bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Prospective Epidemiological Study of Acute Poisoning in Hong Kong
Authors: Chan YC , Fung HT , Lee CK , Tsui SH , Ngan HK , Sy MY , Tse ML , Kam CW , Wong GCK , Tong HK , Lit ACH , Wong TW , Lau FL 
Published: December 2017

Objective To update our epidemiological knowledge of acute poisoning in Hong Kong. Methods A multi-centred prospective study was conducted for six months in six major accident and emergency departments in Hong Kong. A specially designed form was used to collect demographic data, type of poison involved, cause of poisoning, management, disposal as well as final outcome of the poisoned patients. Results A total of 1,467 patients (male: 588, female: 879) were included in the study. Most of them were young adults (32% were between 20 and 40 years old). Suicidal attempt (64%) was the most common cause of poisoning. Notably, 379 (26%) patients took more than one poison. Among the 2,007 counts of poison taken, sleeping pills (24%) and analgesics (18%) were the most commonly used drugs and paracetamol was the commonest single ingredient involved in poisoning. Most patients were treated with supportive measures, and about 40% and 15% of the patients were given gastrointestinal decontamination and specific antidotes respectively in their management, in which activated charcoal and N-acetylcysteine were the most common. Concerning disposal from the emergency department, 91% of the poisoned cases required in-patient management. Most patients had an uneventful recovery but 5 (0.3%) had significant disability and 21 (1.4%) died. Suicidal carbon monoxide poisoning was the leading cause of mortality in our study. Conclusions Most acute poisonings in Hong Kong were suicidal in nature and paracetamol was the commonest agent. Activated charcoal was the most commonly used decontamination method and most patients had an uneventful recovery.
A Study on Trauma Documentation in Accident and Emergency Attendance Records
Authors: Law CY , Wong TW , Lau CC 
Published: December 2017

Aim To study the adequacy of trauma documentation in accident and emergency (A&E) attendance records. Method We reviewed the A&E attendance records of major trauma requiring trauma-team care in the resuscitation room from January to June 1999 and July to December 2001. Thirty-eight items including the history, symptoms and signs of injury were scored with reference to the teaching of the Advanced Trauma Life Support course. The mean score and rate of documentation of each item were calculated. Additional items on biomechanics and environmental factors of injury were also examined. The performance of emergency medicine trainees and non-emergency medicine trainees was analysed. Results A total of 128 records were included, 46 and 82 records being from 1999 and 2001 respectively. The maximum documentation score was 38. The mean documentation score in 2001 was 23.27; and this was significantly better than 20.37 in 1999 (p < 0.05). The documentation rates of pre-hospital, biomechanics and environmental items were poor. Notably, 15 out of the 38 items were preformatted in the A&E records and 11 of these preformatted items had documentation rates of > 80%. Emergency medicine trainees had better scores in 2001 than in 1999. However, non-emergency medicine trainees did not show improvement in their documentation. Conclusion Trauma documentation has improved since 1999 for emergency medicine trainees. Preformatted charts may increase the rate of documentation. Information on pre-hospital care and injury mechanism was not well documented.
An Overview of an Emergency Department Short Stay Ward in Hong Kong
Authors: Fung HT , Tsui KL , Kam CW 
Published: December 2017

Objectives To describe the structure and service pattern of a short stay ward (SSW) named as Emergency Observation and Pre-admission Ward (EOPW) in Hong Kong. The effectiveness of the EOPW was to be examined. Methods This was a retrospective observational cohort study. The facilities, staffing and operation of the EOPW were described. Consecutive patients admitted to the EOPW in the year 2006 were retrieved from the hospital computer database. Admission diagnoses, length of stay (LOS) and destination of disposal were the main outcome variables measured. The ICD coded admission diagnoses were categorised into 24 diagnosis-related groups. Different diagnosis-related groups were compared with respect to the selected efficacy cutoff points of LOS less than 24 hours and hospital admission rate less than 30% respectively. Results The service of the 30-bed short stay ward as started in year 2003 was a pilot project in Hong Kong. In year 2006, 10,111 patients were admitted and the mean age was 54.2 years. The five commonest diagnosis-related groups were psychiatric disease, chest pain, dizziness, musculoskeletal pain and poisoning. The overall hospital admission rate and the mean LOS were 26.8% and 23.4 hours respectively and were below the efficacy cutoff points. Musculoskeletal pain, chronic obstructive pulmonary disease and acute urinary retention were the three diagnostic groups with both LOS and hospital admission rate above the efficacy cutoff points. Conclusion This first SSW in Hong Kong was demonstrated to be effective according to the analysis result of the 2006 data. SSW has become an integral part of emergency medicine and provided an alternative way of effective management in contrast to traditional inpatient management for various selected disease conditions.
Traditional Chinese Medicine Use among Emergency Patients in Hong Kong
Authors: Tse ML , Lau FL 
Published: December 2017

Introduction Traditional Chinese Medicine (TCM) use has been believed to be common in Hong Kong but no data existed on its prevalence among emergency patients. We conducted a prospective survey to study the prevalence of its use, the type of TCM use, frequency and nature of associated adverse reactions. Methods All accident & emergency department (AED) attendances at the United Christian Hospital were screened by the triage nurse and attending doctor for TCM use and its type in a consecutive 31 day period. The causal relationships between the TCM and their presenting illness were also assessed and decided by the doctor in-charge. Results 291 out of 21,475 patients (1.4%) reported TCM use within one week. Among them, 117 (40.2%) consumed Chinese herbal medicine, 75 (25.8%) took proprietary Chinese medicine, 1 (0.3%) took both, 96 (33.0%) received topical treatment and 2 (0.7%) were unclassified, with 22 out of the 291 TCM users (7.6%) presented for TCM-related toxicity. Most complications were mild, the commonest ones being dermatitis after topical treatment (68.2%) and allergic reaction after oral intake (22.7%). Conclusion A small number of patients took TCM treatment shortly before AED consultation. Most TCM-related toxicities were mild and the commonest reactions were dermatitis and systemic allergy.
Subutex®Abuse Presenting to the Emergency Department: A Case Series
Authors: Chew HC 
Published: December 2017

IntroductionSubutex®(sublingual buprenorphine hydrochloride) tablets are prescribed to alleviate symptoms of opiate withdrawal in addicts undergoing a cessation programme. Although Subutex®is safe and effective, parenteral abuse is an emerging phenomenon. A variety of complications may present due to the different areas that patients inject themselves.AimWe present a case series of four patients who presented to the emergency department following complications of Subutex®abuse. The complications included deep venous thrombosis, limb ischaemia and epidural abscess with osteomyelitis of the spine.DiscussionSublingual buprenorphine was launched in Singapore in 2002. It is currently the preferred alternative to methadone for treating opiate dependency locally. Despite safeguards, instances of abuse of buprenorphine exist. These medications can be passed or sold to others not on a cessation programme. Two of the 4 patients in this series obtained Subutex®illegally. Parenteral abuse of Subutex®is of grave concern. In Australia and France, between 23–37% of Subutex®users have abused it in this fashion.ConclusionSubutex®abuse is not uncommon in Singapore. Complications especially from parenteral use can occur and may result in serious morbidity. A high index of suspicion among physicians must be maintained in patients with unusual limb infections, ischaemia or venous thrombosis. Tighter regulations on prescription and consumption of Subutex®may be useful in preventing these complications, in addition to increasing public awareness and education of the risks of parenteral abuse for patients on cessation programme.
A Randomised Control Trial Comparing the Efficacy of Tramadol and Paracetamol against Ketorolac and Paracetamol in the Management of Musculoskeletal Pain in the Emergency Department
Authors: Lee HKH , Ting SM , Lau FL 
Published: December 2017

Background This study aimed to compare the efficacy, acceptance and side effects of intramuscular tramadol and ketorolac in combination with oral paracetamol in the emergency setting. Materials and methods This was a randomised, double blind controlled trial. Patients aged 18 years or above with moderate to severe musculoskeletal pain were recruited. Patients with known allergy, currently on psychiatric medication, with alcohol or opioid dependence, during pregnancy and with major systemic illness were excluded. Tramadol 100 mg or ketorolac 30 mg was given intramuscularly together with paracetamol 500 mg per oral. They were then bed rested in the observation ward for one hour. Visual analogue scale (VAS), satisfaction score, vital signs and side effects were recorded. Results Altogether, 78 (M: 43, F: 35) subjects were recruited from June to September 2005, with equal number in each arm. The mean age was 39.9 for the tramadol group and 43.9 for the ketorolac group. Most of them suffered from back pain (66.7%). There was a significant difference in VAS improvement between the two groups (0.88; P=0.01). However, there were no significant differences in patients' satisfaction score and admission rate. The incidence of side effects was similar between the two groups (tramadol 19, ketorolac 17), mainly dry mouth, and none were major. The tramadol group had more nausea. Conclusion The analgesic effect of the tramadol and paracetamol combination is as effective as the ketorolac and paracetamol combination. Tramadol is well tolerated and relatively safe. It is also cheaper than ketorolac. Hence, we recommend tramadol and paracetamol combination for acute moderate to severe musculoskeletal pain in the emergency setting.
Case Report of Carbon Monoxide Poisoning in a Pregnant Patient: Mother Died, Baby Survived
Authors: Cakir Z , Emet M , Caner I , Aslan S , Saritas A 
Published: December 2017

Carbon monoxide poisoning in pregnant women is a relatively rare condition. We report a 32‐year‐old woman in her 32nd week of pregnancy found unconscious in the bathroom. On arrival, her pulse and blood pressure were undetectable. Cardiopulmonary resuscitation was applied. The mother's carboxyhaemoglobin level was 57%. Due to foetal distress, Caesarean section was performed in the emergency department. The baby was intubated due to the absence of spontaneous respiration. The level of carboxyhaemoglobin in the cord blood was 32%. After staying in the newborn unit for 47 days, the baby was discharged with a sequela of cerebral palsy.
A Retrospective Study on Intracerebral Haemorrhage Reduction by Mri versus Ct in Intravenous Thrombolysis for Acute Ischaemic Stroke
Authors: Yun YH , Chung JY , Kang MJ , Huh JT , Park KW , Cha JK 
Published: December 2017

IntroductionMultimodal MRI may be an effective tool for selecting suitable acute ischaemic stroke patients for thrombolysis, reducing the risk of haemorrhage. In this study, we demonstrated the usefulness of our central alerting system to reduce door‐to‐needle time for thrombolysis following MRI. This system allowed timely intervention and reduced the rate of symptomatic haemorrhage.MethodsWe reviewed the records of 73 patients with hyperacute ischaemic stroke who received intravenous (IV) tissue plasminogen activator (t‐PA) between January 2006 and December 2007 following the adoption of a central stroke alerting system in our hospital.ResultsOf the 73 patients who received IV t‐PA, 44 were based on CT and 29 on MRI findings. The door‐to‐needle time was 10 minutes longer for the MRI group (49.9±23.2 min) compared to the CT group (39.6±19.7 min) but it was still within the recommended 60 minutes time frame. On the other hand, the rate of symptomatic haemorrhage was lower, though insignificantly, in the MRI group (0%) compared to the CT group (13.6%) (p=0.08).ConclusionsIn this study, we demonstrated that the combination of diagnostic MRI and a central alerting system might reduce the rate of symptomatic haemorrhage without compromising the door‐to‐needle time.
Prolonged Qt Interval after Fexofenadine Overdose in the Presence of Hypokalemia and Hypocalcaemia
Authors: Aksakal E , Ulus T , Taş H , Ocak T , Sevimli S 
Published: December 2017

A 23‐year‐old healthy woman was admitted to our emergency department because of syncope and unconsciousness. She had taken 20 tablets of fexofenadine (total 2400 mg) and 9 tablets of furosemide (total 360 mg) for suicide. The electrocardiogram demonstrated bradycardia (48/min) and markedly prolonged QTc interval (684 msec). Endotracheal intubation and nasogastric tube insertion were performed. Gastric lavage was implemented and activated charcoal was given. A transient pacemaker was implanted. Hypokalemia and hypocalcaemia were also present and the electrolyte disturbances were corrected. The heart rate and QTc interval returned to normal limits after treatment. She stayed in our hospital for seven days. She recovered completely and ventricular arrhythmia was not seen during the hospitalization period.
Controlling Seizures in Children: Diazepam or Midazolam? Systematic Review
Authors: Doshi D 
Published: December 2017

IntroductionDiazepam is commonly used to treat acute childhood seizures, but difficulty gaining intravenous access and variability of absorption after rectal administration can limit its efficacy. Midazolam is a water soluble benzodiazepine that has a rapid onset of action after intranasal or buccal administration and provides an alternative to diazepam in the control of acute childhood seizures.MethodsA literature search was performed to identify papers comparing the efficacy and tolerability of midazolam and diazepam in the management of childhood seizures.ResultsIntranasal or buccal midazolam are at least as effective as rectal or intravenous diazepam in controlling acute childhood seizures. In all robust studies reporting a significant difference, time to gain seizure control was shorter in patients treated with midazolam than those treated with diazepam, predominantly due to shorter drug administration time. The incidence of seizure recurrence was lower in patients treated with midazolam than diazepam. Respiratory depression was uncommon in both groups.ConclusionIntranasal or buccal midazolam provides a safe, effective and acceptable alternative to intravenous or rectal diazepam in the management of acute childhood seizures.
Clinical Predictors of Minor Head Injury Patients Presenting with Glasgow Coma Scale Score of 14 or 15 and Requiring Neurosurgical Intervention
Authors: Chan CH 
Published: December 2017

IntroductionMinor head injury is the most common type of head injury assessed in accident and emergency departments. Emergency physicians have concerns in discharging patients with intracranial injuries which require neurosurgical interventions. The aim of this study is to find out the clinical signs and symptoms which can help to predict who need neurosurgical intervention following minor head injury.MethodsThis was a retrospective case‐control study. Patients with head injury and GCS score of 14 or 15 and requiring neurosurgical intervention were recruited. Another group of patients with head injury and GCS score of 14 or 15 but not requiring neurosurgical intervention were enrolled as control. In all cases, clinical signs and symptoms were collected by chart review of the clinical records retrieved by the computerized Clinical Data Analysis & Reporting System (CDARS). The relationship between clinical features and need of neurosurgical intervention was analyzed by chi‐square test with 95% confidence interval.ResultsA total of 22 cases were found and compared with 288 controls to study on the clinical variables for the prediction of the need of neurosurgical intervention. Six warning signs were found statistically significant by univariate analysis: severe headache (p=0.0206), vomiting more than once (p<0.0006), drop in GCS (p<0.0001), confusion/restlessness (p<0.0001), bleeding from ear (p<0.0001) and skull fracture in the X‐ray (p<0.0001).ConclusionPatients with minor head injury presenting with GCS score of 14 or 15 to the accident and emergency department rarely require neurosurgical intervention. Some clinical risk factors can be used as a guide to identify those who need neurosurgical intervention following minor head injury.
Poisoning from Wild Mushroom in the Trakya Region: An Analysis of Seven Years
Authors: Kavalci C , Kavalci G , Guzel A , Inal M , Durukan P , Karasalihoglu S , Cevik Y , Sut N , Sayhan MB 
Published: December 2017

Introduction Mushroom poisoning is a medical emergency, diagnostic and treatment dilemma for physicians. Most cases present with self-limiting gastrointestinal symptoms. The regional profile of poisoning epidemiology in Turkey has previously been reported. However, information about mushrooms is still limited. The aim of this study was to identify the epidemiology of wild mushroom poisonings in the Trakya region in a 7-year period. Materials and methods The study was designed retrospectively by examining the files of the patients who presented to the emergency department of Trakya University Faculty of Medicine from January 2002 to July 2008. Results The overall male to female ratio was 0.88:1. All patients were intoxicated due to accidental pick up and consumption of wild mushrooms from open fields, woodlands and meadows. The most common findings on physical examination were epigastric pain. Fifty-six patients (74.7%) were discharged from the emergency department, 18 patients (24.0%) were hospitalized (one died on the 5th day), and one patient died in the emergency department. Conclusions Care should be taken especially for patients presenting late. Patients may have hepatic dysfunction that needs haemodialysis or even liver transplantation.
Accuracy of Plain Abdominal Radiography in the Differentiation between Small Bowel Obstruction and Small Bowel Ileus in Acute Abdomen Presenting to Emergency Department
Authors: Kim SH , Park KN , Kim J , Eun CK , Park YM , Oh MK , Choi KH , Kim HJ , Kim DW , Choo HJ , Cho JH , Oh JH , Park HY 
Published: December 2017

IntroductionOur purpose was to evaluate whether plain abdominal radiography (PAR) could accurately differentiate between small bowel obstruction (SBO) and small bowel ileus (SBI) in an emergency setting. We also evaluated the value of known classic signs on the PAR for differentiating between SBO and SBI.MethodsThis retrospective study included 216 emergency room patients who had small bowel distension (maximal small bowel diameter ≥2.5 cm) on the PAR and who underwent successive abdominal computed tomography. One radiologist and one emergency physician retrospectively reviewed PAR in consensus, unaware of the patients' clinical data; they divided the patients into an SBO group and an SBI group according to the radiographic findings. Presence or numeric values of 10 radiographic signs were also recorded. Final diagnoses of SBO and SBI were established by a combined analysis of medical charts, surgical records, radiographic findings on abdominal computed tomography, and small bowel studies. The differential diagnoses based on PAR and the final diagnoses were compared, and the sensitivity and specificity of PAR were calculated. We also evaluated the differences among 10 radiographic signs between the final SBO and SBI groups.ResultsSensitivity and specificity of PAR for SBO were 82.0% and 92.4%, respectively. Among the 10 radiographic signs, all except maximal colon diameter were statistically significant predictors on the final diagnosis.ConclusionsPAR is an accurate and effective initial imaging modality for differentiating between SBO and SBI in an emergency setting, and most of the classic radiographic signs have a diagnostic value.
Outcome Evaluation on the Use of Nurse‐Led Transport Kit in Inter‐Facility Transport
Authors: Yeung KL , Chan MWS , Tam PF , Lee LLY , Tong WL , Kalinowski E , Tang SYH , Chan JTS 
Published: December 2017

IntroductionTransport kit is a key element to ensure safe inter‐facility transport (IFT). The kit was generally reported by transport staff to be heavy and inconvenient in accessing the required items.ObjectiveThis study aimed at evaluating the outcome and the feedback from emergency nurses on the use of a new and lighter nurse‐led transport kit (NLTK) in IFT.MethodsA cross sectional study was carried out in two Accident and Emergency Departments in Hong Kong from 1st January 2008 to 31st March 2008. All cases involving nurse‐led IFT were included into the study. Questionnaires for assessing the rating of satisfaction were distributed to the staff after every mission.ResultsEighty‐four questionnaires were returned with a response rate of 80.8%. The overall rating on satisfaction before and after the use of NLTK was 14.6±3.0 and 19±3.2 respectively (mean±SD) with statistically significant improvement in terms of its weight, convenience and spaciousness of kit (p<0.05). Conclusion: The new NLTK is more user‐friendly than the traditional kit in nurse‐led IFT.
The Motor Function and Activities of Daily Living Capacity of Seismic Wounded Patients in Intensive Care Unit Ward in 5.12 Wenchuan Earthquake of China
Authors: Zhang JL , He HC , Lin HD , Luo QL , He CQ 
Published: December 2017

ObjectiveTo describe the motor function and activities of daily living (ADL) functional status of the seismic wounded patients treated in the intensive care unit (ICU) ward, and to provide insight to the planning on their clinical rehabilitation program.MethodA prospective study. Trained assessor applied different common testing methods to measure the motor functions of seismic wounded patients treated in ICU: (1) Manual Muscle Testing (MMT) method to evaluate muscle strength; (2) joint angle ruler to assess joint range of motion (ROM); (3) passive joint activities to assess the muscle tension; (4) Modified Ashworth Score (MAS) to assess spasm; (5) balanced response to assess sitting balance and standing balance; (6) international generic Barthel Index Scale to evaluate ADL. Complications as related to rehabilitation were also recorded. Descriptive statistics were employed to describe the epidemiology, pattern of motor function loss and type of injuries.ResultsThe most common types of injuries in our sample of seismic wounded treated in ICU were: fracture (70%), nervous system injuries (20%), squeezing syndrome (5%) and pulmonary contusion (5%). The fracture proportion was higher in female than male (about 2:1). Amputation and paralysis occurred more in male than female (about 7:1 and 3:1 respectively). Lung infection as a complication in ICU stay was more common in female than male (4:1). We reported that most of the seismic wounded patient had early loss of motor function during the stay in ICU. Conclusion: Limited ROM, declined muscle strength, abnormal muscle tension, balance dysfunction, alteration of ADL capacity and lung infection are the main dysfunctions occurring among the seismic wounded in ICU ward. Loss of motor function can occur early and therefore active physiotherapy should start even during the stay in ICU.