bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Medicine Ward as a Step down Unit for Selected Poisoned Patients after Intensive Care Unit Management: A Pilot Study
Authors: Lam PK , Leung JKS , Chan LW , Wong TW , Lau CC 
Published: December 2017

IntroductionStarting from the 1st July 2009, poisoned patients who fulfilled the emergency medicine ward (EMW) admission criteria were transferred to the EMW for subsequent care after intensive care unit (ICU) management. This study was undertaken to review the impact of such a strategy on the length of stay (ALOS).Study designThis was a retrospective study on consecutive poisoned patients discharged from the ICU from the 1st July 2009 to 31st December 2010. Poisoned patients from the 1st January 2008 to 30th June 2009, who were discharged to the general medical ward or to other specialty wards were used as historical controls for comparison.MethodMedical records of eligible cases were reviewed and data were collected using a standardized data collection form. Disease severity during the ICU stay was assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The median ALOS and APACHE II scores of the 2 groups were compared.ResultsA total of 32 poisoned patients were transferred from the ICU to EMW during the study period, in which 28 patients were included as the study group. For the historical control group, 19 patients were identified for comparison. The study group had a significantly shorter median length of stay in the ICU (21.3 h vs. 36.0 h, p=0.013) and a significantly shorter median ALOS (28.8 h vs. 52.5 h, p=0.002) compared to the historical control group. All patients discharged to the EMW survived with no ICU re‐admission.ConclusionThe strategy of using the EMW as a step‐down unit for selected poisoning cases after ICU discharge is feasible, safe and effective.
The Efficacy of Alternative Cardiopulmomonary Resuscitation Methods When Compared to Standard Cardiopulmonary Resuscitation: A Simulation Study
Authors: Kim CH , Kim GW 
Published: December 2017

ObjectiveThere are limited data comparing the alternative cardiopulmomary resuscitation (CPR) methods (over the head CPR, straddle CPR and one hand CPR) to standard CPR performed by emergency medical technicians (EMTs). Therefore we investigated the efficacy of the alternative CPRs compared to that of standard CPR performed by EMTs in simulated cardiac arrest scenarios.MethodsThirty EMTs of intermediate level participated in this study. The performance of CPR was defined as the average depth, the total number of chest compressions, and the rate of compressions. EMTs performed three minutes of standard CPR and of alternative CPR on standard simulation mannequins with recording devices. Recorded performance was measured and compared between subgroups by the type of CPR, gender of EMTs and gender with various methods of CPR using ANOVA and t test statistics.ResultsThe average depth of compressions was 42.3±5.8, 42.6±4.7, 43.5±3.7, 33.8±6.6 mm (mean±standard deviation) respectively in standard CPR, over the head CPR, straddle CPR and one hand CPR. The total number of chest compression was 330.4±38.1, 334.8±70.2, 334.0±34.9, 312.1±53.5 in 3 minutes. The rate of compressions was found to be 111.5±10.3, 113.8±11.6, 110.5±11.2, 110.7±11.8 times per minute. The comparison of the performance qualities for the four types of CPR showed that the compression depth was significantly lower in one‐hand CPR (p<0.000). No EMT gender difference in the quality of performance of total CPR was noted.ConclusionsThe efficacy of alternative CPRs are shown to be similar to that of standard CPR in a compression‐only simulation cardiac arrest model.
A Retrospective Epidemiological Study of the Traffic-Related Injuries Cases Admitted to a Local Hospital
Authors: Chung WS , Tsui CT , Lit ACH , Leung M 
Published: December 2017

Road traffic injuries (RTI) are important public health problem globally. Accurate data about RTIs and its subsequent health consequences are essential to monitor the effectiveness of current RTI prevention measures and to readdress policies. Objective We presented the surveillance of RTI in Kwai Tsing by integrating data from traffic accident data system (TRADS) and injury surveillance system (ISS) from Princess Margaret Hospital. Method Retrospective observational study to examine traffic-related injuries by integrating data from TRADS and ISS databases. A multivariate analysis was performed to identify risk factors associated with hospital admissions in RTI. Result A total of 725 patients were included. About 19% of the visits led to hospitalisation and six deaths (0.83%) were reported. Pedestrian elders were significantly more at risk to traffic injury mortality and hospitalisation. Conclusion This study demonstrates the feasibility of an integrated surveillance system for RTI based on existing local databases. Special preventive measures should be tailored for pedestrian and elderly to improve their safety by improving the quality of their walking environment.
Sustained Abdominal Aorta Compression Elevates Coronary Perfusion Pressure after Asphyxia‐Induced Cardiac Arrest in a Rabbit Model
Authors: Wang LX , Liu YH , Li XM , Shi HZ , Ji ZX , Guo XD , Sun K , Ma LZ , Guo CC 
Published: December 2017

ObjectiveTo investigate whether sustained abdominal aorta compression (SAAC) can improve coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR) and improve resuscitation outcomes without causing liver laceration.Design and SettingAnimal study.MethodsCardiac arrest was induced by asphyxia in 28 New Zealand rabbits and maintained for 2 minutes before resuscitation. Animals were resuscitated using either standard CPR (STD‐CPR group) or standard CPR and SAAC (SAAC‐CPR group). Restoration of spontaneous circulation (ROSC), restoration of spontaneous breathing (ROSB) and cerebral performance category score were determined. CPP, mean arterial pressure (MAP) and ROSC were compared in the two groups.ResultsMAP and CPP in the SAAC‐CPR group were significantly higher than in the STD‐CPR group. However, MAP and blood gas results showed no significant difference between the two groups during ROSC. ROSC was achieved in seven of fourteen animals in the STD‐CPR group and in eleven of fourteen animals in the SAAC‐CPR group. Five animals in the STD‐CPR group and nine in the SAAC‐CPR group survived 24 hours after ROSC. No liver injury occurred in the two groups.ConclusionsSAAC‐CPR produces an increased CPP and MAP than traditional CPR and it does not lead to liver laceration/injury.
Comparison between the LMA Classic™ and New I‐gel™ Supraglottic Airway Device: A Manikin Study
Authors: Kwak DI , Yoo JH , No HW , Sohn JD , Kim YJ , Nah JH 
Published: December 2017

ObjectiveIt is nowadays well established that the laryngeal mask airway (LMA) is an alternative airway to endotracheal intubation for prehospital environment. However, problems have been reported and many other kinds of supraglottic airway devices (SGDs) were introduced. The I‐gel™ is one of the latest SGD, and it has been designed for easy and fast insertion with non‐inflatable cuff. We compared the efficacy between LMA Classic™ and I‐gel™ by using both normal and difficult airway conditioned manikin.MethodsOne hundred and two non‐experienced volunteers made out of students and nurses participated in the airway management educational program that was held in the emergency medical center of Gwangmyeong Sungae Hospital. After finishing the program, the participants were tested on their performance skills (insertion time) on using the two devices in both normal and difficult airway conditioned manikin. A structured questionnaire was used to measure the knowledge, attitude and preference about each device on a 5‐point scale.ResultsIn the LMA Classic™ and I‐gel™ groups, it took 28.3±8.3 and 10.0±3.7 seconds with normal airway conditioned manikin (p<0.001), and 29.1±8.2 and 10.3±3.0 seconds elapsed with difficult airway conditioned manikin to achieve adequate airway management (p<0.001) in the corresponding order. The attitude and preference scale of the I‐gel™ was higher than those of the LMA Classic™ (p<0.001).ConclusionsThe insertion time of the I‐gel™ was shorter than that of the LMA Classic™ in both normal and difficult airway conditioned manikin, and I‐gel™ had a higher positive response for attitude and preference.
Preliminary Experience of Assessment of Intracranial Lesions by Ultrasound in Multiple Trauma Patients Undergoing Craniectomy
Authors: Lu X , Zhang M , Yang JX , Xu SX , Gan JX 
Published: December 2017

ObjectiveTo explore the feasibility and reliability of B‐mode ultrasound for assessment of intracranial lesions in multiple trauma patients who had undergone craniectomy.Designingle‐centre study.SettingA 16‐bed emergency intensive care unit (ICU) in the emergency department of 2nd Affiliated Hospital of Zhejiang University School of Medicine from July 2006 to June 2010.MethodsWe retrospectively analysed 13 multiple trauma patients with severe head injury admitted to the emergency department of 2nd Affiliated Hospital of Zhejiang University School of Medicine. All 13 patients were admitted to the ICU after craniectomy and received mechanical ventilation. Computed tomography (CT) were conducted when patients' consciousness, pupillary size, light reflex changed apparently, or if the bone window tension and the intracranial pressure increased unexpectedly. Head ultrasonography was performed within 2 hours of CT scanning.ResultsUltrasonography revealed 18 pathological changes in the 13 patients. CT and a second operation helped to identify 23 pathological changes. The results of B‐mode ultrasound were compared with those of CT and the coincidence rate was 78.3%, with no significant difference in the diagnosis of delayed haematoma or midline shift (Kappa=0.898, p<0.05).ConclusionsTranscranial ultrasonography may be a useful tool for monitoring post‐operation intracranial lesions in multiple trauma patients with severe head injury. It is an effective supplement to CT.
Can Emergency Medicine Ward Shorten Hospital Length of Stay in Patients with Nasogastric Tube Related Coffee Ground Aspirate?
Authors: Chan WL , Leung YY , Chan HY , Ng F 
Published: December 2017

IntroductionThe aim of this study was to determine whether elderly patients on nasogastric (NG) tube feeding who presented with coffee ground aspirate could be effectively and safely managed in a local setting of Emergency Medicine Ward (EMW).MethodA retrospective study with data retrieved from all the cases admitted with a diagnosis of coffee ground aspirate or vomiting who were on NG tube feeding during three years before and after EMW was launched. Data including patient demographics, length of stay (LOS), types of pharmaceutical treatment received, need of upper endoscopy, in‐hospital death and readmission rate within fourteen days were studied. Patients who were haemodynamically unstable, having melaena on per rectal examination, on warfarin or with underlying gastrointestinal malignancy were excluded.ResultsA total of 223 patients matching the studied criteria were included in the study, with 103 of them being admitted before the opening of EMW. For the 120 cases admitted after EMW was launched, 70 cases were admitted to EMW and 50 admitted to Medical Ward. The LOS for elderly patients on NG tube feeding presented with coffee ground aspirate was significantly shortened after EMW was launched (5.2 days vs. 4.2 days, p=0.046). In‐hospital mortality and 14‐day readmission rate were similar in the two studied period. Patients admitted to EMW and Medical Ward in the second study period were also analysed. Those admitted to EMW had a shorter LOS than those admitted to Medical ward during the same period (3.4 days vs. 5.3 days, p=0.001).ConclusionThe establishment of EMW in local setting can achieve a significant reduction in hospital LOS without jeopardizing patient outcome for elderly patients who are on NG tube feeding presenting with coffee ground aspirate.
Emergency Physicians' Preparedness for CBRNE Incidents in Hong Kong
Authors: Hung KKC , Lam ECC , Wong MCS , Wong TW , Chan EYY , Graham CA 
Published: December 2017

BackgroundRecent terrorist attacks with biological and chemical weapons have caused much concern for the public. The purpose of this study was to assess emergency doctors' preparedness in handling Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) incidents.MethodsThis is a cross sectional survey of all emergency doctors working in public emergency departments (ED) in Hong Kong. Apart from the experience and confidence to handle these events, data on participants' willingness to participate in CBRNE incidents and training motivations were also analysed.ResultsBiological and radiological events were found to be the least commonly encountered. Few respondents reported they were confident to manage biological events (10.6% to 29.8%), despite 66% of respondents reported having prior training in CBRNE management.ConclusionsThis study demonstrates ED doctors' low confidence in managing specific CBRNE incidents. Current strengths identified include the good awareness of hospital emergency plans and high motivation to get more training.
Outcome Predictors of Patients in Out-Of-Hospital Cardiac Arrests with Pre-Hospital Defibrillation in Hong Kong
Authors: Chan TH , Lui CT , Cheung KH , Tang YH , Tsui KL 
Published: December 2017

Objective To report the epidemiology, outcomes and the predictors of survival in patients with out-of-hospital cardiac arrest (OHCA) with pre-hospital shockable cardiac rhythms in Hong Kong. Methods It was a prospective study based on data from the cardiac arrest registry of emergency departments (ED) in two regional hospitals in Hong Kong from 1st August 2010 to 31st January 2012. All non-traumatic patients aged 18 years or above presented with OHCA with shockable pre-hospital cardiac rhythm and received pre-hospital defibrillation were included. The characteristics of patients, pre-hospital data, management and outcomes were recorded in a standardised form compatible with Utstein template at the time of patient consultation. Binominal logistic regression was applied to evaluate the relationship between survival to admission (STA) and patients' variables. Results A total of 135 patients fulfilled the inclusion criteria. The mean age was 67.0 years old. The STA rate was 34.8% and the survival to discharge (STD) rate was 6.7%. Factors independently associated with better prognosis in terms of STA were presence of bystander cardiopulmonary resuscitation (CPR) (OR 5.76, 95% CI=1.08-30.5), restoration of spontaneous circulation (ROSC) before arrival to ED (OR 43.94, 95% CI= 4.19-460.43) and short time from calling emergency medical services (EMS) to first defibrillation (OR 0.82, 95% CI=0.70-0.96). Conclusion STA rate for adults presenting with shockable OHCA in our study was 34.8%. Patients with shockable OHCA with bystander CPR, short call-to-shock time and achieved ROSC before arrival to ED are significantly associated with higher STA rate.
Can Bedside Ultrasonography of Internal Jugular Vein Replace Ultrasonography of Inferior Vena Cava for Volume Status Estimation?
Authors: Chan MY , Wong CP , Chan HH , Wong TW 
Published: December 2017

IntroductionEstimation of haemodynamic status of acute and critically ill patients at Accident & Emergency (A&E) Departments is important. Measurement of inferior vena cava (IVC) diameter and collapsibility index by bedside ultrasound (USG) was known to correlate well with volume status of these patients. However, the value of similar estimation based on USG measurement of internal jugular vein (IJV) diameter was seldom studied. Whether USG measurement of IJV diameter can replace that of IVC diameter was unknown.MethodsThis was a cross‐sectional study using a convenience sample of healthy volunteers among staff of a local A&E. The diameter of IJV and IVC (IJVD and IVCD) of the 51 participants were measured by bedside USG. The corresponding collapsibility index (CI) of IJV and IVC were then calculated. The correlation between IJVD and IVCD was assessed by the use of Bland‐Altman plot.ResultsMedian value of IVC‐CI and of IJV‐CI was 29.41% and 17.12% respectively. The mean of the difference of measurement of IJV‐CI and IVC‐CI was −11.10% (95% Confidence Interval: −15.27 to −6.92). The limits of agreement of the above difference were −40.77% and 18.58%. The range of these limits was too wide.ConclusionBecause the range of limits of agreement between IJV‐CI and IVC‐CI were too wide, IJV‐CI may not be used as an alternative to IVC‐CI for the estimation of the volume status of normal adults.
A Novel Approach to Patients with Equivocal Non‐Traumatic Acute Abdominal Pain
Authors: Sulu B , Yildiz B 
Published: December 2017

IntroductionPatients with acute abdominal pain are sometimes held under long‐term observation because of failure to make a certain diagnosis. This study investigates the effectiveness of utilising laboratory and clinical variables to choose between surgical and medical treatment to reduce costs and speed up the evaluation period.MethodsIn a university hospital setting, 165 patients with abdominal pain who had undergone surgical (n=115) or nonsurgical (n=50) treatment after observation were prospectively analysed. Upon presentation body temperature, white blood cell count, neutrophil count, seroreactive protein, and malonyl dialdehyde levels were determined. The area under the ROC curve and logistic regression analyses were performed. Surgical probability formula was prepared by using parameters.ResultsBody temperature, white cell count, neutrophil count, C‐reactive protein were higher in the surgical group (p=0.0001). Sensitivity of C‐reactive protein was higher in determining patients who required surgical treatment. Multivariate analysis showed that above mentioned variables (except neutrophil count) along with malonyl dialdehyde levels were effective in determining optimal treatment strategy.ConclusionsIt is possible to identify patients who need to undergo surgery by implementation of a ‘probability of surgery’ model using certain laboratory values from blood samples obtained from patients with abdominal pain and unknown diagnosis, upon presentation in the emergency room.
A Study of the Effectiveness of Psychiatric Clinical Liaison Nurses and Determinants of Psychiatric Admission in an Accident and Emergency Department of Hong Kong
Authors: Leung FYL , Lee HKH , Ng HW , Ting SM , Li KM 
Published: December 2017

BackgroundThis study examines how psychiatric clinical liaison nurses (CLN) services in the accident and emergency department (ED) meet the demand for those people with mental health problems. In addition, we aim to identify determinants for psychiatric admission.MethodsAll psychiatric patients attended the ED within the periods of May to July of 2007, May to July of 2008 and January to March 2012 were recruited. Data was recorded on patients' demographics, past mental history, time of arrival to the ED, time of discharge from the ED, length of stay in the ED, time to urgent psychiatric services (CLN services in 2008 and 2012, and urgent psychiatrist consultation in 2007), and on clinical symptoms and outcome.ResultsTotally 484, 519 and 587 attendances were analysed in 2007, 2008 and 2012 respectively. Results showed that the introduction of CLN to the ED significantly shortens the waiting time for patients from registration in the ED to urgent psychiatric services, from 33.5 hours to 21.4 hours then to nine hours. However, the mean length of stay in the ED was prolonged from three hours to five hours. Overall admission rate was similar. Re‐attendance rate was decreased. Five significant determinants of psychiatric admission in an attendance to the ED were identified: patients presented with psychotic symptoms, violent behavior, suicidality, known to mental health services and depressive symptoms.ConclusionsThe CLN service as described in this study appears to be a useful resource in the ED for patients with mental health problems. Five determinants of psychiatric admission are identified. (Hong Kong j.emerg.med. 2013;20:364‐370)
Bacterial Contamination of Computer and Hand Hygiene Compliance in the Emergency Department
Authors: Hong DY , Park SO , Lee KR , Baek KJ , Moon HW , Han SB , Shin DH 
Published: December 2017

IntroductionThe aim of this study was to determine the degree and nature of bacterial contamination of computer equipment in three Korean emergency departments (ED).MethodsHand 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.ResultsOf 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%).ConclusionsMultiple user computer equipment in the ED may serve as reservoirs for nosocomial infection. Hand hygiene should be performed before and after using all ED equipment, including computer equipment. (Hong Kong j.emerg.med. 2012;19:387‐393)
Acute Myocardial Injury and Complete Atrioventricular Block Induced by Transient Coronary Artery Spasm
Authors: Tsai TC , Wu KH , Kung CT , Li CJ 
Published: December 2017

A 65‐year‐old man with no previous history of heart disease presented with cardiogenic shock. Acute right ventricular failure following extensive inferior wall myocardial infarction and complete atrioventricular block were noted and emergent angiography revealed insignificant coronary arterial stenosis. In view of the finding and absence of myocardial vasculitis, coronary artery spasm was implicated as the cause of myocardial infarction and complete atrioventricular block. After the reversal of the shock and successful angioplasty, the patient continued to take lercanidipine and had been angina‐free during follow‐up of 5 months. (Hong Kong j.emerg.med. 2013;20:396‐399)