bluuebunny/crossref_metadata_2025 huggingface dataset:
Unexpected Haemorrhage Location after Intravenous Thrombolysis for Left Middle Cerebral Artery Infarction
Authors: Chu CI , Po HL
Published: December 2017

Emergency intravenous thrombolytic therapy saves stroke patients. However, unexpected circumstances still occur. Here we report two patients who received intravenous thrombolytic therapy for acute ischaemic infarction and suffered brainstem haemorrhage within 3 hours of thrombolysis. Both patients had left middle cerebral artery ischaemic infarction but not basilar artery infarction. The haemorrhages were concurrent with extremely high blood pressure. Extremely high blood pressure during thrombolysis not only increases possibility of haemorrhagic transformation of ischaemic infarction but also chance of intraparenchymal haemorrhage. (Hong Kong j.emerg.med. 2014;21:112‐115)
Management and Short‐Term Follow‐Up Study of Transient Ischaemic Attack Patients in a University Teaching Hospital
Authors: Zhang LH , Wen ZM
Published: December 2017

Objective

The aim of this study was to describe the management of patients admitted to a university teaching hospital in China who were diagnosed of having transient ischaemic attack (TIA) and to determine the outcome within a 7‐day and 90‐day period.

Methods

A retrospective, hospital‐based study included consecutive patients having TIA from July 2009 to February 2013 was performed. Demographic data, risk factors, symptoms, clinical management, ABCD2 scores were analysed. The main outcome variable was the occurrence of TIA and ischaemic stroke during the 7 and 90 days follow up periods.

Results

A total of 157 patients were evaluated. After excluding 3 patients (1.9%) because they were lost to follow‐up, 154 patients were included in the study. All patients underwent a cranial computed tomogram (CT) to exclude intracranial haemorrhage. If the cranial CT scan result was negative for bleeding or other diagnoses, further comprehensive tests would be initiated following a standardised clinical assessment protocol at the time of hospitalisation. Totally 148 (96%) patients received antiplatelet therapy and 6 (4%) patients received anticoagulation therapy. Eight (5.2%) patients received stenting therapy. Only 3 (1.9%) and 6 (3.8%) TIA patients developed subsequent TIA within 7 days and 90 days respectively. Twelve (7.8%) TIA patients developed ischaemic stroke within 7 days and 19 (12.3%) within 90 days. All the 6 patients who had recurrence of TIA within 90 days proceeded to develop ischaemic stroke. The ABCD2 scores of patients experienced subsequent TIA and ischaemic stroke (4.94±1.39, n=19) were significantly higher than those of patients without recurrence (3.91±1.37, n=135; p<0.05). None of the patients who received stenting therapy developed subsequent TIA or ischaemic stroke during the follow up period.

Conclusions

Our findings suggest that in‐patient evaluation and management of TIA may be a safe and effective strategy. Rapid diagnosis and implementation of treatments for TIA patients are crucial to reduce stroke risk. (Hong Kong j.emerg.med. 2014;21:92‐97)
Are All Intracranial Mass Lesions Always a Contraindication for Thrombolytic Therapy?
Authors: Gullupinar B , Oray N Colak , Bayram B
Published: December 2017

Thrombolytic therapy is regarded as the first treatment choice in haemodynamically unstable patients with pulmonary embolism. Intracranial tumors have long been considered as a contraindication to thrombolytic therapy due to the risk of intracerebral haemorrhage. In this report, we presented a 76‐year‐old female patient with meningioma and massive pulmonary embolism who had received thrombolytic therapy despite a contraindication of intracranial mass. The patient completed the thrombolytic therapy without having complication. (Hong Kong j.emerg.med. 2014;21:98‐102)
Dynamic Internet-Mediated Team-Based Case Management of High-Frequency Emergency Department Users
Authors: Chiang CY , Lee CW , Tsai TC , Li CJ , Lee WH , Wu KH
Published: December 2017

Introduction

We assessed whether a strategy using dynamic, internet-mediated, team-based case management could reduce the number of subsequent emergency department (ED) visits by frequent ED users.

Methods

Patients who attended the ED three or more times within 72 hours in June 2010 were identified. These cases were divided into the pain management or chronic disease group according to their chief complaint. Patients were assessed by expert panels, and initial care plans were developed and posted on an internal website. Thereafter, each emergency physician could follow or adjust the care plans dynamically via the internal website according to the patient's condition and use the website to communicate results. Care plans were revised by the team according to the patient's clinical situation as it changed. Patient ED visits over the subsequent six months were monitored.

Results

Fourteen cases were enrolled in the study, seven in each group. The mean number of visits per patient per month in the pain management and chronic disease groups decreased from 14.9 to 5.79 (p=0.031) and 6.1 to 2.9 (p<0.001) visits per month after the intervention, respectively. The overall mean number of visits per patient per month decreased from 10.5 to 4.36 (p=0.004), a decrease of 6.14 visits (58.27%).

Conclusions

Dynamic internet-mediated team-based case management may help to reduce subsequent visits in patients who frequently visit the ED. (Hong Kong j.emerg.med. 2014;21:161-166)
Rapidly Progressive Lactic Acidosis in Patients with Flufenoxuron Poisoning
Authors: Jeong HH , Yeom SR , Han SK , Park SW
Published: December 2017

Flufenoxuron is an insect growth regulator which inhibits chitin (exoskeleton) biosynthesis in insect's body. Not much is known about its toxicity to human. This report describes three patients who developed worsening lactic acidosis and hypotension after ingestion of flufenoxuron-containing materials. Two of the three patients received continuous renal replacement therapy and survived. (Hong Kong j.emerg.med. 2014;21:181-184)
Fluid Restriction for Treatment of “Fluid Creep” after Acute Burn Resuscitation
Authors: Tang YW , Chen IC , Yen JH , Lu CT , Lai CS , Liu HJ , Chang HC , Chen YW
Published: December 2017

Objective

Fluid creep in patients recovering from acute burns still exists, despite the use of a more treatment conservative approach. Most of our severe burn patients develop fluid overload and body weight increase after acute fluid resuscitation. How to quickly return patients to their pre-injury body weight is an important issue.

Methods

Right after acute fluid resuscitation, we applied a “total fluid requirement” volume (usually 1/2 to 2/3 of initial 24 hour volume) and strictly monitored patients' hourly urine (between 0.5-1 ml/kg/hr). Patients' responses (body weight, enteric feeding amount, pulmonary condition, etc.) were also closely monitored and frequent adjustments of fluid volume administration were performed simultaneously.

Results

Most patients regained their pre-injury body weight within 2-3 weeks. Enteric feeding also improved markedly. No patients had severe oedema-related complications.

Conclusions

Stricter fluid administration after acute burn fluid resuscitation is advised for allowing patients to reduce body weight to their pre-injury weight or at least close to it. We use pre-injury body weight, enteric feeding and urine output as our guides. (Hong Kong j.emerg.med. 2014;21:222-229)
Influence of Automatic Compression Device and Water Rescue Equipment in Quality Lifesaving and Cardiopulmonary Resuscitation
Authors: Barcala-Furelos R , Abelairas-Gomez C , Romo-Perez V , Palacios-Aguilar J
Published: December 2017

Introduction

The purpose of this study was to analyse how the rescue equipment and the automatic compression mechanism influenced the cardiopulmonary resuscitation (CPR) after a water rescue on the beach.

Methods

The sample of our research composed of a group of 65 lifeguards (51 men and 14 women). The lifeguards carried out a 5 minute CPR pretest. Afterwards, the sample was randomly divided into two groups. Both groups performed a test: a water rescue, and immediately afterwards 5 minutes of CPR. One group did not have any additional rescue material, while the other used flippers and a rescue tube to swim. The group with the rescue material performed a CPR with an automatic compression mechanism, the Lund University Cardiac Arrest System.

Results

The use of the automatic compression device improves the conditions in the correct compressions in CPR after a water rescue: (manual: 283±145.25; automatic: 352±119.74, p=0.042). There was no significant difference in the correct breathing (p=0.758). During the water rescue the lifeguards equipped with flippers and a rescue tube were faster (227±69.28 s) than the lifeguards who had not used any additional equipment (271±43.06 s, p=0.003).

Conclusion

The use of flippers and rescue tube improved the rescue time. The CPR quality when the lifeguard was exerted worsened significantly, but the use of the automatic mechanisms of compression improved the performance of quality chest compressions. This was not the case with the ventilations, these being of poor quality in both groups. (Hong Kong j.emerg.med. 2014;21:291-299)
Can use of video Laryngoscopes by Emergency Medical Technicians Facilitate Endotracheal Intubation during Continuous Chest Compression? A Manikin Study
Authors: Han Sk , Choi Pc , Hong Ck , Shin Dh , Na Ju , Hwang Sy , Cho Jh
Published: December 2017

Introduction

We conducted this study to evaluate the utility of two video laryngoscopes (VLs) [Pentax-AWS (AWS), GlideScope (GVL)], compared to the conventional Macintosh laryngoscope (ML), on endotracheal intubation (ETI) involving chest compressions by Level 1 Korean emergency medical technicians (EMTs) who are the equivalent of EMT-I in the United States.

Methods

This was a randomised crossover simulation study. Fifty EMTs performed endotracheal intubation in randomised sequence following two different scenarios: normal airway and difficult airway.

Results

In normal airway scenario, overall success rate did not differ between the three devices. However AWS required a shorter run-time (14.1 [10.9-19.8] seconds) to complete ETI (TC) than ML (17.7 [13.5-21.3] seconds) (p=0.017). And both VLs showed a significant superiority over ML in time required to visualise vocal cords (TVC), percentage of glottic opening (POGO) score, and incidence of dental compression (IDC). In difficult airway scenario, overall success rate of both VLs was significantly higher than ML. The TC of AWS (13.7 [11.2-16.9] seconds) and GVL (20.7 [15.1-25.9] seconds) was shorter than that of ML (24.7 [18.1-34.5] seconds) (p<0.001). The TVC of GVL was significantly shorter than that of AWS and ML. The POGO score, IDC, and ease of intubation were significantly superior with AWS, GVL, and ML, respectively.

Conclusions

Video laryngoscopes can facilitate EMT performing a faster and easier intubation without interrupting chest compressions. Moreover, AWS improves the success rate comparing to ML in difficult airway management. (Hong Kong j.emerg.med. 2014;21:308-315)
CPR Knowledge and Attitudes among High School Students Aged 15-16 in Hong Kong
Authors: Ma Awwma , Wong Kl , Tou Ayl , Vyas L , Wilks J
Published: December 2017

Background

Sudden cardiac arrest is a serious public health problem in Hong Kong, with up to 85% of victims not surviving to hospital admission. International research findings show that teaching cardiopulmonary resuscitation (CPR) to lay bystanders can significantly improve out-of-hospital survival rates. A particular target group for CPR training and education is high school students. Since the commonest site of sudden cardiac deaths in Hong Kong occur at home, school-age adolescents are likely to be the only available bystanders in many emergent situations.

Design

Questionnaire survey.

Methods

This study investigated CPR knowledge and attitudes of 383 students aged 15-16 years across 18 schools in Hong Kong to understand barriers and facilitators for CPR delivery. A questionnaire pilot tested and validated by a panel of health professionals was distributed to students, using a convenience sampling methodology.

Results

Most students (87%) had not received CPR training, with common reasons for not attending being lack of time, lack of interest and not sure where to attend a course. Results of Mann Whitney U tests indicated that students who had received training scored significantly (p<0.05) higher on factual knowledge and also attitudes toward CPR training than those without training. There were no gender differences. Most students reported that they would attempt to perform CPR in a cardiac arrest situation, even if they had not received training, because they believed that CPR could increase the survival rate and it was morally the right thing to do.

Conclusions

Teaching CPR to Hong Kong school students is an effective way to develop the next generation of emergency first responders. (Hong Kong j.emerg.med. 2015;22:3-13)
Clenbuterol Food Poisoning from Snake Meat Consumption: An Outbreak of 13 Cases
Authors: Wang Yj , Lau Kk , Lau Fl
Published: December 2017

We report a documented outbreak of clenbuterol food poisoning involving 13 patients who consumed snake meat in Shenzhen. They developed headache, palpitation, tachycardia, hypokalaemia and other symptoms within first 3 hours after exposure. They were initially treated with gastric lavage, fluid and potassium replacement and other supportive measures. All of them completely recovered after admission for up to 48 hours. Public health investigation identified clenbuterol compound in four victims' urine and the food source of snake meat they consumed. (Hong Kong j.emerg.med. 2015;22:46-49)
Effective Healthcare Worker-Patient Communication in Hong Kong Accident and Emergency Departments
Authors: Slade D , Chandler E , Pun J , Lam M , Matthiessen Cmim , Williams G , Espindola E , Veloso Fod , Tsui Kl , Tang Syh , Tang Ks
Published: December 2017

Introduction

This paper reports on research conducted within a Hong Kong (HK) accident and emergency department (AED), which investigated the effectiveness of health care worker-patient communication over the course of patients' journeys from triage to disposition.

Methods

The research combined qualitative and quantitative ethnographic methods with linguistically-oriented discourse analysis of audiotaped interactions between patients and health care workers. It involved: (1) observations, (2) semi-structured interviews with management and health care workers, (3) surveys with AED staff, (4) audio-recordings of 10 patients' journeys, and (5) follow-up interviews with patients.

Results

The paper described the typically complex communication networks involved in AED care. It then exemplified how certain communicative strategies, balancing the communication of medical knowledge with interpersonal communication, could be used to achieve positive healthcare outcomes. This was illustrated by a case study of one patient's journey through the AED, pinpointing health care workers' effective use of communication strategies, their effect on the patient's participation and subsequently the patient's understanding and evaluation of the care he received.

Conclusion

The high stress nature of AEDs inevitably poses challenges to communication. The results of this study, however, strongly suggest a correlation between health care workers' use of effective, interpersonally sensitive communication strategies and positive patient outcomes. Health care worker-patient communication that effectively balances interpersonal communication with the communication of medical expertise is integral to ensuring patients' participation in, understanding of, and satisfaction with their healthcare. These communication strategies should be required components in health care worker communication training. (Hong Kong j.emerg.med. 2015;22:69-83)
Predictors of Revisit and Admission after Discharge from an Emergency Department in Acute Pyelonephritis
Authors: Kang C , Kim K , Lee Jh , Jo Yh , Park Jw , Lee Sh , Kim Yj , Rhee Je , Kim Dh
Published: December 2017

Introduction

The aim of this study is to construct clinical prediction models to predict emergency department (ED) return visit following initial discharge for acute pyelonephritis (APN) and the need for hospital re-admission upon ED return visits.

Method

A retrospective analysis included 1250 discharged women with APN. Independent risk factors for revisit and subsequent admission after revisit were determined by multivariate analysis, and a prediction model for revisit and subsequent admission after revisit was constructed.

Results

Independent risk factors for revisit were nausea (2 points), age ≥ 65 years (2 points), C-reactive protein >20 mg/dL (2 points), serum albumin <3.3 g/dL (3 points) and urine white blood cell count ≥ 30/high power field (2 points). Re-visit risk scores were categorised to five groups and the re-visit rate was 5.4%, 8.6%, 12.2%, 19.1% and 43.8%, respectively, showing an area under curve (AUC) of 0.62. Risk factors for subsequent admission after revisit were vomiting (1 point), hypertension (2 points), serum creatinine <1.5 mg/dL (2 points), C-reactive protein >20 mg/dL (2 points) and serum albumin <3.3 g/dL (4 points). The subsequent admission after revisit risk scores were classified to three groups and subsequent admission after revisit rate was 3.5%, 15.0%, and 38.2%, respectively.

Conclusion

The developed model can identify a group of patients at high risk for a return visit and for requiring subsequent hospital admission, and might be used to improve initial disposition decision and discharge instructions. (Hong Kong j.emerg. med. 2015;22:154-162)
How Accurate are Emergency Department Medical Staff in the Interpretation of Head Injury Related Computed Tomography?
Authors: Cheung LW , Shih YN , Leung CS , Lo WS , Leung M , Lit ACH
Published: December 2017

Introduction

Computed tomography (CT) brain has become a popular modality to detect head injury related problems for patients seen at the Emergency Departments (ED) in Hong Kong. This study aims to assess the diagnostic accuracy of local ED medical staff in interpretation of head injury related CT and to assess the association between years of working experience of ED medical staff and the diagnostic accuracy of CT brain interpretation.

Methods

This is a retrospective cohort study reviewing all patients attending the ED of Princess Margaret Hospital in three years (from 2008 to 2010) with head injuries requiring CT brain during ED stay. The findings of CT brain by ED medical staff were compared with those by radiologists, the reference standard.

Results

A total of 1716 cases were assessed. The overall sensitivity and specificity for detecting an abnormal CT were 0.66 (95% confidence interval [CI] 0.60‐0.71) and 0.96 (95% CI 0.95‐0.97), respectively. The sensitivity showed an increasing trend from 0.63 (95% CI 0.54‐0.72) in ED staff with 0‐3 years of working experience, to 0.71 (95% CI 0.59‐0.84) with 4‐6 years of experience and 0.75 (95% CI 0.63‐0.86) with 7‐10 years of experience. It dropped to 0.59 (95% CI 0.47‐0.71) with more than 10 years of experience.

Conclusions

The head injury related CT interpretation skill by ED medical staff is suboptimal. More training is necessary. (Hong Kong j.emerg.med. 2015;22:241‐247)
Can “Oral Fluid” be Used Instead of “Urine” for Rapid Screening of Drug of Abuse: A Prospective Pilot Study
Authors: Chow ATY , Ng VCH , Lau FL
Published: December 2017

Introduction

Spot urine tests are commonly employed by emergency physicians in Hong Kong to detect recent abusive drug exposure. Spot tests utilising oral fluid are gaining its popularity in other parts of the world. There was lack of evidence about employment of rapid oral fluid test (ROFT) in the local emergency medical settings. The objective of this study is to determine the operating characteristics of ROFT, and to compare its agreement with the bedside urine immunoassay test (BUIT).

Setting

The emergency department and the substance abuse clinic of a regional hospital.

Methods

This was a single-centered cross-sectional study of diagnostic test. Patients suspected to have drug abuse were tested using either one or both of the commercially available ROFT and BUIT. The sensitivity, specificity and accuracy of both tests were calculated with reference to the laboratory urine toxicology screening results. The agreement between ROFT and BUIT was calculated.

Results

For the detection of ketamine and methamphetamine (the two most prevalent abusive substances), ROFT had 72-100% sensitivity and 93-100% specificity, which were comparable to that of BUIT (74-100% sensitivity and 100% specificity). The overall observed agreement of ROFT and BUIT results was at least 96%. There was good agreement between ROFT and BUIT with kappa values of 0.90-1.00.

Conclusion

In this pilot study, the operating characteristics of ROFT are comparable with that of BUIT, with both tests showing good agreements in the detection of ketamine and methamphetamine uses. ROFT can potentially be employed as an alternative investigation for rapid diagnosis of patients with suspected drug abuse. (Hong Kong j.emerg.med. 2015;22:265-269)
Role of Sodium Bicarbonate in Resuscitation of out-of-Hospital Cardiac Arrest
Authors: Chung CW , Lui CT , Tsui KL
Published: December 2017

Objective

To report the use of sodium bicarbonate (SB) in out-of-hospital cardiac arrest (OHCA) and to explore the role of sodium bicarbonate in resuscitation of OHCA in terms of restoration of spontaneous circulation (ROSC) and survival, and existence of dose-dependent relationship, especially in those with prolonged arrest.

Design

Retrospective cohort study.

Setting

Emergency department of two regional hospitals in a cluster of Hong Kong.

Methods

Adult patients aged at least 18 years old who presented to the study centres with non-traumatic OHCA in the period between March 2013 and December 2013 were included. Cases in which resuscitations were considered medically futile or not actually performed were excluded. Those with do-not-resuscitate (DNR) order or advance directives, those who were death before arrival with postmortem changes, and those who developed ROSC before or within 15 minutes of arrival were excluded from the study. Patients with known poisoning from tricyclic antidepressant or other sodium channel blockers were excluded from analysis if any. The primary outcome of this study was ROSC. Other outcome variables included survival to hospital admission (STA) and survival to hospital discharge (STD).

Results

A total of 489 patients were included during the study period for analysis. We found that patients who received sodium bicarbonate injection (SB group) during CPR had a higher percentage of ROSC than those who did not (no-SB group) (60.8% vs 22.5%; p<0.001). The survival-to-admission rate was higher in the SB group (56.8%) compared with the contrary (21.4%). The difference of survival-to-discharge between the two groups did not reach statistical significance (4.1% in SB group and 2.9% in the no-SB group; p=0.484). The rate of ROSC was found to be dose dependent, being higher in higher dose of SB administration. The ROSC rate increased from no-SB (22.4%) to 57.1% if given 50 ml SB, and further to 64.1% if given ≥100 ml SB.

Conclusions

Our study shows that the use of sodium bicarbonate in the CPR of OHCA is beneficial in ROSC. The effect is dose dependent, with better results in higher dose (>100 ml) of sodium bicarbonate; however, we fail to demonstrate its benefit for prolonged CPR cases (>30 minutes). (Hong Kong j.emerg. med. 2015;22:281-290)
X-Ray and Ultrasonography in Forearm Trauma
Authors: Tandogan M , Katirci Y , Sonmez F Turan , Duymaz H , Altun S , Gunaydin YK , Coskun F
Published: December 2017

Introduction

This study aimed to prevent unnecessary exposure to ionising radiation, and to exclude non-fracture cases in children admitted to the emergency department with a forearm trauma, by showing that forearm trauma could be assessed with ultrasonography (USG) as accurately and precisely as with direct radiography.

Methods

A total of 105 patients (67 males and 38 females) were included in the study. Before performing radiography, the patients were assessed with USG and the results were recorded. The findings of USG and radiography were then compared.

Results

A total of 58 (55%) patients had fractures detected with USG. When compared to X-ray, the sensitivity of USG in detecting forearm fractures was 98.3% (95% confidence interval [CI]: 90.7-100%), specificity was 95.8% (95% CI: 86.0-98.9%), negative likelihood ratio was 0.018, positive likelihood ratio was 23.58, negative predictive value was 97.9% (95% CI: 88.7-99.9%), and positive predictive value was 96.6% (95% CI: 88.1-99.6%).

Conclusion

The use of USG on selected cases of paediatric patients may provide a more rapid evaluation so as to reduce exposure to ionising radiation. We believe that USG will be useful in excluding non-fracture cases. (Hong Kong j.emerg.med. 2015;22:352-358)
Canadian Computed Tomography Head Rule and Its Impact on Singaporean Practice
Authors: Pek JH , Wee JCP , Wong E
Published: December 2017

Introduction

We aim to determine the usefulness of the Canadian Computed Tomography (CT) Head Rule in patients who present with minor and minimal head injury to the emergency department.

Methods

Clinical information was retrospectively collected and the need for CT head was evaluated. The primary outcome measure was the requirement for neurological intervention. The secondary outcome measure was brain injury requiring admission or neurological follow-up.

Results

A total of 1127 cases were reviewed. About 6.3% had clinically important brain injury; and 1.2% required neurological intervention. The high-risk factors were 45.2% sensitive (95% confidence interval [CI]=27.8-63.7%) and 76.2% specific (95% CI=73.5-78.7%) for predicting need for neurological intervention. All seven risk factors were 73.2% sensitive (95% CI=61.2-82.7%) and 69.8% specific (95% CI=66.9-72.5%) for predicting clinically important brain injury. Overall, the rule had a positive predictive value of 14.0 (95% CI=10.7-18.1) and negative predictive value of 97.5 (95% CI=96.0-98.4).

Conclusions

In this retrospective validation of the Canadian CT Head Rule in the Singaporean context, we conclude that the lower sensitivity of the rule could be attributed to local neurosurgical practice, lack of application of the rule among clinicians and inclusion of patients with minimal head injury. Practically, the high NPV will mean that patients who do not fulfill the rule can be safely discharged with head injury advice, without the need for a scan. The judicious use of CT head can achieve savings for our health-care system. (Hong Kong j.emerg.med. 2015;22:359-363)
An Unusual Presentation of Allergic Reactions: Kounis Syndrome
Authors: Çiftci O , Çiftci F , Aydin Ö , Özel BA , Kavalci C , Çelik GE , Benli US , Müderrisoğlu H
Published: December 2017

Kounis syndrome is a rare cause of angina pectoris and acute coronary syndrome associated with acute allergic reactions. We present a case of one middle-aged male with this syndrome presenting with ST elevation on electrocardiogram after amoxicillin intake. It is important that clinicians be aware of the possible link between allergic disorders and acute coronary syndromes. Therefore, an allergic insult should be considered during diagnostic and therapeutic steps in managing acute coronary syndromes in appropriate clinical context. Acute coronary syndromes associated with this syndrome should be managed per relevant guidelines and timely coronary angiography should be performed in majority of cases. (Hong Kong j.emerg.med. 2015;22: 371-375)
Hong Kong Poison Information Centre: Annual Report 2014
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 2014.

Methods

In 2014, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis.

Results

A total of 3,609 poisoned cases were analyzed. There were 1,587 male patients (44.0%), 2,000 female patients (55.4%) and 22 sex unspecified patients (0.6%). Middle aged group (30-39 years) was the commonest and composed of about one-fifth (20.3%) of the poisoning cases while about two-third (66.2%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (42.2%), unintentional exposure (16.5%) and abusive substances use (12.9%). Excluding the common co-ingestant ethanol, five commonest types of poison exposed were benzodiazepine, paracetamol, zopiclone, Chinese herbal medicine and household products. Majority of the patients were managed with supportive measures, and 14.7% and 15.0% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.9% of the poisoning resulted in death and 5.0% had major outcomes.

Conclusions

This 9th 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. 2015; 22:376-387)
Analysis of Road Traffic Injuries by Road User Type in Chongqing, China
Authors: Qiu J , Li Y , Jiang Z , Yuan D , Ll G , Li Y , Zhang L , Zhao X , Zhou J
Published: December 2017

Objective

Road traffic injuries are caused by many different factors. This study aimed to analyse road user type information in Chongqing, China in order to develop prevention strategies as well as treatment protocols.

Methods

Data from road traffic crashes from Chongqing, China were collected prospectively over a seven-year period (2000 to 2006). The data included the road user type, description of the injury, mortality and Abbreviated Injury Scale. Prevalence and cross-tabulations were included in the analysis.

Results

Forty-nine percent of deaths were pedestrians and 27.84% of deaths were drivers. Head injuries (26.49%) of pedestrians were higher than those of drivers and passengers. Thoracic injuries (22.78%) and spinal injuries (4.44%) of injured passengers were higher than those of drivers and pedestrians. There were significant differences in road user types in both injury severity and injury regions.

Conclusions

The distribution of road traffic injuries in Chongqing, China is different from that in developed countries and other developing countries. In managing traffic injuries, it is necessary to examine other regions besides the head according to the road user type, such as facial injuries of drivers and passengers, and chest and spinal injuries of passengers.
Four Cases of Successful Treatment after Podostroma Cornu-Damae Intoxication
Authors: Park Js , Min Jh , Kim H , Lee Sw , Kang Jh , An Jy
Published: December 2017

Four individuals mistook Podostroma cornu-damae for Cordyceps sobolifera and reported diarrhoea and vomiting after consuming the toxic mushroom. All symptoms resolved within four days. However, leukocytopenia, thrombocytopenia, depilation, and desquamation appeared later, and one patient was diagnosed with sepsis. All patients received granulocyte colony-stimulating factor and blood transfusions in an isolated aseptic room, and they recovered without complications. Podostroma cornu-damae is a poisonous mushroom containing trichothecene. This mushroom is not well known and is easy to be mistaken for the more common Cordyceps sobolifera sold as a healthy food in East Asia. Podostroma cornu-damae intoxication has characteristic early and delayed symptoms. Early symptoms are mainly gastrointestinal, while delayed symptoms are caused by inhibition of cellular division causing pancytopenia and can lead to death. A case series of Podostroma cornu-damae poisoning was presented, including one complicated case complicated with life-threatening sepsis.
Psychometric Evaluation of Patient Satisfaction with a Fast Track Protocol Driven Service
Authors: Soong BCP , Fan KP , Ng HY
Published: December 2017

Introduction

We aimed to develop a questionnaire with psychometric evidence of reliability and validity to evaluate patient satisfaction with a Fast Track Protocol Driven Service, which was developed to shorten the waiting time and improve the outcome of selected groups of patients. Such patients were initially managed by well‐trained nurses according to defined protocols and backed up by experienced medical practitioners. We would like to evaluate their satisfaction because traditionally patients used to be managed by doctors.

Methods

We collected data from 199 subjects from July 2014 to February 2015 using a questionnaire consisting of 24 questions. The subjects were given the questionnaire after receiving treatment and they filled in the questionnaire on sole voluntary basis. These 24 items were subject to Principal Component Analysis. The number of components to be extracted depended on the Eigenvalue. We utilised Varimax rotation for further interpretation and determined which question belonged to which component. We then assessed the internal consistency of each component by calculating Cronbach's alpha. Finally we calculated the mean score for each subscale.

Results

Three components were extracted with good internal consistency, namely “Clinical care”, “Negligence” and “Comprehensiveness”. The mean score for the above components was 43.15, 11.27 and 9.62 respectively. They proved good patient satisfaction in all three aspects.

Conclusions

We have developed a questionnaire with reliability and validity for evaluation of patient satisfaction with our service. The data of our survey shows that our patients are satisfied in the three aspects namely “Clinical care”, “Negligence” and “Comprehensiveness” statistically. (Hong Kong j. emerg.med. 2016;23:12‐16)
Investigation of the Relation between Carbon Monoxide Exposure/Intoxication and Tobacco‐Free Narghile Products
Authors: Turedi S , Aksut N , Tatli O , Karaca Y , Turkmen S , Mentese A , Gunduz A
Published: December 2017

Objectives

Use of tobacco‐based narghiles may have potentially fatal consequences, such as carbon monoxide (CO) intoxication. However, there are only limited studies on the effects on human health and CO levels of tobacco‐free narghile products. The primary aim of this study was to investigate the effect of tobacco‐free narghile consumption on carboxyhemoglobin (COHb) levels and whether this would cause CO intoxication in active and passive narghile users.

Design

Observational study.

Methods

Four hundred ninety‐nine individuals exposed to tobacco‐free narghile smoke were divided into four groups; Group I: active narghile smokers, and non‐cigarette smokers, Group II: active narghile smokers and active cigarette smokers, Group III: passive narghile smokers and non‐cigarette smokers and Group IV: passive narghile smokers and active cigarette smokers. Fifty‐nine healthy volunteers were enrolled as control groups (Group V, non‐cigarette smoker controls, and Group VI, cigarette smoker controls). COHb levels were compared among the groups.

Results

Mean pre‐exposure % COHb levels for groups I‐IV were 2.61± 1.46, 3.00±1.37, 2.09±1.45 and 3.00±2.13, and post‐exposure % COHb levels for groups were 3.45±1.92, 4.17±2.01, 2.60±1.66 and 4.50±2.32, respectively. Control groups (V‐VI) % COHb levels were 0.90±0.82 and 1.60±0.85, respectively. COHb levels rose significantly after exposure to tobacco‐free narghile smoke in all groups (p<0.001). COHb levels in all groups were higher than those in healthy individuals. Additionally, 12.8% of those exposed to tobacco‐free narghile smoke had toxic COHb levels.

Conclusion

The use of tobacco‐free narghile products represents a potential danger, and COHb levels in active and passive smokers can reach intoxication levels. (Hong Kong j.emerg.med. 2016;23:17‐27)
Metronome vs. Popular Song: A Comparison of Long-Term Retention of Chest Compression Skills after Layperson Training for Cardiopulmonary Resuscitation
Authors: Hong CK , Hwang SY , Lee KY , Kim YS , Ha YR , Park SO
Published: December 2017

Introduction

Long-term retention of cardiopulmonary resuscitation (CPR) skill is challenging for layperson trainees. This study compared the long-term retention of chest compression skills after either metronome-guided (MG) or popular song-guided (PG) CPR training.

Methods

This was a prospective randomised simulation trial. Untrained laypersons were randomly allocated to MG (n=61) or PG (n=68) groups at CPR training sessions. After CPR training, each participant performed 5-cycle CPR using a manikin with a Skill-Reporter™ immediately and six months afterwards.

Results

Immediately after training, the mean compression rate (MCR) was slightly higher in the PG than the MG group (107.4 vs. 102.2/min; p<0.0001), but there was no significant difference in the proportions of participants with an appropriate chest compression rate (100-120/min) (PSACCR) between the MG and PG (53/61 (86.9%) vs. 65/68 (95.6%); p=0.114). Six months later, MCR was faster in the MG than the PG (124.8 vs. 110.0/min; p<0.0001), and PSACCR in the PG was higher than that in the MG (62/68 (91.2%) vs. 25/61 (41.0%); p<0.0001). In both tests, there were no significant differences in other chest compression parameters of between the two groups, except for a minimal difference in incomplete chest release.

Conclusion

CPR training using a popular song is more effective than metronome-guided training in helping laypersons to maintain recommended compression rates after 6 months. (Hong Kong j.emerg.med. 2016;23:145-152)
Evaluation of a Commercial Phantom and Pork Meat Model for Simulation Based Training of Ultrasound Guided Intravenous Catheterisation
Authors: Leung KY , Mok KL , Yuen CK , Wong YT , Kan PG
Published: December 2017

Introduction

Establishing intravenous access is a common procedure being performed in the emergency department. Ultrasound guidance is useful for difficult intravenous cannulation. We compared a commercially available Blue Phantom™ and a self-made pork meat model for suitability of simulation based training.

Methods

We recruited emergency physicians from two public regional hospitals in our locality. We also recruited Myanmar emergency physicians from an ultrasound course. They were given a 30-minute hands-on practice on both phantoms. Questionnaires, which asked about the practical feeling and overall impression of both phantoms, were distributed afterwards.

Results

Thirty-nine emergency physicians with varied experience in ultrasound guided intravenous catheterisation enrolled in the study. The median score were 4 (i.e. agree) in seven out of eight pairs of questions. The practical feeling and overall personal impression were very similar between Blue Phantom™ and pork meat model.

Conclusions

The suitability of self-made pork meat model was similar to Blue Phantom™ for the training of ultrasound guided IV catheterisation. Pork meat model can used as an alternative training tool. (Hong Kong j.emerg.med. 2016;23:153-158)
Diagnosing Epiglottitis with Radiographs: Can we be More Objective?
Authors: Wong YK , Pan NY , Chu CY , Chan TN
Published: December 2017

Objective

The classical radiographic signs in acute epiglottitis are qualitative. The purpose of our study was to identify objective radiographic parameters to aid diagnosis of acute epiglottitis in Chinese adults.

Methods

A case-control study of Chinese adult patients attending the accident and emergency department (AED) who were subsequently diagnosed to have acute epiglottitis from 1st January 2009 to 31st December 2013 in a public hospital in Hong Kong. Controls were one-to-one age- and sex-matched patients who attended the AED during the study period for orthopaedic problems with cervical spine radiographs taken. Cases and controls were retrieved from the hospital computer system and their radiographs were interpreted by two specialist radiologists with various pharyngeal and laryngeal parameters, including the dimensions of the third cervical vertebral body, epiglottis, aryepiglottic fold, hypopharynx, retropharyngeal soft tissue and retrotracheal soft tissue, measured and analysed. Sensitivity, specificity, positive and negative likelihood ratios were calculated for each of the parameters.

Results

Twenty-six patients and 26 age- and sex-matched controls were included in the study. Epiglottis width of 5.5 mm or more was found to be 96.2% sensitive and 100% specific in diagnosing acute epiglottitis. Positive and negative likelihood ratios were infinity and 0.04 respectively. Aryepiglottic fold width of 5.9 mm or more was 92.3% sensitive and 80.8% specific. Positive and negative likelihood ratios were 4.80 and 0.10 respectively.

Conclusion

The identified objective radiographic parameters should aid in the diagnosis of acute epiglottitis in Chinese adults. (Hong Kong j. emerg.med. 2016;23:168-175)
Blunt Abdominal Trauma with Left Kidney Dropped into Lower Retroperitoneal Cavity: A Case Report and Literature Review
Authors: Lee TY , Chang HM , Shih ML , Chen TW , Hsieh CB , Chan DC , Yu JC , Liao GS
Published: December 2017

Blunt abdominal injury with kidney laceration is not unusually seen in high-energy traffic accident. It can present with no symptoms and yet lead to fatal complications. High-grade lacerations of kidney (American Association for the Surgery of Trauma [AAST] grade IV to V) will show up with contrast extravasation and disrupted kidney/pelvicalyceal system morphology in computed tomography (CT). However, it is rare to see kidney dislocation from retroperitoneal space because of the presence of the Gerota's fascia. We present a case of a 16-year-old boy suffering from traffic accident with blunt truncal/abdominal injury. The contrast CT of abdomen revealed that his left kidney was dislocated from the original retroperitoneal space and sagged to the lower retroperitoneal cavity. We performed emergency left nephrectomy. He recovered well and there was no complication noted after the surgical intervention. We also review the literature of kidney laceration regarding diagnosis and treatment. (Hong Kong j.emerg.med. 2016;24:176-179)
A Paediatric Case of Acute Respiratory Distress Syndrome following Toxicity due to Ecstasy
Authors: Gökay Ss , Yildizdaş Rd , Sari My , çelik T , Horoz öö , Yilmaz Hl
Published: December 2017

Ecstasy, the street name for 3,4-methylenedioxyamphetamine, is a derivative of amphetamine with sympathomimetic effects and may cause life-threatening sudden cardiac arrhythmias, severe hyponatraemia, seizures and multiple organ failures. A three-year-old male child had been intubated after a seizure due to accidental intake of ecstasy when he presented to our paediatric emergency unit. On physical examination, the patient had poor health status and was unconscious and his pupils were mydriatic, his body temperature was 37.6 degree Celsius, his heart rate was 148/min, his blood pressure was 120/80 mmHg, his PaO2/FiO2 was 72 mmHg and his oxygen index was 18. Toxicological analyses showed 3,4-methylenedioxyamphetamine. The patient was diagnosed as acute respiratory distress syndrome. Appropriate ventilation strategies were used. On the ninth day after his admission, the patient had stabile vital signs and he was discharged. In this report, this three-year-old paediatric case of acute respiratory distress syndrome due to ecstasy intake will be presented. (Hong Kong j.emerg.med. 2016;23:238-241)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Isolated Regressive Behaviour: A Case Report
Authors: Chang Hs , Hu Ly , Wen Ch , Su N
Published: December 2017

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, accompanied by a characteristic neuropsychiatric syndrome, predominantly affects young women with ovarian tumors. Although the initial onset of isolated psychiatric symptoms is rare, most cases of anti-NMDAR encephalitis are initially seen by psychiatrists in an emergency room (ER) setting. Furthermore, many of these cases are misdiagnosed as psychiatric disorders. In this report, we discuss a case of a 15-year-old female patient with anti-NMDAR encephalitis. The patient had an initial presentation of sudden-onset regressive behaviour, which is seldom mentioned in the literature. This case may serve as a reminder to psychiatrists, especially ER psychiatrists who are often the first to witness the changing phases of anti-NMDAR encephalitis-associated psychiatric symptoms, to widen the clinical spectrum of this disease. (Hong Kong j.emerg.med. 2016;23:242-245)
Diagnostic value of mean Platelet Volume for Chinese Patient with Acute Coronary Syndrome Presenting to an Emergency Department in Hong Kong
Authors: Lo CH , Ma HM
Published: December 2017

Objective

To determine the diagnostic value of mean platelet volume in local Chinese with acute coronary syndrome who attended emergency department in Hong Kong.

Design

cross sectional study.

Setting

emergency department of a local hospital.

Methods

Data of adult Chinese patients presented to a local emergency department (ED) with chest pain were retrieved from 1st October 2010 to 31st October 2010. Blood test for mean platelet volume (MPV) was drawn, and its relationship with development of acute coronary syndrome (ACS) was studied.

Results

429 patients were enrolled and 77 (17.9%) of them were diagnosed to have ACS. Non‐statistically significant trend of elevated MPV was observed in ACS group vs non ACS group (8.0±1.12 fL vs. 7.8±1.03 fL, p=0.06). Subgroup analysis was performed on patients presented within 4 hours of onset of chest pain. Both MPV and adjusted MPV were higher in ACS group (p<0.03, and p<0.01 respectively). Cut‐off 6.97 fL of adjusted MPV has the best performance, with 90.91% sensitivity and 22.86% specificity.

Conclusions

Adjusted‐MPV is higher in ACS within 4 hour of presentation, but the discriminating power is not adequate. Further study is needed to validate the cut‐off level and its clinical applicability.
Traumatic Dissections of Bilateral Internal carotid Artery with Aneurysms Formation
Authors: Chang CS , Tsai IT , Liang CY , Hsu CW
Published: December 2017

Carotid artery dissection is an unusual complication of blunt neck trauma with high mortality and severe neurological deficits. Traumatic bilateral dissections and dissecting aneurysms are extremely rare. A 17‐year‐old male presented to our emergency department with sudden onset of right hemiparesis and aphasia. Initial computed tomography scan of head and neck showed no remarkable finding. On the second day, a magnetic resonance angiography of head and neck demonstrated bilateral extracranial internal carotid artery dissections. The diagnosis of traumatic carotid artery dissection for emergency physicians is difficult because of the absence or delayed onset in symptomatology. Magnetic resonance angiography is currently considered as an appropriate initial diagnostic tool for carotid artery injury. In clinical practice, early diagnosis by keeping a high index of suspicions is required by emergency physicians.
A Rare Case of Douche Injury Sustained during Water Recreation Activities: More Protection will Mean less Injury
Authors: Chen YC , Peng MY , Wu CJ , Lin YK , Chang SH
Published: December 2017

Douche injury is a rare consequence of water recreation activities; it can manifest as vaginal laceration or even haemoperitoneum. Such severe trauma can cause massive bleeding and hypovolaemic shock; therefore, it is potentially life threatening. Herein, we present the case of a patient who had vaginal laceration and haemoperitoneum due to water recreation activities; surgery was performed to stop the bleeding. We suggest wearing a rubber or neoprene wetsuit during water recreation activities to prevent such potentially lethal injury.