bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Study of Drug Radiopacity by Plain Radiography
Authors: Chan YC , Lau FL , Chan JCS , Hon TYW 
Published: December 2017

Plain abdominal X‐ray (AXR) may be helpful in the management of acute poisoning in the emergency department if the drugs involved are radiopaque. There are varying radiopacity among different medications and even for the same medication from different manufacturers. Therefore, we performed this study to detect local drug radiopacity in Hong Kong. A total of 430 drugs under the formulary of the United Christian Hospital were tested by standard AXR (75 kV, 23 mA) in a specially designed box which corresponded to the soft tissue density of the abdomen. Two different radiologists classified the drug radiopacity into three grades. Eight drugs (1.9%) were graded as definitely radiopaque (ranitidine bismuth citrate, tripotassium dicitratobismuthate, Drixoral SR, amiodarone, ferrous sulphate, sodium chloride, calcium carbonate, and Cafertamin). Another 129 drugs (30.0%) were slightly radiopaque, including slow release drugs, neuroleptics, antacids, ionic salts, beta‐blockers, tricyclic antidepressants, antibiotics and others. The remaining 293 drugs were undetectable. As a significant number of drugs (31.9%) were detectable by plain AXR in vitro and some of them were potentially lethal, we should consider AXR as an adjunct in managing a suspected poisoned patient. Further study may be needed to evaluate these drugs' radiopacity in vivo with respect to the dosage and time of ingestion to assess its clinical application.
The Effect of Wearing a Face Mask on Body Temperature
Authors: Yip WL , Leung LP , Lau PF , Tong HK 
Published: December 2017

ObjectiveTo investigate the effect of wearing a face mask on body temperature in healthy subjects.MethodsThe study was of repeated measures design. It was conducted from July to August 2003 in two accident & emergency departments on Hong Kong Island. Staff of the two departments, who were free from any active disease at the time of measurement, were recruited. Their body temperature (oral and aural) was measured while they were not wearing a mask and at 30 minutes after they had worn a mask (either surgical mask or N95 mask). Paired t‐test was used for significance testing. Pearson product‐moment correlation coefficient was calculated to elucidate the relationship between oral and aural temperature measurement.ResultsNinety‐three subjects were included. Oral temperature was significantly higher when a mask was worn (p=0.002, 95% CI 0.06–0.26). When considered separately, only those wearing N95 mask demonstrated such significance (p=0.005, 95% CI 0.088–0.454). The correlation coefficient for oral/aural temperature measurements was 0.219 (without mask, p=0.035) and 0.169 (with mask, p=0.104).ConclusionWearing a face mask may increase the oral temperature in healthy subjects. However, the difference may not be clinically significant.
Antibiotic Prescribing for Patients with Upper Respiratory Tract Infections by Emergency Physicians in a Singapore Tertiary Hospital
Authors: Lee WY 
Published: December 2017

Objective Despite the paucity of supporting evidence, the use of antibiotics in the management of upper respiratory tract infections (URTI) remains a persistent and worrying trend worldwide. This survey study set out to examine the antibiotic prescribing profile of emergency physicians for patients diagnosed with URTI at a local tertiary hospital. Methods Patients seeking treatment for URTI at the emergency department in the year 2001 were identified by their ICD-9 code. The electronic medical records of a random sample of these patients were reviewed. Patients with the following documented findings were excluded: (a) a duration of more than 7 days between disease onset and date of consultation, (b) prior antibiotic usage or medical consultation, (c) presentation of purulent sputum and/or purulent nasal discharge, and (d) existing medical conditions requiring antibiotic treatment/prophylaxis. Chi-square and multivariate analyses were performed to assess the association of patient-related factors with antibiotic prescribing. Results Of a random sample of 488 cases of URTI, inappropriate antibiotic prescribing was observed in 24% of cases (95% CI 20%, 28%). Significant associations were observed between antibiotic prescribing and month of consultation, patients' temperature and symptom of rhinorrhoea. Conclusion A substantial proportion of emergency department patients with URTI received antibiotics despite the lack of evidence supporting the drugs' effectiveness. Appropriate interventions to promote evidence-based prescribing amongst emergency physicians are required to reduce the extent of inappropriate antibiotic prescribing as well as to ensure the longevity of antibiotic effectiveness.
A Snapshot of Chronic Obstructive Airways Disease in Australian Emergency Departments
Authors: Kerr D , Kelly AM 
Published: December 2017

Objectives To characterise emergency department (ED) attendances for chronic obstructive airways disease (COAD) by patient demographics and severity, to determine treatment and disposition of patients and to determine use of diagnostic tests and treatment provided to different severity groups. A secondary aim was to compare treatment given to established treatment guidelines. Methods Prospective, observational cohort study of patients who presented to nine Australian ED with a primary diagnosis of acute exacerbation of COAD in October 2002. Information collected included demographics, duration of symptoms, co-morbidities, assessment findings, severity, treatment, disposition, tests, in-hospital mortality and length of stay. Results A total of 137 patients were studied. Two-thirds (65%) of the group were male, and most (90%) were aged greater than 60 years. COAD severity was mild in 11%, moderate in 30% and severe in 59%, and 23% were receiving home oxygen therapy. As anticipated, patients with severe COAD were more likely to be admitted to hospital (mild: moderate: severe = 13%: 68%: 99%; p<0.0001) and to require ventilatory support (0%: 0%: 23%; p<0.002). There was under-utilisation of corticosteroids and antibiotics in the moderate and severe groups, and only 35% of the group had received influenza vaccination within the past year. Conclusion This study showed that adherence to best practice guidelines with respect to the use of corticosteroids and antibiotics for patients who presented to the ED with COAD was sub-optimal, as was the prevalence of prior influenza vaccination. Other aspects of treatment and investigation were consistent with available evidence. Efforts to address these deficiencies should be developed.
The Severity and Prognostic Markers of 148 Cases of Carbon Monoxide Poisoning by Burning Charcoal
Authors: Lam KK , Fung HT , Kam CW 
Published: December 2017

Objective To identify and analyse the characteristics of carbon monoxide (CO) poisoning due to burning charcoal in our locality. Methods This was a 3-year retrospective study. All patients presenting with CO poisoning by burning charcoal from August 1999 to December 2002 were recruited. The demographic data, initial vital signs, blood results, treatment regimens and outcomes were collected. Association between clinical outcomes and parameters were calculated. Results The study identified 148 patients (mean age 34.7 years) suffering from CO poisoning by burning charcoal. One hundred and forty-six cases (98.6%) were suicidal. Twenty-five patients (16.9%) were unconscious (GCS ≤ 8) on arrival. The mean initial carboxyhaemoglobin (COHb) level was 21.0%. The mortality rate was 5.4%. Fifteen cases (10.1%) required intensive care. Twelve cases (8.1%) had neurological complications and five (3.4%) suffered from delayed neurological sequelae. Initial blood results showing hyperkalemia and acidosis were associated with likelihood of unconsciousness on arrival (p = 0.007, p = 0.019 respectively). Hyperkalemia and unconsciousness on arrival were associated with longer hospital stay (p < 0.001, p < 0.001 respectively) as well as likelihood of systemic complication (p < 0.001, p < 0.001 respectively). There was no relationship between co-ingestion, age, initial COHb level, initial systolic and diastolic blood pressure with consciousness level on arrival (p = 0.188, p = 0.846, p = 0.264, p = 0.224, p = 0.755 respectively). Age, initial COHb level, acidosis, initial systolic and diastolic blood pressure did not correlate with the duration of hospital stay (p = 0.679, p = 0.176, p = 0.501, p = 0.313, p = 0.868 respectively). Conclusion Suicide almost accounted for all the CO poisonings by burning charcoal in our study group. It caused significant mortality and morbidity. Hyperkalemia, unconscious state and acidosis had prognostic values.
Prognostic Predictive Values of the Initial Electrocardiogram with St‐Segment Elevation Acute Myocardial Infarction in Chinese Patients
Authors: Chan KF , Ng CP , Chung CH 
Published: December 2017

ObjectiveTo study the electrocardiogram (ECG) features that predict 30‐day mortality of ST‐segment elevation acute myocardial infarction (STEMI) in Chinese patients.MethodThis was a retrospective study. Patients presenting within twelve hours after the onset of chest pain with ECG features compatible with STEMI and the diagnosis confirmed after admission were included in the study. Data taken into account included age, sex and thrombolytic therapy in the emergency department. The hospital records of the patients were later retrieved from the computer. The initial ECG performed in the emergency department were reviewed.ResultsA total of 98 patients were included in the study. There was no statistically significant relationship between 30‐day mortality and the type of myocardial infarction or the magnitude of the ST segment changes. Distortion of the terminal portion of the QRS complex and prior evidence of myocardial infarction (in another location different from the presenting one) showed statistically significant relationship with 30‐day mortality, with odds ratio 10.364 (95% CI 1.715–62.620) and 12.731 (95% CI 2.317–69.962) respectively.ConclusionIn newly diagnosed STEMI patients, if there is evidence of terminal distortion of the QRS complex or prior ECG changes of myocardial infarction, the 30‐day mortality will be significantly higher.
A Retrospective Study on Carboxyhaemoglobin Half-Life in Acute Carbon Monoxide Poisoning in Patients Treated with Normobaric High Flow Oxygen
Authors: Li CK , Tsui KL , Hung CY , Yau HH , Kam CW 
Published: December 2017

Objective There has been a vast difference in the reported value for carboxyhaemoglobin (COHb) half-life (COHbt&frac12;) in carbon monoxide (CO) poisoning patients breathing 100% normobaric oxygen (O2). This could be due to the fact that all previous studies were performed on heterogeneous groups of patients with different aetiology. We wished to determine the COHbt&frac12; in a homogenous group of acute CO poisoning patients who attempted suicide by burning charcoal and were treated with normobaric high flow oxygen. Methods It was a retrospective descriptive cohort study for a period of 60 months (January 2001 to December 2005). Setting Accident and Emergency Department of Tuen Mun Hospital, serving a population of 1.5 millions. Population We recruited all cases of CO poisoning by burning charcoal for suicidal attempt and we excluded the cases if (1) there was only one COHb measurement; (2) the patient had not received high flow O2 therapy via tightly fitting facial mask with O2 reservoir, given before the first blood sample or throughout the period until a second blood sample was taken; (3) the first COHb was <10%; (4) the second COHb was <2%; (5) there was significant co-poisoning; (6) the patient was haemodynamically unstable; or (7) the time of blood sampling was not documented. We believed that the elimination of COHb under 100% normobaric O2 was constant and followed a simple exponential decay. Results Forty-three (27.4%) cases met all of the selection criteria and the mean COHbt&frac12; was 78±9 minutes. Conclusion We believed that our patients (i.e. CO poisoning patients who committed suicide by burning charcoal) represented a homogenous group of acute CO poisoning of unique aetiology. The estimated COHbt&frac12; would be useful in deciding the length of normobaric oxygen therapy for this group of patients.
Work‐Related Crushing Injuries with Amputations of Digits, Hands and Forearms
Authors: Lai CH , Tsui KL , Kam CW 
Published: December 2017

ObjectiveTo review work‐related crushing injuries leading to amputation of digits, hands and forearms, by focusing on patients' demographics, and clinical outcomes.DesignRetrospective descriptive study.SettingRegional hospital, Hong Kong.PatientsPatients with work‐related crushing injuries causing amputation of digits, hands or forearms admitted to hospital for treatment from January 2003 to August 2005.MethodsPatients' age, sex, past medical history, occupations, context of injuries including injuring objects and levels of amputation were studied. During a 9‐month follow up period, patients' need for urgent operation, length of hospital stay, duration of sick leave and change of occupational status were analysed.ResultsEighty‐eight patients were studied. The age distribution ranged from 19 to 81 years, with 50% being less than 40 years of age. Most patients (93%) were healthy adult before the injury. Industries frequently involved were construction (24%), manufacturing (17%) and transportation (14%). Machineries and metallic tools were the most common injuring objects. Eighty‐four percent of the amputation injuries involved the finger(s), and 13% the thumb. Most patients (91%) required urgent operation. The mean length of hospital stay was 4 days. The mean duration of sick leave was 152 days. The estimated wage loss was around HK$145,000 per accident. Only 42% of the patients could fully resume working without job restriction.ConclusionTraumatic amputation as a severe work‐related injury is common in Hong Kong. It frequently affects the young and healthy workforce, resulting in devastating physical and psychological disabilities. The clinical, social and economical significances are enormous and far‐reaching.
A One‐Year Hospital‐Based Analysis of Sports Injuries
Authors: Tsui CT , Leung M , Chow CP , Chan KH , Lit ACH 
Published: December 2017

Objectives(1) To survey and analyse the pattern of sports injuries; (2) to make implication from the results.MethodologySubjects with sports injuries attending the emergency department of Princess Margaret Hospital in 2006 were retrieved via the Injury Surveillance System. The characteristics of the subjects and their injuries were evaluated.ResultsIn 2006, 709 subjects had sports injuries, from which 83% were male. The median age was 19. Age below 20 accounted for 53% of the attendance. Football (35%), basketball (25%) and cycling (9%) were the three commonest sport‐injury activities. All sports injuries had the maximum AIS ≤3 and 83% had MAIS of 1 only. Overall, 39% had contusion and scrape, 36% with sprain and strain, and 18% had fracture. Nearly half (47%) had lower limb injury; 30% and 24% had upper limb injury and head injury respectively. Contusion and scrape of the head, and sprain and strain of the lower limb were the two commonest injuries in football and basketball. In cycling, two‐thirds suffered from contusion and scrape of any body region and 57% of those involved the head.ConclusionSports injury surveillance with characterised patterns of injuries helped to devise prevention measures.
A Comparison between Two Different Fixed-Dose Regimens of Terazosin on the Rates of Acute Haemodynamic Complication and Successful Trial without Catheter
Authors: Tsui KL , Fung HT , Kam CW 
Published: December 2017

Objectives To compare the treatment with 2 mg or 4 mg terazosin once daily (an alpha-adrenergic receptor antagonist) on the success rate of trial without catheter (TWOC) and acute haemodynamic complication rate in patients with the first episode of acute urinary retention due to benign prostatic hyperplasia managed by catheterisation in the emergency department. Design Retrospective cohort study. Setting Emergency department of a regional hospital. Methods Medical records of year 2006 were reviewed. Patients taking 2 mg and 4 mg terazosin once daily were compared on the occurrence of acute haemodynamic complications (decrease in mean arterial pressure of more than 25%, orthostatic change of blood pressure of more than 20/10 mmHg or severe dizziness in the supine position) within eight hours post-treatment. The success rates of TWOC during urology follow-up (day 3 onwards) were also compared. Age and history of concurrent anti-hypertensive medication were taken as confounders and controlled. Two binary logistic regression models were applied. Results Sixty-eight patients were studied. The overall, 2 mg and 4 mg success TWOC rates were 55.6%, 44.4% and 60.0% respectively. Overall, 39.7% of the patients developed transient haemodynamic complication but none had significant adverse clinical outcome. The effects of drug dosage (p=0.271) and age (p=0.857) on the success rate of TWOC were not statistically significant. The effects of drug dosage (p=0.111), concurrent use of anti-hypertensive medication (p=0.996) and age (p=0.625) on the occurrence of haemodynamic complication were also not statistically significant. Conclusion There is no statistically significant difference between regimens of terazosin 2 mg and 4 mg once daily on the success rate of TWOC or the occurrence of acute haemodynamic complications.
Etomidate and Midazolam for Procedural Sedation in the Emergency Department of Queen Elizabeth Hospital: A Randomised Controlled Trial
Authors: Chan KKL , Ho HF 
Published: December 2017

Objective The objective of the study was to compare the effectiveness and safety of intravenous etomidate against midazolam in procedures which required sedation and analgesia in our emergency department. Methods The study was conducted in the emergency department of Queen Elizabeth Hospital from 1st November 2005 to 30th June 2006. Adult patients who required procedural sedation and analgesia were recruited and randomised into two groups, in which either etomidate or midazolam was used as the sedative agent. Vital parameters and depth of sedation were closely monitored until they regained full consciousness. Results a total of 87 patients were recruited and randomised into study and control groups, of which 78 patients completed the study and were analysed – 36 patients were in the midazolam group whereas 42 patients were in the etomidate group. There was no statistical difference in mean age, mean weight and procedures between the two groups. Mean time for onset of action was 1.8 minutes for the etomidate group versus 3.4 minutes for the midazolam group (p=0.003). There were no significant differences in total procedure time, total length of stay, pain score, satisfaction score and adverse effects. Conclusion Etomidate achieved adequate depth of sedation for painful procedures in significantly shorter time than midazolam. There were no differences in procedure time, length of stay, pain relief and patient's satisfaction between the two drugs.
Hazmat Emergency Preparedness in Hong Kong: What are the Dangerous Goods in Kowloon?
Authors: Walter FG , Chan JTS , Winegard B , Shirazi FM , Chase PB , Chow YY , de Boer M , Denninghoff K 
Published: December 2017

IntroductionHazmat emergency preparedness is critical, especially as Hong Kong prepares for major international events, such as the 2008 Olympic Equestrian Games. No published medical study has described the identities and quantities of dangerous goods (DG) in the Kowloon area and listed what antidotes are needed for these DG. This study describes what hazardous materials are most common in Kowloon to prioritise emergency preparedness and training.Materials & methodsDesignA descriptive, cross‐sectional study.SettingThe Hong Kong Special Administrative Region, specifically Kowloon.SampleThe Hong Kong Fire Services Department (HKFSD) Dangerous Goods Database (DGD).InterventionsDescriptive statistical analyses with Stata 9.2.Chief outcomeIdentifying and quantifying dangerous goods in the HKFSD DGD.ResultsMost DG do not have antidotes. The most common DG with recognised antidotes are carbon monoxide, methylene chloride, fluorine, fluorides, fluoroboric acid, cyanides, nitriles, methanol, nitrobenzene, nitrites, and nitrates. The most common categories of DG are substances giving off inflammable vapours, compressed gases, and corrosive and poisonous substances.ConclusionsHazmat emergency preparedness and training should emphasize these most common categories of DG. Disaster planning should ensure adequate antidotes for DG with recognised antidotes, i.e., oxygen for carbon monoxide and methylene chloride; calcium gluconate or calcium chloride for fluorine, fluorides, and fluoroboric acid; hydroxocobalamin for cyanides and nitriles; ethanol for methanol; and methylene blue for methaemoglobinaemia produced by nitrobenzene, nitrites, and nitrates. Supportive care is essential for patients exposed to hazardous materials because most dangerous goods do not have antidotes.
Transorbital Sonographic Evaluation of Optic Nerve Sheath Diameter in Normal Hong Kong Chinese Adults
Authors: Chan PYN , Mok KL 
Published: December 2017

ObjectiveTo establish the range of normal values of optic nerve sheath diameter (ONSD) measured by bedside ocular ultrasonography (USG) in Hong Kong Chinese adults.Design and methodsThis was a prospective study conducted between May and June 2007 in the Accident and Emergency Department (AED) of Ruttonjee and Tang Shiu Kin Hospital. Subjects without neurological and ophthalmologic complaint were recruited by convenience sampling. The ONSD of both eyes were measured 3 mm behind the globe using a 7.5 MHz linear probe on the closed eyelids of supine subjects. Repeated measurements (n=4) were carried out for every optic nerve to control the variability of this scanning procedure. Range, mean values and standard deviations were calculated.ResultsOne hundred subjects were recruited to the study. The range for ONSD was from 3.7 mm to 4.7 mm with a mean of 4.05 mm and standard deviation (SD) of 0.19 mm. There were no significant differences in ONSD measurement between males and females (p=0.44), between right and left eye (p=0.83) or between volunteer AED staff and recruited patients (p=0.10). The differences among different age groups (p=0.13) and the correlation between age and ONSD with r=0.19 (p=0.05) were not significant.ConclusionOur results suggest that the range of ONSD in normal Hong Kong Chinese adults is between 3.7 mm and 4.7 mm which is similar to the finding in previous literatures. This study also suggests that bedside ocular USG is a convenient and useful tool in measuring ONSD and the application of this technique is acceptable by patients in our locality.