bluuebunny/crossref_metadata_2025 huggingface dataset:
Serial Serum Cholinesterase Activities as a Prognostic Factor in Organophosphate Poisoned Patients
Authors: Yun HW , Lee DH , Lee JH , Cheon YJ , Choi YH
Published: December 2017

Objective

Organophosphate poisoning is a serious clinical entity and of considerable morbidity and mortality. Several factors have been identified to predict outcomes of organophosphate poisoning. This investigation aims to identify the relationship between the dynamics of serum cholinesterase (SChE) activity and mortality.

Methods

In this retrospective study, medical records of all patients with acute organophosphate poisoning were reviewed from January 2001 to December 2009. Clinical features, SChE activity, Glasgow Coma Scale, laboratory findings, electrocardiogram finding, management and their outcomes were examined.

Results

A total of 169 patients were included in this study. A total of 55 patients were enrolled. Deceased patients were 8 in number. Absence of an increase in SChE activity was related with mortality in organophosphate poisoned patients (p value=0.036; odds ratio, 5.445; 95% confidence interval, 1.121-26.551).

Conclusions

The absence of an increase in SChE activity is associated with higher mortality in organophosphate poisoning. The SChE dynamic activity can provide a guide to physicians in the evaluation and management of organophosphate poisoned patients.
Risk Factors of Acute ST Segment Elevation Myocardial Infarction Patients without Chest Pain
Authors: Wu YF , Wang PC , Hsiao CT , Hsiao KY , Chen IC
Published: December 2017

Introduction

To identify factors associated with ST-segment myocardial infarction (STEMI) patients who had no chest pain, and to improve recognition of STEMI patients without presentation of chest pain in the emergency department (ED).

Method

Clinical characteristics and presentations were recorded in patients diagnosed with STEMI in the ED in a retrospective study of patients treated from 2006 to 2009. Patients with and without chest pain were compared according to clinical features.

Results

Among 260 STEMI patients, 12.7% of patients had no chest pain presentation in the ED. Syncope, epigastric pain, and dyspnea accounted for more than 60% of symptoms in STEMI patients without chest pain. Diabetes mellitus (DM), cerebrovascular accident (CVA), and old age were risk factors for STEMI patients without chest pain.

Conclusions

DM, CVA, and elderly patients are more likely to be without chest pain when STEMI occurred.
Rare Cause of Cerebral Damage: Child with Heatstroke Found inside an Enclosed Vehicle
Authors: Ozcetin M , Arslan MT , Yilmaz R , Yildirim A
Published: December 2017

Many children suffer from preventable diseases. Heat stress is one of the neglected causes of mortality and morbidity. We report here the clinical features of a 3-year-old boy who suffered from near-fatal heatstroke in an enclosed car. He developed multiple organs failure, including neurological insult, acute renal failure, and disseminated intravascular coagulation. Although life-threatening complications were treated with supportive measures and conventional external cooling in the intensive care unit, neurological sequelae persisted. This type of heatstroke is almost always preventable. Similar to many other pediatric emergencies, it can be life-threatening and may result in severe untoward outcomes.
Determinants of Patient Satisfaction with an Emergency Department Observation Unit
Authors: Yardan T , Genc S , Baydin A , Aydinkal E , Sunter AT
Published: December 2017

Introduction

Patient satisfaction is a measure of healthcare quality. The aim of this study was to determine the factors affecting patient satisfaction in an emergency department (ED) multipurpose observation unit (OU) and developing strategies that will improve patient satisfaction.

Methods

In this cross‐sectional study adult patients who were observed in and discharged from an OU were recruited voluntarily to complete the questionnaire over a one‐year period. The global indices of satisfaction – overall satisfaction with care and willingness to return to the same OU – served as the dependent variables and were assessed on a 5‐point Likert scale.

Results

Three hundred patients completed the questionnaire. Their mean age was 46.8±19.8 years, and 187 (62.3%) were female. With the exception of the patient's income, none of the demographic variables was related to the patient's rating of overall satisfaction. Overall satisfaction was significantly related to the doctor's explanation, the nurse's attitude, teamwork, technical quality of care, cleanliness of the unit, and quality of hospital food. In addition, likelihood of the patient's willingness to return was related to the patient's income, quality of hospital food, and overall satisfaction.

Conclusions

Overall satisfaction in the OU is affected by the patient's perception of care rather than demographic variables, it is an important predictor for willingness to return. Improvement in patient communication skills, the process of care and environmental factors in the OU will enhance patient satisfaction and increase the likelihood of their willingness to return.
Nurse‐Initiated Albuterol Metered‐Dose Inhaler for Acute Exacerbations of Chronic Obstructive Pulmonary Disease in an Emergency Department: A Randomised Controlled Trial
Authors: Ho JKM , Yau WH
Published: December 2017

Objective

A randomised controlled trial (RCT) to assess the effectiveness of nurse‐initiated use of albuterol metered‐dose inhaler (MDI) to patients for relieving the signs and symptoms of acute exacerbations of chronic obstructive pulmonary disease (COPD) prior to consultation in an emergency department (ED).

Design

A single‐centre unblinded RCT.

Methods

Known COPD Chinese patients who aged at least 18 years old, previous use of albuterol MDI, competent to blow the peak flow meter and complained of dyspnoea. The anticipated time between nurse‐initiated use of albuterol MDI and consultation was over five minutes. The subjects were recruited from the ED of a hospital in Hong Kong and were allocated to the albuterol or control group by block randomisation. Six albuterol puffs were administered via a MDI to the albuterol group but not the control group. Peak flow rate, blood oxygen saturation, respiratory rate, adverse effects, ED length of stay and admission rate were assessed before nursed‐initiated use of albuterol MDI and prior to consultation.

Results

110 subjects were recruited and randomly allocated into the albuterol (n=55) or control (n=55) group. The PFR increased 2.4 L/minute (p<0.001) in the albuterol group but not in the control group. The oxygen saturation and symptom of dyspnoea also improved in the albuterol group but not in the control group.

Conclusions

Nurse‐initiated use of albuterol MDI can improve PFR prior to consultation so that it should be recommended as a standard practice in EDs to reduce the suffering of patients with acute exacerbations of COPD.
Predictors of Bacteraemia in Emergency Department Patients with Pneumonia
Authors: Patterson M , Kelly AM , Klim S
Published: December 2017

Objective

To determine the proportion of patients investigated in an Australian emergency department (ED) for non‐hospital‐acquired pneumonia with bacteraemia and to identify risk factors for bacteraemia.

Method

Retrospective cohort study of patients with an ED diagnosis of non‐hospital‐acquired pneumonia in whom blood cultures were taken. Data collected included demographics, history of chronic obstructive pulmonary disease (COPD), immunosuppression, intravenous (IV) drug use or diabetes, prior antibiotic use, clinical features, biochemistry, haematology and blood culture results, ED disposition and pneumonia severity index (PSI) class. Outcomes of interest were the proportion of blood cultures that identified bacteraemia and identification of independent predictors of bacteraemia. Data analysis was by descriptive statistics, odds ratios (OR) and multivariate analysis.

Results

Two hundred patients were studied. The bacteraemia rate was 7% (95% CI=4‐11%). IV drug use (OR 16.7, 95% CI=2.65‐105) and pulse rate (OR 1.29, 95% CI=1.01‐1.65, per 10 beat rise) were independently associated with bacteraemia. Overall, 1/199 patients had a significant broadening of therapy based on a blood culture result (0.5%, 95% CI=0.09‐2.8%). On post hoc analysis, using PSI class IV/V or known IV drug use as criteria for blood culture ordering had sensitivity 92.9% (95% CI=64.1‐99.6%) and negative predictive value 98.9% (95% CI=93.5‐99.9%) for bacteraemia.

Conclusion

7% of blood cultures from patients with non‐hospital acquired pneumonia showed bacteraemia. Using the combination of PSI class IV/V or IV drug use as criteria for blood culture ordering shows promise.
Emergency Medicine Ward as a Step down Unit for Selected Poisoned Patients after Intensive Care Unit Management: A Pilot Study
Authors: Lam PK , Leung JKS , Chan LW , Wong TW , Lau CC
Published: December 2017

Introduction

Starting from the 1st July 2009, poisoned patients who fulfilled the emergency medicine ward (EMW) admission criteria were transferred to the EMW for subsequent care after intensive care unit (ICU) management. This study was undertaken to review the impact of such a strategy on the length of stay (ALOS).

Study design

This was a retrospective study on consecutive poisoned patients discharged from the ICU from the 1st July 2009 to 31st December 2010. Poisoned patients from the 1st January 2008 to 30th June 2009, who were discharged to the general medical ward or to other specialty wards were used as historical controls for comparison.

Method

Medical records of eligible cases were reviewed and data were collected using a standardized data collection form. Disease severity during the ICU stay was assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The median ALOS and APACHE II scores of the 2 groups were compared.

Results

A total of 32 poisoned patients were transferred from the ICU to EMW during the study period, in which 28 patients were included as the study group. For the historical control group, 19 patients were identified for comparison. The study group had a significantly shorter median length of stay in the ICU (21.3 h vs. 36.0 h, p=0.013) and a significantly shorter median ALOS (28.8 h vs. 52.5 h, p=0.002) compared to the historical control group. All patients discharged to the EMW survived with no ICU re‐admission.

Conclusion

The strategy of using the EMW as a step‐down unit for selected poisoning cases after ICU discharge is feasible, safe and effective.
The Efficacy of Alternative Cardiopulmomonary Resuscitation Methods When Compared to Standard Cardiopulmonary Resuscitation: A Simulation Study
Authors: Kim CH , Kim GW
Published: December 2017

Objective

There are limited data comparing the alternative cardiopulmomary resuscitation (CPR) methods (over the head CPR, straddle CPR and one hand CPR) to standard CPR performed by emergency medical technicians (EMTs). Therefore we investigated the efficacy of the alternative CPRs compared to that of standard CPR performed by EMTs in simulated cardiac arrest scenarios.

Methods

Thirty EMTs of intermediate level participated in this study. The performance of CPR was defined as the average depth, the total number of chest compressions, and the rate of compressions. EMTs performed three minutes of standard CPR and of alternative CPR on standard simulation mannequins with recording devices. Recorded performance was measured and compared between subgroups by the type of CPR, gender of EMTs and gender with various methods of CPR using ANOVA and t test statistics.

Results

The average depth of compressions was 42.3±5.8, 42.6±4.7, 43.5±3.7, 33.8±6.6 mm (mean±standard deviation) respectively in standard CPR, over the head CPR, straddle CPR and one hand CPR. The total number of chest compression was 330.4±38.1, 334.8±70.2, 334.0±34.9, 312.1±53.5 in 3 minutes. The rate of compressions was found to be 111.5±10.3, 113.8±11.6, 110.5±11.2, 110.7±11.8 times per minute. The comparison of the performance qualities for the four types of CPR showed that the compression depth was significantly lower in one‐hand CPR (p<0.000). No EMT gender difference in the quality of performance of total CPR was noted.

Conclusions

The efficacy of alternative CPRs are shown to be similar to that of standard CPR in a compression‐only simulation cardiac arrest model.
Traumatic Testis Dislocation: A Case Report and Review of the Literature
Authors: Sinasi M , Akoglu E , Akoglu H , Altinok AD , Onur OE , Kosargelir M
Published: December 2017

Dislocation of testis is a rare and underreported condition, commonly associated with delayed diagnosis and treatment in pelvic injuries. Delayed treatment may cause infertility due to elevated temperature exposure leading to a reduced sperm production. It is imperative to look for this entity during the secondary survey in the management of a polytrauma patient. We encountered dislocation of testis in a 26‐year‐old male motorcyclist involving in a road traffic crash. He complained of pelvic pain. A tender mass was felt in the left groin during physical examination. Abdominal computed tomography scan revealed a dislocated left testis. Closed reduction was performed and the patient recovered without any complications.
A Retrospective Epidemiological Study of the Traffic-Related Injuries Cases Admitted to a Local Hospital
Authors: Chung WS , Tsui CT , Lit ACH , Leung M
Published: December 2017

Road traffic injuries (RTI) are important public health problem globally. Accurate data about RTIs and its subsequent health consequences are essential to monitor the effectiveness of current RTI prevention measures and to readdress policies.

Objective

We presented the surveillance of RTI in Kwai Tsing by integrating data from traffic accident data system (TRADS) and injury surveillance system (ISS) from Princess Margaret Hospital.

Method

Retrospective observational study to examine traffic-related injuries by integrating data from TRADS and ISS databases. A multivariate analysis was performed to identify risk factors associated with hospital admissions in RTI.

Result

A total of 725 patients were included. About 19% of the visits led to hospitalisation and six deaths (0.83%) were reported. Pedestrian elders were significantly more at risk to traffic injury mortality and hospitalisation.

Conclusion

This study demonstrates the feasibility of an integrated surveillance system for RTI based on existing local databases. Special preventive measures should be tailored for pedestrian and elderly to improve their safety by improving the quality of their walking environment.
Hypereosinophilic Syndrome Presented as Acute Ischaemic Stroke and Raised Cardiac Enzymes
Authors: Cheung CY , Fu CL , Li CS
Published: December 2017

The hypereosinophilic syndromes (HES) are a group of disorders marked by the sustained overproduction of eosinophils, resulting in multiple organ damage. We report a 55-year-old lady presented with sudden onset of left-sided limb weakness and hypereosinophilia. Cerebral computerised tomography scan showed multiple small infarctions in bilateral corona radiata and right thalamus. A transesophageal echocardiogram revealed endomyocardial damage with mural thrombus suggesting Loeffler endocarditis. The multiple cerebral infarctions were probably due to cardiac thromboembolism. Treatment with prednisolone led to significant clinical improvement. This case illustrates hypereosinophilia should be considered in patients with multiple cerebral infarctions.
Recurrent Hyperammonaemic Encephalopathy in a Patient with Urinary Tract Infection and Urinary Retention
Authors: Oh SH , Wee JH , Choi SP
Published: December 2017

Acute hyperammonaemia is a medical emergency. Most cases are resulted from severely impaired liver function but some cases of non-hepatic causes do occur. In patients with unexplained altered conscious state, immediate measurement of plasma ammonia level is a simple but important step in early diagnosis of hyperammonaemia and prompt reduction of ammonia level to minimise permanent brain damage. We reported a case of recurrent hyperammonaemia and cerebral dysfunction due to urinary tract infection with urinary retention in a patient without underlying liver disease.
Sustained Abdominal Aorta Compression Elevates Coronary Perfusion Pressure after Asphyxia‐Induced Cardiac Arrest in a Rabbit Model
Authors: Wang LX , Liu YH , Li XM , Shi HZ , Ji ZX , Guo XD , Sun K , Ma LZ , Guo CC
Published: December 2017

Objective

To investigate whether sustained abdominal aorta compression (SAAC) can improve coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR) and improve resuscitation outcomes without causing liver laceration.

Design and Setting

Animal study.

Methods

Cardiac arrest was induced by asphyxia in 28 New Zealand rabbits and maintained for 2 minutes before resuscitation. Animals were resuscitated using either standard CPR (STD‐CPR group) or standard CPR and SAAC (SAAC‐CPR group). Restoration of spontaneous circulation (ROSC), restoration of spontaneous breathing (ROSB) and cerebral performance category score were determined. CPP, mean arterial pressure (MAP) and ROSC were compared in the two groups.

Results

MAP and CPP in the SAAC‐CPR group were significantly higher than in the STD‐CPR group. However, MAP and blood gas results showed no significant difference between the two groups during ROSC. ROSC was achieved in seven of fourteen animals in the STD‐CPR group and in eleven of fourteen animals in the SAAC‐CPR group. Five animals in the STD‐CPR group and nine in the SAAC‐CPR group survived 24 hours after ROSC. No liver injury occurred in the two groups.

Conclusions

SAAC‐CPR produces an increased CPP and MAP than traditional CPR and it does not lead to liver laceration/injury.
Comparison between the LMA Classic™ and New I‐gel™ Supraglottic Airway Device: A Manikin Study
Authors: Kwak DI , Yoo JH , No HW , Sohn JD , Kim YJ , Nah JH
Published: December 2017

Objective

It is nowadays well established that the laryngeal mask airway (LMA) is an alternative airway to endotracheal intubation for prehospital environment. However, problems have been reported and many other kinds of supraglottic airway devices (SGDs) were introduced. The I‐gel™ is one of the latest SGD, and it has been designed for easy and fast insertion with non‐inflatable cuff. We compared the efficacy between LMA Classic™ and I‐gel™ by using both normal and difficult airway conditioned manikin.

Methods

One hundred and two non‐experienced volunteers made out of students and nurses participated in the airway management educational program that was held in the emergency medical center of Gwangmyeong Sungae Hospital. After finishing the program, the participants were tested on their performance skills (insertion time) on using the two devices in both normal and difficult airway conditioned manikin. A structured questionnaire was used to measure the knowledge, attitude and preference about each device on a 5‐point scale.

Results

In the LMA Classic™ and I‐gel™ groups, it took 28.3±8.3 and 10.0±3.7 seconds with normal airway conditioned manikin (p<0.001), and 29.1±8.2 and 10.3±3.0 seconds elapsed with difficult airway conditioned manikin to achieve adequate airway management (p<0.001) in the corresponding order. The attitude and preference scale of the I‐gel™ was higher than those of the LMA Classic™ (p<0.001).

Conclusions

The insertion time of the I‐gel™ was shorter than that of the LMA Classic™ in both normal and difficult airway conditioned manikin, and I‐gel™ had a higher positive response for attitude and preference.
Preliminary Experience of Assessment of Intracranial Lesions by Ultrasound in Multiple Trauma Patients Undergoing Craniectomy
Authors: Lu X , Zhang M , Yang JX , Xu SX , Gan JX
Published: December 2017

Objective

To explore the feasibility and reliability of B‐mode ultrasound for assessment of intracranial lesions in multiple trauma patients who had undergone craniectomy.

Design

ingle‐centre study.

Setting

A 16‐bed emergency intensive care unit (ICU) in the emergency department of 2nd Affiliated Hospital of Zhejiang University School of Medicine from July 2006 to June 2010.

Methods

We retrospectively analysed 13 multiple trauma patients with severe head injury admitted to the emergency department of 2nd Affiliated Hospital of Zhejiang University School of Medicine. All 13 patients were admitted to the ICU after craniectomy and received mechanical ventilation. Computed tomography (CT) were conducted when patients' consciousness, pupillary size, light reflex changed apparently, or if the bone window tension and the intracranial pressure increased unexpectedly. Head ultrasonography was performed within 2 hours of CT scanning.

Results

Ultrasonography revealed 18 pathological changes in the 13 patients. CT and a second operation helped to identify 23 pathological changes. The results of B‐mode ultrasound were compared with those of CT and the coincidence rate was 78.3%, with no significant difference in the diagnosis of delayed haematoma or midline shift (Kappa=0.898, p<0.05).

Conclusions

Transcranial ultrasonography may be a useful tool for monitoring post‐operation intracranial lesions in multiple trauma patients with severe head injury. It is an effective supplement to CT.
Acute Myocardial Injury in a 45‐year‐old Female: Hypereosinophilic Syndrome
Authors: Lin WC , Weng YM , Chan YL , Chang H , Huang SL , Chen SY
Published: December 2017

Hypereosinophilic syndrome (HES) can cause eosinophilic infiltration in multiple organ systems resulting in organ damage. Among all, cardiac involvement is the major cause of morbidity and mortality. Early diagnosis and prompt treatment are important to improve the prognosis. We reported a 45‐year‐old woman with a history of eosinophilia presented with chest pain in our emergency department. Laboratory tests revealed marked eosinophilia and elevated cardiac markers. A neurological event, presenting as right‐side limb weakness, supervened later. The diagnosis of HES was established, and prompt treatment with corticosteroids, hydroxyurea, and imatinib resolved the eosinophilia; further cardiac and neurological injury was thus prevented. This case reminds us to consider and, if applicable, to provide the appropriate management for HES in the context of making a differential diagnosis in clinical situations involving organ damage.
Can Emergency Medicine Ward Shorten Hospital Length of Stay in Patients with Nasogastric Tube Related Coffee Ground Aspirate?
Authors: Chan WL , Leung YY , Chan HY , Ng F
Published: December 2017

Introduction

The aim of this study was to determine whether elderly patients on nasogastric (NG) tube feeding who presented with coffee ground aspirate could be effectively and safely managed in a local setting of Emergency Medicine Ward (EMW).

Method

A retrospective study with data retrieved from all the cases admitted with a diagnosis of coffee ground aspirate or vomiting who were on NG tube feeding during three years before and after EMW was launched. Data including patient demographics, length of stay (LOS), types of pharmaceutical treatment received, need of upper endoscopy, in‐hospital death and readmission rate within fourteen days were studied. Patients who were haemodynamically unstable, having melaena on per rectal examination, on warfarin or with underlying gastrointestinal malignancy were excluded.

Results

A total of 223 patients matching the studied criteria were included in the study, with 103 of them being admitted before the opening of EMW. For the 120 cases admitted after EMW was launched, 70 cases were admitted to EMW and 50 admitted to Medical Ward. The LOS for elderly patients on NG tube feeding presented with coffee ground aspirate was significantly shortened after EMW was launched (5.2 days vs. 4.2 days, p=0.046). In‐hospital mortality and 14‐day readmission rate were similar in the two studied period. Patients admitted to EMW and Medical Ward in the second study period were also analysed. Those admitted to EMW had a shorter LOS than those admitted to Medical ward during the same period (3.4 days vs. 5.3 days, p=0.001).

Conclusion

The establishment of EMW in local setting can achieve a significant reduction in hospital LOS without jeopardizing patient outcome for elderly patients who are on NG tube feeding presenting with coffee ground aspirate.
Emergency Physicians' Preparedness for CBRNE Incidents in Hong Kong
Authors: Hung KKC , Lam ECC , Wong MCS , Wong TW , Chan EYY , Graham CA
Published: December 2017

Background

Recent terrorist attacks with biological and chemical weapons have caused much concern for the public. The purpose of this study was to assess emergency doctors' preparedness in handling Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) incidents.

Methods

This is a cross sectional survey of all emergency doctors working in public emergency departments (ED) in Hong Kong. Apart from the experience and confidence to handle these events, data on participants' willingness to participate in CBRNE incidents and training motivations were also analysed.

Results

Biological and radiological events were found to be the least commonly encountered. Few respondents reported they were confident to manage biological events (10.6% to 29.8%), despite 66% of respondents reported having prior training in CBRNE management.

Conclusions

This study demonstrates ED doctors' low confidence in managing specific CBRNE incidents. Current strengths identified include the good awareness of hospital emergency plans and high motivation to get more training.
Cerebral “eThrombosis”: Cerebral Venous Sinus Thrombosis Associated with Prolonged Sitting in Front of a Computer
Authors: Chung MH , Kuo EY , Wu CM , Chen KT , Lin HJ
Published: December 2017

Venous thromboembolism caused by prolonged sitting during air travel has been recognised as economy‐class syndrome for more than 30 years. Since 2003, the term “eThrombosis” has been proposed to describe the 21st Century variant of venous thromboembolism associated with immobilisation. We reported a case of cerebral venous sinus thrombosis presenting with severe headache after a prolonged period of sitting for over 12 hours in front of a computer for recreational purpose. We described this case as cerebral “eThrombosis”. Considering the widespread use of computers for many purposes including working, recreation and communications in the present digital era, we would like to put forward that prolonged immobilisation associated with computer use is a possible provoking risk factor of cerebral venous sinus thrombosis.
Outcome Predictors of Patients in Out-Of-Hospital Cardiac Arrests with Pre-Hospital Defibrillation in Hong Kong
Authors: Chan TH , Lui CT , Cheung KH , Tang YH , Tsui KL
Published: December 2017

Objective

To report the epidemiology, outcomes and the predictors of survival in patients with out-of-hospital cardiac arrest (OHCA) with pre-hospital shockable cardiac rhythms in Hong Kong.

Methods

It was a prospective study based on data from the cardiac arrest registry of emergency departments (ED) in two regional hospitals in Hong Kong from 1st August 2010 to 31st January 2012. All non-traumatic patients aged 18 years or above presented with OHCA with shockable pre-hospital cardiac rhythm and received pre-hospital defibrillation were included. The characteristics of patients, pre-hospital data, management and outcomes were recorded in a standardised form compatible with Utstein template at the time of patient consultation. Binominal logistic regression was applied to evaluate the relationship between survival to admission (STA) and patients' variables.

Results

A total of 135 patients fulfilled the inclusion criteria. The mean age was 67.0 years old. The STA rate was 34.8% and the survival to discharge (STD) rate was 6.7%. Factors independently associated with better prognosis in terms of STA were presence of bystander cardiopulmonary resuscitation (CPR) (OR 5.76, 95% CI=1.08-30.5), restoration of spontaneous circulation (ROSC) before arrival to ED (OR 43.94, 95% CI= 4.19-460.43) and short time from calling emergency medical services (EMS) to first defibrillation (OR 0.82, 95% CI=0.70-0.96).

Conclusion

STA rate for adults presenting with shockable OHCA in our study was 34.8%. Patients with shockable OHCA with bystander CPR, short call-to-shock time and achieved ROSC before arrival to ED are significantly associated with higher STA rate.
Can Bedside Ultrasonography of Internal Jugular Vein Replace Ultrasonography of Inferior Vena Cava for Volume Status Estimation?
Authors: Chan MY , Wong CP , Chan HH , Wong TW
Published: December 2017

Introduction

Estimation of haemodynamic status of acute and critically ill patients at Accident & Emergency (A&E) Departments is important. Measurement of inferior vena cava (IVC) diameter and collapsibility index by bedside ultrasound (USG) was known to correlate well with volume status of these patients. However, the value of similar estimation based on USG measurement of internal jugular vein (IJV) diameter was seldom studied. Whether USG measurement of IJV diameter can replace that of IVC diameter was unknown.

Methods

This was a cross‐sectional study using a convenience sample of healthy volunteers among staff of a local A&E. The diameter of IJV and IVC (IJVD and IVCD) of the 51 participants were measured by bedside USG. The corresponding collapsibility index (CI) of IJV and IVC were then calculated. The correlation between IJVD and IVCD was assessed by the use of Bland‐Altman plot.

Results

Median value of IVC‐CI and of IJV‐CI was 29.41% and 17.12% respectively. The mean of the difference of measurement of IJV‐CI and IVC‐CI was −11.10% (95% Confidence Interval: −15.27 to −6.92). The limits of agreement of the above difference were −40.77% and 18.58%. The range of these limits was too wide.

Conclusion

Because the range of limits of agreement between IJV‐CI and IVC‐CI were too wide, IJV‐CI may not be used as an alternative to IVC‐CI for the estimation of the volume status of normal adults.
A Novel Approach to Patients with Equivocal Non‐Traumatic Acute Abdominal Pain
Authors: Sulu B , Yildiz B
Published: December 2017

Introduction

Patients with acute abdominal pain are sometimes held under long‐term observation because of failure to make a certain diagnosis. This study investigates the effectiveness of utilising laboratory and clinical variables to choose between surgical and medical treatment to reduce costs and speed up the evaluation period.

Methods

In a university hospital setting, 165 patients with abdominal pain who had undergone surgical (n=115) or nonsurgical (n=50) treatment after observation were prospectively analysed. Upon presentation body temperature, white blood cell count, neutrophil count, seroreactive protein, and malonyl dialdehyde levels were determined. The area under the ROC curve and logistic regression analyses were performed. Surgical probability formula was prepared by using parameters.

Results

Body temperature, white cell count, neutrophil count, C‐reactive protein were higher in the surgical group (p=0.0001). Sensitivity of C‐reactive protein was higher in determining patients who required surgical treatment. Multivariate analysis showed that above mentioned variables (except neutrophil count) along with malonyl dialdehyde levels were effective in determining optimal treatment strategy.

Conclusions

It is possible to identify patients who need to undergo surgery by implementation of a ‘probability of surgery’ model using certain laboratory values from blood samples obtained from patients with abdominal pain and unknown diagnosis, upon presentation in the emergency room.
Keeping an Open Mind about Acute Flank Pain in Emergency Department: Acute Kidney Infarction
Authors: Bacaksiz A , Erdogan E , Tasal A , Sharifov R , Sevgili E , Yigit M
Published: December 2017

Differential diagnosis of the acute flank pain in a patient without nephrolithiasis is challenging in emergency department. Renal infarction should be suspected if accompanying cardiac arrhythmia, heart failure or valvular disease is present. Activated protein C resistance is the most common thrombophilia that triggers venous‐obstructive conditions and rarely arterial thromboembolism. We described a young male with a history of non‐ischemic dilated cardiomyopathy and coexisting activated protein C resistance presented with new onset acute flank pain due to acute renal infarction.
Spontaneous Ruptured Splenic Artery Aneurysm: A Case Report
Authors: Katirci Y , Karamercan M Akif , Ramadan H , Baran NT , Aksoy O , Coskun F
Published: December 2017

Splenic artery aneurysms are rare and occur predominantly in women. Most of them are asymptomatic until the aneurysms rupture. We report a previously healthy 46‐year‐old female who attended emergency department with abdominal pain for four hours. She had left upper quadrant tenderness and pulsatile mass. Laboratory tests showed her haematocrit 29.8%. Subsequent examinations with ultrasound and computed tomography (CT) showed a large aneurysm of the splenic artery and a heterogeneous hypodense shadows around the aneurysmal sac and perihepatic area. Just after CT scan she collapsed and was taken into emergency surgery. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the fifth day, she was discharged from the hospital with complete recovery. This case report highlights that rapid resuscitation, diagnostic imaging, surgical consultation, and subsequent laparotomy remain the priorities in patient management.
Clostridial Hepatic Gas Gangrene with Massive Intravascular Haemolysis and Acute Renal Failure: A Case Report and Literature Review
Authors: Au TTS , Wong TW , Chan LW , Man MW , Kwan WH
Published: December 2017

Clostridial hepatic gas gangrene is a rare but highly fatal disease. We report a complicated case of clostridial hepatic gas gangrene, presented with short history of fever, followed by severe back pain and systemic hypertension. Urgent contrast computed tomogram (CT) thorax and abdomen was performed to rule out aortic dissection. Instead, a gas-forming lesion was found in the liver, with multiple areas of hepatic venous gas. Also, CT showed poor renal contrast excretion, indicating acute renal failure. Unexpectedly, the patient developed cardiac arrest shortly after imaging and succumbed despite active resuscitation. Repeated biochemical tests showed gross hemolysis. Autopsy revealed generalised autolytic changes in internal organs with abundance of Gram positive bacilli. The overall picture was compatible with clostridial hepatic gas gangrene, with massive intravascular haemolysis and acute renal failure. Upon literature review, the importance of early diagnosis and aggressive management is highlighted.
A Study of the Effectiveness of Psychiatric Clinical Liaison Nurses and Determinants of Psychiatric Admission in an Accident and Emergency Department of Hong Kong
Authors: Leung FYL , Lee HKH , Ng HW , Ting SM , Li KM
Published: December 2017

Background

This study examines how psychiatric clinical liaison nurses (CLN) services in the accident and emergency department (ED) meet the demand for those people with mental health problems. In addition, we aim to identify determinants for psychiatric admission.

Methods

All psychiatric patients attended the ED within the periods of May to July of 2007, May to July of 2008 and January to March 2012 were recruited. Data was recorded on patients' demographics, past mental history, time of arrival to the ED, time of discharge from the ED, length of stay in the ED, time to urgent psychiatric services (CLN services in 2008 and 2012, and urgent psychiatrist consultation in 2007), and on clinical symptoms and outcome.

Results

Totally 484, 519 and 587 attendances were analysed in 2007, 2008 and 2012 respectively. Results showed that the introduction of CLN to the ED significantly shortens the waiting time for patients from registration in the ED to urgent psychiatric services, from 33.5 hours to 21.4 hours then to nine hours. However, the mean length of stay in the ED was prolonged from three hours to five hours. Overall admission rate was similar. Re‐attendance rate was decreased. Five significant determinants of psychiatric admission in an attendance to the ED were identified: patients presented with psychotic symptoms, violent behavior, suicidality, known to mental health services and depressive symptoms.

Conclusions

The CLN service as described in this study appears to be a useful resource in the ED for patients with mental health problems. Five determinants of psychiatric admission are identified. (Hong Kong j.emerg.med. 2013;20:364‐370)
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. (Hong Kong j.emerg.med. 2012;19:387‐393)
Nontraumatic Acute Anterior Cord Syndrome Caused by Cervical Disc Herniation after Napping with Neck Extension
Authors: Chen YL , Wu YT , Hsia CC , Chang ST , Chiang SL
Published: December 2017

Nontraumatic acute anterior cord syndrome caused by disc herniation occurring in the cervical spine is rare. A 39‐year‐old man presented with a sharp burning pain in bilateral upper limbs and progressive paraplegia after a nap with neck extension. He had impaired sensation of pain and temperature with preservation of proprioception and light touch below the C6 level. The magnetic resonance imaging showed focal hyperintensity of the anterior cord at the C5‐C7 level and central herniation of C5‐6 and C6‐7 discs. An anterior discectomy of C5‐6 and C6‐7 was conducted because of the poor response to a high dose of steroid. A postoperative intensive rehabilitation treatment was also performed. The patient showed significant improvement in motor and sensory function three months postoperatively. Long‐term repetitive neck extension should be avoided because it may be a risk for degenerative spondylotic change and cord compression disorders. Surgical intervention should be considered in a patient with anterior cord syndrome associated with nontraumatic cervical disc herniation. (Hong Kong j.emerg.med. 2013;20:389‐391)
Acute Myocardial Injury and Complete Atrioventricular Block Induced by Transient Coronary Artery Spasm
Authors: Tsai TC , Wu KH , Kung CT , Li CJ
Published: December 2017

A 65‐year‐old man with no previous history of heart disease presented with cardiogenic shock. Acute right ventricular failure following extensive inferior wall myocardial infarction and complete atrioventricular block were noted and emergent angiography revealed insignificant coronary arterial stenosis. In view of the finding and absence of myocardial vasculitis, coronary artery spasm was implicated as the cause of myocardial infarction and complete atrioventricular block. After the reversal of the shock and successful angioplasty, the patient continued to take lercanidipine and had been angina‐free during follow‐up of 5 months. (Hong Kong j.emerg.med. 2013;20:396‐399)
Shorter Symptoms Onset to Emergency Department Presentation Time Predicts Failure of Needle Aspiration in Primary Spontaneous Pneumothorax
Authors: Law PK , Lui CT , Lee MM , Tsui KL , Tang YH
Published: December 2017

Objective

To evaluate factors in predicting the failure of needle aspiration in primary spontaneous pneumothorax, in particular the interval between symptom onset and emergency department presentation.

Methods

This is a retrospective cohort study carried out from January 2010 to October 2012 in two public hospitals in Hong Kong. All consecutive adult patients aged 18 or more who attended the emergency departments in the study period with the diagnosis of primary spontaneous pneumothorax, where needle aspiration was performed as the primary treatment were recruited. Age, smoking status, previous pneumothorax, symptom interval, size of pneumothorax and aspirated gas volume were included in the analysis. The outcome was successful or failed needle aspiration. Logistic regression was used to identify independent predictors of failed needle aspiration.

Results

A total of 196 patients were included. Overall, 105 patients (53.6%) were treated successfully with no recurrence upon discharge. Among those failure patient, 30 patients (15.3%) failed as evidence by the chest X-ray taken immediately after the procedure while 61 patients (31.1%) failed upon subsequent chest X-ray. Multivariate logistic regression showed factors independently associated with failure of needle aspiration included size of pneumothorax (apex to cupola distance) (odds ratio [OR]=1.022, 95% confidence interval [CI]=1.009-1.039, p=0.001) and symptoms onset to emergency department presentation time (OR=0.987, 95% CI=0.976-0.999, p=0.028).

Conclusions

Large pneumothorax and shorter symptoms onset to emergency department presentation time were associated with higher failure rate of needle aspiration for primary spontaneous pneumothorax. (Hong Kong j.emerg. med. 2014;21:16-22)
Usefulness and Problems of Intraosseous Infusion with the Bone Injection Gun™ Using Simulators Under Confined Space Conditions
Authors: Isayama K , Hirakawa A , Tsuda M , Nakatani T
Published: December 2017

Introduction

It is important to have a venous line for infusion as an emergency treatment for patients suffering from crush syndrome or bleeding under confined space (CS) conditions in disaster medicine. However, it is not easy to for Emergency Life-Saving Technicians (ELSTs) to establish a venous line in such settings. Although previous studies have described the use of mechanical intraosseous (IO) devices and IO access while wearing chemical protection gears, problems for the use of IO devices under CS conditions have not been considered. This study aimed to investigate usefulness and problems of using a Bone Injection Gun™ (BIG) for IO infusion by ELSTs and rescue workers in CS conditions.

Methods

The time required and success rate for IO infusion using a BIG in a manikin leg were measured, and for administering intravenous infusion in a manikin arm using either rescue gloves or plastic gloves by ELSTs or rescue workers under CS conditions.

Results

Wearing rescue gloves, ELSTs were significantly faster in placing intraosseous infusion (IOI) compared with rescue workers. The success rate of the placement was not significantly different between ELSTs and rescue workers whether or not they wore rescue or plastic gloves.

Conclusions

Although the finite usefulness of IOI with BIG under CS conditions is indicated, some problems such as the timing of removal of the IOI and difficulty in finding the location of the trocar needle after activating BIG are pointed out. Therefore, there are rooms to consider using IOI with BIG under CS condition. (Hong Kong j.emerg. med. 2014;21:23-30)
Risk Factors of Early Seizure Recurrence in Epileptic Patients Presented to an Emergency Department in Hong Kong
Authors: Chau YM , Mok KL , Wong YT , Kan PG
Published: December 2017

Introduction

While epilepsy is a well-known disease, little is known about early recurrence of seizures, and some patients are admitted to medical ward for the risk of recurrence of epilepsy. The aim of this study was to determine the frequency and risk factors of early seizure recurrence (ESR) among the epileptic adult patients attending the emergency department (ED).

Methods

In this retrospective observational study, medical records of all patients presenting to a regional ED in Hong Kong with seizures from 1 January 2010 to 31 December 2011 were reviewed. Their demographic data and clinical features were analysed to look for the relationship with ESR. ESR was defined as a seizure recurrence during the first 24 hours since the last seizure.

Results

A total of 339 patient records were analysed. The ESR rate was 13.7% at 24 hours and 80% occurred in the first six hours after the last seizure. Age≥40, female sex, repeated seizure in past one day, and abnormal plasma sodium and calcium levels were found to be statistically significantly associated with ESR by univariate analysis. These risk factors remain statistically significant after repeated multivariate logistic regression analysis.

Conclusion

The ESR rate is about 13.7% in our emergency department setting and 80% of them occur within six hour since their last seizure. Five risk factors, namely age group, sex, repeated seizure in past one day and abnormal blood sodium and calcium level are significant factors associated with ESR. We conclude that it is not necessary to admit all the adult epileptic patients with simple breakthrough seizures to hospital. (Hong Kong j.emerg.med. 2014;21:37-43)
Spontaneous Rupture of Abdominal Aorta after Seizure in a 23‐Year‐Old Woman: A Case Report
Authors: Paik JH , Jung HM , Yun SH , Lee JS , Han SB , Kim JS , Kim JH
Published: December 2017

Spontaneous non‐aneurysmal aortic rupture is a rare and life threatening clinical entity. A 23‐year‐old female patient who visited a nearby hospital due to intractable seizure was transferred to our hospital with the impression of hypotension and decreased level of haemoglobin. She had a history of seizure attacks once a month. However, in the 2 weeks before presentation, the frequency of seizure attacks had increased to 2 to 3 times a day. An abdominal‐pelvic computed tomogram scan showed extravasation of contrast from the abdominal aorta at L3 level. An emergency laparotomy revealed a 0.3 cm diameter tear in the posterior wall of the aorta, superior to the iliac bifurcation. We discuss the mechanism of spontaneous aortic rupture and the possibility of aortic rupture related to seizure attacks. (Hong Kong j.emerg.med. 2014;21:103‐106)
Brown‐Sequard Syndrome: A Rare Presentation of Spontaneous Cervical Spinal Epidural Haematoma
Authors: Hsu SY , Chang CJ , Hsieh CT
Published: December 2017

Spontaneous spinal epidural haematoma is a rare but well‐known entity that has been considered a surgical emergency. Brown‐Sequard syndrome resulting from spontaneous cervical spinal epidural haematoma is rare. Only 11 cases have been described in the literature. We reported an 85‐year‐old female who presented with Brown‐Sequard syndrome at the right C5 level, and an acute haematoma located from the C3 to C6 level was diagnosed from the series images. Within two weeks after decompressive surgery, the previous neurological deficits had gradually improved. (Hong Kong j.emerg.med. 2014;21:107‐111)