bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive Factors for the Existence of Foreign Body following Fish Bone Ingestion: A Prospective Study
Authors: Poon KC , Lee HY , Yau WH 
Published: December 2017

ObjectivesTo look at the factors that will affect the likelihood of a fish bone (FB) in throat and help to improve the use of oesophagogastroduodenoscopy (OGD).MethodsIt was a prospective cohort study of patients who attended the Accident and Emergency Department of Queen Elizabeth Hospital because of having foreign body sensation after eating fish in the period of 15th May 2008 to 15th February 2009. A pro forma was designed for the collection of information on various clinical parameters to be studied. Direct laryngoscopic examination (DL) and OGD findings were recorded. Tracing through the computerised Clinical Management System or telephone enquiry for the clinical outcome was employed for patients who refused or defaulted OGD. The primary outcome measured was the predictive power of the sharp pricking sensation symptom, radiographic finding and full visualisation by DL on the presence of FB. The data were analysed by logistic regression.ResultsThe findings of 259 patients were analysed: 94 FBs were found; 83 (88.3%) FBs were lodged at a level above the hyoid bone; 73 FBs (77.7%) were removed by DL and 21 (22.3%) by OGD. Sharp pricking sensation was the only significant predictive factor for the presence of FB (OR=8.27; 95% CI=2.66, 25.76; p<0.01) in the group of patients requiring OGD whereas positive radiological finding (p=0.07) and full visualisation by DL (p=0.36) were not. Full visualisation by DL alone could not reliably rule out the presence of fish bone. Two FBs were missed.ConclusionThe presence of definite sharp pricking sensation is a significant independent predictor for the presence of fish bone whilst full visualisation by DL and positive X‐ray findings are not significant predictors.
Correlation between Physical Features of Elementary School Children and Chest Compression Depth
Authors: Uhm TH , Oh JK , Park JH , Yang SJ , Kim JH 
Published: December 2017

IntroductionThe height and body weight of 6th grade elementary school children may have influence on chest compression.Materials & methodsIn accordance with the 2005 American Heart Association guidelines and 2006 Korean Association of CardioPulmonary Resuscitation (CPR) guidelines, a 25‐minute audiovisual presentation and practical demonstration of CPR were presented by the researchers and assistants. The assistants supervised and corrected the practical performance of the students who performed 5 cycles of CPR (2 minutes each) with the aid of the Laerdal Resusci® Anne SkillReporter™. The students then carried out another 5 cycles of CPR (2 minutes each) using the skill reporter; and a short report was printed.ResultsThe correlation coefficient between body weight and chest compression was 0.467 (p=0.000), and the correlation coefficient between height and chest compression was 0.309 (p=0.009). The intercept between body weight and chest compression was 21.763 (p=0.000), and the slope was 0.324 (p=0.000). Student height showed no linear correlation with chest compression depth.ConclusionsThe body weight of 6th grade elementary school children showed moderate correlation with chest compression depth. A minimal body weight of 50 kg is required to attain a standard chest compression depth of 38 mm. With improved training, some students with body weight less than 50 kg may also achieve satisfactory performance of CPR.
A Case of Cardiac Arrest Caused by Peripartum Cardiomyopathy
Authors: Yun SY , Cho KH , Lee HM , Lee DH , Choi YH 
Published: December 2017

Many women experience dyspnoea, orthopnoea, and peripheral oedema during pregnancy, and diagnosing cardiac problem is confounded by these signs and symptoms of normal pregnancy. Peripartum cardiomyopathy (PPCM) is a rare life‐threatening cardiomyopathy of unknown aetiology that occurs between the last month of pregnancy and the first 5 months postpartum in previously healthy woman. Multiparity, twins, advanced maternal age, preeclampsia, gestational hypertension, and black race are known risk factors. The course of PPCM can range from readily treatable to acutely fatal. We present a lady with dyspnoea in the peripartum period admitted in cardiac arrest as a result of PPCM.
Chewing Gum as an Unusual Cause of Systemic Allergic Reaction
Authors: Cevik Y , Kavalci C 
Published: December 2017

Chewing gum allergy is a rare condition in emergency settings. A 48‐year‐old man presented to the emergency department with generalised itchiness which was more prominent on the periorbital areas, nausea, vomiting, and dyspnoea after taking chewing gum. Vital signs showed hypotension with a blood pressure of 72/45 mmHg, and heart rate 95 beats per minute. Auscultation of the chest revealed diffuse rhonchi and coarse crackles. There was blanchable skin rash over the body especially on the abdomen. As the symptoms were compatible with systemic allergic reactions after chewing gum, the patient was given supplemental oxygen, subcutaneous adrenaline, intravenous methylprednisolone and nebulised salbutamol. The patient responded dramatically. He was discharged with oral hydroxyzine (Atarax® tablet) prescription. Although there are lots of well‐known allergic substances including foods and drugs, we may encounter allergic reactions associated with rare allergens like chewing gum.
Comparison of the Karl Storz Video Laryngoscope with the Macintosh Laryngoscope for Intubating Difficult Airway: A Manikin Study
Authors: Lee IYC , Tung WK , Lo CM 
Published: December 2017

Objective To compare the Karl Storz video laryngoscope (KSVL) with the conventional Macintosh laryngoscope in simulated difficult airway scenarios, using a Laerdal resuscitation manikin. Methods This was a prospective comparative study. The scenarios were normal airway, reduced mouth opening, tongue oedema and cervical spine immobilisation. Thirty-five doctors performed endotracheal intubation with both devices in each of the scenarios. The outcome measures were the successful rate of intubation, time taken for intubation, vocal cord visualisation, and ease of intubation. We also surveyed the doctors' preference for the intubation devices. Results The use of the KSVL resulted in significantly better laryngoscopic grading than the Macintosh laryngoscope in all four scenarios. The mean time of intubation in the cervical spine immobilisation scenario was significantly shorter with the KSVL than the Macintosh laryngoscope (12.56 sec and 14.00 sec, respectively; P=0.049). The mean time of intubation in the tongue oedema scenario was shorter with the KSVL than the Macintosh laryngoscope (19.37 sec and 22.04 sec, respectively), although this was not statistically significant (P=0.546). There was no difference in the mean time required for intubation in the normal and reduced mouth opening scenarios. There was no significant difference in the success rate in all four scenarios. The ease of intubation score of the KSVL was significantly better than that of the Macintosh laryngoscope in all three difficult airway scenarios Conclusions Our study showed that the KSVL provided a better glottic view in both normal and difficult airways than the conventional Macintosh laryngoscope. It also showed an advantage over the conventional Macintosh laryngoscope in the time required for intubation in patients under cervical immobilisation.
Hong Kong Poison Information Centre: Annual Report 2008
Authors: Chan YC , Tse ML , Lau FL 
Published: December 2017

Objective To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2008. Methods From 1st January 2008 to 31st December 2008, all poisoning cases received by HKPIC were retrieved from its database (DATOX & PIC-MS) for analysis. Results 4,029 poisoned cases were analyzed. There were 1,755 male patients (43.6%) and 2,262 female patients (56.1%). Nearly two-thirds of them were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, unintentional exposure and abusive use. Sedatives, household products, paracetamol, and ketamine were common poisons exposed and non-benzodiazepine sedative-hypnotics were involved in about one-seventh of the poisoning cases. The majority of the patients were managed conservatively, with 6.0% and 5.9% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; about 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes. Conclusions This annual report provides updated epidemiological information on poisoning in Hong Kong in 2008 and highlights some changes in comparison with our previous reports. The increase in abusive substance poisoning, in particular ketamine, requires further attention.
Sonographic Measurement of the Epiglottis in Normal Chinese Adults
Authors: Chau CW , Chan HH , Wong CP , Wong TW , Lau CC 
Published: December 2017

Objectives(1) To assess the normal range of thickness of the epiglottis by means of ultrasound measurement. (2) To evaluate inter-observer agreement in measuring the thickness of the epiglottis of normal individuals by ultrasound. (3) To assess the association between biological factors and the thickness of the epiglottis.MethodsFifty adult volunteers working at a local accident and emergency department were recruited. The thickness of the epiglottis was measured by means of ultrasound examination, which was performed twice by two emergency physicians at different time. The study subjects' age, sex, height and body weight were recorded.ResultsThe mean thickness of the epiglottis was 0.236 cm and the standard deviation was 0.020. Male subjects had thicker epiglottis. Interobserver agreement of the two emergency physicians who performed the ultrasound scan was very good. Multiple regression models showed that sex and height were useful predictors of the thickness of the epiglottis.ConclusionsBedside ultrasound assessment of the epiglottis is an easy, rapid and reliable method to evaluate its thickness. Further studies are needed to evaluate the thickness of the epiglottis in patients with epiglottitis before it can be put into clinical use.
Diagnosing Acute Pancreatitis: Amylase or Lipase?
Authors: Chang JWY , Chung CH 
Published: December 2017

Introduction Serum amylase has all along been used to aid the diagnosis of acute pancreatitis in hospitals in Hong Kong. Another serum marker lipase, on the other hand, has been claimed to have better accuracy in other countries. The aim of this study was to evaluate serum lipase as a diagnostic tool compared to the traditional serum amylase. Methods This was a retrospective study in a district hospital in Hong Kong. The two serum markers were taken from 3451 patients with acute abdominal pain who presented to our emergency department over an eight-month period. Receiver operating characteristic (ROC) curve was used to assess the diagnostic accuracy of both markers. Other diagnostic efficacy modalities, including sensitivity, specificity, positive and negative predictor values were also calculated. Results Both amylase and lipase had high accuracy index in the area under the ROC curve (0.992 and 0.996 respectively). The sensitivity and specificity of amylase at 3-fold above normal limit were 63.6% and 99.4% while those of lipase were 95.5% and 99.2% respectively. Conclusion Both serum enzymes had good diagnostic accuracy in our study but lipase was slightly better than amylase.
Monday Syndrome: Using Statistical and Mathematical Models to Fine-Tune Services in an Emergency Department
Authors: Tsoi LCH , Ip SY , Poon LK 
Published: December 2017

Objective To determine the accident and emergency department (A&E) attendance pattern. Design A retrospective study was carried out to examine the attendance pattern on a day-of-the-week basis. Attendance data were collected from 1st April to 30th June 2010 and arranged in the days of the week for analysis. Setting A&E of a regional hospital. Main outcome measures Mean attendance with 95% confidence interval for different days of the week. Result Monday was shown to have 12.2% higher attendance than non-Mondays (95% CI=8.4%, 16.0%). Conclusion Since Monday has the highest attendance, it is necessary to take measures to reduce the “predictable workload” on Monday to ease overcrowding and reduce waiting time to deal with the anticipated attendance.
Snakebites in Hong Kong: How to Face the Possible Changes?
Authors: Fung HT 
Published: December 2017

IntroductionOver the past years, the environmental and scientific changes have shaped the snakebite scenarios and will continue to do so. Their effects ahead are discussed.IncidenceBecause of declining plant agricultural industry and rising urbanization, a falling incidence is reasonably expected in future. In order to maintain the knowledge and skills, training for clinicians will become more crucial.Venom detection kitsKits for Naja atra and Cryptelytrops albolabris have been available overseas. Local data should be gathered regarding their clinical application.AntivenomsThe common local species covered by the haemotoxic and neurotoxic polyvalent antivenoms from Thailand is only Cryptelytrops albolabris. Introduction into Hong Kong is not recommended.Enzyme inhibitorsWith an aim to improve the control of local injury that is unsatisfactorily accomplished by antivenoms, therapy with venom enzyme inhibitors is under research.ConclusionA decreasing number of snakebite is anticipated. Venom detection kits should be explored for the use in appropriate cases. (Hong Kong j.emerg.med. 2011;18:217‐220)
An Extremely Rare Side Effect of Ranitidine: Junctional Rhythm
Authors: Dedeoglu E , Uzun A , Bayram B , Cevik E , Arslan D 
Published: December 2017

Ranitidine is a H2 receptor blocker and rarely cause bradycardia. A 28 years old male patient attended the emergency department for urticaria. He was given 45 mg of phenyramine and 50 mg of ranitidine intravenously. He then complained of dizziness and developed bradycardia and hypotension. Electrocardiogram detected junctional bradycardia rhythm. He was given 0.5 mg atropine intravenously and his rhythm then returned to normal. His symptoms subsided and the blood pressure improved. Ranitidine is a frequently used medication and this case illustrated a rare but serious side‐effect of the medication.
A Prospective Investigation into the Epidemiology of In-Hospital Cardiopulmonary Resuscitation Using the International Utstein Reporting Style
Authors: Song W , Chen S , Liu YS , He NN , Mo DF , Lan BQ , Gao YS 
Published: December 2017

Introduction The Utstein template has been used to guide the assessment and study of cardiopulmonary resuscitation (CPR) in many countries. This article used the Utstein templates for cardiac arrest and resuscitation registries to evaluate outcomes of CPR at Hainan Provincial People's Hospital (HPPH), China. Methods A prospective observational study using Utstein CPR registry form to evaluate the epidemiological characteristics and outcomes of 511 resuscitation cases in the emergency department, HPPH. Results A total of 511 CPR patients registered were studied. Higher cardiac arrest rates were observed for the group of patients who were 40-70 years old. In preexisting chronic diseases, cardiovascular diseases (190, 37.2%) cerebrovascular diseases (48, 9.4%) and respiratory diseases (39, 7.6%) were common in the recruited patients. (173, 33.9%) of the cardiac arrest patients had underlying cardiac causes, of which 109 (21.3%) had acute myocardial infarct (AMI). Eighty (15.7%) patients had ventricular fibrillation as the first witnessed arrest rhythm. The return of spontaneous circulation (ROSC) and survival to discharge rates were 47.0% and 13.5% in the in-hospital cardiac arrest (IHCA) group but 16.7% and 4.7% in out-of-hospital cardiac arrest (OHCA) group (p<0.01) respectively. Conclusions This study indicated that the cardiovascular diseases, cerebrovascular diseases, and respiratory diseases were the most common preexisting chronic diseases. Myocardial infarct, stroke and trauma were the most common precipitation cause of cardiac arrest in the recruited patients. The rate of ROSC and survival to discharge for the patients with IHCA were higher than the ones with OHCA, but figures were still low. (Hong Kong j.emerg.med. 2011;18:391-396)
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.
Determinants of Patient Satisfaction with an Emergency Department Observation Unit
Authors: Yardan T , Genc S , Baydin A , Aydinkal E , Sunter AT 
Published: December 2017

IntroductionPatient 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.MethodsIn 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.ResultsThree 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.ConclusionsOverall 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

ObjectiveA 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).DesignA single‐centre unblinded RCT.MethodsKnown 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.Results110 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.ConclusionsNurse‐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

ObjectiveTo 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.MethodRetrospective 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.ResultsTwo 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.Conclusion7% 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.