bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Epidemiology of Patients with Dizziness in an Emergency Department
Authors: Lam JMY , Siu WS , Lam TS , Cheung NK , Graham CA , Rainer TH 
Published: December 2017

Objectives The aims of this prospective study were (1) to describe the patterns of presentation, causes and disposition of patients with dizziness in an emergency department (ED) and (2) to identify the factors that predict central vestibular disorder. Methods All adult patients (≥18 years) attending our ED with a chief complaint of dizziness were included. Demographic characteristics, presenting complaint, symptoms, past medical illnesses, physical findings, provisional diagnosis and disposition were recorded in a data collection sheet by the medical officers. Results A total of 104 consecutive dizzy patients were recruited from 12th to 19th December 2003. The incidence of adult patients with dizziness was 4.0% (104/2594). There were 34 (32.7%) male and 70 (67.3%) female patients; 64 (61.5%) patients were below 65 and 40 (38.5%) were above 65. Lightheadedness (61.5%), vertigo (31.7%) and disequilibrium (4.8%) were the most frequent complaints. Nausea and/or vomiting (32.7%) and raised blood pressure on arrival (23.1%) were the most common associated symptoms and physical finding respectively. Hypertension (38.5%) was the most common pre-existing medical illness. Of all patients, 63.5% had non-vestibular disorder, 31.7% had peripheral vestibular disorder and 4.8% had central vestibular disorder. A clinical diagnosis could be made in 52.9% of our dizzy patients and about 20 different diagnoses were made. The majority (82.7%) of the patients were discharged from the ED. A presenting complaint of lightheadedness, altered mental state, focal neurological signs, raised blood pressure and history of stroke were predictors of central vestibular disorder (p<0.05). Conclusions Lightheadedness and vertigo were the two commonest presentations of dizzy patients. Most dizzy patients had benign causes and could be discharged from the ED. Lightheadedness, focal neurological symptoms and signs, altered mental state, hypertension and previous stroke were factors that would help to diagnose central vestibular disorder.
Treatment and Outcome of Acute Cardiogenic Pulmonary Oedema Presenting to an Emergency Department in Hong Kong: Retrospective Cohort Study
Authors: Kwok TYT , Mak PSK , Rainer TH , Graham CA 
Published: December 2017

Objectives To explore the epidemiology, treatment and outcome of acute cardiogenic pulmonary oedema (ACPO) in a Hong Kong emergency department (ED). Methods This was a retrospective cohort study in a university hospital ED. Cases were identified from ED records and resuscitation room logbooks. The study extended from 1 September 2004 to 30 April 2005. Parametric tests and logistic regression were used to identify predictors of survival. Results A total of 140 patients were identified, with a mean age of 75 years and male:female ratio of 1:1.4. Mean values (range) on presentation were as follows: pulse rate 103 beats/minute (36–108); blood pressure (BP) 169/88 mmHg (77-274/20-162) and respiratory rate 31 breaths/minute (12–88). Past medical history included previous ACPO (12.1%), diabetes (45.7%), chronic obstructive pulmonary disease (9.3%), ischaemic heart disease (45.0%), hypertension (72.1%) and congestive heart failure (40.7%). On admission, 47.1% had pH<7.35 and 40.7% had PaCO2>5.5kPa. ED treatments included: sublingual nitrates (n=2), intravenous (IV) nitrates (n=89, median 10 mg/hr), IV frusemide (n=85, median 40 mg), IV morphine (n=25, median 3 mg). There were 21 patients on non-invasive ventilation; 27 intubations and 41 patients were admitted to the intensive care unit. Survival to discharge was 95.7%; and median length of hospital stay was 8 days. The 90-day all-cause hospital readmission rate was 30.0%. The 30-day mortality was 12.9% (n=18) and 90-day mortality was 29.3% (n=41). Logistic regression showed that past history of hypertension (p=0.0061), higher systolic BP on ED discharge (p=0.0102) and lower creatinine following treatment (p=0.035) were predictors of improved survival at 90 days. Conclusion ACPO commonly presents to the ED in Hong Kong and has a high 90-day mortality. Previous hypertension, higher systolic blood pressure on leaving the ED and lower creatinine following treatment predict improved survival at 90 days.
Exertional Heat Stroke: A Lucky Bunch of Overly Motivated Policemen!
Authors: Shafie H , Wahab M Abd , Masilamany M , Hassan AA Abu 
Published: December 2017

IntroductionExertional heat stroke is a true medical emergency resulting from thermoregulatory failure. The risk of death is related directly to the peak temperature, duration of exposure and acclimatisation period. This case report illustrates the management of multiple casualties of heat stroke in the emergency department and their outcomes.Clinical featureNine policemen arrived in the emergency department in semiconscious state after being retrieved from a group of policemen who were loaded into a bus without proper ventilation during a selection program. All of them presented with hyperpyrexia, hypotension, tachycardia and altered sensorium.TreatmentImmediate evaporative cooling with support of organ‐system dysfunction was commenced. Six patients were intubated and admitted to the intensive care unit. One patient was monitored in high dependency ward while the other two were admitted to the general medical ward.OutcomeAll patients were extubated within 48 hours. None of them had residual neurological dysfunction. One patient developed coagulopathy which required blood product transfusion. Three patients were discharged in less than one week and the rest were observed in the general ward in stable condition for liver profile monitoring.
A Case of Methanol Poisoning
Authors: Chan CK , Chan YC , Lau FL 
Published: December 2017

A 29‐year‐old male took about 300 ml industrial alcohol in a suicidal attempt. The industrial alcohol was later confirmed to be methanol. He presented to the emergency department 10 hours post‐ingestion with an anion gap metabolic acidosis and an osmol gap of 76.7 mOsm/kg. Ethanol infusion was started in the emergency department at 11 hours post‐ingestion before the availability of serum methanol level. The clinical diagnosis of toxic alcohol ingestion was based on the history, arterial blood gases results and the presence of a significant osmol gap. The patient was then admitted to the intensive care unit for ethanol therapy and haemodialysis. Prompt initiation of ethanol therapy and the subsequent intensive care prevented the development of life‐threatening complications of methanol poisoning in this case.
A Case Series of Puffer Fish Poisoning
Authors: Wan CK , Tsui SH , Tong HK 
Published: December 2017

Puffer fish poisoning caused by tetrodotoxin, a potent neurotoxin, is uncommon in Hong Kong. We report a total of seven cases of puffer fish poisoning with different levels of severity. Two of them developed respiratory distress and subsequently required endotracheal intubation and respiratory support while the others presented with numbness and mild weakness. Most of them experienced perioral numbness as the first symptom. The mean time of symptoms onset was approximately 94 minutes. All of our patients survived the intoxication.
Isolated Posterior Acute Myocardial Infarction Presenting to an Emergency Department: Diagnosis and Emergent Fibrinolytic Therapy
Authors: Lim HC , Goh SH , Fadil MF Mohd 
Published: December 2017

Objectives Isolated posterior acute myocardial infarction (AMI) is rare and possibly underdiagnosed. The incidence of misdiagnosis in the emergency department (ED) is unknown. Delayed diagnosis may prevent timely treatment, particularly emergent fibrinolytic therapy. We describe the experience of an urban ED on this rare condition. Methodology A six years and seven months case series of isolated posterior AMI of initial presentation (as identified by inpatient discharge/death ICD-9-CM diagnosis code) was studied. Patients not admitted from the ED, those who developed isolated posterior AMI only after admission and/or those with concomitant ST segment elevation AMI involving other anatomical locations of the heart (e.g. inferior or lateral walls), were excluded. Results Eleven cases were included in the study. All the nine cases with electrocardiograms available for review demonstrated features consistent with isolated posterior AMI. Eight out of the eleven (72.7%) cases were correctly diagnosed as isolated posterior AMI in the ED. The other three cases were treated as non-ST elevation myocardial infarction (NSTEMI). Nevertheless, their lack of the typical symptoms of acute coronary syndrome and delayed presentation (more than 12 hours) precluded them from fibrinolytics. Three of the eleven cases received fibrinolytics (all streptokinase). All three cases survived to discharge and there were no haemorrhagic complications. None of the cases underwent emergent percutaneous coronary intervention. Conclusion The majority of cases with isolated posterior AMI (72.7%) were diagnosed in the ED. Although three cases were interpreted as NSTEMI, the use of fibrinolytic reperfusion therapy was not affected.
Bleeding Pelvic Fractures: Updates and Controversies in Acute Phase Management
Authors: Lai CH , Kam CW 
Published: December 2017

Background The management of patients with haemodynamic instability related to pelvic fractures is a major challenge with high mortality and morbidity. The treatment priorities have long been a source of debate. Many advocate emergent external fixation (EX-FIX) as the first line of treatment, whereas another school favours the efficacy of transcatheter arterial embolisation (TAE). Decision-making within the ‘Golden Hour’ in the emergency department (ED) is crucial to patients' ultimate outcome. Our aim was to evaluate the current management pathways in our centre and to review the latest literature. Methods We present a 2-year case series (from January 2005 to December 2006) of patients with pelvic ring disruption and haemodynamic instability. Data were collected regarding patients' demographics, fracture patterns according to the Young & Burgess classification, concomitant intra-abdominal injuries, treatment pathway and the response to treatment. Results There were 7 patients identified. Five were males and 2 were females, with a mean age of 42 years. Fracture types included 3 lateral compression, 1 anteroposterior compression, 2 vertical shear, and 1 combined mechanism. Four patients had significant intraperitoneal haemorrhage identified by Focused Assessment by Sonography for Trauma (FAST). They all needed laporotomy and pelvic packing, initially or subsequently. EX-FIXs were offered to 6 patients as the primary intervention, and 4 of them subsequently required diagnosis with angiography followed by therapeutic embolisation to restore haemodynamic stability. Only 1 patient underwent a second angiographic study to control the arterial bleeding. Two patients died of severe intra-abdominal injuries within 24 hours after admission. Conclusion In patients with pelvic fractures and hypotension, EX-FIX is currently the first line of treatment, with variable efficacy. On the other hand, the high successful embolisation rate and reasonable safety profile of TAE in our patients have been impressive. The latter offers a much better alternative to surgical intervention in selected patients. However, precautions should be taken including proper pelvic stabilisation by non-invasive devices, creation of a safe environment in the angiography suite, and early multidisciplinary decision in the ED.
Bier'S Block for Emergency Department Management of Distal Radius Fractures
Authors: Richards CH , Graham CA , Munro PT 
Published: December 2017

Background Distal radius fractures commonly present to emergency departments (ED). Optimum treatment methods remain unclear and individual hospital practices differ. Objectives To ascertain the number and success rate of manipulation under intravenous regional anaesthesia (IVRA) of distal radius fractures, and to determine the re-manipulation rate. Methods Retrospective observational study of patients undergoing manipulation of distal radius fracture under IVRA in the ED from January 2003 to January 2004. The resuscitation room procedure log, hospital computer records, ED records and theatre records were examined for each patient. Results A total of 84 manipulations were performed. Complete information was available for 74 procedures (73 patients). Manipulation was successful in 73.5% with only 19 out of 73 patients requiring operation. All patients were manipulated under IVRA with middle grade or consultant supervision; and 52 (71.2%) patients were managed entirely as outpatients. Conclusion Our policy of manipulating displaced distal radius fractures under IVRA in the ED has a high success rate and allows the majority of patients to be managed as outpatients. This policy may lead to cost savings from a health service financing perspective.
Hepatic Capsular Enhancement: Is it a Hallmark for the Diagnosis of Fitz-Hugh-Curtis Syndrome?
Authors: Oh JH 
Published: December 2017

Introduction Hepatic capsular enhancement on contrast-enhanced computed tomography (CT) is regarded as a typical finding of the Fitz-Hugh-Curtis syndrome. Nevertheless, similar hepatic capsular enhancement may occur in peritoneal carcinomatosis. Clinical picture A 67-year-old man presented with diffuse abdominal pain. CT showed hepatic capsular enhancement and a mass in the sigmoid colon. Treatment As the patient was inoperable, supportive care was provided. Outcome He was transferred to a regional hospital for hospice care. Conclusion When we see a patient with hepatic capsular enhancement on contrast-enhanced CT, we should seek other causes of perihepatitis, in addition to the Fitz-Hugh-Curtis syndrome.
Free Fluid Accumulation following Blunt Abdominal Trauma: Potential for Expansion of the Fast Protocol
Authors: Simpson N , Page P , Taylor DM 
Published: December 2017

ObjectiveTo determine sites of free intra‐peritoneal fluid collection following blunt abdominal trauma, with a view to refinement of the Focused Assessment by Sonography for Trauma (FAST) protocol.MethodsThis was a retrospective observational study of CT scans of subjects who had suffered blunt abdominal trauma and had free intra‐peritoneal fluid detected on CT scan within 24 hours. The depth from the skin and amount of fluid at 14 abdominal sites were determined.ResultsCT scans of 105 patients were examined: 68 (64.8%) were male, mean age 36.7±18.4 years, mean injury severity score 25.4±11.6. Fluid collected most commonly at three sites: right mid‐axillary line at the level of the xiphisternum (52 patients, 49.5%), lateral margin of the right rectus muscle at the level of the anterior superior iliac spine (49 patients, 46.7%) and right mid‐axillary line at the level of the umbilicus (40 patients, 38.1%). Mean depth of fluid at these sites were 3.6, 3.6 and 4.2 cm, respectively.ConclusionsFree fluid collects commonly in the area of the right iliac fossa following blunt abdominal trauma. The inclusion of this site in the FAST protocol may increase the ultrasonographic detection of free fluid in the acute trauma setting.
Clinical Predictors of Intra‐Abdominal Injury in Severe Blunt Trauma Patient
Authors: Goh PL , Schull MJ 
Published: December 2017

IntroductionThe early recognition of intra‐abdominal injury (IAI) in patients with blunt trauma is essential, yet physical examination is often unreliable. Computed tomography (CT) scans are used widely to further evaluate possible IAI but these require time and expense. IAI may be associated with certain objective risk factors or other specific injuries, but this association has not been widely studied. Identification of such risk factors will help to prioritize patients in need for further evaluation of possible IAI.MethodsA retrospective chart review was conducted of all 622 adult severe blunt trauma patients (Injury Severity Score [ISS] >12) presenting to a level 1 trauma centre in 2004. Various clinical predictors of IAI were analyzed statistically with univariate and multivariate analysis using SAS software.ResultsIn multivariate analysis, four significant predictors of IAI were found: positive focused assessment with sonography for trauma (FAST) (OR=48.5, p<0.0001), presence of pelvic fracture (OR=2.4, p=0.0002), chest tube insertion (OR=1.8, p=0.0211), and systolic blood pressure (SBP), where every 10 mmHg decrease indicates a 14% increase in risk (OR=0.986, p=0.001). The absence of all four predictors predicted the absence of IAI with a specificity of 0.776 (95% CI 0.741 to 0.808) and a LR of 2.7 (95% CI 2.0 to 3.5).ConclusionThis study suggests that positive FAST, presence of pelvic fracture, chest tube insertion, and SBP are significant predictors of IAI in adult blunt trauma patients with ISS > 12. The absence of all four predictors is associated with a reduced risk of IAI.
Preferences and Perceptions of Patients Attending Emergency Departments with Low Acuity Problems in Hong Kong
Authors: Graham CA , Kwok WO , Tsang YL , Rainer TH 
Published: December 2017

ObjectiveTo explore why patients in Hong Kong seek medical advice from the emergency department (ED) and to identify the methods by which patients would prefer to be updated on the likely waiting time for medical consultation in the ED.MethodsThe study recruited 249 semi‐urgent and non‐urgent patients in the ED of Prince of Wales Hospital from 26th September 2005 to 30th September 2005 inclusive. A convenience sample of subjects aged ≥15 years old in triage categories 4 or 5 were verbally consented and interviewed by research nurses using a standardized questionnaire.ResultsFrom 1715 potential patients, 249 were recruited ad hoc (mean age 44 years [SD18]; 123 females). About 63% indicated that an acceptable ED waiting time was less than or equal to two hours, and 88% felt that having individual number cards and using a number allocation screen in the ED waiting area would be useful. Perceived reasons for attending the ED rather than other health care providers such as primary health care or the general outpatient clinic (GOPC) included: a desire for more detailed investigations (56%); a perception that more professional medical advice was given in the ED (35%); patients were under the continuing care of the hospital (19%); and patients were referred to the ED by other health care professionals (11%). Notably, 26% of participants had considered attending the GOPC prior to attending the ED. Patients educated to tertiary level expected a shorter waiting time than those educated to lesser degrees (p=0.026, Kruskal‐Wallis test). Suggestions were made on how to provide a more pleasant ED environment for the wait for consultations, which included the provision of a television screen with sound in the waiting area (43%), more comfortable chairs (37%) and health care promotion programs (32%).ConclusionPatients chose ED services because they believed they would receive more detailed investigations and more professional medical advice than available alternatives. Clear notification of the likely waiting times and enhancement of comfort before consultation are considered desirable by patients. Enhanced public education about the role of the ED and making alternatives to ED care more accessible may be useful in reducing inappropriate ED attendances in Hong Kong.
A Fatal Case of Iatrogenic Bilateral Pneumothorax after Acupuncture
Authors: Lam CW , Ng CP , Chung CH 
Published: December 2017

We report a case of fatal iatrogenic pneumothorax after acupuncture. A patient with motor neurone disease presented with shortness of breath after acupuncture. Bilateral pneumothoraces were detected. Bilateral chest drains were inserted. However, the patient succumbed 41 days after admission. On reviewing the literature, pneumothorax was not uncommonly seen after acupuncture, and most patients recovered uneventfully. However, fatal cases still happened.
Association of Renal Dysfunction with Stroke Subtypes in Acute Stroke Patients
Authors: Kavalci C , Guldiken B , Ustundag S , Guldiken S 
Published: December 2017

ObjectivesThere are conflicting published data about the association of renal dysfunction with cerebrovascular diseases. Both diseases have shared risk factors such as hypertension, diabetes mellitus and smoking. In the present study, the relationship of renal dysfunction with stroke subtypes and stroke severity was investigated.Materials and methodsOne hundred and sixty‐two acute stroke patients without known history of renal disease and 148 control subjects were enrolled in the study. Serum urea, serum creatinine level and glomerular filtration rate (GFR) as estimated by the Modification of Diet in Renal Disease formula were used to evaluate renal dysfunction. Stroke patients were divided into two groups as haemorrhagic and ischemic stroke, the latter being further subdivided into small and large vessel disease subtypes according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Stroke severity was assessed by the modified Rankin Scale.ResultsSerum creatinine and urea levels were significantly higher and GFR was significantly lower in the stroke group than the controls (p<0.001, p<0.001, p<0.001, respectively). Serum creatinine level was found significantly higher in haemorrhagic stroke than ischaemic stroke subtypes (p<0.001). There was no difference between ischemic subtypes regarding the measured renal parameters. Stroke severity correlated with increased creatinine levels (p<0.001, β=0.404, 95% CI=1.85‐3.50).ConclusionAcute stoke patients have impaired renal function. Renal dysfunction is particularly more prominent in haemorrhagic stroke and exists probably prior to the stroke. Whether renal dysfunction is an independent risk factor for stroke needs to be clarified by large population studies.
Hong Kong Poison Information Centre: Annual Report 2007
Authors: Chan YC , Tse ML , Lau FL 
Published: December 2017

ObjectiveTo report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2007.MethodsFrom 1st January 2007 to 31st December 2007, all poisoning cases received by HKPIC were retrieved from its database (DATOX) for analysis.Results2842 poisoned cases were analyzed. There were 1199 male and 1610 female patients and more than two‐thirds of the cases were between 20 and 59 years old. Common causes of exposure were suicidal attempt, accident and abusive use. Non‐benzodiazepine sedative‐hypnotic, household products and paracetamol were common poisons exposed. The majority of the patients were managed conservatively, with 8.4% and 6.4% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; less than 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes.ConclusionsThis 2007 annual report provided updated epidemiological information on the poisoning pattern in Hong Kong and highlighted some changes in comparison to the situation in 2006.