bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Incidence and Types of Acid‐Base Imbalance for Critically ill Patients in Emergency
Authors: Song ZF , Gu WH , Li HJ , Ge XL 
Published: December 2017

ObjectiveTo explore the incidence and types of acid‐base imbalance or disorder (ABD) for critically ill patients in emergency room.MethodsClinical data of all critically ill patients managed in the resuscitation room were collected prospectively during the period from 1st December 2008 to 31st March 2009. Arterial and venous blood samples were taken simultaneously for blood gas analyses and serum electrolytes. Acid‐base homeostasis or imbalance was judged according to the criteria.ResultsA total of 766 cases were collected and the incidence of ABD was 97.3% (N=745). Simple acid‐base disorder (SABD) was present in 149 cases (20.0%). Dual acid‐base disorder (DABD) was present in 525 patients (70.5%) while triple acid‐base disorder (TABD) was found in 71 patients (9.5%). After calculating the anion gap (AG), the incidence of metabolic acidosis increased from 72.2% (N=538) to 91.0% (N=678) and the rate of missed diagnosis for metabolic acidosis was 20.6% (140 out of 678 cases). Meanwhile, the incidence of TABD increased from 1.6% (N=12) to 9.5% (N=71) and the rate of missed diagnosis for TABD was 83.1% (59 out of 71 cases). Similar phenomenon was observed when potential bicarbonate was calculated. The incidence of TABD increased from 1.1% (N=8) to 9.5% (N=71) and the rate of missed diagnosis of TABD was 88.7% (63 out of 71 cases). Patients with TABD (77.9±10.7 years old) were older (P<0.01) than the groups of SABD and DABD. APACHE II scores and the incidence of multiple organ dysfunction syndrome (MODS) were significantly higher among TABD patients. Mortality of patients with TABD on the first, second, third and seventh days were 14.1%, 23.9%, 26.8% and 38.0% respectively and were significantly higher than SABD and DABD.ConclusionThe incidence of ABD in our group of critically ill patients was 97.3%. The commonest type of ABD was DABD. Calculating AG and potential bicarbonate could help us to uncover metabolic acidosis and TABD in time. Patients with TABD had a poorer prognosis. Age and APACHE II scores were key factors closely related to TABD.
Preparedness of Young Male Physicians for Biological Terrorism and Warfare in South Korea
Authors: Ahn JH , Chung JW , Kim CW , Lee DH 
Published: December 2017

IntroductionThe events of 11th September 2001, and the subsequent anthrax attacks in the United States brought the threat of bioterrorism to the forefront of concern for public health departments. Moreover, the rising confrontation between North and South Korea emphasizes the possibility of aggression with biological weapons and our vulnerability to bioterrorism. While the importance of physicians' interests and management ability is becoming more critical, no studies have yet been undertaken in Korea to assess whether primary care physicians are well informed and capable of managing bioterrorism. This study evaluates the awareness and response of young male physicians to potential bioterrorism in South Korea.MethodA total of 692 young male physicians completed the knowledge and awareness survey during the education period of military service on 9th April 2005.ResultsForty‐five percent of the participants responded that the possibility of biological warfare in Korea was high. The level of bioterrorism knowledge, however, was low. Eighty‐seven percent acknowledged the necessity of education and training for bioterrorism, and 69.9% were willing to accept education and training in bioterrorism preparedness.ConclusionThese findings suggest that young physicians should receive continuous education and training to improve preparedness for biological terrorism and warfare in South Korea.
Echocardiographic Delineation of Type a Aortic Dissection
Authors: Yuan SM , Lavee J , Kuperstein R 
Published: December 2017

IntroductionIn addition to proving the visualisation data, studies on the intimal flaps of aortic dissection based on echocardiography have been very limited.MethodsTwenty‐seven patients undergoing an operation of type A aortic dissection with preoperative transthoracic and/or intraoperative transesophageal echocardiography archived in the Horizon Cardiology Web of the hospital available for review and measurement were selected into this retrospective study. By way of quantitative and qualitative approaches, flap movement, dissection extent and aortic obstruction were sufficiently evaluated.ResultsAn intimal flap was visualised in 22 (81.5%) patients and linear artifact was viewed in 1 (3.7%), and in the remaining 4 (14.8%), neither an intimal flap nor a linear artifact was visible. Dissection extents were 2.78±1.53 cm and 2.03±1.19 cm in the horizontal and vertical direction, respectively. Sub‐ or semi‐circumferential dissection was noted in 14 (51.8%) patients. No total circumferential dissection was found in this patient population with type A aortic dissection. The obstruction of the aortic valve orifice or aortic cavity developed in 11 (40.7%) patients. Flow disturbance and thrombus in the false lumen were visualised in 24 (88.9%) and 4 (14.8%) patients, respectively. The breadth of flap movement in short‐axis plane was much larger in the Aortic Obstruction Group than that of the Non‐Obstruction Group (1.55±1.14 cm vs. 0.75±0.526 cm, p <0.05).ConclusionsPreoperative transthoracic or transesophageal echocardiographic evaluations offer a convenient and precise diagnostic tool for aortic dissection. The dissection extent may directly correlate and substantially reflect the clinical symptoms of the patients with type A aortic dissection in response to the haemodynamic impairment. Preoperative echocardiographic delineation would assure adequate means and extent of the impending operation.
Hong Kong Poison Information Centre: Annual Report 2010
Authors: Chan YC , Tse ML , Lau FL 
Published: December 2017

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2010. Methods In 2010, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis. Results A total of 4,418 poisoned cases were analysed. There were 1,863 male patients (42.2%) and 2,540 female patients (57.5%). More than two-third of cases (68.3%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, unintentional exposure and abusive use. Benzodiazepine, paracetamol, ketamine, zopiclone, and Chinese herbal medicine were the common agents involved. Majority of the patients were managed supportively, with 10.2% and 9.7% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 1.0% of the poison exposure resulted in death and 5.3% of the exposure had major outcomes. Conclusions This fifth annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.
Continuous Renal Replacement Therapy in a Patient with Cardiac Arrest after Glyphosate‐Surfactant Herbicide Poisoning
Authors: Lee BK , Lee HY , Ryu HH , Jeung KW 
Published: December 2017

Intractable hypotension is a major cause of death after glyphosate‐surfactant herbicide poisoning. However, there is no specific treatment besides conservative care. Herein, we report a patient poisoned by glyphosate‐surfactant herbicide experiencing cardiac arrest but was successfully resuscitated and treated with continuous venovenous haemodiafiltration (CVVHDF). The 60‐year‐old patient was brought to our emergency department after ingesting glyphosate‐surfactant herbicide. He developed pulmonary oedema, severe metabolic acidosis (pH 6.960), and hyperkalaemia (serum potassium 8.8 mmol/L). Although he experienced cardiac arrest for about 12 minutes, the use of CVVHDF improved the metabolic acidosis and hyperkalaemia, and finally stabilised his vital signs. He regained an alert mental state after therapeutic hypothermia. CVVHDF, which is a better tolerated renal replacement therapy than haemodialysis in haemodynamically unstable patients, should be considered in glyphosate‐surfactant poisoned patients of intractable hypotension with severe metabolic acidosis or hyperkalaemia.
The Role of Electrocardiography in Follow up of Pulmonary Thromboembolism
Authors: Kιlιç H , Köktürk N , Varol A , Aydoğdu M , Babaroğlu S , Topal S , Ateş C , Ekim N 
Published: December 2017

ObjectiveElectrocardiography (ECG) is a simple, valuable and easily applicable test that can be used in supporting the diagnosis and assessing the severity of pulmonary thromboembolism (PTE). In this study, it was aimed to identify the role of ECG scoring in diagnosis and follow up of PTE in comparison with community acquired pneumonia (CAP).MethodsPatients with the diagnosis of PTE and CAP were included in the study prospectively between January 2007 and January 2009. ECG scorings were evaluated by two different cardiologists by the method described by Daniel et al at admission (day 0) and day 3, 10 and one month of treatment. Median values of ECG scorings were compared between days and between groups.ResultsForty‐five patients with PTE, 35 patients with CAP were included in the study. Although no statistically significant difference was identified between the ECG scorings of the two groups in each measurement point, ECG scores decreased more rapidly in PTE group within days. Within the PTE group, day 0 ECG score was identified higher in submassive patients than nonmassive ones (p=0.001).ConclusionsAlthough ECG score did not differentiate PTE from CAP, depending on its rapid decrease in PTE, it can be used in the follow up. For submassive PTE patients that must be diagnosed and treated immediately, ECG scorings can be used to support the diagnosis and to assess the clinical severity.
Managing Older Patients Safely in the Time Critical Environment of an Emergency Department
Authors: Lowthian JA , Brand C , Barker AL , Andrianopoulos N , Smith C , Batey C , Smit PDeV , Newnham HH , Hunter P , Cameron PA 
Published: December 2017

Demand for emergency department (ED) services is increasing worldwide. The fastest growth in ED presentations is by patients aged ≥65 years, currently representing 18% of all attendances. Older patients present with more complex clinical conditions and multiple co‐morbidities. This means they are likely to spend more time in ED, are more likely to be admitted to hospital, and are more likely to re‐attend. The Safe Elderly Emergency Discharge (SEED) project aims to determine whether current models of emergency care ensure safe discharge and facilitate optimal health outcomes for older patients; and develop a tailored evidence‐based care framework applicable to Australian and international settings. Risk screening for unsafe discharge will be conducted on patients aged ≥65 years discharged home from ED. Patients will be followed for 6 months post‐ED presentation to monitor health outcomes and map their care journey. Demographic, clinical, and functional characteristics will be collected. The primary outcome is unsafe discharge, defined as unplanned re‐presentation/admission within 30 days of the index presentation. Secondary outcomes include unplanned ED re‐presentation/hospital admission within 6 months; patient experience; change in functional status; functional decline; health service utilisation; and death within 6 months. The effectiveness of the ED discharge risk screening tools for predicting unsafe discharge will be evaluated at 30 days and 6 months. SEED will determine the risk factors for unplanned ED re‐presentation/hospital admission at 30 days for patients aged ≥65 years presenting to ED; which will inform the development of an evidence‐based older patient care framework for EDs.
The Impact of Enhanced Triage on the Emergency Service with Special Track Streams
Authors: Lam HC , Lee HKH , Ting SM , Li KM 
Published: December 2017

BackgroundOver sixty percent of emergency department (ED) attendances belonged to the semi-urgent or non-urgent categories. The existing triage system failed to detect those patients in need of emergency service within these groups. It increased the risk to patients and affected the quality of care especially with overcrowding and long waiting time.ObjectiveTo assess the impact of a special track program in providing medical services to targeted groups and on the overall emergency service.MethodFour special groups of patients triaged as semi- or non-urgent and required procedural interventions or possible in-hospital treatment were identified. The impact on waiting time, length of stay, rate of left without being seen and re-attendances rate were measured and studied prospectively.ResultsA total of 438 cases were analysed. Special track groups had a shorter mean waiting time and mean disposal time (36.6 minutes and one hour) when compared with all category 4 patients. Special track group had no disappeared case and a smaller re-attendance rate.ConclusionsSpecial track program improves the safety and quality of care in patients of fast track streams without compromising care to other semi-urgent or non-urgent categories patients.
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.
Bedside lung ultrasonography for diagnosis of pneumonia
Authors: Unluer EE , Karagoz A , Senturk GO , Karaman M , Olow KH , Bayata S 
Published: December 2017

ObjectiveThe aim of this study was to investigate the accuracy of bedside lung ultrasound (BUS) in the diagnosis of community‐acquired pneumonia (CAP) in patients with dyspnoea presenting to the emergency department (ED) and to analyse the characteristic sonographic findings of CAP.MethodsAfter a six‐hour training program, BUS procedures were performed between October 2011 and February 2012 to prospectively evaluate patients presenting to the ED with dyspnoea. Chest X‐ray (CXR) or computerised tomography (CT) were ordered, depending on the presence of consolidation signs on CXR. The outcome was determined by consolidation findings on CXR or CT. BUS results were compared using Chi‐squared testing.ResultsOf the 112 enrolled patients with dyspnoea, 40 patients were excluded and 72 were included in the study. Thirty‐four patients were BUS positive. Of these, CXR or CT findings agreed with the BUS findings in 27 patients. In 38 cases, BUS was negative, and one patient was diagnosed with pneumonia based on the CT report. The sensitivity, specificity, PPV, NPV, and the positive and negative likelihood ratios for BUS were 96.4%, 84.1%, 79.4%, 97.4%, 6.1 and 0.042, respectively. The diagnostic accuracy of BUS was 89%. The presence of consolidation signs, either shred or hepatisation, were the most frequent sonographic findings in our study.ConclusionsAcute alveolar consolidation can be diagnosed easily by performing BUS with high degree of accuracy in EDs.
Acute and Delayed Traumatic Diaphragmatic Ruptures Presenting at the Emergency Service: What are We Missing?
Authors: Alar T , Dedeoglu E , Bulut T , Yapucu MU , Dedeoglu B 
Published: December 2017

IntroductionDiaphragmatic rupture is rarely a cause of death by itself. It is especially difficult to diagnose diaphragmatic ruptures in patients with unstable vital signs who present at the emergency service with concurrent chest, abdomen, and extremity injuries as a result of blunt trauma. We evaluated the diagnostic processes, clinical findings and treatment results of acute and delayed traumatic diaphragmatic ruptures (TDR) cases that presented at the emergency service.MethodsA total of 29 patients that underwent surgical treatment with a diagnosis of TDR among 1021 patients that presented at the Canakkale State Hospital Emergency Service with acute or delayed thoracoabdominal trauma were retrospectively investigated. The age, gender, trauma etiology, diagnosis duration, injury severity score (ISS), rupture location, accompanying organ injuries, operation type, inpatient duration, morbidity and mortality were recorded on prepared forms to analyse the cases.ResultsThe mean age of the 29 patients with TDR was 45.31 + 17.76 years with and 20 (69%) males and 9 (31%) females. The trauma was blunt in 22 (76%) and penetrating in 7 (24%) cases. The TDR was acute in 16 (55%) and delayed in 13 (45%) patients. The surgery for TDR treatment consisted of with thoracotomy in 16 (55%) patients, laparotomy in 11 (38%) patients and both thoracotomy and laparotomy in 2 (7%) cases. Mortality occurred in 3 (10%) patients that presented at the acute stage.ConclusionsThe patients undergoing thoracoabdominal trauma, should be explained the probability, although low, of rupture of the diaphragm. These patients should be followed up and it should be emphasized that they should absolutely tell this trauma history to the physician who examines them when they present at the emergency service.
A 2-hour Accelerated Chest Pain Protocol to Assess Patients with Chest Pain Symptoms in an Accident and Emergency Department in Hong Kong
Authors: Ko HF , Lee HY , Ho HF 
Published: December 2017

Background The present study is a follow up analysis of ASPECT study. We aimed to prospectively validate a 2-hour accelerated chest pain protocol (ACPP) to assess patients presenting to emergency department with chest pain symptoms suggestive of acute coronary syndrome. Methods This observational study was carried out between June 2009 and July 2010. Patients were included if they were older than 18 years old and presented with at least 5 minutes duration of chest pain. The ACPP included modified Thrombolysis in Myocardial Infarction score, electrocardiograph and point-of-care troponin I at presentation and 2-hour after. Primary endpoint was major adverse cardiac event (MACE) at 45-day of initial hospital attendance. Results A total of 384 Chinese patients were recruited and completed 45-day follow up. Forty-five (11.7%) had 45-d MACE. The ACPP identified 124 (32.3%) low risk patients who could be discharged early. No MACE occurred within 45 days among these patients, giving a sensitivity of 100% (95% CI 90-100), a negative predictive value of 100% (96-100), and a specificity of 36.6% (31.5-42). Conclusions The ACPP is able to identify very low risk chest pain patients who might be suitable for early discharge without increasing risk of developing MACE. The observation period can be shortened to 2-hour of ED presentation. The variables are objective and easily available. This 2-hour Hong Kong Chest Pain Rule is applicable to Chinese population and has the potential to change the current practice in Emergency Departments in Hong Kong and China.
Over‐Triage in Casevac Categorisation is Common in Hong Kong
Authors: Mok VFS , Leung JKS , Wong CP , Wong TW , Lau CC 
Published: December 2017

ObjectiveTo review the categorisation of patients who were transferred out from out‐lying islands to urban hospitals utilising casualty evacuation (CASEVAC), and to search for possible patient characteristics which might have contributed to mis‐categorisation during the ‘non‐flying’ hours.MethodsThe medical records of 459 patients, who were transferred out in the year 2009 were reviewed. Correctness of categorisation was determined by 2 independent assessors according to the CASEVAC guidelines. The rates of mis‐categorisation between ‘clinic hours’ and ‘AED hours’, and that between the ‘flying’ and ‘non‐flying’ hours, were compared. The patients' demographic data and their presenting symptoms were collected and analysed using logistic regression models to identify factors contributing to mis‐categorisation.ResultsThe mis‐categorisation rate was 60.1%. Among them, all were over‐categorised. The over‐categorisation rates between ‘clinic hours’ and ‘AED hours’, and between ‘flying’ and ‘non‐flying’ hours, were not significantly different (p=0.07 and 0.09, respectively). Abnormal pulse rate was significantly associated with over‐categorisation (p<0.01). Patients at extremes of age and psychiatric/drunk patients were significantly less likely to be over‐categorised (p<0.05 and p<0.01, respectively). There was 20% disagreement between the two assessors when applying the existing CASEVACs guidelines (kappa score 0.58 or ‘moderate agreement’).ConclusionsOver‐triage in CASEVAC categorisation is common irrespective of the time of day. Revision of the current CASEVAC guidelines is recommended. (Hong Kong j.emerg.med. 2013; 20:327‐336)
Comparison of Clinical Prediction Rules for Termination of Resuscitation of Out‐of‐Hospital Cardiac Arrests on Arrival to Emergency Department
Authors: Chan KM , Lui CT , Tsui KL , Tang YH 
Published: December 2017

ObjectiveTo compare the discriminative capacities of various termination of resuscitation (TOR) rules in the prediction of futile resuscitation in the emergency department (ED).DesignProspective cohort study.Setting2 public hospitals in a cluster in Hong Kong.MethodsThe data were obtained from a Cardiac Arrest Registry of the EDs of two hospitals, including consecutive adult patients suffering from non‐traumatic out‐of‐hospital cardiac arrest from 1st August 2010 to 30th June 2012. Those with return of spontaneous circulation before ED arrival and cases without resuscitation in the EDs were excluded. The modified basic life support (BLS), modified advanced life support (ALS) and neurologic TOR rules were applied to the cohort. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated. The outcome measures were survival to hospital admission (STA) and survival to discharge (STD).ResultsTotally 1125 cases were included. The mean age was 72.4. Return of spontaneous circulation and STA occurred in 302 patients and 9 had STD. Regarding the outcome of STD, the modified ALS and neurologic TOR rules had outperformed the modified BLS rule. The specificity and PPV were 100% for both rules in predicting death when the rules suggested TOR. Regarding the outcome of STA, the neurologic TOR rule had the highest specificity [84.4%; 95% confident interval (CI): 79.7‐88.2%] and PPV (84.5%; 95% CI: 79.8‐88.3%).ConclusionsThe modified ALS and neurologic TOR rules have similar discriminative capacities to predict STD. The neurologic TOR rule has the highest ability to predict STA in the ED. (Hong Kong j.emerg.med. 2013;20:343‐351)