bluuebunny/crossref_metadata_2025 huggingface dataset:
Sublingual and Supraglottic Haemorrhage as a Complication of Warfarin Therapy
Authors: Yaman H , Guven DG , Kandis H , Subasi B , Alkan N , Yilmaz S
Published: December 2017

Anticoagulant-induced haemorrhage in the upper airway is rare, but it can be life threatening if airway obstruction develops. Treatment is mainly conservative. Urgent control of airway and coagulopathy are the essential of management. Vitamin K1 or combination of fresh frozen plasma and vitamin K1 should be used for reversal of the coagulopathy. In this report, two elderly patients were reported to have oral anticoagulant (warfarin)-induced haemorrhage in the sublingual and supraglottic areas.
Poison Exposure in the Emergency Department: A Singaporean Experience
Authors: Chiu LQ , Lim BL , Vasu A , Phua DH , Goh HK
Published: December 2017

Introduction

Poison exposure is a significant problem in emergency departments (EDs) with high admission rates. Our study aims were to describe the demographics, exposure patterns and clinical outcomes of our ED patients as well as to explore predictors of Intensive Care Unit (ICU) / High Dependency (HD) admission.

Methods

In this retrospective study, we recruited patients aged over 16 years who presented with poison exposure to our ED over one year. We collected demographical and clinical data using our hospital databases. Primary outcomes were mortality rate and disposition status. Secondary outcomes were predictors for ICU/HD admission. Logistic regression was applied to identify these predictors.

Results

We recruited 615 patients from an ED attendance of 162,159. Four hundred and nineteen (68%) patients were females; the majority [410 (66.7%)] was Chinese. The median age was 33 years [interquartile range (IQR): 24‐44]. Four hundred fifty‐six (74.1%) and 159 (25.9%) exposures were intentional or accidental respectively. There were no mortalities. The majority [466 (75.8%)] was admitted to the general ward and only 24 (3.9%) cases were ICU/HD admissions. We identified four factors associated with ICU/HD admission. Odds ratios (95% confidence intervals) for hypotension (systolic blood pressure <90 mmHg), pupillary changes, previous psychiatric history and tricyclic antidepressant overdose were 19.7 (5.57‐69.65), 31.9 (7.01‐145.76), 3.1 (1.08‐9.07) and 30.1 (9.40‐96.52) respectively.

Conclusions

Poison exposure is an infrequent ED occurrence with high admission rates but low mortality. Our study identified risk factors for ICU/HD admission that could be used in future studies to triage at‐risk patients for treatment escalation.
Hong Kong Poison Information Centre: Annual Report 2009
Authors: Chan YC , Tse ML , Lau FL
Published: December 2017

Objective

To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2009.

Methods

In 2009, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis.

Results

Totally 4338 poisoned cases were analysed. There were 1955 male patients (45.1%), 2,367 female patients (54.6%) and 16 patients with no gender specified. More than two‐third of cases (68.6%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, abusive use and unintentional exposure. Paracetamol, ketamine, zopiclone, benzodiazepine and household products were the common poisons exposed. Majority of the patients were managed supportively, with 13.6% and 13.1% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; about 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes.

Conclusions

The 2009 annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.
A Case of Unintentional Methadone Overdose Followed by Hypoglycaemia
Authors: Fung HT , Cheung KH , Lam SK , Wong OF , Leung KL , Leung SH
Published: December 2017

Methadone overdose is expected to result in intoxication simulating the other opioids. We report a case of hypoglycaemia following accidental methadone ingestion. A 21‐year‐old woman presented to a local accident and emergency department 10 hours after ingestion of 800 mg of methadone. She was found to have coma, respiratory suppression, hypotension, prolonged QTc and hypoglycaemia. The hypoglycaemia was reversed by dextrose replacement. The patient required intubation and inotropic support because of cardio‐respiratory instability. She eventually recovered without consequence. To date, this is the first reported case of methadone overdose induced hypoglycaemia.
Five Cases of Carbon Monoxide Poisoning Due to Narghile (Shisha)
Authors: Arziman I , Acar YA , Yildirim AO , Cinar O , Cevik E , Eyi YE , Kaldirim U
Published: December 2017

Narghile known in different names as shisha, hookah, hubble‐bubble, waterpipe has been smoked widely in Middle East countries traditionally and recently began to spread to European countries and USA. Narghile is consumed particularly by university youth in cafes as a social activity in Turkey. We report a case series of five patients presented with narghile induced carbon monoxide (CO) poisoning. We believe that this problem might be overlooked and underreported. We want to emphasize that, in the differential diagnosis of nonspecific neurological complaints (especially headache, nausea, vomiting and vertigo) CO poisoning must be considered and patient must be questioned about the usage of narghile smoking especially in areas popular of it.
Maisonneuve Injury: Beware of the ‘Isolated’ Medial Malleolus or Proximal Fibula Fracture
Authors: Pastides P , Gulati V , Peena S , Tibrewal S
Published: December 2017

Ankle injuries are a common presentation of patients to the emergency department. When fractures are noted around the ankle, it is mandatory that the entire leg and knee are examined. We present three cases of patients who attended our emergency department with ankle injuries. Each patient was diagnosed with isolated malleolar fractures and discharged to the fracture clinic. On review by the orthopaedic team, they were all found to have associated proximal fibula fractures, the Maisonneuve injury, which required surgical intervention. Maisonneuve type injuries are easily overlooked in busy emergency departments. Full clinical examination of the entire limb is mandatory and suspicion should be raised if there is (a) tenderness on palpation of the proximal fibula; (b) evidence of talar shift within the joint; (c) isolated malleolar or fibula fractures.
Posterior Reversible Encephalopathy Syndrome in Early Postpartum Woman
Authors: Cho HJ , Lee HJ
Published: December 2017

There have been reports about posterior reversible encephalopathy syndrome (PRES) associated with pregnancy, especially peripartum. However, the pathophysiology of PRES is not still clear. Tonic‐clonic seizure occurred during early postpartum in a woman with the tendency toward pre‐eclampsia developed after vaginal delivery followed by emergency cesarean hysterectomy. Postictal findings included headache, loss of vision, and short‐term memory loss and magnetic resonance imaging (MRI) findings suggesting PRES were noted. Neurologic symptoms and cerebral lesions were gradually improved with immediate supportive managements.
Clinical Characteristics of Patients with Pseudo-Subarachnoid Haemorrhage who were Successfully Resuscitated from Out-of-Hospital Cardiopulmonary Arrest
Authors: Ahn JH , Choi SC , Jung YS , Min YG
Published: December 2017

Introduction

Pseudo-subarachnoid haemorrhage (PSAH) is a rare neuroradiological finding seen in patients with diffuse cerebral edemas. We investigated clinical characteristics and risk factors for the development of PSAH.

Method

The successfully resuscitated patients in emergency department were classified into two groups: those with pseudo-SAH [PSAH (+)] and those without pseudo-SAH [PSAH (-)]. Clinical variables were analysed.

Results

Pseudo-SAH was found in 31.6% of patients. PSAH was more common in males (p=0.042). The mean age was 39.9±10.3 years in the PSAH (+) group and 54.4±22.0 years in the PSAH (-) group (p=0.038). Outcomes measured by Cerebral Performance Category score were also significantly different between the two groups (p=0.037). Logistic regression analysis found that serum lactate concentration and duration of anoxia were associated with the development of PSAH (with odds ratios and p values of 1.92, p=0.01 and 1.13, p=0.02, respectively).

Conclusions

PSAH itself is a phenomenon that could be seen in post-resuscitation encephalopathy as a consequence of severe anoxic insult.
Does Intravenous Magnesium Benefit Patients of Cardiac Arrest? a Meta-Analysis
Authors: Chen F , Lin Q , Chen G , Wang X , Lin S
Published: December 2017

Objective

Evidence shows that magnesium has anti-arrhythmic roles. However, clinical trials suggest that there are conflicting outcomes of cardiac arrest patients given magnesium. The study aimed to examine the effects of magnesium sulfate therapy on cardiac arrest patients using a meta-analysis.

Methods

We searched the MEDLINE (1966-July 2011), OVID (1980-July 2011), EMBASE (1980-July 2011), Chinese bio-medical literature & retrieval system (1978-July 2011), Chinese medical current contents (1995-July 2011), and Chinese medical academic conference (1994-July 2011). Studies were included if (1) the study design was a randomised controlled trial (RCT); (2) the study population included cardiac arrest patients who received cardiopulmonary resuscitation and either intravenous magnesium or placebo (0.9% normal saline); (3) the study provided data on return of spontaneous circulation (ROSC) and survival to hospital discharge. Relative risk (RR) and 95% confidence interval (CI) were used to pool the effect.

Results

The study included six RCTs with a total of 531 participants from cardiac arrest. The pooled data demonstrated that ROSC and hospital discharge rates in patients treated with magnesium were 35.5% (95% CI=29.7%-41.3%) and 10.4% (95% CI=6.7%-14.1%) compared with placebo (ROSC rate: 31.3%, 95% CI=25.8%-36.8%; hospital discharge rate: 8.5%, 95% CI=5.2%-11.8%). Administration of intravenous magnesium sulfate could not significantly increase ROSC (RR=1.14, 95% CI=0.91-1.43, P=0.26) and survival to hospital discharge (RR=1.22, 95% CI=0.74-2.02, P=0.43) compared with placebo.

Conclusions

Administration of magnesium sulfate does not improve ROSC and survival to hospital discharge in patients of cardiac arrest.
Osborn Wave in a Patient with Intracranial Haematoma and Hypothermia
Authors: Dedeoglu E , Bayram B , Dedeoglu B
Published: December 2017

Hypothermia is defined as a core body temperature below 35°C. Hypothermia affects all organs, especially the brain and heart. Osborn wave (J) is a positive deflection that is seen at the end of the QRS wave in electrocardiography (ECG) and could be seen in cases such as intracranial events, and hypercalcemia besides hypothermia. An 85-year-old male patient was found unconscious in cold weather. He was hypothermic and J wave was detected in his ECG examination. His brain CT scan revealed intracerebral haematoma. Our aim is to reiterate that intracranial haemorrhage can be a differential diagnosis for patients who come to the emergency department with hypothermia and Osborn wave in ECG.
Comparison of the Efficacies of Topical Anaesthetics in the Reduction of the Pain during Peripheral Intravenous Cannulation: A Randomised Trial
Authors: Armagan E , Kocabas E , Koksal O , Simsek G , Bal H
Published: December 2017

Objective

This study aimed to compare the efficacies of two different topical anesthetic agents and placebo in the reduction of the pain observed during intravenous (IV) cannulation.

Methods

Study enrolled a total of 129 healthy male donors and IV cannulation was performed to antecubital region. The donors were assigned into three groups. Prilocaine‐lidocaine mixture cream (E), lidocaine spray (X) and Placebo cream (P) were given to patients. After the administration the donors were waited for approximately 45 minutes. The pain experienced by the donors after the insertion of 16 gauge cannula in arms was recorded as “pain experienced at minute 0, 5 and 15” on 100 mm visual analog scale (VAS).

Results

In the first group, there was no significant difference between mean VAS scores recorded after the administration of prilocainelidocaine mixture cream and lidocaine spray before IV cannulation. Mean VAS value was 9.1 mm with prilocaine‐lidocaine mixture cream and 9.3 mm with lidocaine spray. In the second group, we detected significant difference between mean VAS scores recorded after the administration of lidocaine spray and placebo cream. Mean VAS value was 9.8 mm with lidocaine spray and 24.3 mm with placebo (p<0.05). In the third group, we found statistically significant difference between VAS scores recorded after the administration of prilocaine‐lidocaine mixture cream and placebo cream. Mean VAS value was 8.8 mm with prilocaine‐lidocaine mixture cream and 33.0 mm with placebo cream (p<0.05).

Conclusion

Although both agents administrated before IV cannulation were superior to placebo in adult patients in this study, we can state that these drugs were not superior to each other and showed similar efficacy.
Comparison of the Accuracy of Local and International Prediction Models for Massive Transfusion in Major Trauma Patients
Authors: Poon KM , Lui CT , Tsui KL
Published: December 2017

Objective

To validate a local prediction model (Rainer's score) for massive transfusion in trauma patients and compare its accuracy with international prediction models (TASH score and ABC score) using local trauma data.

Methods

Patients were recruited retrospectively from the trauma registry of a regional trauma centre during the period from January 2005 to December 2010. Patients with Injury Severity Score (ISS) ≥9 and aged ≥12 years were included. Burn and drowning patients, patients with known severe anemia (haemoglobin <7 g/dL) and renal failure were excluded. Massive transfusion was defined as delivery of ≥10 units of packed red blood cells within 24 hours. The sensitivity specificity positive and negative predictive values, positive and negative likelihood ratio and accuracy were calculated for different prediction models. The overall discriminatory capacities of models were compared using the area under the receiver operating characteristic (ROC) curve.

Results

A total of 1030 patents met the inclusion criteria and 27 patients required ≥10 units packed cells within 24 hours. The accuracy was the best in the TASH score (97.3%) when compared to the Rainer's score (96.5%) and ABC score (95.1%). Sensitivity was better in Rainer's score (33.3%) and ABC score (33.3%) than in the TASH score (25.9%). The area under ROC curve for TASH score, Rainer's score and ABC score were 0.911, 0.886 and 0.809 respectively.

Conclusions

We validate the prediction model (Rainer's score) by a set of local, non‐university institution data. Rainer's score has high accuracy (97%) in predicting the need for massive transfusion and is comparable to TASH score and ABC score.
Confusion in Patients with Shingles and Renal Failure: Acyclovir Neurotoxicity or Herpes Encephalitis
Authors: Ng HW , Pang CT
Published: December 2017

It is not uncommon for patients with shingles and renal failure who develop confusion during the course of therapy. The patient may have suffered from the adverse reaction of acyclovir or have the neurologic complication related to the dermatological herpes zoster. Acyclovir induced neurotoxicity and herpes encephalitis have similar clinical feature but their treatments are completely different. Often, doctors face challenges in differentiating the two conditions and the dilemma of whether to continue or stop acyclovir. We reported two cases of renal impairment patient who developed altered mental state after receiving oral acyclovir for the herpes skin lesion. One suffered from varicella encephalitis and the other had acyclovir‐induced neurotoxicity. The difference in clinical features among the two conditions and the management of acyclovir‐induced neurotoxicity was highlighted.
How Do Adult and Paediatric Intussusceptions Differ? a 10‐Year Retrospective Study
Authors: Wong KB , Lui CT , Fung HT
Published: December 2017

Introduction

Intussusception in adult is considered to be an uncommon surgical condition. Our study aims to gather the epidemiology data of intussusception in local population and to compare the clinical characteristics, investigation and management between adult and paediatric intussusceptions.

Methods

This is a retrospective study of patients who were diagnosed intussusception from January 2001 to June 2011 in the study centre. Demographic data, clinical presentation, investigation and management were compared between adult and paediatric patients.

Results

There were 79 patients included in the study period. Twenty‐two of them (27.8%) were adults (aged at least 18 years) while 57 (72.2%) of them were paediatrics patients (age <18 years). Forty‐three (54.4%) of them were male and 36 (45.6%) of them were female. Mean age of intussusception in adult and paediatric groups were 56.1 years and 23.9 months respectively. The median duration of onset of the presentation of adult patient was 3.5 days which is longer than that of paediatrics group (1 day) (p<0.001), per‐rectal bleeding occurred in 18.2% (4/22) of adult patients while 47.4% (27/57) of paediatric intussusception had per‐rectal bleeding (p=0.017). There was also significantly more vomiting (78.9%, 45/57) in paediatric intussusception compared with 31.8% in adults (p<0.001). A total of 72.7% (16/22) of adult intussusception were diagnosed by CT scan while 94.7% (54/57) of paediatrics was diagnosed by ultrasound by radiology department. 77.3% (17/22) of the adult intussusceptions had a neoplastic leading point. All the adult intussusception required surgical management while only 21.1% (12/57) of the paediatrics group required surgical reduction with or without bowel resection. The median length of stay (LOS) of adult group was 9 days which is longer than that of the paediatrics group (4 days) (p<0.001).

Conclusions

Intussusception in adult patients lacks classical presentation of per‐rectal bleeding and vomiting and the onset is commonly sub‐acute when compared with paediatrics cases. Most of the adult intussusceptions have pathological leading points that warrant surgical management.
Kounis Syndrome, a Cause of Chest Pain to Keep in Mind, May be Associated with E148Q Mutation
Authors: Şaylan B , Çevik A , Firat C
Published: December 2017

Chest pain is among the leading complaints in paediatric emergency. The Kounis syndrome is a rare allergic coronary vasospasm, which can cause angina and myocardial infarction. Even though organic causes are infrequent as a cause of chest pain in children, it is important to know when and how this symptom may become serious. We reported a patient who had been admitted with chest pain to the emergency department, hospitalised for coronary vasospasm and diagnosed to have Kounis syndrome and heterozygous E148Q mutation. The finding could be a coincidental finding, but considering of the heterogeneity and phenotypic differences in FMF, the relationship between E148Q mutation and Kounis syndrome should be explored further.
New Era of CPR: Application of I-Technology in Resuscitation
Authors: Chan TK , Wan KA , Chan JCK , Lam HKC , Wong YT , Kan PG
Published: December 2017

Introduction

The present study evaluated the performance and acceptance of a cardiopulmonary resuscitation (CPR) feedback application for the iPhone (“PocketCPR®”) designed to improve chest compression performance.

Methods

We randomly assigned participants into two groups to perform chest compression with (study group) or without (control group) using the “PocketCPR®” on a manikin. The participants performed totally four sets of chest compression simulating two CPR scenarios. In the first scenario, no advanced airway was inserted while in the second scenario, advanced airway was inserted. We measured and compared the rate and depth of chest compression between the groups in both scenarios. Participants in study group also finished a questionnaire on the use of feedback application.

Results

The mean compression depth of the study group was significantly deeper both in the first scenario (5.22 cm; 4.56 cm, p=0.002; 5.30 cm; 4.56 cm, p=0.001) and the second scenario (5.34 cm; 4.56 cm, p<0.001; 5.35 cm; 4.49 cm, p<0.001). However, the mean compression rate of study group was significantly slower than the control group both in the first scenario (105.19; 118.58, p<0.001; 105.23; 119.36, p<0.001) and the second scenario (106.10; 121.08, p<0.001, 106.61; 117.42, p=0.002).

Conclusion

A mobile phone feedback application “PocketCPR®” improves chest compression quality by increasing the compression depth in laboratory setting. Further study is indicated to demonstrate its benefit in clinical setting.
Predictors of Outcomes of Pedestrian Casualties in Motor Vehicle Injuries Managed in Emergency Department
Authors: Leung CH , Lui CT , Tsui KL
Published: December 2017

Introduction

Pedestrian injury is a major health care concern. This study aims to identify predictors of mortality and severe injury in pedestrian casualties in motor vehicle injury managed in emergency department in the local setting.

Methods

This is a retrospective cohort study of a linked hospital and police trauma registry (2004 to 2008). All pedestrian casualties treated in the emergency department (ED) of two regional hospitals in Hong Kong were included. Logistic regression was performed for potential predictor variables (age >65 years; injury patterns including head or face, thorax/abdomen/pelvis, neck/spine, extremities; existence of multiple injuries; heavy vehicles involved; body impact with the vehicles; injury at night and wet road surface) against mortality and severe injury, defined as Injury Severity Scale (ISS) >15.

Results

A total of 1542 pedestrian casualties were analysed. Age >65 was found to be an independent predictor of mortality in pedestrian casualties, with odds ratio (OR) of 5.15 (95% CI=2.21‐12.00; p<0.001). Other independent predictors of mortality included injury to head/face (OR=4.52, 95% CI=1.75‐11.7, p=0.002), injury to thorax/abdomen/pelvis (OR=13.36, 95% CI=5.64‐31.6; p<0.001), multiple injuries (OR=4.0, 95% CI=1.06‐15.1; p=0.041) and wet road surface (OR=3.27, 95% CI=1.31‐8.17; p=0.011). These factors were also independent predictors for severe injury. Involvement of heavy vehicles and body impact with vehicles were not independent predictors of mortality. However, these were significant predictors of severe injury (OR=1.86 and 2.85 respectively).

Conclusion

Old age, injury to head/face or thorax/abdomen/pelvis, multiple injuries and wet road surface in accident scene are independent predictors for mortality in pedestrian casualties. In addition, involvement of heavy vehicles and body impact with vehicles are predictors of severe injury.
Overwhelming Postsplenectomy Sepsis Presenting as Purpura Fulminans due to Streptococcus Suis Infection
Authors: Ng HW
Published: December 2017

Splenectomised patients are more likely to suffer from severe infections, such as sepsis and meningitis. This condition is called overwhelming postsplenectomy infection (OPSI) syndrome. The risk of OPSI is greatest in the early months, and even years, after the operation, but never disappears entirely. The course of OSPI is rapid, the clinical presentations serious, and the prognosis poor. We present here a case of OPSI in a posttraumatic splenectomised adult who had features of fulminant sepsis such as hypotension, renal and liver failure, coagulopathy, and generalised skin rash presented as purpura fulminans. The culprit was found to be Streptococcus suis by the polymerase chain reaction technique. By reporting this case, we hope to emphasize the importance of preventive strategies: vaccination, antibiotic prophylaxis, and patient education. The management of Streptococcus suis infection and the use of 16S rRNA gene sequencing for bacterial identification were also highlighted.
Agreement between Arterial and Venous Blood Gases In Emergency Medical Care: A Systematic Review
Authors: Kelly AM
Published: December 2017

Aim

The objectives of this review are to describe the agreement between arterial and venous blood gas values for pH, pCO2, bicarbonate and base excess.

Methods

MEDLINE search of papers published 1966-September 2012 for studies comparing arterial and peripheral venous blood gas values for any of pH, pCO2, bicarbonate and base excess in adult patients with any condition in an emergency department setting. The outcome of interest was mean difference weighted for study sample size.

Results

The weighted mean arterio-venous difference in pH was 0.034 pH units (n=2087), with narrow limits of agreement. The weighted mean arterio-venous difference for pCO2 was 6.2 mmHg (n=1043), but with 95% limits of agreement up to the order of ±20mmHg. Venous pCO2<45 mmHg has 100% sensitivity and negative predictive value for prediction of arterial hypercarbia (n=529). For bicarbonate, the weighted mean difference between arterial and venous values was −1.20 mEq/L (n=1403), with 95% limits of agreement of the order of ±5 mmol/L. Regarding base excess, the mean arterio-venous difference was 0.4 (n=295) but data are conflicting regarding the width of 95% limits of agreement.

Conclusion

For patients who are not in shock, venous pH and bicarbonate have sufficient agreement to be clinically interchangeable for arterial values. Agreement between arterial and venous pCO2 is too poor and unpredictable to be clinically useful as a one-off test but venous pCO2 may be useful to screen for arterial hypercarbia.
Inguinal Hernia Mimicking as a Spigelian Hernia
Authors: Tse PY , Chan CC , Wong WM , Cheung CC
Published: December 2017

Inguinal hernia is a common surgical condition requiring surgical intervention. The usual clinical presentation is a supra-inguinal swelling with the neck just above and medial to pubic tubercle. We report a case of inguinal hernia in an old lady that presented as an abdominal wall swelling, clinically suggestive of a Spigelian hernia.
A Rare Complication of Boerhaave's Syndrome: Tension Pneumothorax
Authors: Atilla O Duman , Sever M , Dogan T , Uslu T
Published: December 2017

Boerhaave's syndrome is a very rare disease characterised by spontaneous rupture of the oesophagus. Clinical presentation is varied and may depend on the cause, location, size, degree of contamination, and site of injury. Patients may present with abdominal pain, pneumothorax, hydropneumothorax, and pneumomediastinum. Tension pneumothorax after esophageal perforation has been rarely reported in the medical literature. In our report, a case of tension pneumothorax secondary to Boerhaave's syndrome in a 44‐year‐old male is presented here.
Elevated Aminotransferases are Predictors of Hepatic Injury in Blunt Abdominal Trauma Patients
Authors: Chang CH , Lin HJ , Liao YY , Chu FY , Chen KT
Published: December 2017

Objective

Computed tomography (CT) scan is currently the most commonly used tool for evaluating solid‐organ injuries in trauma management. However, liberal use of CT scanning increases the risk of excess radiation exposure and toxicity from contrast material. Animal studies and clinical research on the paediatric population indicated that liver enzymes elevations were related to hepatic injury. The present study was undertaken to determine whether elevated liver enzymes were associated with the occurrence of hepatic injury in adult patients with blunt abdominal trauma.

Methods

This is a cross‐sectional study from August 2003 to October 2006. All adult patients with blunt injury to abdomino‐pelvic organs documented by CT or surgery who were admitted to Chi‐Mei Medical Centre in the captioned period were included. The study population sorted to hepatic injury (HI) and no hepatic injury (NHI) groups according to the presence or absence of hepatic injury. Variables including liver enzymes were compared between the groups.

Results

Totally 419 patients were included, including 150 patients in the HI group and 269 patients in the NHI group. The HI group was younger and had a lower rate of laparotomy (36.3 years old vs 41.4 years old; 26% vs 42%, respectively). The mean levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the HI group were significantly higher than levels in the NHI group (439.6 IU/L vs 104.7 IU/L; 353.5 IU/L vs 76.6 IU/L, p<0.01). We define AST >200 IU/L or ALT level >125 IU/L as abnormal according to previous studies. The diagnostic characteristics of hepatic injury were 87.3% sensitivity, 80.3% specificity, 71.2% positive predictive value, and 91.9% negative predictive value.

Conclusion

In adults who have experienced blunt abdominal trauma, AST >200 U/L or of ALT >125 U/L are practical predictors of hepatic injury. Screening serum aminotransferases will have a role in detecting occult hepatic injury and may reduce the hazards of excessive CT scanning. (Hong Kong j.emerg.med. 2013;20:337‐342)
Wunderlich Syndrome: An Unusual Cause of Abdominal Pain with Hypovolaemia
Authors: Chan KP
Published: December 2017

Wunderlich syndrome, or spontaneous retroperitoneal haemorrhage, is a rare but potentially fatal condition. I report a case of a middle‐aged lady who presented with this rare condition where a bedside point‐of‐care ultrasound scan expedited the management of the patient. (Hong Kong j.emerg.med. 2013;20:385‐388)
Ischaemic Stroke following Minor Head Trauma: A Case Report and Review of the Literature
Authors: Eken C , Serinken M , Armagan HH , Duman O , Cira K
Published: December 2017

Head trauma is one of the leading causes of emergency department (ED) presentations. However, ischaemic stroke due to the minor head trauma is an unusual and unexpected condition for ED physicians. We report a ten‐month‐old boy was presented to the ED with disability in the left leg and arm. The child fell off the bed to the floor from a height of approximately 0.5 meter while sleeping. The cranial computed tomogram scan revealed a hypodense lesion in the posterior limb of right internal capsule that was consistent with brain infarct. ED physicians may consider a possible ischaemic stroke in children presented with minor head trauma without any pathological finding on the physical examination. (Hong Kong j.emerg.med. 2013;20:392‐395)
Kernohan‐Woltman Notch Phenomenon Caused by Acute Traumatic Subdural Haematoma
Authors: Chen PY , Chen TY , Lee YC , Liliang PC
Published: December 2017

A 27‐year‐old man suffered from right hemiparesis after a closed head injury. Computed tomography (CT) revealed a right hemisphere subdural haematoma with midline structure shifted to the left. The CT finding was believed to be mislabeled because the site of haematoma did not correlate with an ipsilateral hemiparesis. Magnetic resonance imaging revealed a right transtentorial uncal herniation and a small lesion within left cerebral peduncle, suggesting Kernohan‐Woltman notch phenomenon (KWNP). KWNP has been rarely seen in patients with acute traumatic subdural haemorrhage. Anatomical small maximum tentorial notch width is the possible anatomical factor predisposing our patient to this phenomenon. (Hong Kong j.emerg.med. 2014;21:116‐119)
Predictors of Outcome in Out-Of-Hospital Cardiac Arrest Survived to Hospital Admission
Authors: Au WK , Tsui KL , Tang YH , Lui CT
Published: December 2017

Objective

To identify the independent predictors of survival to hospital discharge in the group of patients admitted to hospital with out-of-hospital cardiac arrest.

Design

Prospective cohort study.

Setting

Two public hospitals in a cluster in Hong Kong.

Methods

Data were reported to local Cardiac Arrest Registry using Utstein style template from 1st August 2010 to 31st October 2012. The post cardiac arrest care and outcome, premorbid mobility, activities of daily living (ADL) and medical illnesses were traced from medical records. Independent predictors were calculated using logistic regression model.

Results

A total of 323 patients were recruited in this study. Patients' age (Odds raio [OR]=0.966; 95% confidence interval [CI]=0.937-0.996), total down time (OR=0.897; 95% CI=0.858-0.938), pre-hospital defibrillation (OR=5.649; 95% CI=1.673-19.07), post-cardiac arrest intensive care (OR=3.674; 95% CI=1.001-13.951) were independent predictors of survival to hospital discharge.

Conclusions

Younger age, shorter down time, prehospital defibrillation for shockable rhythm, post-cardiac arrest intensive care are independent predictors of survival to discharge for patients admitted to hospital after out-of-hospital cardiac arrest. Premorbid health conditions, ADL and mobility are not predictors to patient's survival. (Hong Kong j.emerg.med. 2014;21:131-139)
Traumatic Asphyxia: A Rare Clinical Syndrome
Authors: Kartal M , Goksu E , Yigit O , Aydin AG
Published: December 2017

Traumatic asphyxia is a rare clinical syndrome characterised by cyanosis, oedema and petechial haemorrhage of the face, neck and upper chest due to the sudden, transient and severe thoraco-abdominal compression trauma. The huge increase in intra-thoracic pressure caused by the compression constitutes all the symptoms. Although mortality and morbidity due to traumatic asphyxia can happen, most of the patients survive without any sequel. Herein, we report three cases of traumatic asphyxia assessed in our emergency department. (Hong Kong j.emerg.med. 2014;21:185-188)
Presentations of Runners in Kong Kong Marathon to a Local ED: A 10 Years' Glance
Authors: Chan PYN , Mok KL , Wong YT , Kan PG
Published: December 2017

Objective

To determine the basic characteristics, presentations, diagnoses and critical outcomes (heat Stroke, heat exhaustion, post-cardiac arrest and acute coronary syndrome) of patients in Accident and Emergency Department (AED) of Ruttonjee and Tang Shiu Kin Hospital (RHTSK) who participated in Hong Kong Marathon from 2003 to 2012.

Methodology

This was a simple descriptive epidemiology study to analyze patients who were participants of Hong Kong Marathon and attended AED of RHTSK for any complaint during or after the event.

Results

There were a total 170 participants who attended AED of RHTSK in these ten years; in which, 74.1% were male, with a mean (SD) age of 38.08 (11.29). Totally, 77.1% were non-trauma cases and 46.5% were critical/urgent cases (category in AED triage 1-3). Among all cases, 31.8% required admission, 4.1% were care in intensive care unit (ICU), 12.4% were managed in resuscitation room and 3.5% required intubation. The majority of cases were heat stroke and heat exhaustion. There were 4 cases of post cardiac arrest, 3 of them admitted to ICU after successful resuscitation. Number of critical/urgent cases increased with apparent temperature on Marathon Day. The correlation coefficient of percentage of critical/urgent cases with apparent temperature was 0.827 (p=0.011).

Conclusion

Total number of participants increased dramatically in Hong Kong Marathon throughout these ten years, participants' required medical attendance and emergency service also increased respectively. Number of critical/urgent cases increased with apparent temperature on Marathon Day. The majority of cases were heat-related illness, 4 cases presented with post cardiac arrest and one failed in resuscitation. (Hong Kong j.emerg.med. 2014;21:197-204)
A Survey of the Residents of Zhejiang, China on the Knowledge and Awareness of Community Cardiopulmonary Resuscitation and Expectation of the Emergency Medical Service
Authors: Tu JF , Yang Y , Cai WW , Chen H , Chen L , Zhou SA , Zhang MQ , Yang XH , Zhang K , He HQ
Published: December 2017

Objectives

To investigate the opinions and expectations of residents from Zhejiang Province on the prehospital emergency medical services (EMS). To evaluate the differences among main urban areas, county-level areas and rural areas in Zhejiang Province. To provide objective data for relevant departments to make further improvement and promote balanced development of the pre-hospital EMS cause.

Methods

The study was conducted from 1st April 2011 to 30th December 2011. It was carried out in 11 cities and 1,650 residents were included by stratified random sampling method. The survey mainly focused on residents' expectations of EMS and residents' knowledge of emergency skills, the emergency response time, the actions of EMS dispatchers, the fees charged for EMS. Pearson's Chi-Square Test was also used to compare the differences of the current status and residents' expectations of EMS among main urban areas, county-level areas and rural areas.

Results

The survey showed that the top four emergency skills most needed by residents are cardiopulmonary resuscitation (CPR), bandaging to stop bleeding, first aids for heatstroke and drowning. Trauma patients account for 37.5% (95% CI: 35.08-39.92%) of all those who received EMS service, ranking the first place. While the percentage receiving “wound care” was rated as the most needed emergency skill. There were statistically significant differences in the rate of knowing CPR, independently conducting CPR and emergency response time less than 5 minutes among main urban areas, county-level areas and rural areas in Zhejiang Province.

Conclusions

Residents of Zhejiang Province lack knowledge and awareness of emergency skills. Their mastery and expectation of emergency skills vary greatly from rural areas to urban areas. Trauma patients have become the main receiver of EMS in these three different regions. The emergency response time, as well as the services provided by EMS dispatchers, is far below the expectation of residents. In addition, the majority of respondents expect EMS to send patients to the nearest hospital and most of the trained paramedics are qualified for the pre-hospital care. (Hong Kong j.emerg.med. 2014;21:237-248)
Hong Kong Poison Information Centre: Annual Report 2013
Authors: Chan YC , Tse ML , Lau FL
Published: December 2017

Objective

To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2013.

Methods

In 2013, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis.

Results

A total of 3,783 poisoned cases were analysed. There were 1,595 male patients (42.2%), 2,185 female patients (57.8%) and 3 sex unspecified patients (0.1%). Middle aged group (30-39 years) composed about one-fifth (20.8%) of the poisoning cases while about two-third (66.8%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (43%), unintentional exposure (15.3%) and abusive substances use (14.5%). Five commonest types of poison exposed were paracetamol, benzodiazepine, zopiclone, household products and Chinese herbal medicine. Majority of the patients were managed with supportive measures, and 13.2% and 10.8% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.9% of the poisoning resulted in death and 4.3% had major outcomes.

Conclusions

This 8th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports. (Hong Kong j. emerg.med. 2014;21:249-259)
Emergency Physician Job Satisfaction in Hong Kong
Authors: Shao Jf , Shen Hy
Published: December 2017

Objective

We aimed to explore the visibility of emergency medicine (EM) journals in mainland China based on the coverage by major indexing and abstracting information agencies and services.

Methodology

We first searched each journal by entering its title in Google's search engine, and then entered its home page to collect associated information, like publication cycle, journal language, publisher, editorial board, authors, and journal website. Second, to collect the inclusion information, totally ten databases were selected on the basis that they were considered as representative sources within the biomedicine. We adopted two forms for searching every journal: searching for every Chinese EM journal title (both English title and Chinese ‘ping yin’ title), and searching for the word ‘China’ from the fields provided for publisher of sources or for country of publication of sources indexed.

Results

Currently, in Mainland China, there were 13 EM journals, 12 in Chinese and one in English. Among them, both Science Citation Index Expanded (SCIE) and BIOSIS Previews (BP) did not include any EM journals; both MEDLINE and Abstract Journals (AJ) included only one, respectively; Scopus, EMBASE, Index Copernicus (IC), and Japan Science and Technology Agency (JST) indexed two journals, respectively; Western Pacific Region Index Medicus (WPRIM) included four journals, and Chemical Abstracts (CA) included six journals.

Conclusion

Only a few Chinese EM journals are indexed or abstracted in the international databases. More work should be done to achieve higher visibility of EM journals. (Hong Kong j.emerg.med. 2015;22:41-45)
Colorectal Injury in a Personal Watercraft (Jet Ski) Passenger: A Case Report and Review of the Literature
Authors: Culcu D , Ozban M , Aydin B , Aydin C
Published: December 2017

As the popularity of the personal watercraft (PWC) or Jet Ski increases, injuries suffered from the usage of them become more common. Most severe injuries in this setting are typically related to blunt head trauma. Here we present an unusual case of hydrostatic injury to the rectum and sigmoid colon due to exposure to a high-pressure jet stream of water in a passenger thrown from the rear of a PWC. In addition, a review of the literature of similar cases is briefly discussed. (Hong Kong j.emerg.med. 2014;21:322-325)
Iliac Arterial Injury Associated with Pelvic Fracture in Blunt Abdominal Trauma: A Case Report
Authors: Ip Kc , Lee Kb
Published: December 2017

Exsanguination accounts for up to 65% mortality of traumatic patients with known pelvic fracture. Majority of the haemorrhage is caused by bleeding from venous plexuses and fractured cancellous bone. Arterial bleeding only accounts about 15% of the haemorrhage and primarily from branches of iliac arteries. Injury to iliac arteries with bleeding or thrombosis is uncommon and difficult to diagnose. It is a devastating condition associated with significant consequences including limb loss or even mortality without prompt diagnosis and management. The diagnosis can only be made with high index of suspicion and repeated careful examination. In this report, we describe the management of a case of pelvic fracture with multiple concomitant injures including common iliac artery occlusion that was successfully managed with a femorofemoral bypass. (Hong Kong j.emerg.med. 2014;21:329-333)
Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl
Authors: Ozturk T Cimilli , Guneysel O , Akoglu H
Published: December 2017

Objective

Procedural Sedation and Analgesia is used in managing emergency painful procedures. The aim of this study is to compare the effects of propofol and midazolam on haemodynamic parameters when used in combination with fentanyl in isolated anterior shoulder dislocations and to measure the patient and physician satisfactions.

Methods

The study is a randomised single blind prospective trial. All procedural sedations were performed by emergency medicine specialists and the shoulder reductions were performed by orthopaedic surgeons. Two groups were defined. Group A received intravenous fentanyl and midazolam and Group B received intravenous fentanyl and propofol. The orthopaedic surgeons were not informed about the drugs. The emergency medicine specialist observed the patients. The patients and the orthopaedic surgeons were asked for a satisfaction scoring.

Results

Midazolam group consisted of 37 patients and propofol group consisted of 38 patients. Both groups were similar in demographic characteristics and pre-procedural vital signs. There was only one statistically significant difference at one time and it was the 5th minutes SpO2 levels between groups. There were statistically significant changes in the measurements of vital parameters in both groups when compared with the baseline levels. However none of them was clinically important. In midazolam and propofol group, 10.8% and 10.5% respectively had respiratory compromise. Patient and physician satisfactions were similar in both groups.

Conclusions

Midazolam and propofol are both relatively safe drugs using in combination with fentanyl in anterior shoulder dislocations. Patients and physicians can be highly satisfied with the two groups of drugs. (Hong Kong j.emerg.med. 2014;21:346-353)
Emergency Medical Service in Rural Mountain Areas in Taiwan: A Nantou Mountain Areas Based Study
Authors: Hung Sc , Li Yh , Chen Mc , Lai Sw , Sung Fc , Liu Ll , Chen Yr , Lin Kc
Published: December 2017

Background

This study explored the emergency medical service (EMS) in rural mountain areas in Taiwan to establish the public health policies in rural mountain areas.

Methods

This was a retrospective study. Based on mission records available at 3 EMS branches in Ren-Ai and Sinyi townships of Nantou County, we evaluated dispatched status, patient characteristics, and pre-hospital emergency managements.

Results

From January to June 2011, a total of 765 EMS were dispatched from these 3 mountain branches. Each dispatched EMS team was consisted of one official emergency medical technician (EMT) with EMT II certificate (100%), and one (88.0%) or two (11.2%) volunteers as EMT I personnel. Most of missions were conducted in the daytime and peaked during 10am to 12pm. Patients were characterised with more men and elderly and predominant with non-traumatic medical complains (55.0%). Approximately 38.7% EMS patients required the advanced life support. Of these 3 mountain EMS branches, the mean response time was 15.3±16.9 minutes, the mean management time on site was 6.1±6.9 minutes and the mean transport time was 38.0±15.9 minutes. The response time and transportation time of EMS in rural mountain areas were relatively longer than that in urban towns in Taiwan.

Conclusions

The rural EMS is under the challenges of providing appropriate and adequate medical care. Each EMS team should be equipped with adequate emergency care facilities and well trained personnel. (Hong Kong j.emerg.med. 2014;21:373-381)
Role of Dominant Hand Position during Chest Compression by Novice Rescuers: An Observational Simulation Study
Authors: Jo Ch , Ahn Jh , Shon Yd , Cho Gc
Published: December 2017

Introduction

The aim of this study was to determine the effect of hand positioning on the quality of external chest compression (ECC) by novice rescuers.

Methods

This observational simulation study was conducted for 117 included participants. After completion of an adult cardiopulmonary resuscitation (CPR) training program for 3-h, the participants selected which of their hands would be in contact with the mannequin during ECC and performed 5 cycles of single rescuer CPR on a recording mannequin. The participants were assigned to 2 groups: the dominant hand group (DH; n=40) and the non-dominant hand group (NH; n=29). The depth and rate of ECC were analysed to compare the effectiveness of ECC between 2 groups.

Results

The rate of ECC was significantly faster in the DH group (mean, 117.3 ±11.4/min) than in the NH group (mean, 110.9±12.2/min) (p=0.028). However, the depth of ECC in the dominant hand group (mean, 52.4±5.9 mm) was not significantly different from that in the non-dominant hand group (mean, 50.8±6.0 mm) (p=0.287). Similarly, the portion of ECC with inadequate depth in the dominant hand group (mean, 1.8±4.3%) was not significantly different from that in the non-dominant hand group (mean, 5.3±15.6%) (p=0.252).

Conclusions

ECC can be performed with an acceptably higher rate of compressions when the dominant hand of the novice rescuer is placed in contact with the sternum. However, the position of the dominant hand does not affect the depth of ECC. (Hong Kong j.emerg.med. 2014;21:382-386)