’ technique) with intravenous (IV) morphine. A convenience sample of patients presenting to the emergency department of a district general hospital with a clinically or radiologically suspected fractured NOF were recruited. They were randomised to receive either 0.1 mg/kg IV bolus of morphine or a ‘3-in-1’ femoral nerve block with 30 ml of 0.5% plain bupivacaine. Visual analogue pain scores were noted prior to treatment and at 30 minutes, 2 hours, 6 hours and 12 hours after treatment. Immediate complications such as vascular puncture or the requirement for naloxone were noted.

Results

Forty patients were recruited, 22 patients were randomised to IV morphine and 18 patients were randomised to ‘3-in-1’ femoral nerve block. Complete data were available for 33 patients. There was no significant difference in initial median pain score (p=0.45). Analysis using the Wilcoxon test showed a significant decrease in pain score for the morphine group (p=0.01) and the nerve block group (p<0.01) at 30 minutes compared with baseline. Analysis using the Mann-Whitney U test between median pain scores at each time point showed a significant lower pain score in the nerve block group at 30 minutes (p=0.046). There were no immediate complications in either group.

Conclusion

Our results suggest that a ‘3-in-1’ femoral nerve block is at least as effective as IV morphine when used as primary analgesia for patients with fractured NOF. Our results suggest that the femoral nerve block may provide better analgesia at 30 minutes. Further larger scale randomised trials are warranted.
Hong Kong Poison Information Centre: Annual Report 2006
Authors: Chan YC , Tse ML , Lau FL
Published: December 2017

Objective

To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2006.

Methods

From 1st January 2006 to 31st December 2006, all poisoning cases received by HKPIC were retrieved from its database (DATOX) for analysis.

Results

A total of 2555 poisoned cases were analysed. There were 1051 male and 1466 female patients and nearly 60% of the cases were between 20 and 49 years old. Common causes of exposure were suicidal attempts and accidents. Paracetamol, sedative-hypnotic and household products were common sources of poison exposure. The majority of the patients were managed conservatively, with 18.8% and 10.5% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; less than 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes. Nearly half of the cases were managed in the accident & emergency department without hospitalisation.

Conclusions

This annual report provides updated epidemiological information on poisoning in Hong Kong. Subsequent annual reports would provide important information on the trend of poisoning pattern and may guide further strategies in poison control and prevention in Hong Kong.
The Use of Patient Education Video in Improving Patient Satisfaction in the Accident and Emergency Department
Authors: Chan LW , Choi SY , Chan HH , Wong TW , Lau CC
Published: December 2017

Objective

To study the impact of patient education video in improving patient satisfaction in the accident and emergency department (AED).

Methods

This was a descriptive questionnaire study. A 20-minute patient education video in Cantonese was produced. The video was shown in the waiting hall from 9 am to 5 pm during the weekdays of a week in January 2008. All category 4 (semi-urgent) and category 5 (non-urgent) patients were invited to fill in an evaluation questionnaire after watching the video. The demographics of the patients were collected. There were two parts in the questionnaire. Part 1 contained four questions to test patients' knowledge retention after watching the video. These included questions on pharmacy location, triage system, use of patient identification slip and scope of the AED service. Part 2 contained six evaluation items (based on the 5-point Likert scale) to assess patients' opinion on the education video, understanding of the AED workflow and level of satisfaction after watching. Statistical analysis was performed to compare the knowledge retention scores and the Likert responses between different age and education level subgroups.

Results

Altogether 177 questionnaires were returned; 72 were excluded due to incomplete answers or absent patient gum label; and 105 completed questionnaires were analysed. Of the latter, 83 (79%) respondents scored 75% or more in the questions on knowledge retention, 79 (75%) respondents agreed that they understood the workflow of the AED better, 63 (60%) respondents thought that the video covered most frequently asked questions, and 69 (66%) respondents agreed that their level of satisfaction had improved after watching the video. There was no statistically significant difference on comparing the knowledge retention scores between different age and education level subgroups. Respondents more than 60 years old stated a better understanding about the location of consultation rooms after watching the video.

Conclusion

A patient education video is useful in providing information about operation and improving patient satisfaction in the accident and emergency department.