bluuebunny/crossref_metadata_2025 huggingface dataset:
An Unusual Case of Dizziness Presenting to Emergency Department: Acute Cerebellitis
Authors: Cheung KH , Fung HT
Published: December 2017

Acute cerebellitis is an uncommon and potentially fatal disease which usually presents initially with non-specific symptoms. There is scarce report on local cases of isolated acute cerebellitis. We report a patient with isolated acute cerebellitis attending emergency department with predominant symptom of dizziness. Diagnosis was made by magnetic resonance imaging assisted by lumbar puncture. He received timely medical treatment and the clinical course was benign. The clinical feature, diagnosis, and managements of acute cerebellitis are discussed.
Continuous Renal Replacement Therapy in a Patient with Cardiac Arrest after Glyphosate‐Surfactant Herbicide Poisoning
Authors: Lee BK , Lee HY , Ryu HH , Jeung KW
Published: December 2017

Intractable hypotension is a major cause of death after glyphosate‐surfactant herbicide poisoning. However, there is no specific treatment besides conservative care. Herein, we report a patient poisoned by glyphosate‐surfactant herbicide experiencing cardiac arrest but was successfully resuscitated and treated with continuous venovenous haemodiafiltration (CVVHDF). The 60‐year‐old patient was brought to our emergency department after ingesting glyphosate‐surfactant herbicide. He developed pulmonary oedema, severe metabolic acidosis (pH 6.960), and hyperkalaemia (serum potassium 8.8 mmol/L). Although he experienced cardiac arrest for about 12 minutes, the use of CVVHDF improved the metabolic acidosis and hyperkalaemia, and finally stabilised his vital signs. He regained an alert mental state after therapeutic hypothermia. CVVHDF, which is a better tolerated renal replacement therapy than haemodialysis in haemodynamically unstable patients, should be considered in glyphosate‐surfactant poisoned patients of intractable hypotension with severe metabolic acidosis or hyperkalaemia.
The Role of Electrocardiography in Follow up of Pulmonary Thromboembolism
Authors: Kιlιç H , Köktürk N , Varol A , Aydoğdu M , Babaroğlu S , Topal S , Ateş C , Ekim N
Published: December 2017

Objective

Electrocardiography (ECG) is a simple, valuable and easily applicable test that can be used in supporting the diagnosis and assessing the severity of pulmonary thromboembolism (PTE). In this study, it was aimed to identify the role of ECG scoring in diagnosis and follow up of PTE in comparison with community acquired pneumonia (CAP).

Methods

Patients with the diagnosis of PTE and CAP were included in the study prospectively between January 2007 and January 2009. ECG scorings were evaluated by two different cardiologists by the method described by Daniel et al at admission (day 0) and day 3, 10 and one month of treatment. Median values of ECG scorings were compared between days and between groups.

Results

Forty‐five patients with PTE, 35 patients with CAP were included in the study. Although no statistically significant difference was identified between the ECG scorings of the two groups in each measurement point, ECG scores decreased more rapidly in PTE group within days. Within the PTE group, day 0 ECG score was identified higher in submassive patients than nonmassive ones (p=0.001).

Conclusions

Although ECG score did not differentiate PTE from CAP, depending on its rapid decrease in PTE, it can be used in the follow up. For submassive PTE patients that must be diagnosed and treated immediately, ECG scorings can be used to support the diagnosis and to assess the clinical severity.
Managing Older Patients Safely in the Time Critical Environment of an Emergency Department
Authors: Lowthian JA , Brand C , Barker AL , Andrianopoulos N , Smith C , Batey C , Smit PDeV , Newnham HH , Hunter P , Cameron PA
Published: December 2017

Demand for emergency department (ED) services is increasing worldwide. The fastest growth in ED presentations is by patients aged ≥65 years, currently representing 18% of all attendances. Older patients present with more complex clinical conditions and multiple co‐morbidities. This means they are likely to spend more time in ED, are more likely to be admitted to hospital, and are more likely to re‐attend. The Safe Elderly Emergency Discharge (SEED) project aims to determine whether current models of emergency care ensure safe discharge and facilitate optimal health outcomes for older patients; and develop a tailored evidence‐based care framework applicable to Australian and international settings. Risk screening for unsafe discharge will be conducted on patients aged ≥65 years discharged home from ED. Patients will be followed for 6 months post‐ED presentation to monitor health outcomes and map their care journey. Demographic, clinical, and functional characteristics will be collected. The primary outcome is unsafe discharge, defined as unplanned re‐presentation/admission within 30 days of the index presentation. Secondary outcomes include unplanned ED re‐presentation/hospital admission within 6 months; patient experience; change in functional status; functional decline; health service utilisation; and death within 6 months. The effectiveness of the ED discharge risk screening tools for predicting unsafe discharge will be evaluated at 30 days and 6 months. SEED will determine the risk factors for unplanned ED re‐presentation/hospital admission at 30 days for patients aged ≥65 years presenting to ED; which will inform the development of an evidence‐based older patient care framework for EDs.
Myocardial Muscle Bridge: An Unusal Cause of Acute Myocrdial Infarction
Authors: Şarli B , Baktir AO , Saglam H , Dogan S , Arinc H
Published: December 2017

Myocardial muscle bridge is an uncommon cause of acute myocardial infarction. Although several treatment modalities including medical therapy have been suggested, agreement on optimal treatment has not yet been determined. We describe a case of myocardial bridging which presented as ST segment elevation myocardial infarction, and was treated successfully with medical treatment.
A Death Case of Bulimia Nervosa Presented with Abdominal Distention
Authors: Lee ES , Ohk TG , Lee WW , Park SM , Ahn JY , Sohn YD , Ahn HC
Published: December 2017

Bulimia nervosa is one of the eating disorders. Psychological manifestations of this disease, such as guilt or denial, may interfere with patient communication. The patients with bulimia nervosa are most commonly between ages of 17 and 25 years old, and often maintain normal body weight. It is not easy to screen out and diagnose bulimia nervosa patients at the emergency department. We reported two bulimia nervosa patients who visited our emergency department with abdominal distension, and one of them died of abdominal compartment syndrome. We confirmed collapse of the abdominal aorta and key arteries in enhanced abdominal computed tomography. Promptly, we performed gastrostomy for reduction of abdominal pressure, but she finally succumbed due to multiple organ failure 12 hours after the surgery.
An Unusual Case of Blunt Traumatic Pulmonary Artery Pseudoaneurysm Detected within a Day
Authors: Yeom SR , Min MK , Lee SH , Park SW
Published: December 2017

Chest trauma can injure intrathoracic vessels, usually affecting the aorta and arch branches; however, a traumatic pulmonary artery pseudoaneurysm (PAP) has been reported, albeit relatively rarely. Blunt chest trauma as an aetiology for a PAP is even more rare than penetrating chest trauma. There is usually a time delay from several days to several months between injury and detection of a PAP. Traditionally, operative management has been recommended because of the risk of PAP rupture. Here, we describe an unusual case of a PAP following blunt trauma that was detected early on computed tomography, 8 hours after injury, and the PAP resolved with conservative management.
Catamenial Pneumothorax: A Rare Cause of Chest Pain in the Emergency Department
Authors: Hasman H , Cinar O , Cevik E , Jay L
Published: December 2017

Catamenial pneumothorax (CP) is defined as recurrent spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. The aetiology of this syndrome is unknown, although many theories have been proposed to explain it. A 43-year-old female presented to our emergency room with a complaint of left sided chest pain. She had no dyspnoea or haemoptysis during the admission. She had a history of pelvic endometriosis without any complaints for three years. Pneumothorax or pneumonia was not detected on chest X-ray. Blood tests and electrocardiogram findings did not support any cardiac or infectious cause. Computed tomography showed a pneumothorax on the mediastinal side of left hemithorax. The patient was referred to a thoracic surgeon. A thoracoscopy for histological confirmation was performed and the diagnosis of CP was made with a histological intervention.
The Impact of Enhanced Triage on the Emergency Service with Special Track Streams
Authors: Lam HC , Lee HKH , Ting SM , Li KM
Published: December 2017

Background

Over sixty percent of emergency department (ED) attendances belonged to the semi-urgent or non-urgent categories. The existing triage system failed to detect those patients in need of emergency service within these groups. It increased the risk to patients and affected the quality of care especially with overcrowding and long waiting time.

Objective

To assess the impact of a special track program in providing medical services to targeted groups and on the overall emergency service.

Method

Four special groups of patients triaged as semi- or non-urgent and required procedural interventions or possible in-hospital treatment were identified. The impact on waiting time, length of stay, rate of left without being seen and re-attendances rate were measured and studied prospectively.

Results

A total of 438 cases were analysed. Special track groups had a shorter mean waiting time and mean disposal time (36.6 minutes and one hour) when compared with all category 4 patients. Special track group had no disappeared case and a smaller re-attendance rate.

Conclusions

Special track program improves the safety and quality of care in patients of fast track streams without compromising care to other semi-urgent or non-urgent categories patients.
Bacterial Contamination of Computer and Hand Hygiene Compliance in the Emergency Department
Authors: Hong DY , Park SO , Lee KR , Baek KJ , Moon HW , Han SB , Shin DH
Published: December 2017

Introduction

The aim of this study was to determine the degree and nature of bacterial contamination of computer equipment in three Korean emergency departments (ED).

Methods

Hand hygiene practices of ED doctors and nurses were observed before contact with computer equipment. Microbiological swab samples were obtained from 112 multiple-user computer keyboards and electronic mice in the ED of three teaching hospitals. Isolated organisms were identified by a clinical microbiologist using Gram stain, colony morphology, and susceptibility test.

Results

Of the 112 samples, 103 (92.0%) showed growth of organisms on culture. Thirty-eight (33.9%) pieces of computer equipment yielded multiple bacterial species. Coagulase-negative Staphylococcus was the most common microorganism isolated (85.7%). Methicillin-resistant Staphylococcus aureus was obtained from two keyboards in two hospitals (1.8%). Hand hygiene compliance was observed on 29.9% occasions. Hand hygiene compliance after patient contact (38.0%) was higher than after other environmental contact (20.7%).

Conclusions

Multiple user computer equipment in the ED may serve as reservoirs for nosocomial infection. Hand hygiene should be performed before and after using all ED equipment, including computer equipment.
Severe Hypokalaemic Paralysis due to Chronic use of Acanthopanax Senticosus Ingestion: A Case Report
Authors: Lee JH , Eo EK , Lee DH
Published: December 2017

Acanthopanax senticosus is a traditional herb in China, Russia and many other Asian countries. However no comprehensive study has evaluated its side effects in humans. We report a rare case of hypokalaemic paralysis possibly attributed to A. senticosus induced pseudohyperaldosteronism.
Sibutramine Associated Cardiac Arrest in a Chinese Healthy Young Lady
Authors: Lam SK , Wong OF , Fung HT , Yam PW
Published: December 2017

Sibutramine is a slimming agent and acts on reducing appetite and increasing satiety. It was withdrawn from the market world‐wide, including Hong Kong, since November 2010 due to its side effects on the cardiovascular system. However, sibutramine is still commonly found as adulterant in the slimming medications which could be bought from internet or over‐the‐counter. A Chinese healthy young lady developing sudden cardiac arrest after taking sibutramine for weight reduction is described.
Pneumomediastinum, Surgical Emphysema and Pneumorrhachis after Insufflation of Ketamine
Authors: Wong OF , Kwan GWM , Tsang PHK , Lee HM , Yip KH
Published: December 2017

We report a rare complication after ketamine abuse. A 26‐year‐old known ketamine abuser developed pneumomediastinum, extensive surgical emphysema and pneumorrhachis after ‘snorting’ ketamine. He also suffered from acute on chronic renal failure and liver function impairment due to ketamine use. His pneumomediastinum and subcutaneous emphysema resolved with conservative management. Pneumomediastinum is a well‐reported complication after illicit drug use, particularly smoking ‘crack’ cocaine. This case illustrates that such complication may also occur in ketamine abuse.
Heimlich Maneuver on Self: From Theory to Practice
Authors: Anđelić S
Published: December 2017

The Heimlich maneuver is an emergency procedure for management of foreign body obstruction of the airway. We reported an emergency physician who had airway obstruction due to a large chunk of orange. He applied Heimlich maneuver on himself to remove the foreign body that could have caused suffocation. This case illustrated that a timely and appropriately performed Heimlich maneuver could help remove a foreign body obstructing the airway for self‐salvation.
Bedside lung ultrasonography for diagnosis of pneumonia
Authors: Unluer EE , Karagoz A , Senturk GO , Karaman M , Olow KH , Bayata S
Published: December 2017

Objective

The aim of this study was to investigate the accuracy of bedside lung ultrasound (BUS) in the diagnosis of community‐acquired pneumonia (CAP) in patients with dyspnoea presenting to the emergency department (ED) and to analyse the characteristic sonographic findings of CAP.

Methods

After a six‐hour training program, BUS procedures were performed between October 2011 and February 2012 to prospectively evaluate patients presenting to the ED with dyspnoea. Chest X‐ray (CXR) or computerised tomography (CT) were ordered, depending on the presence of consolidation signs on CXR. The outcome was determined by consolidation findings on CXR or CT. BUS results were compared using Chi‐squared testing.

Results

Of the 112 enrolled patients with dyspnoea, 40 patients were excluded and 72 were included in the study. Thirty‐four patients were BUS positive. Of these, CXR or CT findings agreed with the BUS findings in 27 patients. In 38 cases, BUS was negative, and one patient was diagnosed with pneumonia based on the CT report. The sensitivity, specificity, PPV, NPV, and the positive and negative likelihood ratios for BUS were 96.4%, 84.1%, 79.4%, 97.4%, 6.1 and 0.042, respectively. The diagnostic accuracy of BUS was 89%. The presence of consolidation signs, either shred or hepatisation, were the most frequent sonographic findings in our study.

Conclusions

Acute alveolar consolidation can be diagnosed easily by performing BUS with high degree of accuracy in EDs.
Acute and Delayed Traumatic Diaphragmatic Ruptures Presenting at the Emergency Service: What are We Missing?
Authors: Alar T , Dedeoglu E , Bulut T , Yapucu MU , Dedeoglu B
Published: December 2017

Introduction

Diaphragmatic rupture is rarely a cause of death by itself. It is especially difficult to diagnose diaphragmatic ruptures in patients with unstable vital signs who present at the emergency service with concurrent chest, abdomen, and extremity injuries as a result of blunt trauma. We evaluated the diagnostic processes, clinical findings and treatment results of acute and delayed traumatic diaphragmatic ruptures (TDR) cases that presented at the emergency service.

Methods

A total of 29 patients that underwent surgical treatment with a diagnosis of TDR among 1021 patients that presented at the Canakkale State Hospital Emergency Service with acute or delayed thoracoabdominal trauma were retrospectively investigated. The age, gender, trauma etiology, diagnosis duration, injury severity score (ISS), rupture location, accompanying organ injuries, operation type, inpatient duration, morbidity and mortality were recorded on prepared forms to analyse the cases.

Results

The mean age of the 29 patients with TDR was 45.31 + 17.76 years with and 20 (69%) males and 9 (31%) females. The trauma was blunt in 22 (76%) and penetrating in 7 (24%) cases. The TDR was acute in 16 (55%) and delayed in 13 (45%) patients. The surgery for TDR treatment consisted of with thoracotomy in 16 (55%) patients, laparotomy in 11 (38%) patients and both thoracotomy and laparotomy in 2 (7%) cases. Mortality occurred in 3 (10%) patients that presented at the acute stage.

Conclusions

The patients undergoing thoracoabdominal trauma, should be explained the probability, although low, of rupture of the diaphragm. These patients should be followed up and it should be emphasized that they should absolutely tell this trauma history to the physician who examines them when they present at the emergency service.
Acute Abdomen in a Cervical Spinal Cord Injury Patient: A Case Report and Review of the Literature
Authors: Cho KT , Lee SC , Lee HJ , Kang HW
Published: December 2017

Acute abdomen, including appendicitis, is an emergent condition requiring early detection and, often, immediate surgical intervention. Although patients with spinal cord injury (SCI) have an incidence of acute abdomen similar to that of the general population, diagnosing them is even more difficult and complex than it is in the general population. Because of the disruption of normal sensory pathways, the early symptoms are subtle and physical examination of the abdomen is often not helpful. In addition, because of concomitant common conditions in SCI patients, such as urinary tract infection, atelectasis, pneumonia, and decubitus ulcer, laboratory results are not reliable. Delayed diagnoses lead to higher mortality rates among SCI patients with acute abdomen than those of the general population. We report a case of appendicitis in a patient with cervical SCI and discuss the clinical characteristics and diagnostic pitfalls of acute abdomen in SCI patients.
Unexpected Aetiology in Elderly Patient Presenting with Acute Hypercapnic Coma
Authors: Altinsoy B , Altintas N , Ozyurt S
Published: December 2017

In an emergency room setting, hypercapnic respiratory failure is a clinical entity infrequently encountered. It results from inadequate removal of carbon dioxide from distal alveoli. Goitre is defined as abnormal enlargement of the thyroid gland. It may cause compression of surrounding structures including trachea as thyroid dimension increases. Goitre associated with breathing difficulty is a very well‐known situation. Retrosternal goitre can be misinterpreted as asthma and can lead to diagnostic delay. We report a case in which the patient with retrosternal goitre presented rarely with acute hypercapnic coma.
A 2-hour Accelerated Chest Pain Protocol to Assess Patients with Chest Pain Symptoms in an Accident and Emergency Department in Hong Kong
Authors: Ko HF , Lee HY , Ho HF
Published: December 2017

Background

The present study is a follow up analysis of ASPECT study. We aimed to prospectively validate a 2-hour accelerated chest pain protocol (ACPP) to assess patients presenting to emergency department with chest pain symptoms suggestive of acute coronary syndrome.

Methods

This observational study was carried out between June 2009 and July 2010. Patients were included if they were older than 18 years old and presented with at least 5 minutes duration of chest pain. The ACPP included modified Thrombolysis in Myocardial Infarction score, electrocardiograph and point-of-care troponin I at presentation and 2-hour after. Primary endpoint was major adverse cardiac event (MACE) at 45-day of initial hospital attendance.

Results

A total of 384 Chinese patients were recruited and completed 45-day follow up. Forty-five (11.7%) had 45-d MACE. The ACPP identified 124 (32.3%) low risk patients who could be discharged early. No MACE occurred within 45 days among these patients, giving a sensitivity of 100% (95% CI 90-100), a negative predictive value of 100% (96-100), and a specificity of 36.6% (31.5-42).

Conclusions

The ACPP is able to identify very low risk chest pain patients who might be suitable for early discharge without increasing risk of developing MACE. The observation period can be shortened to 2-hour of ED presentation. The variables are objective and easily available. This 2-hour Hong Kong Chest Pain Rule is applicable to Chinese population and has the potential to change the current practice in Emergency Departments in Hong Kong and China.
Complete Resolution of the Left Ventricular Pedunculated Thrombus with Tirofiban Infusion in a Patient with Severe Left Ventricular Dysfunction
Authors: Çil H , Yavuz C , Atilgan ZA , Gunduz E , Soydinc S
Published: December 2017

A 28-year-old man was admitted with symptoms of heart failure. Echocardiography revealed severe left ventricular dysfunction, apical aneurysm, and a 40 × 11 mm sized mobile thrombus attached to apical septum with a narrow stalk. The patient had anterior myocardial infarction two years ago. Heparin infusion was started at 1000 IU/hour for 48 hours. There was no detected change on the size of the thrombus. Surgery recommended to the patient was refused by him because of the procedural risks. Tirofiban infusion was started. Repeat echocardiography showed significant reduction in thrombus size after 24 hours, and complete resolution of the thrombus after 48 hours. To our knowledge, this is the first case with left ventricular mobile thrombus treated successfully with tirofiban infusion.
Genital Tuberculosis Presenting as Acute Scrotum Mimicking Fournier's Gangrene
Authors: Pong YH , Chang CJ , Tsai VFS , Tsai DC , Tsai JH , Lee IC , Huang PL
Published: December 2017

Genital tuberculosis usually presents as local symptoms such as lower abdominal pain and a sensation of scrotal bloating. We report a rare case of genital tuberculosis in a 46-year-old man presenting with symptoms that mimic Fournier's gangrene. He had a progressive local symptoms of scrotal tenderness, redness, swelling, and local rise in temperature. The patient underwent emergency open debridement, and pathology confirmed tuberculosis infection. Recovery was uneventful after 6 months of anti-tuberculosis drug treatment. Literature of genital tuberculosis is also reviewed.
An Unusual Oesophageal Foreign Body: A Total Denture
Authors: Kavalci C , Sayhan MB , Durukan DB , Sezenler E , Sogut Ö
Published: December 2017

A mentally retarded man ingested a total denture and the denture was impacted at the cervical oesophagus. Plain X-ray imaging confirmed the diagnosis. The denture was removed via a rigid oesophagoscope. The clinical management was discussed.
Over‐Triage in Casevac Categorisation is Common in Hong Kong
Authors: Mok VFS , Leung JKS , Wong CP , Wong TW , Lau CC
Published: December 2017

Objective

To review the categorisation of patients who were transferred out from out‐lying islands to urban hospitals utilising casualty evacuation (CASEVAC), and to search for possible patient characteristics which might have contributed to mis‐categorisation during the ‘non‐flying’ hours.

Methods

The medical records of 459 patients, who were transferred out in the year 2009 were reviewed. Correctness of categorisation was determined by 2 independent assessors according to the CASEVAC guidelines. The rates of mis‐categorisation between ‘clinic hours’ and ‘AED hours’, and that between the ‘flying’ and ‘non‐flying’ hours, were compared. The patients' demographic data and their presenting symptoms were collected and analysed using logistic regression models to identify factors contributing to mis‐categorisation.

Results

The mis‐categorisation rate was 60.1%. Among them, all were over‐categorised. The over‐categorisation rates between ‘clinic hours’ and ‘AED hours’, and between ‘flying’ and ‘non‐flying’ hours, were not significantly different (p=0.07 and 0.09, respectively). Abnormal pulse rate was significantly associated with over‐categorisation (p<0.01). Patients at extremes of age and psychiatric/drunk patients were significantly less likely to be over‐categorised (p<0.05 and p<0.01, respectively). There was 20% disagreement between the two assessors when applying the existing CASEVACs guidelines (kappa score 0.58 or ‘moderate agreement’).

Conclusions

Over‐triage in CASEVAC categorisation is common irrespective of the time of day. Revision of the current CASEVAC guidelines is recommended. (Hong Kong j.emerg.med. 2013; 20:327‐336)
Comparison of Clinical Prediction Rules for Termination of Resuscitation of Out‐of‐Hospital Cardiac Arrests on Arrival to Emergency Department
Authors: Chan KM , Lui CT , Tsui KL , Tang YH
Published: December 2017

Objective

To compare the discriminative capacities of various termination of resuscitation (TOR) rules in the prediction of futile resuscitation in the emergency department (ED).

Design

Prospective cohort study.

Setting

2 public hospitals in a cluster in Hong Kong.

Methods

The data were obtained from a Cardiac Arrest Registry of the EDs of two hospitals, including consecutive adult patients suffering from non‐traumatic out‐of‐hospital cardiac arrest from 1st August 2010 to 30th June 2012. Those with return of spontaneous circulation before ED arrival and cases without resuscitation in the EDs were excluded. The modified basic life support (BLS), modified advanced life support (ALS) and neurologic TOR rules were applied to the cohort. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated. The outcome measures were survival to hospital admission (STA) and survival to discharge (STD).

Results

Totally 1125 cases were included. The mean age was 72.4. Return of spontaneous circulation and STA occurred in 302 patients and 9 had STD. Regarding the outcome of STD, the modified ALS and neurologic TOR rules had outperformed the modified BLS rule. The specificity and PPV were 100% for both rules in predicting death when the rules suggested TOR. Regarding the outcome of STA, the neurologic TOR rule had the highest specificity [84.4%; 95% confident interval (CI): 79.7‐88.2%] and PPV (84.5%; 95% CI: 79.8‐88.3%).

Conclusions

The modified ALS and neurologic TOR rules have similar discriminative capacities to predict STD. The neurologic TOR rule has the highest ability to predict STA in the ED. (Hong Kong j.emerg.med. 2013;20:343‐351)
Boerhaave's Syndrome Secondary to Migration of Gastrostomy Tube
Authors: Yang PS , Yeh CH , Chao YK
Published: December 2017

Percutaneous endoscopic gastrostomy is a safe procedure for providing nutrition. Complications associated with tube migration such as duodenal obstruction or pancreatitis have been reported. For the first time, we reported a rare complication of gastrostomy tube migration manifested by Boerhaave's syndrome. (Hong Kong j.emerg.med. 2013;20:400‐401)
Effects of Different Treatment Options on the Prognosis of Wasp Stings
Authors: Xia JB , Xu SS , Yang L , Zhang XW , Zhong WQ , Peng AM
Published: December 2017

Introduction

Severe wasp sting injuries often threaten patient's life. We compared the effects of three different therapies on the prognosis of wasp stung patients.

Methods

We conducted a randomised single-blind controlled trial. Patients stung by wasp were randomly assigned to one of the three treatment groups: group A received symptomatic treatment; those complicated with acute renal failure and haemolysis also received haemoperfusion combined with haemodialysis; for patients with severe haemolytic anaemia, plasmapheresis were applied; for patients with haemodynamic instability, continuous renal replacement therapy was used. Group B received intravenous methylprednisolone injection, 80 mg/d for continuous 3 days in addition to the symptomatic therapy; for patients with haemolysis, methylprednisolone 0.5 g/d was injected intravenously for 3-5 days. For group C, in addition to all treatments administrated to group B patients, subcutaneous injection of 0.5 ml 0.1% epinephrine was given immediately after admission. Primary endpoint was mortality. Major complications (gastrointestinal haemorrhage, toxic encephalopathy, haemolysis, and acute left ventricular failure) and serum enzyme spectrum elevate (alanine aminotransferase [ALT], creatine kinase [CK] isoenzyme and serum creatinine) were secondary endpoints.

Results

Of 134 patients recruited, 45, 44 and 45 patients were assigned to group A, B or C respectively. Therapy in group C reduced mortality compared with group A and B (respectively 24.4%, 9.09%, 0.00% for group A, B, C respectively; p<0.001); there was no significant effects on major complications among three groups (p >0.1). The incidence of elevated ALT was significantly lower in group B and group C than in group A (p<0.001). The incidence of elevated CK isoenzyme was significantly lower in group C than in group A and group B (p<0.001).

Conclusions

For patients with concurrent organ impairment by wasp sting, early combination of epinephrine and methylprednisolone with supportive treatment with renal replacement therapy can effectively reduce the incidence of organ damage and mortality. (Hong Kong j.emerg.med. 2013;20:270-275)
Detection of Intraocular Foreign Body with Ultrasound
Authors: Göksu E , Nokay AE , Sayraç AV , Kartal M , Kiliç T
Published: December 2017

Objective

To evaluate the accuracy of emergency ultrasound in the diagnosis of varying location, size, and composition (metal, plastic, wooden) of intraocular foreign body in a sheep model.

Methods

This was an experimental study using freshly harvested adult articulated sheep eyes. A total of 8 fresh sheep heads were used. Two of the eyes were randomised to include more than one foreign body, the first one with three different sizes of metallic fragments of 0.46×0.81×0.46 mm, 0.46×0.93×0.46 mm, 0.46×0.82×0.46 mm and the second eye containing plastic fragments with a size of 0.97×0.67×0.67 mm and 1.00×0.67×0.67 mm. The wooden fragment was 0.52×0.76 mm and the metallic fragment was 0.45×0.46×0.46 mm. Half of the eyes were chosen as the control group and the sclera of the control group was also punctured. A total of 5 residents, from different postgraduate years, and 2 attending physicians participated in the study.

Results

Regardless of the nature and number of foreign bodies, correct identification of the intraocular foreign body was achieved in 44 of the 56 assessments. The overall sensitivity was 78% (95% confidence interval [CI], 65%‐87%), and the overall specificity was 30% (95% CI, 19%‐44%). Positive and negative predictive values were 53% and 58% respectively.

Conclusion

The dynamic nature of the ultrasound examination may be helpful in localising and determining the size and composition of the foreign body, but if the intraocular foreign body is a concern and the ultrasound and physical examination are negative, another imaging modality, such as a computed tomography scan of the globe, should be obtained. (Hong Kong j.emerg.med. 2014;21:88‐91)
A Randomised, Cross over Study Using a Mannequin Model to Evaluate the Effects on CPR Quality of Real-Time Audio-Visual Feedback Provided by a Smartphone Application
Authors: Park CS , Kang IG , Heo SJ , Chae YS , Kim HJ , Park SS , Lee MJ , Jeong WJ
Published: December 2017

Objective

To evaluate the effect of real time feedback provided by smartphone application on cardiopulmonary resuscitation (CPR) performance.

Methods

Participants were randomised in two groups based on whether chest compression with or without the assistance of the smartphone application. Both groups performed hands-only CPR on a mannequin for 4 minutes. Data on CPR performance of both groups was compared. To assess the reliability the feedback value, we compared the CPR data from Skillmeter and data from smartphone. A questionnaire survey to participants about the usefulness of the application was also evaluated.

Results

Twenty-one subjects were recruited for the study. We found no significant difference in mean chest compression rate (103.3±5.0/min vs. 107.1±1.7/min; p=0.133) and depth between the two groups (47.3 [39.3, 56.2] mm vs. 45.8 [40.3, 49.9] mm; p=0.085). The proportion of adequate compression depth over the total compression was significantly higher in the group using the smartphone (38.1% vs. 22.2%; p=0.034). The CPR data displayed on smartphone application in mannequin's chest was not different from Skillmeter software. The majority of the participants considered the application easy to use, but holding the smartphone during CPR hampered compression.

Conclusions

Real-time audio-visual feedback on CPR depth and rate using a smartphone application can help to maintain the adequate chest compression depth in prolonged CPR. A better method to hold the smartphone may maximise the feedback effect on CPR quality. (Hong Kong j.emerg.med. 2014;21:153-160)
NT-Pro Brain Natriuretic Peptide: Is it a New Indicator of Brain Oedema?
Authors: Cetin GN , Albayrak SB , Yolcu S , Senol N , Tomruk O
Published: December 2017

Objective

To assess the role of the N-terminal prohormone form of brain natriuretic peptide (NT-proBNP) in patients with acute brain oedema.

Methods

This is a case control study. Twenty-two patients with acute brain oedema evidenced by computed tomography (CT) were recruited and compared to a control group of 30 healthy adult volunteers. Levels of NT-proBNP were measured in all patients at hospital admission and on the 12th and 24th hours after admission; as well as in a control group of 30 healthy blood donors.

Results

Twenty-two patients with brain oedema and 30 controls were included. There were significant differences between the brain oedema group and the control group on the NT-proBNP levels at admission time, on 12th or 24th hours after admission. There was no significant difference in NT-proBNP levels at admission time with the severity of brain oedema evidenced by CT. When we considered the relationship between mannitol usage and NT-proBNP levels, we found a significant difference between brain oedema severity and NT-proBNP level according to brain oedema severity after anti-oedema treatment, for 12th and 24th hours NT-proBNP levels.

Conclusions

There is a possible association between brain oedema and elevated serum NT-proBNP levels. (Hong Kong j.emerg.med. 2014;21:167-171)
Anomia and Mild Headache: A Subtle Presentation of Cerebral Venous Thrombosis
Authors: Kuan WS
Published: December 2017

A 52-year-old lady presented to the emergency department with mild headache and anomic aphasia progressing to expressive aphasia. Computed tomography (CT) scan of the brain revealed parenchymal haemorrhage in the left temporoparietal region and suspicion of a left transverse sinus thrombosis. CT venogram of the brain showed extensive thrombus at the left transverse sinus, sigmoid sinus and internal jugular vein. This rare condition should be considered in CT scan showing haemorrhagic changes. Anti-coagulation is the mainstay of treatment of this once highly deadly disease. (Hong Kong j.emerg.med. 2014;21:172-175)
Massive Pulmonary Embolism in a Pregnant Woman with an Excellent Response to Early Thrombolytic Therapy
Authors: Petrov DB , Peneva AI , Milanova MH
Published: December 2017

Thrombolytic agents have been used successfully to treat patients with massive pulmonary embolism and cardiorespiratory insufficiency. Experience with these drugs in pregnancy is limited, nevertheless. We report a 32-year-old pregnant female, who was at 16 weeks of gestation, presented with acute collapse and progressive dyspnea caused by massive pulmonary embolism. The diagnosis was rapidly made in the emergency department with two dimensional-doppler echocardiography that showed signs of right ventricular dysfunction and pulmonary hypertension, as well as direct visualisation of large thrombus at the bifurcation of the main pulmonary artery. Because of significant haemodynamic instability and no improvement after intravenous heparin, the patient was successfully treated with recombinant tissue plasminogen activator and low-molecular-weight heparin. The response to fibrinolytic therapy was excellent without haemorrhagic complications and a healthy child was born at term. We conclude that early thrombolytic therapy may be a reasonable treatment for pregnant patients with unstable pulmonary embolism. (Hong Kong j.emerg.med. 2014;21:260-265)
Clinical Experience of Therapeutic Hypothermia in Cases of Near-Hanging and Recovered from Cardiac Arrest Due to Hanging
Authors: Lee Yh , Ahn Hc , Sohn Yd , Ahn Jy , Park Sm , Hong Ck , Hwang Sy , Na Ju , Shin Dh , Jo Ij , Song Kj , Sim Ms
Published: December 2017

Objective

There is no specific treatment for comatose patients after near-hanging or in those who recover from cardiac arrest (CA) caused by hanging. Since 2009, we have used therapeutic hypothermia (TH) to treat all comatose survivors of near-hanging and in patients who recovered from CA caused by hanging. The purpose of this study was to describe the outcomes in comatose patients after near-hanging.

Design

Case series.

Setting

Emergency departments of two regional hospitals.

Methods

We collected patient data from the Samsung Medical Center hypothermia database between November 2009 and November 2011. We included all patients presented with near-hanging or CA caused by hanging; who remained comatose and received TH after resuscitation for analysis. Clinical characteristics and outcome of patients were presented. Results During the study period, 26 patients were admitted to the emergency department after near-hanging or CA caused by hanging; 21 patients were enrolled in this study. Twelve patients with CA and 9 comatose patients without CA were treated with TH. Only 1 patient with CA had a good neurological outcome. By contrast, all near-hanging patients without CA had a good neurological outcome.

Conclusions

TH can be an effective therapeutic modality in cases of near-hanging without CA. However, the effectiveness of TH is questionable in patients who survive from CA caused by hanging. (Hong Kong j.emerg.med. 2014;21:316-321)
The Epidemiology of Household Rodenticides Poisoning in Hong Kong and its Risk Factors for Developing Coagulopathy
Authors: Othman N , Chan Ck , Lau Fl
Published: December 2017

Objective

To (1) describe the epidemiology of household rodenticides poisoning in Hong Kong, (2) evaluate the proportion of patients who have develop coagulopathy after rodenticide poisoning, (3) identify the risk factors for developing coagulopathy in rodenticide poisoning.

Design

Case series study.

Setting

Sixteen accident and emergency departments in Hong Kong.

Patients

Patients with household rodenticide ingestion who presented to accident and emergency departments during the period from July 2008 to February 2012.

Results

110 patients were reported to have rodenticide exposure during the study period. Eighty-seven patients were included in the final analysis. The mean age was 40.1 and the male-to-female ratio was 1.29:1 (49:38). Most patients (91%) took the rodenticide intentionally. Sixty-nine patients (79%) exposed to anticoagulants type of rodenticide based on history or laboratory findings. The ingredient of the rodenticide ingested in 18 patients (21%) was untraceable. The only clinically significant presentation reported after rodenticide exposure was coagulopathy. Thirty-one patients (36%) developed coagulopathy with an international normalised ratio greater or equal to 1.3. Clinical significant bleeding was only observed in one patient. Presence of coagulopathy in rodenticide poisoning was significantly associated with older patient, intentional ingestion, ingestion of warfarin, ingestion of more than one pack and presence of co-ingestion. Multiple logistic regression analysis showed that only two factors were independent predictor of coagulopathy: Ingestion of warfarin rodenticide (p=0.001, odds ratio [OR] = 18.20, 95% confidence interval [CI]=3.44-96.42), and ingestion of more than one pack of rodenticide (p=0.02, OR=10.01, 95% CI=1.43-69.87).

Conclusions

Clinically significant household rodenticide poisoning in Hong Kong is solely related to ingestion of anticoagulant type of rodenticide. Patients who have ingested warfarin rodenticide and higher ingestion dose are more likely in developing coagulopathy. (Hong Kong j.emerg.med. 2014;21:339-345)
The Use of Clinician-Performed Ultrasonography to Determine the Treatment Method for Suspected Paediatric Appendicitis
Authors: Kim C , Kang B , Park Jb , Ha Yr
Published: December 2017

Objective

To investigate whether the clinician-performed ultrasonography based on the specific criteria for paediatric appendicitis could decrease the negative appendectomy rate without treatment failure.

Methods

The study was a retrospective review of paediatric patients with suspected appendicitis who presented at the emergency department of a teaching hospital over a period of 18 months. The clinicians performed the ultrasound and decided whether the patients with suspected appendicitis should be referred to surgery or managed conservatively. The determinative ultrasound criteria were the presence of periappendiceal fat infiltration and/or an obstructing appendicolith.

Results

The 166 paediatric patients with suspected appendicitis underwent ultrasonography performed by clinicians on weekdays; forty (24.1%) cases with an obstructing appendicolith and/or periappendiceal fat infiltration were treated surgically, and none had a pathologically negative appendectomy, which was significantly lower than the number in the computed tomography scan group (10.4%, 11/106) on weeknights or weekends. The remaining 126 (75.8%) patients without obstructing appendicolith or periappendiceal fat infiltration were treated conservatively, regardless of their appendiceal diameter, and no patients experienced a treatment failure.

Conclusions

The clinician-performed ultrasonography bases on the strict use of above specific ultrasound criteria to determine treatment strategies for suspected paediatric appendicitis can reduce the negative appendectomies without treatment failure. (Hong Kong j.emerg.med. 2015;22:31-40)
Coverage of Journals from Mainland China in the Field of Emergency Medicine by Major International Biomedicine Databases
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)
Gelsemium Poisoning in a Family after Consumption of Cassytha Filiformis Linn. Collected in the Countryside
Authors: Lam Pk , Au Tts , Leung Jks , Wong Tw
Published: December 2017

Acute poisoning through consumption of plants picked from the wild is not uncommon in Hong Kong. Gelsemium elegans Benth. is one of the most poisonous native plants which can cause toxicities ranging from dizziness to respiratory depression and muscle paralysis after ingestion. We report three cases of gelsemium poisoning in a family after consumption of a homemade herbal soup made of a plant believed to be Cassytha filiformis Linn. collected in the countryside. All of them presented with dizziness, nausea and generalised weakness and bilateral ptosis about 1 hour post-ingestion. C. filiformis is generally regarded as non-toxic and it does not contain gelsemium alkaloids. The exact origin of the gelsemium was not known in this case. This case highlighted the potential public health threat posed by the practice of picking and consumption of wild plants. Emergency physicians should also be aware that the plant species reported by the patients may not always be the ones causing clinical toxicities. (Hong Kong j.emerg.med. 2015;22:60-63)
Effect of Safety Belts on Chest Compression Quality in a Moving Ambulance
Authors: Cho Ys , Kim Gw , Kim Gy , Lee Jh
Published: December 2017

Objective

This study aimed to examine the effect of specially designed safety belts on standard cardiopulmonary resuscitation (CPR) quality in a manikin and to determine whether straddle (STR) CPR is equivalent to standard CPR in a moving ambulance.

Methods

Thirty-five emergency medical technicians were recruited and divided into two groups. The first group subjects were randomly assigned to perform standard CPR with or without safety belts. The second group subjects wore safety belts and were randomly assigned to perform STR or standard CPR. Chest compression quality was evaluated by measuring the average rate, depth of compressions, the hands off time and incorrect hand position.

Results

The compression rate was significantly higher in the safety belt group (114.0/min vs. 106.5/min, p=0.001), but the compression depth was not significantly different. The hands-off time was also shorter in the safety belt group (24.5 seconds vs. 40 seconds, p=0.003). When STR CPR was performed, the compression depth was significantly deeper (42 mm vs. 36 mm, p=0.004), and the hands off time was shorter (6 seconds vs. 10 seconds, p=0.039) than with standard CPR. A follow-up questionnaire revealed that 65.7% of the respondents had stopped CPR in the past due to safety reasons, and 48.6% had been injured during CPR.

Conclusions

Wearing belts in a moving ambulance situation can increase the quality of CPR. If an appropriate belt can be designed, the STR method may be used effectively. (Hong Kong j.emerg.med. 2015;22:145-153)