bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Patients with Successfully Converted Paroxysmal Supraventricular Tachycardia after Four Hours of Observation in an Emergency Department of a District Hospital in Hong Kong
Authors: Chan HY , Yuen WL 
Published: December 2017

Objective Paroxysmal supraventricular tachycardia (PSVT) is a common problem encountered in the accident & emergency department (AED). Most patients can be successfully converted to sinus rhythm by vagal manoeuvres or adenosine tri-phosphate (ATP) or may even convert spontaneously in the AED. The objective was to test the safety of a protocol in managing this group of patients. The outcomes and recurrence rate of PSVT patients who had been converted to sinus rhythm and discharged from the AED after a period of observation using a simple protocol were studied. Methods This was a prospective study on PSVT patients aged between 18–70 years from June 2003 to August 2005. The outcomes and recurrence rates of the PSVT patients within two periods, namely, 24 hours and 90 days after discharge from the AED, were assessed by the computerized system in public hospitals under the Hong Kong Hospital Authority. Results A total of 42 PSVT patients after successful conversion were discharged from the AED after four hours of observation. None had recurrence of PSVT within 24 hours. Four patients (9.5%) presented with recurrent PSVT within 90 days after discharge without negative outcomes. The timing of recurrence ranged from 2 to 22 days (mean 15 days). All the four patients had past history of PSVT and three of them had already been on long term anti-arrhythmic medication. One recurrent PSVT patient was arranged to undergo radiofrequency ablation. Conclusion PSVT patients successfully converted by vagal manoeuvre or ATP or converted spontaneously can be safely discharged from the emergency department after four hours of observation under the study protocol.
Pulse Oximetry: A Survey of Knowledge among Staff of an Emergency Department
Authors: Lee LLY , Yeung KL , Lo WYL , Chan JTS 
Published: December 2017

Introduction Pulse oximetry measures arterial oxygen saturation and was introduced into the clinical field since the 1980s. It provides a simple, portable, non-invasive and inexpensive way for monitoring blood oxygen saturation. Previous studies demonstrated that most hospital staff had limited knowledge on the correct use of pulse oximetry and what might affect the readings. This study aimed at evaluating the extent of knowledge in pulse oximetry among the clinical staff of an emergency department. Method A 25-item multiple-choice type questionnaire was given to the medical and nursing staff of the Accident and Emergency Department (AED) of the Alice Ho Miu Ling Nethersole Hospital. In addition to demographic information, respondents were required to answer questions relating to the basic principles of pulse oximetry, recognition of physiological factors limiting its accuracy and management regarding hypothetical scenarios. The scores were expressed and analysed on a scale of 0–100. Results A total of 44 questionnaires were completed by 27 nurses and 17 doctors with their test scores ranging from 20 to 72 (median=46). Doctors (median=56) did better than nurses (median=44) in general (P=0.036) but this advantage, however, did not apply to questions on hypothetical scenarios where nurses performed better on the contrary. Correlation analysis proved that there was no linear relationship between respondents' test scores and their years of clinical experience (r=0.051, Spearman). This absence of linear relationship also applied to individual doctors (r=0.244, Spearman) and nurses groups (r=0.162, Spearman). Conclusion There was insufficient knowledge on the use of pulse oximetry among staff of the AED. The level of understanding did not correlate with their clinical experience. Training programs targeting both the fresh and the experienced staff are recommended.
How Do Critically Ill Children Present to a Local Emergency Department?
Authors: Fan KL 
Published: December 2017

ObjectiveTo describe the profile of critically ill paediatric patients presenting to a local emergency department.MethodsThis was a retrospective review of all triage Category 1 (critical) children aged from 0 to 16 years presenting to the emergency department of Queen Mary Hospital. The study period was from January 1998 to September 2006.ResultsA total of 277 patients were analyzed. Trauma was a major cause of presentation. It constituted 37.9% of the cases. Of the trauma cases, head injury was the most common. For non‐trauma cases, convulsion was the commonest reason of attendance. Cardiorespiratory arrest was uncommon (3.6%). The overall mortality rate was 7.6%. A high proportion (43.3%) of the patients was managed solely by staff of the emergency department. Resuscitative procedures, such as intraosseous line, were infrequently practised.ConclusionTrauma and convulsion were the major presentations of critically ill children. The fact that A&E staff managed a high proportion of the cases alone and the infrequent practice of resuscitative procedures make continuous training in paediatric resuscitation particularly important.
The Impact of an Emergency Department Toxicology Team in the Management of Acute Intoxication
Authors: Chung AHY , Tsui SH , Tong HK 
Published: December 2017

Objective To evaluate the impact of the recently established Emergency Department (ED) Toxicology Team of Queen Mary Hospital (QMH) in the management of acute intoxication. Method A descriptive comparative study with retrospective data collection from all intoxicated and suspected intoxicated patients over two separate half-year periods in 2001 and 2006, before and after the establishment of the ED Toxicology Team in July 2005. Data on reasons of intoxication, drugs and substances involved, ED treatments, patient disposition, length of stay in ED, length of stay in hospital, patient outcome, and 30-day ED re-attendance and hospital re-admission were collected and examined. Results A total of 333 intoxicated patients were included in the study, 171 in 2001 and 162 in 2006. The basic epidemiological data were similar in both groups. There was a marked reduction in hospital admissions from 89.5% to 40.7% (P<0.01) and significant decline in average length of hospital stay from 46.8 hours to 29.2 hours (P<0.05). There was no statistically significant difference in patient outcome, 30-day ED re-attendance and hospital re-admission. Conclusion Our findings showed that the establishment of the ED Toxicology Team in QMH achieved significant reductions in hospital admissions and the length of stay in hospital in the management of patients with acute intoxication without jeopardising patient outcome. The results illustrate that the new model has a beneficial role in reducing cost and alleviating stress on hospital bed availability, therefore it can be recognised as a cost-effective means of management of acute intoxication.
How Safe is Intravenous N‐Acetylcysteine for the Treatment of Paracetamol Poisoning?
Authors: Merl W , Koutsogiannis Z , Kerr D , Kelly AM 
Published: December 2017

ObjectiveParacetamol poisoning remains one of the most common and potentially lethal ingestions. N‐acetylcysteine (NAC) has been proven to be a highly effective antidote. The aim of this study was to determine the rate of adverse drug reactions (ADR) to intravenous (IV) NAC. Our hypothesis was that IV NAC for the treatment of paracetamol toxicity has a low rate of adverse events.MethodsThis was an observational cohort study undertaken by explicit retrospective medical record review. It included patients who presented to the emergency department with paracetamol overdose over the ten‐year period from July 1995 to June 2004. The primary outcome measure was the occurrence of an ADR during NAC administration. Adverse drug reactions were classified as minor (including flushing, urticaria, pruritus, bronchospasm, tachycardia, and non‐ischaemic chest pain) and major (including hypotension, angio‐oedema and death). Data analysis was by descriptive statistics and chi‐square analysis using univariate analysis, Fisher's exact test and Mann‐Whitney U‐test. Inter‐rater agreement was checked for 9% of the sample.ResultsThere were 470 cases of paracetamol poisoning. Of these, 320 received IV NAC. Thirty‐six (11%, 95% CI 8–15%) of these patients developed ADRs. There were two major ADRs, one hypotension and one angio‐oedema (0.6%, 95% CI 0.02–2%). Two patients died during hospitalisation, but neither had an ADR to NAC. The most common ADRs were urticaria (20), flushing (15), bronchospasm (12), and pruritus (3). None of the variables analysed was a clinically significant predictor of increased ADR risk.ConclusionAdverse drug reactions after IV NAC infusion occur commonly, but most are minor. Treatment of paracetamol poisoning with IV NAC appears to be safe, however a large prospective study would be required to confirm this.
Elevated Heart‐Type Fatty Acid‐Binding Protein Predicts Early Myocardial Injury and Aids in the Diagnosis of Non‐St Elevation Myocardial Infarction
Authors: Naroo GY , Ali S Mohamed , Butros V , Haj A Al , Mohammed I , Alosert M , Terris J , Fikree M 
Published: December 2017

BackgroundBiomarkers play an important role in the early diagnosis, risk stratification and management of patients with the acute coronary syndrome.ObjectiveThe objective of this study was to evaluate the clinical reliability of heart‐type fatty acid‐binding protein (h‐FABP) in identifying patients with the acute coronary syndrome in the early hours of chest pain.MethodsCreatine kinase (CK‐MB) (in laboratory), troponin T (in laboratory) and h‐FABP (with point‐of‐care test CardioDetect®) were performed on 791 patients who presented with chest pain with duration since onset ranging from 20 minutes to 12 hours.ResultsData of the 791 patients were analysed. h‐FABP had a higher sensitivity of 75.76% and a specificity of 96.97% compared with 58.59% and 98.84% for troponin T and 68.69% and 97.54% for CK‐MB respectively (in the first 6 hours). Conclusion: h‐FABP was found to be a better biomarker of cardiac necrosis in the early hours in the diagnosis of non‐conclusive ECG in patients with acute myocardial infarction. (Hong Kong j.emerg.med. 2009;16:141–147)
The Minimum Clinically Significant Difference in Visual Analogue Scale Pain Score in a Local Emergency Setting
Authors: Mark MSM , Au TTS , Choi YF , Wong TW 
Published: December 2017

ObjectivesTo determine whether the minimum clinically significant difference (MCSD) in visual analogue scale (VAS) pain score varies with age, gender, education level and cause of pain (trauma versus non‐trauma) in Chinese patients.MethodsThis was a prospective descriptive study of local Chinese patients 15 years of age or older who presented with pain to the accident & emergency department. On presentation, patients were asked to indicate their current pain severity with a single mark through a standard 100–mm visual analogue scale. Then they would be offered an analgesic for pain‐relief. After 30–45 minutes, the patients were asked to give a verbal categorical rating of their pain as ‘a lot better’, ‘a little better’, ‘much the same’, ‘a little worse’, or ‘much worse’ and to mark the level of pain on a VAS of the same type as used previously. The MCSD in VAS pain score was defined as the mean difference between the current and preceding scores when the subject reported ‘a little worse’ or ‘a little better’ in pain. Data were compared based on gender, age, education level, and traumatic versus non‐traumatic causes of pain.Results186 patients were enrolled in the study, yielding 77 evaluable comparisons where pain was rated as ‘a little better’ or ‘a little worse’. Overall, the MCSD in VAS pain score in the group was 17 mm (95%CI 13.6 mm to 20.6 mm). There were statistically significant differences between the MCSD in VAS pain score between genders and causes of pain (trauma versus non‐trauma).ConclusionsThe MCSD in VAS pain scores was found to be 17 mm. There was significant differences in MCSD in VAS pain score in different genders and between trauma and non‐trauma cases.
What Have We Learnt from Bacterial Stool Culture Results? a Retrospective Study of Hospitalised Gastroenteritis Cases in a Regional Hospital in Hong Kong
Authors: Wong HT , Que TL , Ho PL 
Published: December 2017

BackgroundStool culture is one of the common investigations done for patients with gastroenteritis, and fluoroquinolones have been used frequently for suspected bacterial gastroenteritis.ObjectiveTo study the yield of bacterial pathogens in stool culture in a local regional hospital for in‐patients with gastroenteritis and the individual pathogens identified. Also, the value of stool culture and the prescription of fluoroquinolones as empirical antibiotics were reviewed.MethodsThis was a retrospective study. All in‐patients with the principal diagnosis of “gastroenteritis” in the year 2007 were reviewed. We excluded pregnant patients and patients under 18 years of age. Patients were divided into two age groups and data were analysed including demographics, clinical findings, admission time and culture results. Antibiotics prescription behaviour was also analysed.ResultsA total of 837 adult patients fulfilled the criteria. Among them, 562 cases had their stool saved and sent for bacterial culture. Eighty‐nine cases were found to have their stool cultures positive for bacteria. The identified pathogens were namely Vibrio parahaemolyticus (38.2%), Salmonella species (34.8%), Campylobacter species (11.2%), Plesiomonas species (10.1%) and Aeromonas species (3.4%) respectively. The yield of positive stool culture was 15.8%.ConclusionVibrio parahaemolyticus and Salmonella species were still the most common pathogens for bacterial gastroenteritis among hospitalized patients in Hong Kong, especially in the young and middle aged. Their occurrence followed a seasonal pattern. Physicians had a tendency to prescribe fluoroquinolones for cases with fever and travel history. Also, the problem of antibiotic resistance did exist. It is important for practitioners to follow local guidelines before ordering microbiological investigations on stool and prescribing empirical antibiotic treatment.
Venomous Fish Sting Cases Reported to Hong Kong Poison Information Centre: A Three‐Year Retrospective Study on Epidemiology and Management
Authors: Chan HY , Chan YC , Tse ML , Lau FL 
Published: December 2017

ObjectiveTo study the epidemiology of venomous fish sting injuries, management and clinical outcomes of injured patients reported to the Hong Kong Poison Information Centre (HKPIC).MethodsAll venomous fish sting cases reported to HKPIC from July 2005 to June 2008 were retrieved from its database (DATOX) and the Hong Kong Hospital Authority (HA) Electronic Patient Record (ePR) computer system for analysis.ResultsThere were a total of 33 fish sting cases in this study. The average age of the patients was 43 years (range 20 to 84) and 24 patients were males. Most cases were injured by catfish (n=12), followed by stonefish (n=7) and lionfish (n=4). Ten cases sustained fish sting injury whilst at work. Five patients developed fish sting complications including cellulitis, subacute tenosynovitis, abscess formation and foreign body retention. No mortality was recorded. Within 7 cases of stonefish injury, 3 cases were classified as moderate effect outcome. Two patients received stonefish antivenom and none developed anaphylaxis.ConclusionThe majority of marine envenomations did not result in significant morbidity and required only supportive management. However, stonefish injuries might be associated with an increased risk of severe local symptoms which therefore required aggressive treatment including antivenom.
Ruptured Abdominal Aortic Aneurysm: A 7‐Year Retrospective Observational Study in an Emergency Department of Hong Kong
Authors: Chu NH 
Published: December 2017

ObjectivesTo review the clinical presentations and outcomes of patients with ruptured abdominal aortic aneurysm (AAA) in a regional hospital and its evaluation in the accident and emergency department (AED).MethodsThis is a retrospective observational study of patients admitted through the AED with the discharge or post‐mortem diagnosis of ruptured AAA from 1st January 2002 to 31st December 2008 in a regional pubic hospital of Hong Kong. Their demographic and clinical data were recorded and analysed. The sensitivity of the AED in detecting ruptured AAA or symptomatic AAA was evaluated.ResultsTwenty‐six patients were found to have ruptured AAA and included in the study. All were Chinese. Seventeen patients had repair surgery done by open surgical method. Eighteen (69%) patients were diagnosed to have ruptured AAA or found to have symptomatic AAA in the AED. Three (12%) ruptured AAAs were diagnosed at post‐mortem. The most common presenting symptoms were abdominal pain (73%) and loss of consciousness (46%). Only five (19%) patients had the classical triad of abdominal pain, haemorrhagic shock and a pulsatile abdominal mass. Ultrasound of aorta was performed in 74% of cases in the group with ruptured AAA or symptomatic AAA diagnosed in the AED but none in the delayed diagnosis group (p=0.001). The former group were 3.7 times more likely to proceed to repair surgery (p=0.188) and had surgical repair operation 40.8 hours earlier than the latter group (p=0.006). Systolic blood pressure less than 90 mmHg at any time point before operation was found to correlate significantly with mortality (p=0.029).ConclusionA high index of suspicion and prompt recognition of ruptured AAA is of paramount importance. Emergency physicians should familiarise themselves with the clinical presentation and management of patients with ruptured AAA. Emergency ultrasound performed in the AED helps in the early detection of AAA.
Evaluating the Role of a Triage Electrocardiogram Protocol at an Urban Emergency Department
Authors: Lim BL , Vasu A , Lim GH 
Published: December 2017

ObjectiveOur emergency department (ED) performs triage ECG for a variety of complaints to identify patients in need of treatment escalation. The aim of this study was to evaluate the existing triage ECG protocol as a means of treatment decision making.MethodsThis prospective observational study was conducted in an urban ED over one week. We recruited all patients aged 18 years and above with an undiagnosed complaint requiring a triage ECG based on the existing departmental protocol. As part of the protocol, an experienced emergency doctor then reviewed the ECG to determine the need for treatment escalation. Explicit data collection was performed using our electronic database. The outcome measures were proportions of triage treatment escalations, reasons for escalation and disposition status. Analysis was by descriptive statistics.Results739 patients were recruited from a total attendance of 3228. The rate of triage ECG was 23%. There were 22 (3%) triage escalations. Usually each escalation resulted from a combination of reasons. These included important ECG changes (77%), abnormal vital signs (5%) and ongoing symptoms (95%).ConclusionsThe triage ECG protocol resulted in important escalations in a small proportion of presentations. Future research is needed to refine guidelines on the use of triage ECG for different ED complaints.
Incarcerated Inguinal Hernia in Children
Authors: Turkyilmaz Z , Sonmez K , Karabulut R , Demirogullari B , Ozen IO , Kapisiz A , Kale N , Basaklar AC 
Published: December 2017

IntroductionThe aim of this study was to document the data of incarceration in a group of children with inguinal hernia and to investigate whether incarceration could have been prevented.Materials and methodsA retrospective study reviewed the records of 3100 children who underwent herniorrhaphy between 1989 and 2007 in one centre, with 113 patients having hernia incarceration. In 16 patients, manual reduction was not attempted because of signs of strangulation, and in the remaining ones, reduction following sedation was not successful. The patients were evaluated with respect to age, postoperative mortality, and morbidity and especially whether he or she had been scheduled for operation in a surgical department. The incidence of incarcerated inguinal hernia and risk factors were analysed.ResultsOf the 113 patients with incarcerated inguinal hernia, 105 were boys (92.9%), with a male to female ratio of 13:1. The majority of the patients were under one year of age (n=73); and 47 were 0‐3 months old. Three laparotomies, 7 small intestinal resection and primary anastomoses, 2 oophorectomy, 7 partial omentectomy and 8 appendectomies were performed. During the 6 months to 18 years follow‐up, testicular atrophy was seen in 4 boys. Two babies died. Scrotal oedema, testicular atrophy and mortality rate were significantly higher in incarcerated hernia patients compared with those without incarceration (all with p=0.001).ConclusionsApparently, incarceration may be a preventable problem. Priority should be given to the treatment of inguinal hernias in infants less than 1 year of age, especially those 1‐3 months old, as their risk of incarceration is higher.
Traumatic Rupture of Giant Pulmonary Hydatid Cyst in a Child
Authors: Karamustafaoglu Y Altemur , Gungor A 
Published: December 2017

Introduction Trauma as a cause of hydatid cyst rupture leads to various clinical conditions, especially in children. Current literatures regarding the clinical presentation and management of such patients are rare. Case report A 14-year-old child was admitted with chest pain and dyspnoea due to blunt thoracic trauma after falling off a bicycle. Chest computed tomography showed right hydropneumothorax and cystic cavity. After chest tube insertion, massive air leak was observed from the tube. Cystotomy and capitonnage were performed on the right lower lobe via a posterolateral thoracotomy. He was discharged from the hospital in good condition. Conclusion Ruptured hydatid cysts into the pleura are difficult to diagnose radiologically. It can be misdiagnosed radiologically as empyema or hydrothorax. In undetermined cases, all the findings may be suggestive but not diagnostic. Operation must be performed early for exploration when the condition is suspected. High complication rate has been found in children who were operated late.