bluuebunny/crossref_metadata_2025 huggingface dataset:
A Simplified Appendicitis Score in the Diagnosis of Acute Appendicitis
Authors: Goh PL
Published: December 2017

Introduction

Scoring systems such as the Modified Alvarado Score (MAS) can help in the early diagnosis of acute appendicitis (AA) but is cumbersome to use and has not found widespread popularity. A more robust, user‐friendly Simplified Appendicitis Score (SAS) was investigated.

Methods

Patients presenting with suspected AA were prospectively enrolled. The performance of the SAS (using only 5 variables – migratory pain, right lower quadrant tenderness, rebound pain, fever >37.3 degrees Celsius and leucocytosis >12,000/uL) was analysed and compared to the MAS.

Results

Out of 238 patients enrolled over four months, 95 (39.9%) patients underwent appendectomy, of which 81 patients had histologically proven AA. A MAS of ≥8 was 92.4% specific for ruling in AA, while a score of <5 was 91.4% sensitive in ruling out AA. A SAS of ≥6 was 91.7% specific for ruling in AA, while a score of <4 was 90.1% sensitive in ruling out AA.

Conclusions

The performance of the MAS can be maintained by omitting the two subjective variables – “anorexia” and “nausea/vomiting”, and increasing the leucocytosis cut‐off level. A SAS using only 5 variables performed as well as the original MAS.
Spontaneous Coronary Artery Dissection Seen in the Postpartum Period
Authors: Turtay MG , Cansel M , Oguzturk H , Yumrutepe S
Published: December 2017

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. It is usually seen during pregnancy and the postpartum period of middle‐aged women. Coronary angiography is important in diagnosis and treatment planning. Treatment modalities are mainly medical therapy, coronary artery bypass surgery, percutaneous transluminal coronary angioplasty and/or stenting. Thrombolytics appear to be relatively contraindicated. This case report deals with the diagnosis, treatment and clinical presentation of a 37‐year‐old woman who had spontaneous coronary artery dissection emerging on the fourth day postpartum.
The Impact of Emergency Medicine Ward in Acute Intoxication Management
Authors: Ko S , Chan HY , Ng F
Published: December 2017

Background

The Emergency Medicine Ward (EMW) was established in Caritas Medical Centre (CMC) in November 2007 under the management of emergency physicians. With the support from the psychiatric team and medical social workers, it provided effective management for intoxicated patients as an alternative to traditional inpatient service.

Objective

The aim of this study was to evaluate the impact of the EMW in the management of acute intoxication.

Method

A retrospective comparative study with data retrieved from all admitted intoxicated and suspected intoxicated patients was carried out over two separate half-year periods in 2007 and 2008, before and after the establishment of the EMW. Data on patient demographics, reason of exposure, substance involved, treatment, psychiatric service offered, clinical outcome, hospital length of stay (LOS) and 28-day hospital re-admission were compared.

Results

A total of 316 intoxicated patients were admitted to CMC with 165 in the 2007 group and 151 in the 2008 group. Both groups shared similar basic epidemiological data. There was a marked reduction in hospital LOS from 80.1 hours to 45.9 hours (p<0.01), a markedly increased proportion of patients receiving psychiatric service from 47.9% to 71.5% (p<0.01) and a significant decline in the access time of psychiatric assessment from 27.4 hours to 10.6 hours (p<0.05). There were no statistically significant difference in treatment, patient clinical outcome and 28-day hospital re-admission.

Conclusions

The establishment of EMW achieved a significant reduction in hospital LOS of intoxicated patients without jeopardizing patient outcome. The results also illustrate that EMW can provide a good platform for the integration of psychiatric service for these patients.
Mass Casualty Incident Involving Pepper Spray Exposure: Impact on the Emergency Department and Management of Casualties
Authors: Oh JJ , Yong R , Ponampalam R , Anantharman V , Lim SH
Published: December 2017

Introduction

Exposure to pepper spray in an urban shopping complex resulted in 13 casualties being treated at a tertiary public hospital emergency department (ED). This report describes the ED's organisation in response to the disaster, and clinical management of those affected.

Results

Thirteen casualties – 11 acute, 2 delayed – presented with symptoms ranging from ocular, respiratory and skin irritation to nausea, vomiting and giddiness. The culprit agent was determined basing on the index patient's history and physical findings. All cases were decontaminated at the ED's on-site Hospital Decontamination Station. Nine adults were monitored overnight in the Emergency Observation Ward under the Toxic Inhalation Protocol and discharged well. The index case was treated symptomatically with improvement, but discharged against medical advice three hours later. No ED re-attendances were recorded.

Conclusions

The effects of pepper spray exposure are brief and self-limiting, but ED management can pose challenges in a mass casualty situation.
A Case of Naphazoline Intoxication after the Ingestion of a Topical Antiseptic Solution
Authors: Lee DH , Yun SY , Cho KH , Lee HM , Choi YH
Published: December 2017

Senepul™ solution is frequently used as a topical antiseptic solution in Korea in cases with abrasion, laceration and impetigo. 100 ml of this solution contains a mixture of 100 mg naphazoline hydrochloride, 100 mg dibucaine hydrochloride, 200 mg chlorpheniramine maleate, and 100 mg benzethonium chloride. Naphazoline is an alpha sympathomimetic and an imidazoline derivative. In excessive dosage or ingested by accident, naphazoline may cause not only local but also systemic side effects like hypertension, bradycardia with arrhythmia, hypotension, respiratory depression, excitation or severe central nervous system depression. We report a case of a patient with prolonged bradycardia, hypotension, central nervous system depression that occurred after ingestion of a small amount of this topical antiseptic solution.
A Case of Spontaneous Spinal Epidural Haematoma in the Emergency Department Associated with Warfarin Therapy
Authors: Yardan T , Baydin A , Genc S , Cokluk C , Acar E , Aydin K
Published: December 2017

Spontaneous spinal epidural haematoma (SSEH) is a neurosurgical emergency that requires early diagnosis and treatment. An 88-year-old man presented to the emergency department with complaints of weakness in the legs, walking deficit, incontinence and back pain for the last two days. He had been on warfarin therapy for 5 years for atrial fibrillation. There was no antecedent trauma. The neurological examination revealed hypoesthesia below the T6 level, anaesthesia below the T10 level and complete paraplegia of both lower extremities. The INR level was 7.81 on admission. Magnetic resonance imaging revealed a posterolateral epidural haematoma extending from T2 to L5. He was given fresh frozen plasma and vitamin K in the emergency department. Emergency thoracic and lumbar laminectomy was performed by neurosurgeons. The probability of SSEH should be investigated in any patient under anticoagulation therapy who presents with signs of spinal compression in the emergency department.
Incarcerated Morgagni Hernia Provoked by Pregnancy
Authors: Oğuztürk H , Ateş M , Turtay MG , Dogan M , İnce V
Published: December 2017

Morgagni hernias are rare diaphragmatic hernias, usually occurring on the right and located in the anterior mediastinum. Herniation of abdominal contents is typically caused by an increase in intraabdominal pressure secondary to trauma, pregnancy or obesity. In this article, a 35-year-old pregnant woman with a Morgagni hernia diagnosed on chest X-ray is presented. Emergency laparotomy was performed with reduction of the herniation and repair of the diaphragmatic defect. To our knowledge, this is the first reported case of hernia in a pregnant woman with incarcerated bowel presenting with respiratory and gastrointestinal symptoms from Turkey.
A Retrospective Study on Imperforate Hymen and Haematometrocolpos in a Regional Hospital
Authors: Lui CT , Chan TWT , Fung HT , Tang SYH
Published: December 2017

Objective

To find out the characteristics and presentations of imperforate hymen in the local population in Hong Kong and to assess if diagnosis of imperforate hymen made in the emergency department can reduce time to operation and length of hospital stay.

Design

Retrospective study.

Setting

A regional public hospital in Hong Kong.

Patients

We retrospectively collected data of all patients with the diagnosis of imperforate hymen (ICD 9 coding 752.42) from the period of January 1999 to June 2009. Demographics of the patients, their presenting symptoms and signs, the diagnostic process, investigation findings and time of operation were recorded and analysed.

Results

Fifteen cases of imperforate hymen were reported during that period. All were adolescent girls aged from 10 to 15 years. A total of 13 patients presented to the accident and emergency department (AED). Seven patients had the diagnosis made in the AED and 2 patients received bedside pelvic ultrasound. More than half of them (8 patients) presented with acute retention of urine. Other presentations included lower abdominal pain, constipation, lower abdominal mass, and protruding introital mass. Most cases diagnosed in the AED (5 out of 7) were admitted to the gynaecology ward while the others were admitted to the surgical or urology wards. Five out of the 7 cases diagnosed in the AED received operation within 24 hours; whereas only 1 out of the 6 cases with the diagnosis made after admission had operation within 24 hours. The difference was statistically significant (p=0.035, Fisher's exact test). The mean length of stay of the group diagnosed in the AED was 1.9 days while the mean length of stay for the group diagnosed after admission was 4.2 days.

Conclusion

Early diagnosis of imperforate hymen and haematometrocolpos in the AED for adolescent girls with primary amenorrhoea could have positive impact on proper admission to the gynaecology ward, prompt operation and shorter length of stay in hospital.
Reversible Increases in Qt Dispersion and P Wave Dispersion during Carbon Monoxide Intoxication
Authors: Cevik Y , Tanriverdi F , Delice O , Kavalci C , Sezigen S
Published: December 2017

Objectives

Carbon monoxide (CO) is a potent myocardial toxin. We investigated the association between acute CO intoxication and electrocardiographic QT interval (QTmax/QTmin), corrected QT interval (cQTmax/cQTmin), QT dispersion (QTd) and corrected QT dispersion (cQTd), P wave duration (Pmax/Pmin) and P wave dispersion (Pd), which were known as predictors of ventricular arrhythmias, atrial fibrillation and sudden death.

Methods

Electrocardiography with 12-leads and blood gas were taken from 65 patients with CO intoxication as well as 65 control patients with similar age and gender distribution at the admission time to the emergency department and at the 4th hour post-therapy. The carboxyhaemoglobin (COHb) levels and the relationships with electrocardiographic parameters were studied.

Results

The mean COHb levels were 21.43±6.85% and 1.37±0.98% in intoxicated patients and in the control group respectively. QTmax, QTd, cQTmax, cQTd, Pmax, and Pd were found significantly higher in intoxicated patients when compared to the control group (373.98±40.35 vs. 355.98±32.88, p=0.006; 49.29±22.66 vs. 20.43±11.16, p<0.001; 455.38±30.72 vs. 419.57±22.27, p<0.001; 60.88±25.99 vs. 25.75±13.13, p<0.001; 107.91±13.28 vs. 96.65±12.65, p<0.001, 46.85±13.49 vs. 35.22±10.07, p<0.001 respectively). In Pearson correlation analysis, there were significant correlations between COHb level and QTmax, QTd, cQTmax, cQTd, Pmax and Pd (r=0.211, p=0.016; r=0.610, p<0.001; r=0.599, p<0.001; r=0.628, p<0.001; r=0.458, p<0.001; r=0.414, p<0.001 respectively).

Conclusion

A correlation between reversible increases in QTd, cQTmax, cQTd, Pmax and Pd in the electrocardiogram and COHb can be observed in acute CO intoxication patients.
Ball Bearing (BB) Gun Injuries
Authors: Tsui CL , Tsui KL , Tang YH
Published: December 2017

War game has become quite a popular recreational game in Hong Kong nowadays. Ball bearing (BB) and pellet gun-related injuries should not be overlooked. This article presented a case of BB gun-related soft tissue injury on the face with retained pellet. We also reviewed the types, power levels, and the injuries of non-power guns. The management of BB and pellet gun-related injuries and the preventive measures concerning legislation, education program, product safety awareness and protective gears usage would be emphasized.
Mechanism of Injury and Clinical Variables in Thoracic Spine Fracture: A Case Control Study
Authors: Singh R , Taylor DM , D'Souza D , Gorelik A , Page P , Phal P
Published: December 2017

Objective

To determine the mechanisms of injury and clinical findings significantly associated with traumatic thoracic spine (T-spine) fractures.

Methods

This was a case-control study in a tertiary adult trauma centre. Cases were patients admitted with traumatic T-spine fractures between January 1999 and August 2007, inclusive. Each case had two controls matched for gender, age and injury severity. Data were collected from patient medical records and the trauma service database. Factors potentially associated with T-spine fracture were derived from the literature, expert consensus and univariate analysis. Multivariate logistic regression was employed to determine factors significantly associated with T-spine fracture.

Results

Two hundred and sixty one cases and 512 controls were enrolled. Univariate analysis showed the mechanisms of fall from a height ≥2 meters (m) and motorbike accident ≥60 kilometers per hour were significantly associated with T-spine fracture (p<0.001). The clinical findings of thoracic back pain, tenderness, intoxication, step deformity and abnormal neurological symptoms were also significantly associated with T-spine fracture (p<0.05). Multivariate analysis indicated that falls from a height of ≥2 m and thoracic back pain were significantly and positively associated with T-spine fracture (p<0.001). However, intoxication was negatively associated with T-spine fracture.

Conclusions

Patients with T-spine injury are significantly more likely to have fallen from a height ≥2 m or to have had thoracic back pain but less likely to be intoxicated. These findings should be validated prospectively prior to development of clinical guidelines for the identification of patients who may benefit from CT screening of the thoracic spine.
Management of Suspected Deep Venous Thrombosis in an Emergency Medicine Ward in Hong Kong
Authors: Hung KKC , Graham CA , Yim WT , Yam ESF , Cheung NK , Rainer TH
Published: December 2017

Introduction

Clinical signs and symptoms can vary for patients with deep venous thrombosis (DVT). DVT is an important diagnosis to recognise as it can lead to proximal embolism into the pulmonary circulation resulting in sudden collapse and death. The objective of this study is to describe the management of patients with suspected DVT in the emergency medicine ward (EMW) setting in Hong Kong using a standardised clinical pathway.

Methods

A retrospective review was conducted for patients with suspected DVT admitted to the EMW from April to December 2008 using a standardised protocol. The use of a clinical prediction rule and diagnostic tests (including the modified Well's score, D-dimer and ultrasound examination) and outcomes (including the length of stay and secondary admission rate) were investigated.

Results

A total of 100 patients with suspected DVT were admitted to the EMW in the nine-month study period. DVT was confirmed in 30% using ultrasonography. Fifty-two percent of patients were in the high-risk category according to the modified Well's score. Seventy-six percent of patients had positive D-dimer results. Ten percent of patients were safely discharged without an ultrasound examination. Mean length of stay in the EMW was 1.99 days. Thirteen percent of patients required second admission to other specialties.

Conclusions

This study suggests that a standardised clinical pathway based in the EMW can be used for patients with suspected DVT to reduce hospital admission.
Pneumomediastinum after Smoking Cocaine: A Case Report and Review of Literature
Authors: Lam PK , Wong TW , Lau CC
Published: December 2017

Cocaine abuse has become more affordable and popular amongst drug abusers locally in recent years. Spontaneous pneumomediastinum is an uncommon but a well-reported complication after smoking “crack” cocaine in the West. We report a case of spontaneous pneumomediastinum after smoking cocaine. The patient was managed conservatively and he recovered uneventfully. A review of literature on the mechanism, clinical presentation and management is presented.
Sealed off Perforated Gastric Ulcer Detected by Transabdominal Ultrasonogram
Authors: Shum JSF , Wong EMF , Chau WK , Sy ANL
Published: December 2017

The assessment of the stomach pathologies is not commonly included in the scanning protocol of upper abdominal ultrasound. However, in patients presented with epigastric pain, careful assessment of the stomach wall thickness and epigastric peritoneum for signs of pneumoperitoneum may sometimes yield invaluable information. We present a case of sealed off perforated gastric ulcer at gastric antrum detected by transabdominal ultrasound. The diagnosis was confirmed by laparotomy.
A Retrospective Study on Mucocele of the Appendix Presented with Acute Abdomen or Acute Appendicitis
Authors: Yakan S , Caliskan C , Uguz A , Korkut MA , Çoker A
Published: December 2017

Objective

We reported the demographic, clinical, radiologic, preoperative and postoperative characteristics and outcomes on patients of appendix mucocele that presented with or operated for acute appendicitis or acute abdomen.

Methods

A retrospective study. Patients who were presented or operated for acute appendicitis or acute abdomen and had an operative histopathological diagnosis as appendix mucocele (simple mucocele, mucinous cystadenoma, mucinous cystadenocarcinoma) were included. Demographic, clinical, radiologic, preoperative and postoperative data of eligible cases were evaluated.

Results

From January 2003 to February 2010, a total of 2120 patients with the pre-operative diagnosis of acute appendicitis were treated in our center, and nine (0.42%) patients were diagnosed to have mucocele of the appendix. Seven patients (78%) were female. Average age of the patients was 59.5 (range=25-74). Major complaint was right lower quadrant pain in eight (89%) patients. In preoperative ultrasonographic examination of the patients, appendiceal cystic masses (mucocele) were diagnosed in four (44.5%) patients. In histopathologic examination, the number of patients diagnosed to have simple mucocele was two (22%), mucinous cystadenoma was four (45%), and mucinous cystadenocarcinoma was three (33%). No postoperative morbidity or mortality was noted.

Conclusion

Appendix mucocele is a rare disease and it is usually diagnosed histopathologicaly in appendectomy specimens. When a cystic mass in appendix is seen during operation, appendiceal mucocele should be kept in mind to avoid iatrogenic perforation causing pseudomyxoma peritonei and possible concomitant malignancies should be searched.
How Useful are Vital Signs in Identifying Patient with Ruptured Ectopic Pregnancy? A Retrospective Correlation Study
Authors: Wong WY , Tsui KL , Tang YH
Published: December 2017

Objectives

To determine whether initial vital signs correlate with the amount of haemoperitoneum in patient with ruptured ectopic pregnancy presenting to accident and emergency department.

Method

A retrospective study in a regional public hospital in Hong Kong. We retrospectively collected data of all patients with the diagnosis of rupture ectopic pregnancy (ICD-9-CM 633) from the period of January 2006 to December 2007. Demographics of the patients, gestational ages, triage vital signs (pulse rate and blood pressure), emergency department ultrasound record and operation record were reviewed. Mean arterial pressure and shock index were calculated accordingly. Different vital signs were used to correlate with the amount of haemoperitoneum by using Pearson correlation analysis.

Results

Ninety-three patients with ruptured ectopic pregnancy were recruited. Mean age of patients was 30 years (range 17-47, ±6 SD). Mean week of gestation was 6.7 week (range 3-12, ±2 SD). Forty-two patients (47%) had intraperitoneal free fluid shown in emergency department ultrasound scan. Pearson correlation coefficients between vital signs and amount of haemoperitoneum were: systolic blood pressure (-0.44, p<0.001), diastolic blood pressure (-0.24, p=0.01), mean arterial pressure (-0.37, p<0.001), pulse (0.18, p=0.05) and shock index (0.45, p<0.001).

Conclusion

None of the vital signs showed good correlation with the amount of haemoperitoneum. Doctors should consider fluid resuscitation and urgent referral to gynaecologist for immediate operation even though the vital signs are normal, as patient may already have significant intraperitoneal bleeding.
Rectus Sheath Haematoma: A Rare Cause of Abdominal Pain
Authors: Akay S , Caliskan C , Gonullu H , Dal O , Korkut MA , Erkan N
Published: December 2017

Objective

Rectus sheath haematoma (RSH) is a rare entity described as accumulation of blood within the rectus muscle. Patients can present with varying symptoms and signs, mimicking acute abdominal conditions. Failure to diagnose can result in unnecessary diagnostic procedures and surgical interventions.

Methods

We presented a series of 14 cases of RSH presenting to two emergency departments (ED) within a period of 3 years. Their demographic characteristics, medical history, presenting signs, symptoms and treatment were analyzed.

Results

Fourteen cases were diagnosed RSH. Seven cases were on warfarin treatment. Three RSH cases were diagnosed by ultrasonography (USG) only while the remainders had additional computed tomography (CT). Two cases had surgery due to haemoperitoneum, and the rest were treated conservatively with bed rest, analgesics and reversal of anticoagulation therapy. All patients were discharged from hospitals.

Conclusions

RSH is an important entity which must be considered in patients with known risk factors presenting to ED with abdominal pain. In elderly patients with a history of cough, anticoagulant use with palpable mass on abdominal wall, RSH must be considered as a possible diagnosis for unexplained abdominal pain. USG, together with CT in selected cases, should be performed to reveal this rare disease entity.
Iliopsoas Haematoma: An Uncommon Differential Diagnosis for Groin Pain
Authors: Choa GPH , Lim CS
Published: December 2017

Bleeding complications should be considered in the differential diagnosis of any patient on warfarin therapy. A 66-year-old man presenting with right groin pain due to a spontaneous iliopsoas hematoma is reported. Computed tomography of the abdomen and pelvis at the emergency department confirmed the diagnosis. Fresh frozen plasma was given to correct the clotting derangement. The patient was managed conservatively. He was subsequently discharged well without complication. Iliopsoas haematoma or spontaneous retroperitoneal haemorrhage is an uncommon complication that needs to be considered in the differential diagnosis of a patient on warfarin therapy with abdominal, flank or groin pain.
Hot Water Immersion Therapy with a Thermal Isolator in Patient with Marine Envenomation
Authors: Lau KK , Chan CK , Tse ML , Lau FL
Published: December 2017

Objective

Hot water immersion (HWI) has been proven to be effective for the treatment of pain due to marine envenomation. Our preliminary study by simply measuring the temperature change over time on the hot water in our conventional metal tray method revealed a too rapid fall in water temperature that happened in minutes. The aim of this study was to review the current practice of HWI for patients with marine envenomation in the emergency departments in Hong Kong, and to look for the optimal equipment in performing HWI.

Method

We first conducted a phone survey to 16 registered nurses or nursing officers from 16 emergency departments of public hospitals in Hong Kong for the current practice of hot water immersion. The second part of our study was an in‐vitro experiment done in observation room that a healthy subject immersed a hand into the water bath in metallic tray, sharp box and thermal isolator with and without covering of aluminum foil or plastic foil. The temperature change of the water bath in these containers was serially monitored.

Results

In our phone survey, 14 respondents used plastic tray or sharp box for hot water immersion. Nine of them claimed that they commonly encountered inadequate wound pain relief and early cooling of the hot water bath. The experiment showed that the water temperature dropped out of optimal range for 5 minutes and 15 minutes in metallic tray and sharp box respectively. The thermal isolator kept the optimal temperature throughout 30 minutes of the study time.

Conclusion

Our purposed thermal isolator is a safe, practical and effective device for HWI therapy.
A Case of Respiratory Failure Due to Poison Hemlock Poisoning Presented to an Emergency Department
Authors: Erenler AK , Baydin A , Duran L , Yardan T , Turkoz B
Published: December 2017

Poison hemlock (Conium maculatum) is one of the most poisonous plants in the world. Accidental ingestion of the plant could result in central nervous system depression, respiratory failure and even death. Airway and breathing management followed by fluid resuscitation is the mainstay of treatment. Poison hemlock poisoning is an important differential diagnosis for patients with impaired consciousness and respiratory failure after plant ingestion in areas of natural habitat for the plant. Early and proper diagnosis is vital for patients with poison hemlock poisoning. In this report, we present a case of life‐threatening poisoning due to taking the poison hemlock mistaken for Helichrysum arenarium.
Acquired 5‐Oxoprolinuria (Pyroglutamic Acidaemia) as a Cause of Early High Anion Gap Metabolic Acidosis in Acute Massive Paracetamol Overdose
Authors: Leung PSC , Tsui SH , Siu TS , Tam S
Published: December 2017

5‐oxoprolinuria is an uncommon and under‐recognised cause of early high anion gap metabolic acidosis after paracetamol overdose. We reported a 30‐year‐old Indian woman with history of chronic alcoholism who ingested 150 g crushed paracetamol tablets for suicide 14 hours before attendance to the A&E Department. Initial arterial blood gas showed a high anion gap metabolic acidosis with respiratory compensation. Serum paracetamol level reached 5004 umol/L and a prolonged course of N‐acetylcysteine was given. She was complicated by hepatotoxicity and 5‐oxoprolinuria (with laboratory confirmation) which reverted after antidote administration. There were no neurological and hepatic sequelae. In case of massive overdose, pathways of drug metabolism are altered prior to the centrilobular hepatic necrosis. A metabolic intermediate of gamma‐glutamyl cycle, 5‐oxoproline, accumulates upon saturation of endogenous glutathione store. The specific antidote N‐acetylcysteine is the only definitive treatment. Prolonged course of antidote may be required in cases of massive overdose and treatment should be individualised. (Hong Kong j.emerg. med. 2011;18:264‐270)
Acute Pyelonephritis in Emergency Medicine Ward: A Four Years Retrospective Review
Authors: Chan TWT , Lam SK , Fung HT
Published: December 2017

Objective

To study the characteristics of patients with acute pyelonephritis (AP) admitted to the emergency medicine ward (EMW) and sensitivity pattern of bacteria cultured from urine as well as to find out which antibiotic should be the best empirical treatment.

Methods

This was a retrospective study. All patient diagnosed with AP admitted to the EMW in Tuen Mun Hospital from January 2007 to December 2010 were included in this study. Data on patients' demographics, length of stay, urine culture and antibiotic sensitivity results as well as the types of antibiotics administered to them were collected and analysed.

Results

Altogether 308 patients were admitted to the EMW during the study period, accounting for 58% of all hospital admissions with the same diagnosis. There were comparatively more female patients (p<0.001) and fewer patients with diabetes (p<0.001) admitted to the EMW compared with other departments. The mean length of stay in EMW (2.2 days) was significantly shorter than that in other departments (7.1 days) (p<0.001). E. Coli was the commonest cultured bacterium, accounting for 94% of all positive growths. Cefuroxime sodium had high sensitivity (84%) in treating AP, which was significantly higher than that of amoxicillin-clavulanate (75%) (p<0.001). Levofloxacin also had high sensitivity (86%) but the difference between cefuroxime sodium and levofloxacin was not statistically significant (p=0.67).

Conclusions

Patients with AP admitted to local EMWs should be given either cefuroxime sodium intravenously or levofloxacin orally (if they can tolerate oral intake) as empirical treatments. Oral levofloxacin can be continued upon discharge.
The Urgent Rehabilitation Technique Education Program for Wenchuan Earthquake Victims
Authors: He HC , Chen P , Liu SX , Lei ZJ , Yang YH , He CQ
Published: December 2017

An Urgent Rehabilitation Technique Education Program was conducted in response to the needs of the enormous number of the Wenchuan earthquake patients and the shortage of rehabilitation professionals. This program referred to an urgent training program of several rehabilitation techniques that was beneficial to earthquake victims. This short-term program covered the basic clinical technical trainings in physiotherapy, occupational therapy, prosthetics and orthotics, which were included in concentrated technical training, decentralized technical training, and disaster area technical advising. More than 1,500 health-care professionals in Sichuan province took this education program at different locations, which can improve the shortage of rehabilitation professionals, addressing to the clinical need of the earthquake patients, improving local rehabilitation technique, and standardized of the rehabilitation treatments for earthquake patients. This program could be considered as an economical and effective method to help the disaster situation especially there was shortage of health professionals. (Hong Kong j.emerg.med. 2011;18:324-327)
Is There Any Difference in Cardiopulmonary Resuscitation Performance According to Different Instructional Models of Cardiopulmonary Resuscitation Education for Junior and Senior High School Students?
Authors: Kim SE , Lee SJ , Noh H , Lee DH , Kim CW
Published: December 2017

Objective

This study aims to determine whether or not cardiopulmonary resuscitation (CPR) skills differ according to different instructional models for CPR education and training for junior and senior high school students.

Methods

This was a prospective and randomised study including 519 junior and senior high school students. After the lecture on CPR, students practiced the skill on the manikin. Group 1 used model 1 and Group 2 used model 2 for practical training and practical skills and CPR performance quality were evaluated.

Results

Data from skill tests were analysed in 229 students in group 1 and 210 students in group 2. The total score of sequence skill tests was 17.8±2.0 points. During 2 cycles, no chest elevation was observed in 33.3% and was significantly lower in group 1. There were no significant differences in the frequency of proper ventilation and in ventilation volume between the 2 groups. Excessive ventilation was more frequently observed in group 1 and insufficient ventilation was observed more frequently in group 2. The percentage of the frequency of a proper chest compression rate was 80.5±31.2% and there were no significant differences in proper and insufficient depths, mean rate and recoil of the chest in chest compression between the 2 groups.

Conclusions

There were differences in CPR skills according to different CPR training manikins. Therefore, certain conditions seem to be considered in selection of instructional models for CPR psychomotor skills. (Hong Kong j.emerg.med. 2011;18:375-382)
Effects of Ketamine on Icam-1 Expression during Lipopolysaccharide Induced Acute Lung Injury in Rats
Authors: Hong S , Kim J , Jeong S , Park K , Song D , Baik T , Kim J , Cho B , Lee S
Published: December 2017

Introduction

Intercellular adhesion molecule-1 (ICAM-1) serves very important roles in lung injury, and increases in ICAM-1 are associated with severity of lung injury. We intended to examine whether ketamine could have favourable effects on ICAM-1 expression in lipopolysaccharide (LPS)-induced acute lung injury in the rat.

Methods

The acute lung injury was induced by instilling LPS into the tracheas of 72 anaesthetised rats. The animals were divided into four groups including a sham group with intratracheal saline, an LPS group with intratracheal LPS and intraperitoneal saline, and two ketamine treatment groups with intratracheal LPS and treated with 1 mg/kg or 10 mg/kg doses of intraperitoneal ketamine hydrochloride. Half of the animals were sacrificed at three hours and the remaining animals were sacrificed at six hours. Real time PCR was performed on the lung tissues obtained. Concentration of the soluble ICAM-1 was measured in the bronchoalveolar lavage fluid. Expression of ICAM-1 was measured.

Results

The transcriptional activity of ICAM-1 mRNA increased 9.92 fold in the LPS group compared to the sham group but decreased by 84.1% and 83.3%, respectively, in the 1 and 10 mg/kg ketamine treatment groups. The concentration of soluble ICAM-1 in bronchoalveolar lavage fluid increased 2.23 fold in the LPS group compared to the sham group while decreasing by 75.0% and 74.5% respectively in the 1 mg/kg and 10 mg/kg ketamine treatment groups. The intensity of immunohistochemical staining for ICAM-1 was also decreased in both ketamine treatment groups.

Conclusion

Ketamine attenuates ICAM-1 expression during acute lung injury in rats. (Hong Kong j.emerg.med. 2011;18:397-405)
Pain and Pain Management in a Hong Kong Emergency Department
Authors: Wong MT , Ip M , Graham CA
Published: December 2017

Background

The prevalence of pain is high in emergency departments (ED), according to previous studies. There is little information on the epidemiology of pain in Hong Kong EDs. This study aimed to explore the epidemiology of pain in a single academic ED in Hong Kong, and to evaluate the pain management policy in the ED.

Methods

Retrospective case review study with explicit record review of ED clinical records; records obtained by means of systematic sampling of a seven-consecutive-day period attendance. Data on the prevalence and location of pain, waiting time for drugs for pain relief, and pain drug prescription rates were obtained. Descriptive data analysis was performed.

Results

A total of 494 ED clinical records were reviewed. The prevalence of pain was 60.7% (300/494) during the study period. 72.3% (217/300) of patient attendances with pain had duration of pain not exceeding three days; 79.0% (237/300) of them were classified as ‘semi-urgent’ or ‘non-urgent’. 41.7% (125/300) of patients suffering from pain were given drugs for pain relief. The median time for patients to receive analgesic drugs was 56.0 (IQR 25.0-104.5) minutes after registration. Pain assessment using a numerical rating scale was positively associated with drug prescriptions for pain relief.

Conclusion

The prevalence of pain in ED patients was high, and comparable with the figures from studies in other EDs. Patients attending with pain had to wait more than 60 minutes for drugs for pain relief on average. (Hong Kong j.emerg.med. 2011;18:406-411)
Iodide-Induced Parotitis after Coronary Angiography
Authors: Cansel M , Yagmur J , Cuglan B , Tasolar H
Published: December 2017

A 55-year-old woman with stable angina pectoris who had undergone elective coronary catheterization five years ago, no coronary artery disease had been reported at that time. Recent noninvasive stress testing was performed and the result was positive. Coronary angiography was repeated by using iodinated contrast medium. At catheterization, no angiographically significant coronary stenoses was found. About 36 hours after coronary angiography she presented to the emergency department for swelling of face and throat bilaterally. Her parotid glands were diffusely and symmetrically enlarged to twice the normal size and glands were firm and non-tender. This case had taken iodinated contrast medium before and she had the same symptoms. So she might be an example of recurrent parotitis caused by repeated iodide exposure. (Hong Kong j.emerg.med. 2011;18:421-423)
Traumatic Multiple Fractures Associated with Blunt Diaphragmatic Rupture and Diaphragmatic Hernia: A Case Report
Authors: Zhou XG , Xu KW , Zou LJ , Xia Y , Zhang Q
Published: December 2017

Traumatic multiple fractures are a serious, infrequent and potentially life-threatening medical emergency. In addition, traumatic blunt diaphragmatic rupture and diaphragmatic hernia are rare and potentially life-threatening clinical entities associated with injuries. A case of traumatic multiple fractures associated with blunt diaphragmatic rupture and diaphragmatic hernia is reported. The operative management of this type of injury and clinical experience are discussed. (Hong Kong j.emerg.med. 2011;18:424-427)
Outcome and Prognostic Factors of Patients in Out‐Of‐Hospital Cardiac Arrests Presenting with Non‐Shockable Rhythm in Hong Kong
Authors: Leung KL , Lui CT , Cheung KH , Tsui KL , Tang YH
Published: December 2017

Objective

To obtain the recent local epidemiological data and evaluate factors associated with outcomes of adult patients in non‐traumatic non‐shockable out‐of‐hospital‐cardiac‐arrest (OHCA) in Hong Kong.

Methods

It was a cross‐sectional study lasting for nine months (from July 2009 to March 2010) in two emergency departments (ED) which served a population of 1.1 million. All non‐traumatic OHCA patients aged equal or greater than 18 years presented with non‐shockable cardiac rhythms to ED without postmortem changes were included. The pre‐hospital factors, managements and outcomes were recorded in a standardised data entry form at the time of patient consultation. Logistic regression was used to evaluate the relationship between survival to admission (STA) and various prognostic factors.

Results

A total of 348 patients fulfilled the inclusion criteria. The mean age was 75.9 years old. Overall, there were 61 patients (17.5%) with restoration of spontaneous circulation and 58 patients (16.7%) had STA. The survival to hospital discharge (STD) rate was 0.86% (3 patients). Factors independently associated with better prognosis in terms of STA were initial pulseless electrical activity arrest (PEA) rhythm in ED (OR=4.72, 95% CI 2.30‐9.69), witnessed arrest (OR=8.00, 95% CI 3.38‐18.96) and non‐cardiac cause of arrest (OR=2.17, 95% CI 1.00‐4.67).

Conclusion

STA for adults presenting with non‐traumatic non‐shockable OHCA in our centre is 16.7%. Witnessed non‐shockable OHCA patients presenting with initial PEA arrest rhythm and with a presumed non‐cardiac in etiology are significantly associated with higher STA rate.
The Incidence and Types of Acid‐Base Imbalance for Critically ill Patients in Emergency
Authors: Song ZF , Gu WH , Li HJ , Ge XL
Published: December 2017

Objective

To explore the incidence and types of acid‐base imbalance or disorder (ABD) for critically ill patients in emergency room.

Methods

Clinical data of all critically ill patients managed in the resuscitation room were collected prospectively during the period from 1st December 2008 to 31st March 2009. Arterial and venous blood samples were taken simultaneously for blood gas analyses and serum electrolytes. Acid‐base homeostasis or imbalance was judged according to the criteria.

Results

A total of 766 cases were collected and the incidence of ABD was 97.3% (N=745). Simple acid‐base disorder (SABD) was present in 149 cases (20.0%). Dual acid‐base disorder (DABD) was present in 525 patients (70.5%) while triple acid‐base disorder (TABD) was found in 71 patients (9.5%). After calculating the anion gap (AG), the incidence of metabolic acidosis increased from 72.2% (N=538) to 91.0% (N=678) and the rate of missed diagnosis for metabolic acidosis was 20.6% (140 out of 678 cases). Meanwhile, the incidence of TABD increased from 1.6% (N=12) to 9.5% (N=71) and the rate of missed diagnosis for TABD was 83.1% (59 out of 71 cases). Similar phenomenon was observed when potential bicarbonate was calculated. The incidence of TABD increased from 1.1% (N=8) to 9.5% (N=71) and the rate of missed diagnosis of TABD was 88.7% (63 out of 71 cases). Patients with TABD (77.9±10.7 years old) were older (P<0.01) than the groups of SABD and DABD. APACHE II scores and the incidence of multiple organ dysfunction syndrome (MODS) were significantly higher among TABD patients. Mortality of patients with TABD on the first, second, third and seventh days were 14.1%, 23.9%, 26.8% and 38.0% respectively and were significantly higher than SABD and DABD.

Conclusion

The incidence of ABD in our group of critically ill patients was 97.3%. The commonest type of ABD was DABD. Calculating AG and potential bicarbonate could help us to uncover metabolic acidosis and TABD in time. Patients with TABD had a poorer prognosis. Age and APACHE II scores were key factors closely related to TABD.
Preparedness of Young Male Physicians for Biological Terrorism and Warfare in South Korea
Authors: Ahn JH , Chung JW , Kim CW , Lee DH
Published: December 2017

Introduction

The events of 11th September 2001, and the subsequent anthrax attacks in the United States brought the threat of bioterrorism to the forefront of concern for public health departments. Moreover, the rising confrontation between North and South Korea emphasizes the possibility of aggression with biological weapons and our vulnerability to bioterrorism. While the importance of physicians' interests and management ability is becoming more critical, no studies have yet been undertaken in Korea to assess whether primary care physicians are well informed and capable of managing bioterrorism. This study evaluates the awareness and response of young male physicians to potential bioterrorism in South Korea.

Method

A total of 692 young male physicians completed the knowledge and awareness survey during the education period of military service on 9th April 2005.

Results

Forty‐five percent of the participants responded that the possibility of biological warfare in Korea was high. The level of bioterrorism knowledge, however, was low. Eighty‐seven percent acknowledged the necessity of education and training for bioterrorism, and 69.9% were willing to accept education and training in bioterrorism preparedness.

Conclusion

These findings suggest that young physicians should receive continuous education and training to improve preparedness for biological terrorism and warfare in South Korea.
Echocardiographic Delineation of Type a Aortic Dissection
Authors: Yuan SM , Lavee J , Kuperstein R
Published: December 2017

Introduction

In addition to proving the visualisation data, studies on the intimal flaps of aortic dissection based on echocardiography have been very limited.

Methods

Twenty‐seven patients undergoing an operation of type A aortic dissection with preoperative transthoracic and/or intraoperative transesophageal echocardiography archived in the Horizon Cardiology Web of the hospital available for review and measurement were selected into this retrospective study. By way of quantitative and qualitative approaches, flap movement, dissection extent and aortic obstruction were sufficiently evaluated.

Results

An intimal flap was visualised in 22 (81.5%) patients and linear artifact was viewed in 1 (3.7%), and in the remaining 4 (14.8%), neither an intimal flap nor a linear artifact was visible. Dissection extents were 2.78±1.53 cm and 2.03±1.19 cm in the horizontal and vertical direction, respectively. Sub‐ or semi‐circumferential dissection was noted in 14 (51.8%) patients. No total circumferential dissection was found in this patient population with type A aortic dissection. The obstruction of the aortic valve orifice or aortic cavity developed in 11 (40.7%) patients. Flow disturbance and thrombus in the false lumen were visualised in 24 (88.9%) and 4 (14.8%) patients, respectively. The breadth of flap movement in short‐axis plane was much larger in the Aortic Obstruction Group than that of the Non‐Obstruction Group (1.55±1.14 cm vs. 0.75±0.526 cm, p <0.05).

Conclusions

Preoperative transthoracic or transesophageal echocardiographic evaluations offer a convenient and precise diagnostic tool for aortic dissection. The dissection extent may directly correlate and substantially reflect the clinical symptoms of the patients with type A aortic dissection in response to the haemodynamic impairment. Preoperative echocardiographic delineation would assure adequate means and extent of the impending operation.
A Case of Young Man with Stroke Caused by Internal Carotid Artery Dissection
Authors: Soong BCP , Chan HY , Ng F
Published: December 2017

Internal carotid artery dissection is one of the most frequent causes of stroke in young people. Seventy percents of cases are under 50 years old and there is a slight predominance of males. Trivial head injury or neck trauma may cause dissection. Magnetic resonance angiography is important in diagnosis and management planning. Early anti‐thrombotic therapy is the main treatment modality. In this case report, a 27 years old male van driver who has played boxing for several years presented to us with acute confusion after a car accident. The patient was put on warfarin for several months and enjoyed good recovery at follow up.
Secondary Intoxication of Emergency Department Personnel with a Flammable and Highly Toxic Gas: A Lethal Aluminum Phosphide Poisoning Case
Authors: Akinci E , Kocasaban DU , Vural K , Coskun F
Published: December 2017

Aluminum phosphide (AlP) is a relatively low cost and highly toxic pesticide. Besides being lethal to the patient poisoned by AlP, this substance may easily contaminate emergency medicine personnel through the release of toxic gases such as phosphine. Furthermore, these toxic gases are flammable and may explode during certain patient interventions, such as gastric lavage. We present a case of lethal poisoning of a patient caused by the intentional ingestion of AlP and secondary intoxication of emergency medicine personnel with the explosive phosphine gas.
Hong Kong Poison Information Centre: Annual Report 2010
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 2010.

Methods

In 2010, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis.

Results

A total of 4,418 poisoned cases were analysed. There were 1,863 male patients (42.2%) and 2,540 female patients (57.5%). More than two-third of cases (68.3%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, unintentional exposure and abusive use. Benzodiazepine, paracetamol, ketamine, zopiclone, and Chinese herbal medicine were the common agents involved. Majority of the patients were managed supportively, with 10.2% and 9.7% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 1.0% of the poison exposure resulted in death and 5.3% of the exposure had major outcomes.

Conclusions

This fifth annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.