bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initial Experience of Ultrasonographic Assessment for Paediatric Patients with Hip Pain in the Emergency Department
Authors: Siu Ayc , Wong Tw , Lau Cc , Poon Akc , Lam Ck , Ip Fk 
Published: December 2017

Introduction Hip pain is a common paediatric presentation to the emergency department. Plain radiographs have been the main imaging modality of choice in the past. There is a lack of published local emergency department experience on the assessment of non-traumatic hip pain in children using ultrasound. We undertake to describe our initial experience. Method Patients less than 12 years presenting with non-traumatic hip pain or knee pain suspected to be referred from hip were recruited. A 7.5 mHz linear ultrasound probe was used to detect hip effusion. Hip effusion was defined as an anterior capsular distance (ACD) of greater than 5 mm measuring from the neck of femur and a difference of greater than 2 mm from the normal side. Patients with effusion were advised admission and those not admitted would be followed up in the Emergency Department. Result 45 patients (Male: 32; Female: 13) with a mean age of 5.4 years were recruited from November 1997 to October 1998. Hip pain and limping gait were reported in 34 and 22 patients respectively. The initial scan detected hip effusion in 31 cases (69%). Thirty four patients were admitted and the others were followed up in A&E. All patients who had hip effusion were diagnosed to have transient synovitis. Nine out of 14 patients (64.3%) who did not have hip effusion were also presumed to be due to transient synovitis in the in-hospital record. The sensitivity and specificity for ultrasound assessment of hip pain were 76.9% and 93.3% respectively. No septic arthritis was found. Conclusion Our experience supports ultrasound evaluation as an important evaluation tool for children presenting with irritable hip in the emergency department.
Case and Literature Review: Adult Acute Epiglottitis – Rising Incidence or Increasing Awareness?
Authors: Chung CH 
Published: December 2017

Objective The prevalence of adult acute epiglottitis is probably more common than is generally appreciated. A retrospective case review in a district hospital and a medical literature search may provide baseline information to guide future strategies. Methods Cases of acute epiglottitis in a period of 3 years and 4 months were traced from the hospital computer systems. Medical records were reviewed. Medical literature on “adult acute epiglottitis” was searched through Medline and EMBASE. Relevant full text articles were retrieved through hospital library network. Results From February 1998 to June 2001, 11 cases of acute epiglottitis were identified. The age range was 34–78 (mean 47.5, median 41). There was no paediatric case. The male to female ratio was 9:2. Eight presented with fever, sore throat and dysphagia, one presented with dyspnoea and two presented as foreign body in throat. Nine were treated successfully conservatively. Two were intubated prophylactically. There was no case fatality. Conclusion Adult acute epiglottitis has become much commoner than its paediatric counterpart. Acute epiglottitis should be suspected in all patients with a sore throat and dysphagia, especially if symptoms are out of proportion to the pharyngeal inflammation.
Delays in the Presentation of Stroke Patients to Hospital and Possible Ways of Improvement
Authors: Lau KK , Yeung KM , Chiu LH , Sheng B , Choi KW , Shih YN 
Published: December 2017

ObjectiveStroke patients often came late to hospital and arrived beyond the therapeutic time window for thrombolytic therapy. We studied the time from stroke onset to arrival at Accident and Emergency (A&E) department and examined what barred them from early medical attendance.MethodsAll acute stroke patients attending A&E between 15 March 1999 to 14 June 1999 were recruited. For those brought in by ambulance, their time intervals were divided into three: phase I was between stroke onset to call 999; phase II was between call 999 to A&E arrival; and phase III was between A&E arrival to being seen by doctor. For those who did not come by ambulance, they were divided into two groups: those who consulted other doctors and those who did not consult other doctors before coming to A&E. Their time lags from stroke onset to A&E consultation were compared.ResultsOne hundred and fifteen stroke patients were consecutively recruited. Sixty‐five ambulance users had median time for phase I as 151 minutes, for phase II as 32 minutes, for phase III as 17 minutes. The total median time lag was 190 minutes. Fifty were ambulance non‐users. For those who did not consult other doctors before A&E attendance, the median time lag was 641 minutes. For those who consulted others doctors before A&E attendance, their median time lag was 3,672 minutes. As a group their median time lag was 950 minutes. For the 65 ambulance users, we further studied the time intervals between A&E arrival and being seen by doctors; and the median waiting time for doctors was 17 (range 0 to 60) minutes.ConclusionsPublic education was of paramount importance. Some common stroke signs could be widely propagated for recognition. Phase I should be less than 80 minutes. The median time for phase II would likely remain to be 32 minutes. Further shortening could be achieved in phase III. As category III & IV patients were most likely potential candidates for thrombolysis, they should be seen within 15 minutes. This would leave only 53 minutes for clinical assessment, CT brain and preparation of thrombolytic agent. These measures could increase the chance of providing thrombolytic treatment within the therapeutic time window.
A Profile of Bicycle‐Related Injuries in Tai Po
Authors: Lee LLY , Yeung KL , Chan JTS , Chen RCI 
Published: December 2017

BackgroundImplementation of prevention programs for bicycle safety should be based on a good understanding of the profile of bicycle accidents. The objective of this study was to investigate the differences in the severity of bicycle‐related injuries when comparing with various risk factors, and to utilize this information to formulate the intervention measures.MethodsA retrospective review was conducted on all patients (n=116) who were treated for bicycle‐related injuries within a period of 66 days at the emergency department of a district hospital in Tai Po, New Territories.ResultsSchool‐aged children, especially boys, were more commonly injured. The head and lower extremities were the common sites of injuries. Female gender (χ2=4.39; P<0.05) and injuries involving head and upper extremities (χ2=12.61; P<0.05) were associated with higher chance of serious injury.ConclusionTai Po district had a high incidence of bicycle accidents due to its geographical location. Population at a greater risk for bicycle injury was the male gender school‐aged children and therefore prevention program should be targeted at them.
A Study of Orotracheal Intubation in Emergency Departments of Five District Hospitals in Hong Kong
Authors: Choi YF , Wong TW , Lau CC , Siu AYC , Lo CB , Yuen MC , Tung WK , Ng P , Kam CW , Mui TK , Yuen WL , Lim B , Lit ACH 
Published: December 2017

Objective To study the success rates and complications of orotracheal intubation in emergency departments of five district hospitals in Hong Kong in order to identify ways for improvement. Method This was a prospective observational study. The emergency department doctors performing the intubation were asked to complete an intubation study form immediately after the procedure over a period of four months. Data collected included vital signs, experiences of intubators, method of intubation and complications. Results A total of 347 cases were collected and 93% of them were non-trauma cases. Fifty-two percent (52%) of the cases were in cardiac arrest before intubation. Rapid sequence intubation (RSI) was applied in 36% of the cases. Junior doctors first intubated about 72% of the patients. Successful intubation was achieved in 1 and 2 attempts in 70% and 89% of the cases respectively. In 10 cases (3%), secondary methods such as laryngeal mask airway, Combitube, Trachlight or cricothyroidotomy were needed. The overall complication rate was 7.8% and the complication rate in the RSI group was 15.3%. The complication rate was even higher (20%) if intubation without medication was used in non-cardiac arrest patients. Significant drop in blood pressure was the most common complication and it could be attributed to the use of midazolam as induction medication. The success rate was found to correlate with the experience of the first intubator (p<0.05) and the laryngeal view (p<0.001). The complication rate increased with repeated attempts (p<0.001) and was higher among junior doctors (p<0.05). Early use of elastic gum bougie was associated with lower complication and higher success rates. Conclusion Orotracheal intubation in the emergency department was associated with high complication rate. Many complications came from junior intubators. Hypotension was the most common complication. Potentially avoidable complications may be a result of failure to use RSI in non-cardiac arrest patients and failure to use bougie in cases of poor laryngeal view.
Acute Infectious Diarrhoea in Adults: Identifying Clinical Parameters Associated with Specific Pathogens
Authors: Chan SSW , Ng KC , Lam PKW , Lyon DJ , Cheung WL , Rainer TH 
Published: December 2017

Introduction Infectious diarrhoea may be caused by viral, bacterial or protozoan agents. The objective of this study was to explore the possibility of correlating presenting clinical and demographic features with the specific types of stool pathogens subsequently identified. Materials & Methods A retrospective study was performed in the setting of an Accident & Emergency (A&E) department of an urban acute-care hospital in Hong Kong. The inclusion criteria were adults (age ≥16); presentation with features of acute infectious diarrhoea; treated as out-patients with or without observation; and with stool cultures requested from A&E. All consecutive culture-positive cases (n=130) satisfying the above criteria were included. The control-group (n=119) consisted of a random sample of culture-negative cases during the same study period. For each of the six pathogens identified, statistical analyses were performed to compare differences in clinical features amongst three groups: (i) cases positive for the specific pathogen; (ii) cases positive for other pathogens; and (iii) cases with negative culture. Results Salmonella was associated with significantly higher body temperatures at presentation. Vibrio parahaemolyticus (VP) was associated with a significantly shorter duration of diarrhoea and of abdominal pain at presentation. Other variables were not helpful in predicting the type of stool pathogen. Conclusion In patients presenting with acute infectious diarrhoea in an A&E setting in Hong Kong, Salmonella and VP may be suspected according to the clinical features identified in this study.
Emergency Management of Paraphimosis
Authors: Chung Ch 
Published: December 2017

Objective To review the treatment modalities available for paraphimosis, with special emphasis on those applicable to the emergency department. Data source Relevant medical literature was searched through MEDLINE, EMBASE, CINAHL, and Cochrane Database. Manual search was performed in books on Urology, General Surgery and Emergency Medicine available in the Hospital Library. Further information was obtained through the Internet at < www.infoseek.com >. References cited in articles were also retrieved. Study selection Key words for the literature, Internet and textbook search were ‘paraphimosis’ and ‘treatment’. All available years of study were reviewed. Data extraction Relevant full text articles were obtained through the hospital library network. Original articles, review papers, medical practice, case reports, and relevant book chapters were reviewed. Data synthesis There were no prospective, randomised, controlled studies available. The majority were case series and expert experience or opinions only. Currently, a multitude of non-invasive and invasive treatment options are available, including manual reduction, help of non-crushing tissue forceps, puncture technique and dorsal slit. Conclusion All treatment methods are within the capability of the emergency physician. Hospitalization should rarely be required, unless there are serious complications.
Outpatient Management of Deep Vein Thrombosis: a Model with a Breakdown of the Continuum of Care
Authors: Paes C , Kelly AM 
Published: December 2017

Objectives For emergency department (ED) patients with deep venous thrombosis (DVT) treated as outpatients, to determine treatment duration, complications and follow-up arrangements, in particular thrombophilia screening. Methods Explicit, retrospective medical record review of patients with an ED discharge diagnosis of DVT over a three-year period. Data collected included demographics, location of DVT, duration of treatment, complications, hospital admission, mortality, follow-up arrangements and referral for thrombophilia screening. Main outcomes were the duration of treatment, rate of complications and requirement for hospital admission, follow-up arrangements and referral for thrombophilia screening for patients treated as outpatients. Results Two hundred and fourteen patients with DVT were identified, of whom 74 [35%] were treated as outpatients. For this group, the median duration of treatment was eight days. There was one death from advanced neoplasia, two proven pulmonary emboli (PE) [2.7%, 95% CI 0.74–9.3%] and one suspected PE [1.4%, 95% CI 0.24–7.3%]. One patient had a recurrence of DVT within three months [1.4%, 95% CI 0.24–7.3%]. Few patients received specialist follow-up [25/74, 34%]. In 20 cases [27%], thrombophilia screening was neither performed nor recommended, despite no obvious cause for the DVT. Conclusion Outpatient treatment of selected DVT is safe, although there is a small incidence of non-fatal PE. Follow-up and screening arrangements were sub-optimal in the study sample and treatment duration was long. An ambulatory care model with direct physician control is recommended to improve follow-up arrangements, monitor service performance and ensure that the service evolves with new evidence and processes.
A Pilot Study on the use of Tramadol Hydrochloride for Pain Control in an Emergency Department
Authors: Siu AYC , Chung CH 
Published: December 2017

Introduction Tramadol hydrochloride is a synthetic μ,-opioid agonist. It has been used in the control of moderate to severe pain. Most of the studies on tramadol were related to post-operative pain control. Data on acute pain control in the emergency setting were limited. This study reported on the initial evaluation of tramadol for pain control in an emergency department. Materials and methods It was a prospective observational study. Patients aged 16 years or above attending our emergency department with moderate to severe pain were recruited. Patients with known allergy, current psychiatric medication, intake of alcohol, major systemic illness and opioid dependence were excluded. All patients received 100 mg intramuscular tramadol injection. A 10 cm Visual Analogue Scale (VAS) was used to assess the pain severity before injection, 30 minutes and 60 minutes after injection. Vital signs and side effects were also recorded. Results Forty patients (M: 24, F: 16) were recruited from October to December 2002. Their mean age was 53.5 years. The majority of them suffered from acute musculoskeletal pain or arthritis. Tramadol was shown to be effective in pain control. The VAS decreased by 1.90 (p<0.001) and 3.38 (p<0.001) at 30 minutes and 60 minutes respectively. Four patients reported nausea and three patients vomited. Conclusion Tramadol appeared to be a safe drug to be used in the emergency setting. Only a few insignificant side effects were reported. The comparison of efficacy with other analgesics requires further studies.
Feasibility Study Comparing Oral Paracetamol and Oral Non-Steroidal Anti-Inflammatory Drugs for Treating Pain after Musculoskeletal Injury: a Randomised, Double Blind, Controlled Trial
Authors: Man SY , Woo WK , Lam PKW , Rainer TH 
Published: December 2017

Objectives To investigate the efficacy and safety of oral paracetamol compared with oral non-steroidal anti-inflammatory drugs (NSAIDs) or combination therapy in relieving pain after limb injury in an emergency department. Design Double blind, randomised, controlled study. Setting Emergency department of a university hospital in the New Territories of Hong Kong. Subjects 50 adult patients with painful isolated limb injuries. Main outcome measures Primary outcome measures were pain relief at rest and with limb movement, and adverse events. Results There was no statistical difference in the mean reduction in pain score between oral paracetamol and oral NSAIDs in the first two hours of treatment or over three days. Patients' pain reduced significantly over three days but it was unclear whether this was due to natural healing rather than analgesic medication. There was no significant difference in pain relief between paracetamol and NSAIDs over three days treatment. All combinations appeared to be safe with no major adverse effects reported in the study. Conclusion Oral paracetamol may be as effective and as safe as moderate dose of NSAIDs in the management of musculoskeletal pain. A larger study is required to confirm this hypothesis.
Go‐Kart Related Injuries: A Local Scene
Authors: Ng CP , Chung CH 
Published: December 2017

ObjectivesTo study the characteristics and nature of injuries relating to go‐kart in the local setting and to compare the findings with those reported in the medical literature.MethodsA prospective survey of patients with go‐kart related injuries attending the accident and emergency department of a public district hospital in Hong Kong within the year 2002. The data were analysed and compared with previous studies.ResultsForty‐two patients were collected in the study. The mean age was 26 years. Ten patients (23.8%) were at or below the age of 20 years. Twenty‐nine patients (69.0%) were males. Out of the 42 patients, all were riders except one who was a bystander. Thirty‐three patients (78.6%) had injuries in indoor tracks. Ten (23.8%) patients were admitted and five (50%) of those admitted required operations. There was no fatality. Twenty‐seven patients (64.3%) had only single injury. Most (64.2%) were minor soft tissue injuries. However, fractures or dislocations occurred in 13 patients (31.0%). Two patients (4.8%) suffered from internal organ injuries. Isolated head and facial injuries occurred in 11.9% of patients. All were simple concussion. Nine patients (21.4%) suffered from isolated lower limb injuries, with more than half sustaining fractures or dislocations. Collision with other karts (40.5%) was the most frequent mechanism of injury. Riding in outdoor track was associated significantly with increased admission when compared with indoor track (77.8% vs 9.1%, p<0.001). There was no association between rider's age, gender, previous riding or injury experience, or the presence of briefing before the race with the rate of admission.ConclusionGo‐kart racing and working on racing track can be a recreation or occupation with potential dangers. In our study, characteristics of patients, mechanisms and types of injuries were similar to other western studies. Accidents on outdoor tracks appeared to be more serious and more likely admitted than those on indoor circuits. Special safety precautions on outdoor events may help to reduce the severity of injuries. However, drivers with more riding or injury experiences were not exempted from severe injuries. Moreover, presence of briefing before the race did not help reduce the admission rate either. Perhaps, a safe and careful attitude of the rider and a seriously conducted briefing by a qualified instructor would be more important to reduce accidents. Further proper large scale controlled epidemiological studies will definitely help to improve the understanding of go‐kart related injuries.
Short-Haul Flight: Is it a Risk to Pulmonary Embolus?
Authors: Wahab M Abd , Hassan Aa Abu 
Published: December 2017

Introduction Pulmonary thromboembolism (PTE) still remains a diagnostic challenge to junior doctors working in emergency departments. Being aware of the condition and its associated risk factors can improve the diagnostic accuracy. Association between passenger travelling long-haul flight and PTE has been well documented; however its association with short-haul flight is very rare and controversial. This case report illustrates the possible linkages between short-haul air travel with the development of classic non-fatal PTE. Clinical feature A young Indian gentleman after travelling four hours on a flight complained of progressive worsening of breathlessness when he arrived at Kuala Lumpur. Clinically he was tachypnoeic and tachycardiac. The electrocardiogram showed T inversion in leads III and aVF, and S wave in lead I. Oligaemia was shown on the chest X-ray and hypoperfused areas were seen on the spiral computed tomographic angiogram. Treatment He was started on unfractionated heparin, switched to low molecular weight heparin, and then warfarin and subsequently admitted to the coronary care unit. Outcome He was discharged well on day 7 after admission with warfarin and medical advice before returning to India. Conclusion Non-fatal PTE is at times difficult to diagnose and requires a high index of suspicion. Its association with healthy passengers of short-haul flight is not well established and this case report illustrates the possibility of linkages.
Nebulizer versus Inhaler with Spacer for Beta-Agonist Treatment in Acute Bronchospastic Disease
Authors: Lee GPC , Sung WY , Fung HT , Kam CW 
Published: December 2017

Objectives To compare the efficacy of nebulized wet aerosol with metered-dose inhaler with a spacer (MDIS) in the management of acute bronchospasm. Methods It was a retrospective study by reviewing the clinical records of patients with acute exacerbation (chief complaint of shortness of breath) of asthma or chronic obstructive pulmonary disease (COPD) presenting to the Accident and Emergency Department (AED) of Tuen Mun Hospital from 1st to 30th November 2002 and 2003 respectively. All patients received beta-agonist by nebulizer, in the year 2002 (pre-SARS period) while all patients received treatment by MDIS in the year 2003 (post-SARS period). Treatment outcome measures included admission rate, length of hospitalisation for those admitted and AED re-attendance within 7 days for those discharged from the AED. Results Altogether 821 patients were recruited in this retrospective study, 522 belonged to the nebulizer group and 299 were of the MDIS group. The two groups had similar demographic characteristics. Concerning the admission rate (47% in the nebulizer group and 41% in the MDIS group; p=0.089) and re-attendance rate (7% in the nebulizer group and 6% in the MDIS group; p=0.607), the differences were not statistically significant. For the length of hospital stay, it was shorter in the nebulizer group than the MDIS group (3.65±SD 1.88 days vs 4.10±SD 1.94 days; p=0.035). However, the admission rate in the adult subgroup (61% in the nebulizer group and 47% in the MDIS group; p=0.002) was shown to be statistically significant. In multivariate analysis, usage of nebulizer, increase in respiratory rate and age were associated with a higher admission rate. Increase in SpO2, absence of co-morbidity and asthma patients were associated with a lower admission rate. Increase in age, respiratory rate and usage of MDIS were associated with an increase in hospital stay. Asthma was associated with a decrease in AED re-attendance rate as compared to COPD. Conclusions This retrospective study showed that both nebulizer and MDIS were effective for beta-agonist therapy in acute bronchospasm in AED with respect to hospital admission rate and AED re-attendance rate, but the length of hospital stay was slightly prolonged when using MDIS.