Publisher: RMIT Publishing   (Total: 387 journals)

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Showing 1 - 200 of 387 Journals sorted alphabetically
40 [degrees] South     Full-text available via subscription   (Followers: 4)
Aboriginal and Islander Health Worker J.     Full-text available via subscription   (Followers: 16)
Aboriginal Child at School     Full-text available via subscription   (Followers: 7)
About Performance     Full-text available via subscription   (Followers: 13)
Access     Full-text available via subscription   (Followers: 27)
ACCESS: Critical Perspectives on Communication, Cultural & Policy Studies     Full-text available via subscription   (Followers: 13)
Accounting, Accountability & Performance     Full-text available via subscription   (Followers: 18)
ACORN : The J. of Perioperative Nursing in Australia     Full-text available via subscription   (Followers: 19, SJR: 0.198, CiteScore: 0)
Adelaide Law Review     Full-text available via subscription   (Followers: 23, SJR: 0.122, CiteScore: 0)
Advocate: Newsletter of the National Tertiary Education Union     Full-text available via subscription   (Followers: 1)
Agenda: A J. of Policy Analysis and Reform     Full-text available via subscription   (Followers: 1)
Agora     Full-text available via subscription   (Followers: 6)
Agricultural Commodities     Full-text available via subscription   (SJR: 0.123, CiteScore: 0)
Agricultural Science     Full-text available via subscription   (Followers: 2)
AIMA Bulletin     Full-text available via subscription   (Followers: 4)
AJP : The Australian J. of Pharmacy     Full-text available via subscription   (Followers: 14, SJR: 0.142, CiteScore: 0)
Analysis     Full-text available via subscription   (Followers: 3)
Ancient History : Resources for Teachers     Full-text available via subscription   (Followers: 10)
Anglican Historical Society J.     Full-text available via subscription   (Followers: 4)
Annals of the Royal Australasian College of Dental Surgeons     Full-text available via subscription   (Followers: 5)
ANZSLA Commentator, The     Full-text available via subscription   (Followers: 4)
Appita J.: J. of the Technical Association of the Australian and New Zealand Pulp and Paper Industry     Full-text available via subscription   (Followers: 16, SJR: 0.168, CiteScore: 0)
AQ - Australian Quarterly     Full-text available via subscription  
Arena J.     Full-text available via subscription   (Followers: 1)
Around the Globe     Full-text available via subscription   (Followers: 1)
Art + Law     Full-text available via subscription   (Followers: 12)
Art Monthly Australia     Full-text available via subscription   (Followers: 10)
Artefact : the journal of the Archaeological and Anthropological Society of Victoria     Full-text available via subscription   (Followers: 3)
Artlink     Full-text available via subscription   (Followers: 5)
Asia Pacific J. of Clinical Nutrition     Full-text available via subscription   (Followers: 12, SJR: 0.697, CiteScore: 2)
Asia Pacific J. of Health Management     Full-text available via subscription   (Followers: 4)
Aurora J.     Full-text available via subscription  
Australasian Biotechnology     Full-text available via subscription   (Followers: 1, SJR: 0.1, CiteScore: 0)
Australasian Catholic Record, The     Full-text available via subscription   (Followers: 6)
Australasian Drama Studies     Full-text available via subscription   (Followers: 1)
Australasian Epidemiologist     Full-text available via subscription  
Australasian Historical Archaeology     Full-text available via subscription   (Followers: 7, SJR: 0.212, CiteScore: 0)
Australasian J. of Early Childhood     Full-text available via subscription   (Followers: 5, SJR: 0.535, CiteScore: 1)
Australasian J. of Gifted Education     Full-text available via subscription   (Followers: 7, SJR: 0.123, CiteScore: 0)
Australasian J. of Human Security     Full-text available via subscription   (Followers: 1, SJR: 0.144, CiteScore: 0)
Australasian J. of Irish Studies, The     Full-text available via subscription   (Followers: 9)
Australasian J. of Regional Studies, The     Full-text available via subscription   (Followers: 1, SJR: 0.118, CiteScore: 0)
Australasian Law Management J.     Full-text available via subscription   (Followers: 7)
Australasian Leisure Management     Full-text available via subscription   (Followers: 3)
Australasian Musculoskeletal Medicine     Full-text available via subscription   (Followers: 3)
Australasian Music Research     Full-text available via subscription   (Followers: 4)
Australasian Parks and Leisure     Full-text available via subscription   (Followers: 2)
Australasian Plant Conservation: J. of the Australian Network for Plant Conservation     Full-text available via subscription   (Followers: 4)
Australasian Policing     Full-text available via subscription   (Followers: 6)
Australasian Public Libraries and Information Services     Full-text available via subscription   (Followers: 34)
Australasian Review of African Studies, The     Full-text available via subscription   (Followers: 2)
Australian Aboriginal Studies     Full-text available via subscription   (Followers: 8, SJR: 0.13, CiteScore: 0)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Ageing Agenda     Full-text available via subscription   (Followers: 7)
Australian and Aotearoa New Zealand Psychodrama Association J.     Full-text available via subscription   (Followers: 1)
Australian and New Zealand Continence J.     Full-text available via subscription   (Followers: 4)
Australian and New Zealand Sports Law J.     Full-text available via subscription   (Followers: 10)
Australian Art Education     Full-text available via subscription   (Followers: 8)
Australian Bookseller & Publisher     Full-text available via subscription   (Followers: 1)
Australian Bulletin of Labour     Full-text available via subscription   (Followers: 2)
Australian Canegrower     Full-text available via subscription   (Followers: 2)
Australian Coeliac     Full-text available via subscription   (Followers: 1)
Australian Cottongrower, The     Full-text available via subscription   (Followers: 1)
Australian Family Physician     Full-text available via subscription   (Followers: 3, SJR: 0.317, CiteScore: 1)
Australian Field Ornithology     Full-text available via subscription   (Followers: 4, SJR: 0.209, CiteScore: 0)
Australian Forest Grower     Full-text available via subscription   (Followers: 4)
Australian Grain     Full-text available via subscription   (Followers: 2)
Australian Holstein J.     Full-text available via subscription   (Followers: 1)
Australian Humanist, The     Full-text available via subscription   (Followers: 4)
Australian Indigenous Law Review     Full-text available via subscription   (Followers: 21)
Australian Intl. Law J.     Full-text available via subscription   (Followers: 22)
Australian J. of Acupuncture and Chinese Medicine     Full-text available via subscription   (Followers: 4, SJR: 0.116, CiteScore: 0)
Australian J. of Adult Learning     Full-text available via subscription   (Followers: 15, SJR: 0.297, CiteScore: 0)
Australian J. of Advanced Nursing     Full-text available via subscription   (Followers: 14, SJR: 0.299, CiteScore: 1)
Australian J. of Asian Law     Full-text available via subscription   (Followers: 4)
Australian J. of Cancer Nursing     Full-text available via subscription   (Followers: 9)
Australian J. of Dyslexia and Learning Difficulties     Full-text available via subscription   (Followers: 8, SJR: 0.1, CiteScore: 0)
Australian J. of Emergency Management     Full-text available via subscription   (Followers: 30, SJR: 0.354, CiteScore: 0)
Australian J. of French Studies     Full-text available via subscription   (Followers: 7, SJR: 0.123, CiteScore: 0)
Australian J. of Herbal Medicine     Full-text available via subscription   (Followers: 5)
Australian J. of Language and Literacy, The     Full-text available via subscription   (Followers: 4, SJR: 0.282, CiteScore: 1)
Australian J. of Legal History     Full-text available via subscription   (Followers: 15)
Australian J. of Medical Science     Full-text available via subscription   (Followers: 2)
Australian J. of Music Education     Full-text available via subscription   (Followers: 4)
Australian J. of Music Therapy     Full-text available via subscription   (Followers: 9, SJR: 0.549, CiteScore: 1)
Australian J. of Parapsychology     Full-text available via subscription   (Followers: 2, SJR: 0.511, CiteScore: 0)
Australian J. on Volunteering     Full-text available via subscription   (Followers: 2)
Australian J.ism Review     Full-text available via subscription   (Followers: 8)
Australian Life Scientist     Full-text available via subscription   (Followers: 2)
Australian Literary Studies     Full-text available via subscription   (Followers: 6)
Australian Mathematics Teacher, The     Full-text available via subscription   (Followers: 7)
Australian Nursing J. : ANJ     Full-text available via subscription   (Followers: 6)
Australian Orthoptic J.     Full-text available via subscription  
Australian Primary Mathematics Classroom     Full-text available via subscription   (Followers: 5)
Australian Screen Education Online     Full-text available via subscription   (Followers: 3)
Australian Senior Mathematics J.     Full-text available via subscription   (Followers: 2)
Australian Sugarcane     Full-text available via subscription  
Australian TAFE Teacher     Full-text available via subscription   (Followers: 4)
Australian Tax Forum     Full-text available via subscription   (Followers: 3)
Australian Universities' Review, The     Full-text available via subscription   (Followers: 4)
Australian Voice     Full-text available via subscription   (Followers: 6)
Bar News: The J. of the NSW Bar Association     Full-text available via subscription   (Followers: 8)
Bioethics Research Notes     Full-text available via subscription   (Followers: 14)
BOCSAR NSW Alcohol Studies Bulletins     Full-text available via subscription   (Followers: 4)
Bookseller + Publisher Magazine     Full-text available via subscription   (Followers: 5)
Breastfeeding Review     Full-text available via subscription   (Followers: 18, SJR: 0.183, CiteScore: 0)
British Review of New Zealand Studies     Full-text available via subscription   (Followers: 4)
Brolga: An Australian J. about Dance     Full-text available via subscription   (Followers: 3)
Cancer Forum     Full-text available via subscription   (SJR: 0.115, CiteScore: 0)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Chain Reaction     Full-text available via subscription  
Childrenz Issues: J. of the Children's Issues Centre     Full-text available via subscription  
Chiropractic J. of Australia     Full-text available via subscription   (SJR: 0.111, CiteScore: 0)
Chisholm Health Ethics Bulletin     Full-text available via subscription   (Followers: 1)
Church Heritage     Full-text available via subscription   (Followers: 5)
Commercial Law Quarterly: The J. of the Commercial Law Association of Australia     Full-text available via subscription   (Followers: 5)
Communicable Diseases Intelligence Quarterly Report     Full-text available via subscription   (Followers: 2, SJR: 0.563, CiteScore: 1)
Communication, Politics & Culture     Open Access   (Followers: 14)
Communities, Children and Families Australia     Full-text available via subscription   (Followers: 3)
Connect     Full-text available via subscription   (Followers: 2)
Contemporary PNG Studies     Full-text available via subscription  
Context: J. of Music Research     Full-text available via subscription   (Followers: 8)
Corporate Governance Law Review, The     Full-text available via subscription   (Followers: 8)
Creative Approaches to Research     Full-text available via subscription   (Followers: 14)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 25, SJR: 1.032, CiteScore: 1)
Cultural Studies Review     Full-text available via subscription   (Followers: 16)
Culture Scope     Full-text available via subscription   (Followers: 4)
Dance Forum     Full-text available via subscription   (Followers: 6)
DANZ Quarterly: New Zealand Dance     Full-text available via subscription   (Followers: 4)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Deakin Law Review     Full-text available via subscription   (Followers: 15)
Developing Practice : The Child, Youth and Family Work J.     Full-text available via subscription   (Followers: 20)
Early Days: J. of the Royal Western Australian Historical Society     Full-text available via subscription  
Early Education     Full-text available via subscription   (Followers: 8)
EarthSong J.: Perspectives in Ecology, Spirituality and Education     Full-text available via subscription   (Followers: 1)
East Asian Archives of Psychiatry     Full-text available via subscription   (Followers: 3, SJR: 0.36, CiteScore: 1)
Educare News: The National Newspaper for All Non-government Schools     Full-text available via subscription  
Educating Young Children: Learning and Teaching in the Early Childhood Years     Full-text available via subscription   (Followers: 20)
Education in Rural Australia     Full-text available via subscription   (Followers: 3)
Education, Research and Perspectives     Full-text available via subscription   (Followers: 14)
Educational Research J.     Full-text available via subscription   (Followers: 18)
Electronic J. of Radical Organisation Theory     Full-text available via subscription   (Followers: 3)
Employment Relations Record     Full-text available via subscription   (Followers: 3)
English in Aotearoa     Full-text available via subscription   (Followers: 2)
English in Australia     Full-text available via subscription   (Followers: 2, SJR: 0.18, CiteScore: 0)
Essays in French Literature and Culture     Full-text available via subscription   (Followers: 9)
Ethos: Official Publication of the Law Society of the Australian Capital Territory     Full-text available via subscription   (Followers: 5)
Eureka Street     Full-text available via subscription   (Followers: 5)
Extempore     Full-text available via subscription  
Family Matters     Full-text available via subscription   (Followers: 10, SJR: 0.228, CiteScore: 1)
Fijian Studies: A J. of Contemporary Fiji     Full-text available via subscription   (Followers: 1)
Focus on Health Professional Education : A Multi-disciplinary J.     Full-text available via subscription   (Followers: 7)
Food New Zealand     Full-text available via subscription   (Followers: 4)
Fourth World J.     Full-text available via subscription   (Followers: 1)
Frontline     Full-text available via subscription   (Followers: 18)
Future Times     Full-text available via subscription   (Followers: 3)
Gambling Research: J. of the National Association for Gambling Studies (Australia)     Full-text available via subscription   (Followers: 5)
Gay and Lesbian Law J.     Full-text available via subscription   (Followers: 2)
Gender Impact Assessment     Full-text available via subscription   (Followers: 3)
Geographical Education     Full-text available via subscription   (Followers: 2)
Geriatric Medicine in General Practice     Full-text available via subscription   (Followers: 8)
Gestalt J. of Australia and New Zealand     Full-text available via subscription   (Followers: 2, SJR: 0.1, CiteScore: 0)
Globe, The     Full-text available via subscription   (Followers: 4)
Government News     Full-text available via subscription   (Followers: 2)
Great Circle: J. of the Australian Association for Maritime History, The     Full-text available via subscription   (Followers: 7)
Grief Matters : The Australian J. of Grief and Bereavement     Full-text available via subscription   (Followers: 11)
He Puna Korero: J. of Maori and Pacific Development     Full-text available via subscription   (Followers: 4)
Headmark     Full-text available via subscription   (Followers: 2)
Health Inform     Full-text available via subscription  
Health Issues     Full-text available via subscription   (Followers: 2)
Health Promotion J. of Australia : Official J. of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 8, SJR: 0.531, CiteScore: 1)
Health Voices     Full-text available via subscription  
Heritage Matters : The Magazine for New Zealanders Restoring, Preserving and Enjoying Our Heritage     Full-text available via subscription   (Followers: 2)
High Court Quarterly Review, The     Full-text available via subscription   (Followers: 3)
HIV Australia     Full-text available via subscription   (Followers: 3)
HLA News     Full-text available via subscription   (Followers: 3, SJR: 0.438, CiteScore: 1)
Hong Kong J. of Emergency Medicine     Full-text available via subscription   (Followers: 5, SJR: 0.19, CiteScore: 0)
Idiom     Full-text available via subscription   (Followers: 1)
Impact     Full-text available via subscription   (Followers: 2)
InCite     Full-text available via subscription   (Followers: 17)
Indigenous Law Bulletin     Full-text available via subscription   (Followers: 20)
InPsych : The Bulletin of the Australian Psychological Society Ltd     Full-text available via subscription   (Followers: 2)
Inside Film: If     Full-text available via subscription   (Followers: 6)
Institute of Public Affairs Review: A Quarterly Review of Politics and Public Affairs, The     Full-text available via subscription   (Followers: 12)
Instyle     Full-text available via subscription   (SJR: 0.116, CiteScore: 0)
Intellectual Disability Australasia     Full-text available via subscription   (Followers: 11)
Interaction     Full-text available via subscription   (Followers: 4)
Intl. Employment Relations Review     Full-text available via subscription   (Followers: 3)
Intl. J. of Disability Management Research     Full-text available via subscription   (Followers: 3)
Intl. J. of e-Business Management     Full-text available via subscription  
Intl. J. of Employment Studies     Full-text available via subscription   (Followers: 8)
Intl. J. of Home Economics     Full-text available via subscription   (Followers: 1)
Intl. J. of Narrative Therapy & Community Work     Full-text available via subscription   (Followers: 8)
Intl. J. of Punishment and Sentencing, The     Full-text available via subscription   (Followers: 9)
Irrigation Australia: The Official J. of Irrigation Australia     Full-text available via subscription   (Followers: 3)
ISAA Review     Full-text available via subscription   (Followers: 1)
J. (Australian Native Plants Society. Canberra Region)     Full-text available via subscription   (Followers: 1)
J. of Applied Law and Policy     Full-text available via subscription   (Followers: 3)
J. of Australian Colonial History     Full-text available via subscription   (Followers: 7)
J. of Australian Naval History, The     Full-text available via subscription   (Followers: 3)

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Similar Journals
Journal Cover
Hong Kong Journal of Emergency Medicine
Journal Prestige (SJR): 0.19
Number of Followers: 5  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1024-9079 - ISSN (Online) 2309-5407
Published by RMIT Publishing Homepage  [387 journals]
  • Volume 26 Issue 6 - Comparison of the reliability of scoring systems in
           the light of histopathological results in the diagnosis of acute
           appendicitis
    • Abstract: Ozdemir, Zehra Unal; Ozdemir, Hakan; Sunamak, Oguzhan; Akyuz, Cebrail; Torun, Mehmet
      Background: Acute appendicitis is a very common surgical emergency. Early and correct diagnosis and early intervention are necessary to prevent complications. It is often diagnosed on clinical signs and a certain ratio of negative appendectomy is acceptable. For early and accurate diagnosis, various scoring systems such as Alvarado, Ohmann, Eskelinen and more recently Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) have been developed.

      Objective: In this study, we aimed to compare the effectiveness and accuracy of scoring systems.

      Materials and methods: The patients who attended emergency department and operated with acute appendicitis pre-diagnosis were evaluated retrospectively. Alvarado, Ohmann, Eskelinen, and RIPASA scores were calculated and compared with histopathologic results by reviewing the patient files.

      Results: A total of 76 patients (44 males and 32 females) were included in the study. The mean age was 33.8 +- 13.2 years. Of which, 59 patients (77.6%) were diagnosed to have acute appendicitis on histopathological examination. The mean leukocyte count was 13.9 +- 3.7 103 muL. Sensitivity and specificity of Alvarado, Ohmann, Eskelinen, and RIPASA were 36%-82%; 58%-71%; 36%-8%, and 68%-71%, respectively. Cut-off values were 8, 14, 55.63, and 10, respectively. RIPASA had the highest accuracy. The cut-off value of leukocyte counts was 13,900 103/muL. Sensitivity and specificity were 64% and 88%, respectively; positive predictive value was 95%. In the receiver operating curve analysis, the area under the curve was found to be 74%.

      Conclusion: The RIPASA scoring system is a more reliable scoring system than Ohmann, Eskelinen, and Alvarado scoring systems. In cases of suspected acute appendicitis, it may be useful to evaluate patients with RIPASA score in emergency departments by general practitioners, where there is no general surgeon. Thus, patients can be guided in a timely manner to reduce the complications that may arise from delays. The cut-off value of 13,900 103/muL is an important marker for the presence of acute appendicitis.

      PubDate: Mon, 6 Jan 2020 14:25:17 GMT
       
  • Volume 26 Issue 6 - Predictive factors for special care units admission
           and in-hospital mortality among geriatric patients that presented to the
           emergency department of a teaching hospital
    • Abstract: Lim, Khai Yen; Nik Ab Rahman, Nik Hisamuddin
      Background: The world population is experiencing ageing and this phenomenon certainly gives significant impact to the social, economic as well as health care services globally.

      Objectives: This study aimed to determine the prevalence of geriatric patients treated in critical zone in an emergency department of a teaching hospital and the factors associated with special care units admission and in-hospital mortality.

      Methods: A single-centre prospective cross-sectional study was carried out from 1 January 2016 to 31 December 2016 at the Emergency Department Hospital at Universiti Sains Malaysia, Malaysia. All patients aged 60 years and above were included. Systematic random sampling was used. Variables were analysed using simple and multiple logistic regressions.

      Results: The total number of patients included in this study was 328, 55.8% were male and the mean age was 70.6 (standard deviation: 7.5) years. The commonly presenting diseases in this study were cardiovascular (31.4%), infectious (29.6%), neurological (14.9%) and respiratory (12.5%). Out of the 328 patients studied, 187 (57.0%) were admitted to general wards and 110 (33.5%) to special care units. A total of 55 patients (16.8%) succumbed within the period of in-hospital treatment. The factors associated with special care units admission were the usage of non-invasive ventilation and the administration of inotropic support. The factors associated with in-hospital mortality were blood urea level, serum albumin level and the application of mechanical ventilation.

      Conclusion: Geriatric patients who presented to emergency department requiring ventilator and inotropic support had been observed to exhibit worse outcome. The associated factors for special care units admission and in-hospital mortality had been identified, and this will enable better settings cater to the needs for critically ill geriatric patients.

      PubDate: Mon, 6 Jan 2020 14:25:17 GMT
       
  • Volume 26 Issue 6 - Expectations and needs of relatives of critically ill
           patients in the emergency department
    • Abstract: Ocak, Umut; Avsarogullari, Levent
      Background: The care of critically ill patients is a strong indicator of service quality provided in the emergency department. Since families are the major social support sources, assessing the family members' needs may reduce their anxiety and depression owing to the acute situation of their loved ones while improving the patients' recovery.

      Objective: We aimed to evaluate the expectations and needs of relatives of critically ill patients to formulate solutions to improve the quality of emergency department service.

      Methods: We conducted a prospective, cross-sectional survey of 873 relatives of nontraumatic, critically ill patients who completed the Turkish version of the Critical Care Family Needs Inventory in the emergency department of a university hospital in Turkey. The needs statements were evaluated under five subheadings: meaning, proximity, communication, comfort, and support.

      Results: In total, 249 (28.5%) participants were females and 624 (71.5%) were males (mean age, 41.79 years). The "meaning" category was given the highest priority, followed by "communication," with average points of 3.75 and 3.57, respectively. The most important needs were being informed regularly about the patient's condition and being assured that the patient is under the best possible care, whereas personal, physical, and emotional needs were the least important.

      Conclusion: Relatives of critically ill patients primarily focus on the quality of patients' care. Creating a positive rapport based on trust and providing a healthcare environment where the expectations and needs of relatives are met should be prioritized by emergency department physicians, nurses, and other staff while caring for critically ill patients.

      PubDate: Mon, 6 Jan 2020 14:25:17 GMT
       
  • Volume 26 Issue 6 - Evaluation of dynamic thiol/disulfide homeostasis in
           adult patients with community-acquired pneumonia
    • Abstract: Sener, Alp; Celik, Gulhan Kurtoglu; Ozhasenekler, Ayhan; Gokhan, Servan; Tanriverdi, Fatih; Kocaoglu, Salih; Neselioglu, Salim; Erdogan, Serpil
      Background: Community-acquired pneumonia is an important cause of mortality and morbidity in all age groups. Oxidant and antioxidant mechanisms play an important role in the pathogenesis and mortality of community-acquired pneumonia.

      Objectives: In this study, the role of thiol/disulfide homeostasis in the diagnosis and prognosis of community-acquired pneumonia was investigated.

      Methods: This was a prospective, controlled, observational study involving 73 community-acquired pneumonia patients and 68 healthy volunteers.

      Results: The native thiol and total thiol, which are thiol/disulfide homeostasis components, were significantly lower in the community-acquired pneumonia group. It was also found that the native thiol was lower in the high-risk community-acquired pneumonia group and that the native thiol and total thiol were associated with the Pneumonia Severity Index, CRB65 (confusion, respiratory rate, blood pressure, ⩾65 years old), and CURB65 (confusion, uremia, respiratory rate, blood pressure, ⩾65 years old) scores. The thiol compound levels were also associated with the C-reactive protein and procalcitonin levels. However, there was no significant difference between the survivors and non-survivors in terms of the thiol/disulfide homeostasis parameters.

      Conclusion: This study demonstrated the important role that oxidative stress plays in the pathogenesis of community-acquired pneumonia. The thiol/disulfide homeostasis biomarkers especially the native thiol and index-1 levels were significantly lower in patients with community-acquired pneumonia. Further studies are needed to investigate the diagnostic and prognostic value of thiol/disulfide homeostasis parameters in community-acquired pneumonia.

      PubDate: Mon, 6 Jan 2020 14:25:17 GMT
       
  • Volume 26 Issue 6 - A fatal case of chlorfenapyr poisoning following
           dermal exposure
    • Abstract: Han, Sang-Kyoon; Yeom, Seok-Ran; Lee, Sung-Hwa; Park, Soon-Chang; Kim, Hyung-Bin; Cho, Young-Mo; Park, Sung-Wook
      Introduction: Chlorfenapyr is a pyrrole-based pro-insecticide. The main activity of this agent is the inhibition of adenosine triphosphate synthesis, and it is used in agriculture to control several insects and mites resistant to carbamate, organophosphate and pyrethroid insecticide. The World Health Organization classifies this agent as a class II toxin (moderately hazardous).

      Case presentation: All previously reported cases of chlorfenapyr poisoning in humans occurred following oral ingestion except one case involving exposure to chlorfenapyr vapour.

      Discussion: In this report, we describe a case of chlorfenapyr intoxication after skin exposure in a 49-year-old patient who died 5 days after exposure.

      Conclusion: This case demonstrates that similar to oral ingestion, dermal absorption of chlorfenapyr may also be fatal.

      PubDate: Mon, 6 Jan 2020 14:25:17 GMT
       
  • Volume 26 Issue 6 - A case of rectus sheath haematoma related to severe
           coughing in a patient with acute exacerbation of chronic obstructive
           pulmonary disease
    • Abstract: Wong, Ching Hin Kevin; Tsang, Ho Kai Patrick; Wong, Oi Fung; Ma, Hing Man; Lit, Chau Hung Albert
      Introduction: Rectus sheath haematoma is a rare condition which is often misdiagnosed. Apart from abdominal trauma and anticoagulation, severe coughing is an uncommon precipitating cause of this rare condition.

      Case presentation: An elderly gentleman with history of ischaemic heart disease on aspirin developed rectus sheath haematoma due to severe coughing during an episode of acute exacerbation of chronic obstructive pulmonary disease. He developed severe abdominal pain and was noted to have epigastric bruising extending to bilateral loins. Ultrasound abdomen and computed tomography of the abdomen with contrast revealed haematoma over bilateral upper rectus abdominis muscles, which subsided with conservative management.

      Discussion and conclusion: Rectus sheath haematoma can be related to severe coughing. In patients, especially those with predisposing factors, presenting with abdominal pain and palpable painful abdominal mass, clinicians should raise the suspicion of this uncommon cause so that timely and appropriate management can be provided.

      PubDate: Mon, 6 Jan 2020 14:25:17 GMT
       
  • Volume 26 Issue 6 - Clinical manifestations and causes of gelsemium
           poisoning in Hong Kong from 2005 to 2017: Review of 33 cases
    • Abstract: Chow, Tin Yat Anthony; Ng, Chun Ho Vember; Tse, Man Li
      Background: 'Gelsemium elegans' is an extremely toxic plant, but gelsemium poisoning is seldom reported in the English literature. Objectives: To evaluate the clinical manifestations and causes of gelsemium poisoning in Hong Kong.

      Methods: A retrospective review of gelsemium poisoning recorded by the Hong Kong Poison Information Centre from 2005 to 2017.

      Results: In total, 33 cases (55% female, median age 44 (interquartile range: 30-56)) were identified in 14 incidences. Consumption of contaminated 'Ficus hirta' soup is the commonest cause (52%). Other causes include misidentification of herbs (12%), consumption of parasitic plant 'Cassytha filiformis' (15%) and suicidal ingestion of 'Gelsemium elegans'. Most patients (94%) had mild to moderate toxicity, with one fatal case and one severe case presented with coma and respiratory depression. All patients complained of dizziness (100%), followed by visual blurring (34%) and nausea (28%). More than half (53%) had ocular manifestations (e.g. visual blurring, ptosis, nystagmus, diplopia) which are not commonly reported in other herbal poisoning. The time of symptom onset was early (median: 50 min (interquartile range: 30-60)) and all occurred within 2 h after oral intake. Most patients (94%) recovered uneventfully with conservative treatment.

      Conclusion: Most gelsemium poisoning in Hong Kong was due to contamination or misidentification. Early-onset dizziness (
      PubDate: Mon, 6 Jan 2020 14:25:17 GMT
       
  • Volume 26 Issue 6 - The 10 commandments of exsanguinating pelvic fracture
           management
    • Abstract: Kam, Chak Wah; Law, Ping Keung Joe; Lau, Hon Wai Jacky; Ahmad, Rashidi; Tse, Chiu Lun Joseph; Cheng, Mina; Lee, Kin Bong; Lee, Kin Yan
      Background: Unstable pelvic fractures are highly lethal injuries.

      Objective: The review aims to summarize the landmark management changes in the past two decades.

      Methods: Structured review based on pertinent published literatures on severe pelvic fracture was performed.

      Results: Ten key management points were identified.

      Conclusion: These 10 recommendations help diminish and prevent the mortality. (1) Before the ABCDE management, preparedness, protection, and decision are essential to optimize patient outcome and to conserve resources. (2) Do not rock the pelvis to check stability, avoid logrolling but prophylactic pelvic binder can be life-saving. (3) Computed tomography scanner can be the tunnel to death for hemodynamically unstable patients. (4) Correct application of pelvic binder at the greater trochanter level to achieve the most effective compression. (5) Choose the suitable binder (BEST does not exist, always look for BETTER) to facilitate body examination and therapeutic intervention. (6) Massive transfusion protocol is only a temporizing measure to sustain the circulation for life maintenance. (7) Damage control operation aims to promptly stop the bleeding to restore the physiology by combating the trauma lethal triad to be followed by definitive anatomical repair. (8) Protocol-driven teamwork management expedites the completion of the multi-phase therapy including external pelvic fixation, pre-peritoneal pelvic packing, and angio-embolization, preceded by laparotomy when indicated. (9) Resuscitation endovascular balloon occlusion of aorta can reduce the pelvic bleeding while awaiting hospital transfer or operation theater access. (10) Operation is the definitive therapy for trauma but prevention is the best treatment, comprising primary, secondary, and tertiary levels.

      PubDate: Mon, 6 Jan 2020 14:25:17 GMT
       
  • Volume 26 Issue 6 - A young lady with right peripheral facial palsy
    • Abstract: Lau, James Siu Ki; Ng Chan, Puisy Yau; Kan, Pui Gay
      A common diagnosis to patients with sudden onset of peripheral facial paralysis is Bell's palsy. However, when there are other clinical features, such as increased intracranial pressure or bidirectional nystagmus, one must consider central causes. This report illustrates the importance of detailed observation and identification of nystagmus in arriving at an accurate clinical diagnosis.

      PubDate: Mon, 6 Jan 2020 14:25:17 GMT
       
  • Volume 26 Issue 6 - [November 2019] reciprocal abstracts
    • PubDate: Mon, 6 Jan 2020 14:25:17 GMT
       
  • Volume 26 Issue 4 - Differentiating Takotsubo cardiomyopathy from
           ST-segment elevation myocardial infarction
    • Abstract: Asher, Elad; Odeh, Qasim; Sabbag, Avi; Goldkorn, Ronen; Elian, Dan; Ben Zekry, Sagit; Peled, Yael; Abu-Much, Arsalan; Mazin, Israel; Beigel, Roy; Matetzky, Shlomi
      Background: Takotsubo cardiomyopathy affects between 1.7% and 2.2% of patients hospitalized with suspected acute coronary syndromes. Characterized by chest pain, electrocardiogram changes, and transient left ventricular apical wall motion abnormality, it is under-recognized and often misdiagnosed.

      Objectives: In order to better differentiate between St-segment myocardial infarction and Takotsubo cardiomyopathy, we developed a scoring system.

      Methods: Of the 82 patients enrolled with Takotsubo cardiomyopathy, 67 had ST-segment elevation on electrocardiogram and were compared with 79 ST-elevation myocardial infarction patients. A multi-variant logistic regression model was used to find factors independently associated with Takotsubo cardiomyopathy. The Platelets and Thrombosis in Sheba (PLATIS)-Takotsubo cardiomyopathy is based on a 10-point scoring system: stressful events (3), females (2), no history of diabetes mellitus (2), estimated left ventricular ejection fraction =7, the receiver-operating characteristic curve was 0.82 with a sensitivity of 75% and a specificity of 89% (positive predictive value = 85% and negative predictive value = 80%).

      Conclusion: The Takotsubo cardiomyopathy scoring system is a simple, reliable tool that can assist in diagnosing and differentiating between patients with Takotsubo cardiomyopathy and those with ST-elevation myocardial infarction.

      PubDate: Wed, 18 Sep 2019 19:30:45 GMT
       
  • Volume 26 Issue 4 - Another important time target in st-elevation
           myocardial infarction management - door-in door-out time: Do we meet
           door-in door-out time targets'
    • Abstract: Dogan, Ismahan; Corbacıoglu, Seref Kerem; Emektar, Emine; Aytar, Halit; Cevik, Yunsur
      Background: In non-PCI capable hospitals, another important time to be noticed in patients who have been referred for PCI-capable centers; is the time of doo-in door-out (DIDO), defined as the duration of time from patient discharge from the transferrring hospital. In our country, there is no clear information about the duration of DIDO time and transfer time. Consequently, very little is known about how frequently these targets can be met nationally.

      Objectives: This study aimed to measure door-in door-out time for ST-elevation myocardial infarction diagnosed patients who admitted to emergency department of a hospital capable of non-percutaneous coronary intervention and to measure whether door-in door-out time meets the guidelines.

      Methods: This single-center, prospective study was conducted in emergency department (non-percutaneous coronary intervention capable) between 1 August 2015 and 1 August 2016 with patients who presented to the emergency department and were diagnosed with ST-segment elevation myocardial infarction. All the times including door-in time, door to electrocardiogram time, door to emergency medical services activation time, door to defined percutaneous coronary intervention hospital, and finally door-in door-out time were measured and recorded.

      Results: During the study period, 135 of patients met the inclusion criteria and diagnosed with ST-elevation myocardial infarction and referred to another hospital for percutaneous coronary intervention. When the median values (interquartile range of 25%-75%) of the time periods are examined, it is found door-in door-out time was 55 (43-74) min. It was found that the number of patients meeting the recommended duration of door-in door-out (30 min or less) was 12 (8.9%). Of the remaining 123 patients (91.1%), door-in door-out times were found to be over 30 min.

      Conclusion: In conclusion, our study showed that compliance with door-in door-out time is very poor and is far behind to met the criteria which is recommended by current guidelines.

      PubDate: Wed, 18 Sep 2019 19:30:45 GMT
       
  • Volume 26 Issue 4 - Point-of-care coagulation testing for reducing
           in-hospital delay in thrombolysis
    • Abstract: Han, Jung Hee; Jang, Seongsoo; Choi, Mi-Ok; Yoon, Mi-Jeong; Lim, Seung-Bok; Kook, Jeong-Ran; Kang, Dong-Wha; Kwon, Sun U; Kim, Jong S; Jeon, Sang-Beom
      Background: The confirmation of prothrombin time international normalized ratio by a central laboratory often delays intravenous thrombolysis in patients with acute ischemic stroke.

      Objectives: We investigated the feasibility, reliability, and usefulness of point-of-care determination of prothrombin time international normalized ratio for stroke thrombolysis.

      Methods: Among 312 patients with ischemic stroke, 202 who arrived at the emergency room within 4.5 h of stroke onset were enrolled in the study. Patients with lost orders for point-of-care testing for the prothrombin time international normalized ratio or central laboratory testing for the prothrombin time international normalized ratio (n = 47) were excluded. We compared international normalized ratio values and the time interval from arrival to the report of test results (door-to-international normalized ratio time) between point-of-care testing for the prothrombin time international normalized ratio and central laboratory testing for the prothrombin time international normalized ratio. In patients who underwent thrombolysis, we compared the time interval from arrival to thrombolysis (door-toneedle time) between the current study population and historic cohort at our center.

      Results: In the 155 patients included in the study, the median door-to-international normalized ratio time was 9.0 min (interquartile range, 5.0-12.0 min) for point-of-care testing for the prothrombin time international normalized ratio and 46.0 min (interquartile range, 38.0-55.0 min) for central laboratory testing for the prothrombin time international normalized ratio (p < 0.001). The intraclass correlation coefficient between point-of-care testing for the prothrombin time international normalized ratio and central laboratory testing for the prothrombin time international normalized ratio was 0.975 (95% confidence interval: 0.966-0.982). Forty-nine of the 155 patients underwent intravenous thrombolysis. The door-to-needle time was significantly decreased after implementation of point-of-care testing for the prothrombin time international normalized ratio (median, 23.0 min; interquartile range, 16.0-29.8 vs median, 46.0 min; interquartile range, 33.5-50.5 min).

      Conclusion: Utilization of point-of-care testing for the prothrombin time international normalized ratio was feasible in the management of patients with acute ischemic stroke. Point-of-care testing for the prothrombin time international normalized ratio was quick and reliable and had a pivotal role in expediting thrombolysis.

      PubDate: Wed, 18 Sep 2019 19:30:45 GMT
       
  • Volume 26 Issue 4 - Trauma and injury severity score modification for
           predicting survival of trauma in one regional emergency medical center in
           
    • Abstract: Kang, In Hye; Lee, Kang Hyun; Youk, Hyun; Lee, Jeong Il; Lee, Hee Young; Bae, Keum Seok
      Background: The problem that is central to trauma research is the prediction of survival rate after trauma. Trauma and Injury Severity Score is being used for predicting survival rate after trauma. Many countries have conducted a study on the classification, characteristics of variables, and the validity of the Trauma and Injury Severity Score model. However, few investigations have been made on the characteristics of coefficients or variables related to Trauma and Injury Severity Score in Korea.

      Objectives: There is a need for coefficient analysis of Trauma and Injury Severity Score which was created based on the United States database to be optimized for the situation in Korea.

      Methods: This study examined how the currently used Trauma and Injury Severity Score coefficients were developed and created for trauma patients visiting the emergency department in a hospital in Korea using the analytical method. A total of 34,340 trauma patients who were hospitalized into an emergency center from January 2012 to December 2014 for 3 years were analyzed with trauma registry established on August 2006.

      Results: Trauma and Injury Severity Score coefficients were transformed with the methods that were used to make the existing Trauma and Injury Severity Score coefficients using the trauma patients' data. Regression coefficients (B) were drawn by building up a logistic regression analysis model that used variables such as Injury Severity Score, Revised Trauma Score, and age depending on survival with Trauma and Injury Severity Score.

      Conclusion: With regard to Trauma and Injury Severity Score established in the United States differing from Korea in injury types, it seems possible to realize significant survival rate by deriving coefficients with data in Korea and reanalyzing them.

      PubDate: Wed, 18 Sep 2019 19:30:45 GMT
       
  • Volume 26 Issue 4 - Diagnostic value of Tei index for acute myocardial
           infarction in patients presenting to emergency department with ischemic
           chest pain and correlation with Hs-troponin
    • Abstract: Ucar, Asli Bahar; Akoglu, Ebru Unal; Ozturk, Tuba Cimilli; Eyinc, Yalman; Ak, Rohat; Demir, Hasan; Ilgezdi, Zeynep Demet; Onur, Ozge
      Background: Acute myocardial infarction is one of the most common causes of mortality in developed countries, and high-sensitive troponin test usually becomes positive within 3 h from the onset of symptoms. Myocardial perfusion index (Tei index) is a parameter measured during the echocardiographic examination.

      Objectives: The aim of this study is to investigate the diagnostic value of the Tei index for early diagnosis of acute myocardial infarction in the emergency department and to evaluate the correlation between the Tei index and Hs-Troponin value.

      Materials and Methods: A total of 129 cases were evaluated, and patients were divided into two groups according to their final diagnosis as "acute myocardial infarction (non-ST segment elevation myocardial infarction)" and "non-acute myocardial infarction" groups. Baseline and third-hour Hs-Troponin levels and Tei index values were determined, and their correlation was analyzed.

      Results: A total of 84 cases were diagnosed with acute myocardial infarction (non-ST segment elevation myocardial infarction), 84.5% had positive Tei index results at the time of admission while the remaining 45 patients were diagnosed as non-acute myocardial infarction and only 48.9% of them had positive Tei index. The diagnostic value of the Tei index and Hs-troponin were calculated as 79.8% and 60%; 67.9% and 60%, respectively. Also, we found that a 0.02 or more increase in the Tei index value has a 97.6 sensitivity and 97.5 specificity for the diagnosis of non-ST segment elevation myocardial infarction. A weak correlation was found between the Tei index and Hs-Troponin values in the acute myocardial infarction group (r = 0.425) and a negative correlation in non-acute myocardial infarction patients at presentation.

      Conclusion: It is suggested that the use of Tei index might be used as a supportive measure for the early diagnosis of acute myocardial infarction, and the deterioration of Tei index seems to be more significant than Hs-Troponin especially in ruling out acute myocardial infarction.

      PubDate: Wed, 18 Sep 2019 19:30:45 GMT
       
  • Volume 26 Issue 4 - Feasibility of predictive model by clinical and
           
    • Abstract: Lui, Chun Tat; Ching, Wei Ming; Tsui, Kwok Leung; Chu, Ho Cheung; Tsui, Alex To Shing; Au, Tak Shun; Wong, Tai Wai; Fan, Kit Ling; Leung, Ling Pong
      Background: Assessment of geriatric patients presented with abdominal pain had been challenge for emergency physicians with the ageing population. A rapid, reproducible risk stratification model for the assessment of the need for admission for geriatric abdominal pain would be required to identify low-risk patients to be managed as out-patient basis.

      Objective: Assess the feasibility of risk stratification model to predict the need of hospital admission based on readily available bedside parameters in emergency departments.

      Methods: This is a multicenter retrospective cohort study in four emergency departments. Patients aged at least 65 who presented with chief complaint of abdominal pain within the previous 7 days of attendance as the chief complaint were included. Chart review was performed for the included patients. The primary outcome was defined as a composite of mortality, abdominal surgery or endoscopic treatment, and other inpatient treatments for abdominal diseases within 14 days, surrogating the need of hospital admission. Logistic regression was modeled to identify independent predictors. The diagnostic accuracy of the risk model was evaluated with the receiver operating characteristic curve and compared with the clinical gestalt of decision for hospital admission by the attending physician.

      Results: In total, 553 patients were included. Symptoms of upper gastrointestinal bleeding, non-ambulatory presenting status, pain duration, focal abdominal tenderness, hyperglycemia, leukocytosis, and elevated creatinine were independent predictors of the outcome. The area under the receiver operating characteristic curve of the predicted probabilities of the logistic model was 0.741. In keeping for a low-risk criterion to achieve more than 90% sensitivity, the predictive model would only achieve 18.2% specificity which was inferior to clinical gestalt for hospital admission (sensitivity 99.3%, specificity 44.3%).

      Conclusion: Risk stratification model by clinical assessment and laboratory markers alone were inadequate and inferior to clinical gestalt for identification of the group of patients requiring inpatient treatment.

      PubDate: Wed, 18 Sep 2019 19:30:45 GMT
       
  • Volume 26 Issue 4 - Spinal dural arteriovenous fistula presenting as low
           back pain
    • Abstract: Chan, Kwok-Chun; Cheng, Fu-Jen; Hsu, Chih-Wei; Tsai, I-Ting; Chua, Choon-Bing; Chang, Chao-Sheng
      Introduction: Low back pain or numbness of the lower extremities is quite common in the present population. Numerous conditions may cause these symptoms, including spinal vascular anomaly. Identifying and diagnosing the cause of these symptoms are crucial for treatment. Accurate diagnosis based on particular radiological findings in magnetic resonance imaging is crucial for administering adequate therapy to patients, especially in spinal dural arteriovenous fistula.

      Case presentation: We report a case presenting with low back pain and rapid deterioration in paraplegia. Magnetic resonance imaging provided the typical image presentations such as spinal cord edema with tortuous dilated perimedullary venous plexus. The patient was subsequently successfully treated with endovascular embolization.

      Discussion: Spinal dural arteriovenous fistula should be suspected in any patient who presents with myelopathy. Angiography remains the gold standard for confirmation of diagnosis.

      Conclusion: Prompt treatment with endovascular embolization or surgery could improve patients' outcomes.

      PubDate: Wed, 18 Sep 2019 19:30:45 GMT
       
  • Volume 26 Issue 4 - Reciprocal abstract publication
    • PubDate: Wed, 18 Sep 2019 19:30:45 GMT
       
  • Volume 26 Issue 4 - Letter to the editor
    • PubDate: Wed, 18 Sep 2019 19:30:45 GMT
       
  • Volume 26 Issue 5 - Clinical features of patients with acute epiglottitis
           in the emergency department
    • Abstract: Wu, I-Ying; Lin, Pei-Chen; Hsu, Chien-Chin; Chen, Kuo-Tai
      Background: Acute epiglottitis is a potentially life-threatening condition, but its clinical manifestations are usually nonspecific.

      Objectives: We investigated the clinical differences between patients with and those without acute epiglottitis and identified the risk factors of patients with acute epiglottitis who may develop airway compromise.

      Methods: We studied patients suspected of having acute epiglottitis in the emergency department. All patients received fibre-optic laryngoscopy performed by an otorhinolaryngologist and were subsequently divided into two groups: patients with acute epiglottitis and those without.

      Results: Of the 311 adult patients, 108 were diagnosed with acute epiglottitis. In the nonepiglottitis group, more complaints of fever (p < 0.001), cough (p < 0.001), and rhinorrhoea (p = 0.048) and more systemic comorbidities were reported. People with acute epiglottitis generally had a higher prevalence of head and neck tumours (p = 0.015), odynophagia (p = 0.037) and an elevated white blood cell level (p < 0.001). The proportion of patients with cardiovascular disease (p = 0.014) or diabetes mellitus (p = 0.019), drooling (p = 0.026) or sore throat (p = 0.042), a high respiratory rate (p = 0.009), an elevated white blood cell level (p = 0.002) and a higher C-reactive protein level (p = 0.005) was higher among those who required airway intervention.

      Conclusion: Clinical manifestations alone were insufficiently reliable for diagnosing acute epiglottitis but could predict disease severity. Laryngoscopy should be performed as soon as possible once a patient is suspected of having acute epiglottitis.

      PubDate: Wed, 18 Sep 2019 13:02:51 GMT
       
  • Volume 26 Issue 5 - Is multiple viral infection a predictor of severity in
           children with acute bronchiolitis'
    • Abstract: Yurtseven, Ali; Turan, Caner; Elibol, Pelin; Cicek, Candan; Saz, Eylem Ulas
      Background: Acute bronchiolitis is a common cause of pediatric emergency department admissions in children younger than 2.

      Objectives: The study aimed to compare the outcomes and the severity of bronchiolitis in young children with multiple simultaneous respiratory virus infections to those with single virus infection and no virus identified group.

      Methods: Patients with moderate and severe bronchiolitis who visited our emergency department between November 2016 and May 2017 had nasopharyngeal swab samples results tested by multiplex polymerase chain reaction were included in the study. Patients' characteristics, clinical severity of illness, and outcome (pediatric emergency department discharge, admission to ward or pediatric intensive care unit) were compared with the detected viral agents.

      Results: A total of 241 patients were included in the study. The mean age was 7.8 +- 2.6 months and 147 (61%) were male. Respiratory syncytial virus was the most common detected viral agent in 108 (39%) cases followed by human rhinoviruses in 67 (24%). Respiratory syncytial virus was found more frequently in February and March (p = 0.002). Leukocytosis and pneumonia were more likely observed in patients with only human rhinoviruses (+) subjects (p = 0.010 and p = 0.015, respectively). Intensive care hospitalization rate (16%) was higher in patients with multiple viral agents (p = 0.004).

      Conclusions: Respiratory syncytial virus remains the most common detected viral agent in acute bronchiolitis patients. While the pathogens detected were seasonally different, there was a significant relationship between leukocytosis, bacterial pneumonia, and detected viral agents. The disease was more severe in patients with multiple viral agents.

      PubDate: Wed, 18 Sep 2019 13:02:51 GMT
       
  • Volume 26 Issue 5 - Can the emergency department sustain the first
           strike': Experience from the 2016 earthquake in Tainan
    • Abstract: Yang, I-Ching; Peng, An-Chi; Hsu, Chien-Chin; Chen, Kuo-Tai
      Background: After the main shock of a major earthquake, casualties cluster in a short period and may overwhelm the capacities of health care facilities. An earthquake with a magnitude of 6.4 on the Richter scale struck Tainan City causing 117 fatalities and 513 injuries.

      Objectives: We conducted a retrospective study to review the medical records of emergency department after the attack of earthquake. The aim of this study was delineating the medical resource requirements after the disaster.

      Methods: We reviewed the medical records of patients admitted to the emergency department of Chi Mei Medical Center. Each chart indicating that the emergency department visit was earthquake-related was reviewed. After the earthquake struck, the Chi Mei Medical Center mobilized off-duty staff through a preset 333 code. Subsequently, routine surgeries and nonurgent admissions were postponed to reserve the maximal capacity for wounded patients.

      Results: A total of 150 patients were reviewed during the study period. In all, 25 cases (23.8%) required admission, and 9 of them (8.6%) were admitted to the intensive care unit. Patients with earthquake-related injuries constituted 62.8% of all traumatic patients in the 24-h aftermath. The requirements for wound sutures, blood component transfusion, numbers of radiographic/computed tomographic scans, and invasive procedures increased dramatically (earthquakerelated/ total: 66.0%, 30.0%, 72.1%/57.4%, and 47.7%, respectively).

      Conclusion: Patients with earthquake-related injuries arrived at the emergency department soon after the earthquake occurred and substantial emergency department resources were utilized in the 24-h aftermath. Each hospital should have a preset mobilization signal to call in off-duty workers to treat casualties resulting from the main shock of an earthquake. Subsequently, hospital-based mobilization should be initiated to provide comprehensive care to severely injured patients.

      PubDate: Wed, 18 Sep 2019 13:02:51 GMT
       
  • Volume 26 Issue 5 - N-acetylcysteine for adults with acute respiratory
           distress syndrome: A meta-analysis of randomized controlled trials
    • Abstract: Lu, Xin; Ma, Yong; He, Jianqiang; Li, Yi; Zhu, Huadong; Yu, Xuezhong
      Background: Acute respiratory distress syndrome is regarded as a formidable clinical challenge due to its high prevalence and mortality. The treatment of acute respiratory distress syndrome is very complex and difficult. As an adjuvant therapy, the antioxidant N-acetylcysteine has been investigated for several years but the benefit is controversial.

      Objectives: We performed the systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy of N-acetylcysteine on patients with acute respiratory distress syndrome.

      Methods: We searched PubMed, CENTRAL, and CBM databases. Randomized controlled trials comparing the effects of N-acetylcysteine and control were included. Overall mortality was the primary outcome; length of intensive care unit stay, duration of mechanical ventilation, glutathione levels, and PaO2/FiO2 were the secondary outcomes.

      Results: Eight trials with a total of 289 patients were included. Compared to the control group, the N-acetylcysteine group did not lower the overall mortality (risk ratio: 0.83; 95% confidence interval: 0.62 to 1.11; P = 0.21; I2 = 0%). However, N-acetylcysteine significantly shortened intensive care unit stay in the random-effects model (mean difference: -4.47 days; 95% confidence interval: -8.79 to −0.14; P = 0.04; I2 = 46%). Due to substantial heterogeneity and limited number of studies, the data of duration of mechanical ventilation, glutathione levels, and PaO2/FiO2 could not be pooled in the meta-analysis.

      Conclusion: N-acetylcysteine is ineffective in reducing mortality but beneficial for intensive care unit stay. Nonetheless, the effectiveness of N-acetylcysteine for acute respiratory distress syndrome is limited and further research is required before strong recommendations can be made.

      PubDate: Wed, 18 Sep 2019 13:02:51 GMT
       
  • Volume 26 Issue 5 - Correlation between the pre-hospital triage scale and
           emergency department triage scale
    • Abstract: Sung, Sil; Kang, Chan Young; Lee, Hee Young; Lee, Jung Hun; Kim, Oh Hyun; Youk, Hyun; Lee, Kang Hyun
      Background: While emergency patient triage system is effective when the pre-hospital triage acuity scale is linked with the in-hospital triage acuity scale. However, the 119 emergency medical triage system and the Korea Triage and Acuity Scale are not linked in Korea.

      Objective: This study aimed to investigate the correlation between the two triage systems and to utilize the results as basic data for the future development of a pre-hospital triage system.

      Methods: Among the 1114 patients who visited a regional emergency medical center by a 119 ambulance from April to May 2016, we analyzed the correlation between the pre-hospital and in-hospital triage systems based on the general characteristics of the patients and their reason of hospital visit (non-trauma or trauma).

      Results: Upon reclassifying the pre-hospital and in-hospital triage systems into three levels, among the 289 patients (28.1%) in level 3 of the pre-hospital triage, 79 (27.3%) were reclassified as the highest level (Resuscitation) in the inhospital triage. The kappa coefficient as a measure of agreement between the two triage systems was very low at 0.211 (95% confidence interval, 0.164-0.258), and the kappa coefficient of the paramedic category was 0.232 (95% confidence interval, 0.161-0.303).

      Conclusion: There is a low agreement between the pre-hospital and in-hospital triage systems.

      PubDate: Wed, 18 Sep 2019 13:02:51 GMT
       
  • Volume 26 Issue 5 - Documentation and standardization of altered mental
           status
    • Abstract: Aslaner, Mehmet Ali; Baykan, Necmi; Dogan, Nurettin Ozgur; Ziyan, Murat
      Background: Although altered mental status is a term commonly used for older patients, the limits of the definition are unclear.

      Objectives: We aimed to determine the predictive factors of altered mental status and to standardize this broadspectrum definition.

      Methods: The level and content of consciousness were assessed both in the basal status and in the emergency department presentation status of patients who were aged 65 years and above. The Richmond Agitation-Sedation Scale (RASS) for level and five features for content of consciousness were used to determine the actual change in consciousness.

      Results: Among 1250 patients, the rate of true altered mental status was 7.7% (n = 96), transient altered mental status was 3.5% (n = 44), and non-altered mental status was 88.8% (n = 1110). The 1- and 3-month mortality rates were higher for patients with true altered mental status (32.3% and 40.6%, respectively) than for other patients (3.3% and 8.4%, respectively; p < .001). The following criteria predicted true altered mental status with a high specificity: a change in RASS score ⩾2 points, newly disorganized thoughts, a perception disorder, inattention and disorientation, and an inability to communicate.

      Conclusion: True altered mental status criteria can be used to determine alterations in consciousness that lead to high mortality, and they can also be used as a common language for current and further investigations.

      PubDate: Wed, 18 Sep 2019 13:02:51 GMT
       
  • Volume 26 Issue 5 - Reciprocal abstract publication
    • PubDate: Wed, 18 Sep 2019 13:02:51 GMT
       
  • Volume 26 Issue 5 - Pictorial quiz: A 2-year-old boy with abdominal pain
    • Abstract: Huang, Hsin-Ju; Tsai, Ming-Jen
      A 2-year-old boy presented with abdominal pain and non-coffee-ground emesis for 1 day. He was afebrile and without decreased activity. Examination showed lower abdominal tenderness, but psoas and obturator signs were negative. Laboratory test showed mildly elevated C-reactive protein (1.321 mg/dL) without leukocytosis. An abdominal X-ray revealed a high-attenuation-calcified lesion near the right sacroiliac joint which was highly suspected as an appendicolith. Subsequent abdominal computed tomography proved an appendicitis with appendicolith inside. He underwent laparoscopic appendectomy and was discharged uneventfully 4 days later. Acute appendicitis is a commonly misdiagnosed pediatric emergency because of the atypical presentations. Appendicoliths are presented in more than half of pediatric appendicitis and are highly associated with perforation. Surgery is recommended instead of antibiotics therapy alone to manage appendicolith-related appendicitis. A careful interpretation of the plain abdominal films and keeping a high suspicion are vital to early diagnosis of this disease.

      PubDate: Wed, 18 Sep 2019 13:02:51 GMT
       
  • Volume 26 Issue 5 - A case of streptococcus necrotizing fasciitis
           secondary to acute tonsillitis and review of literatures
    • Abstract: Li, Yongsheng; Liu, Lu; Huang, Zhonghui; Yang, Le; Ye, Yan; Li, Renjie
      Necrotizing fasciitis, officially named by Wilson in 1952, was a rare potentially life-threatening necrotizing soft tissue infections disease. The main lesions showed subcutaneous fat and fascia layer in progressive necrosis, generally not involving muscles. It was characterized by acute onset, rapid progress, and dangerous condition, often accompanied by systemic toxin shock, which was a relatively rare clinical acute critical disease with high mortality rate. Necrotizing fasciitis is a rare but clinical critical disease. The overall incidence of necrotizing fasciitis is approximately 0.04 cases per 1000 persons in the United States, the 30-day mortality is 27%, and necrotizing fasciitis-related mortality in Asian region is about 28%. Streptococcus pyogenes (group A streptococcus) are human-specific pathogens that can cause upper respiratory tract infection such as tonsillitis, associated with post-infection diseases such as rheumatic fever, and also can induce severe invasive diseases such as necrotizing fasciitis and streptococcus toxin shock syndrome. This article reports a case of streptococcus necrotizing fasciitis secondary to suppurative tonsillitis, which was seldom reported before and our successful management with delayed debridement. This study was anonymous and was approved by the local Research Ethics Committee. Informed consent was obtained from the patient.

      PubDate: Wed, 18 Sep 2019 13:02:51 GMT
       
  • Volume 26 Issue 3 - The significance of the levels of fibrin/fibrinogen
           degradation products for predicting trauma severity
    • Abstract: Murata, Masato; Hagiwara, Shuichi; Aoki, Makoto; Nakajima, Jun; Oshima, Kiyohiro
      Background: On initial treatment in the emergency room, trauma patients should be assessed using simple clinical indicators that can be measured quickly.

      Objectives: The purpose of this study is to investigate the relationship between the injury severity score and blood test parameters measured on emergency room arrival in trauma patients.

      Methods: Trauma patients transferred to Gunma University Hospital between May 2013 and April 2014 were evaluated in this prospective, observational study. Blood samples were collected immediately on their arrival at our emergency room and their hematocrit, platelet, international normalized ratio of prothrombin time, activated partial thromboplastin time, fibrin/fibrinogen degradation products, and D-dimer were measured. We evaluated the correlations between the injury severity score and those biomarkers, and examined whether the correlation varied according to the injury severity score value. We also evaluated the correlations between the biomarkers and the abbreviated injury scale values of six regions.

      Results: We analyzed 371 patients. Fibrin/fibrinogen degradation products and D-dimer showed the greatest coefficients of correlation with injury severity score (0.556 and 0.543, respectively). The area under the curve of the receiver operating characteristic was larger in patients with injury severity score ⩾ 9 than in those with injury severity score ⩾ 4; however, patients with injury severity score ⩾ 9 or ⩾16 showed no significant differences. The area under the curve of fibrin/fibrinogen degradation products was larger than that of D-dimer at all injury severity score values. The chest abbreviated injury scale had the strongest relationship with fibrin/fibrinogen degradation products.

      Conclusion: Fibrin/fibrinogen degradation products and D-dimer were positively correlated with injury severity score, and the relationships varied according to trauma severity. Chest trauma contributed most strongly to fibrin/fibrinogen degradation product elevation.

      PubDate: Fri, 21 Jun 2019 16:25:29 GMT
       
  • Volume 26 Issue 3 - Optimal treatment for blunt trauma patients with
           cardiopulmonary arrest: An account of a successful case and review of the
           literature
    • Abstract: Kondo, Yutaka; Abe, Toshikazu; Fukami, Masataka; Kukita, Ichiro
      Introduction: Prognosis of cardiopulmonary arrest occurring in patients with blunt trauma is very poor; patients rarely recover from this condition. We either do not attempt cardiopulmonary resuscitation or terminate it after some time in blunt trauma-cardiopulmonary arrest cases. We presented a rare case of successful resuscitation of a patient with blunt trauma-cardiopulmonary arrest.

      Case presentation: A 54-year-old man was admitted to our emergency department after being injured in a traffic accident. The patient suffered from ventricular fibrillation, and spontaneous circulation was restored by a defibrillator. The estimated arrest time was 20 min.

      Discussion: On arrival of our emergency department, the patient showed intra-abdominal hemorrhage and we performed emergency surgery; 10 days after admission, the patient suffered from pulseless ventricular tachycardia- coronary angiography was performed, which revealed that the patient had coronary artery stenosis.

      Conclusion: We experienced trauma patients concealed with coronary artery stenosis. In traumatic arrest with ventricular fibrillation, it may be due to a medical reason, and more prolonged and intensive resuscitation may be considered.

      PubDate: Fri, 21 Jun 2019 16:25:29 GMT
       
  • Volume 26 Issue 3 - Delayed diagnosis of long QT syndrome in a patient
           with seizures
    • Abstract: Shin, Seung Yong; Hong, Jun Young; Lee, Dong Hoon
      Introduction: Long QT syndrome accompanied by a seizure episode is often misdiagnosed as primary epilepsy. Although patients with Long QT syndrome who are misdiagnosed and improperly managed are likely to result in fatality, their first clinical manifestations are seizure episodes in many cases.

      Case presentation: A 17-year-old boy visited the emergency department with poorly controlled seizure during epilepsy treatment was found to have been misdiagnosed with epilepsy when he was 7 years old. His electrocardiography showed a prolonged QT interval. After careful re-evaluation, he was finally diagnosed with Long QT syndrome and recovered without any seizure episodes in the absence of anti-epileptic agents.

      Discussion and conclusion: Careful initial assessment including repetitive electrocardiography, when abnormal, is required for those who visit the emergency department with a seizure or who show no definite abnormalities in diagnostic work up process.

      PubDate: Fri, 21 Jun 2019 16:25:29 GMT
       
  • Volume 26 Issue 3 - The prevalence of cross-reactivity of cephalosporin in
           penicillin-allergic patients: A cross-sectional study in Thailand
    • Abstract: Aiyaka, Panadda; Techakehakij, Win
      Background: Cross-reactivity between penicillin and cephalosporin is of crucial concern among patients who have had a previous allergic reaction to penicillin, and cephalosporin is the first choice for their diseases. There is very little evidence concerning the prevalence of cross-reactivity in the Asian population.

      Objectives: This study aims to explore the cross-reactivity between penicillin and cephalosporin in the Asian population.

      Methods: This study included patients who were registered at Lampang Hospital from January 2011 to January 2018. Only patients who were prescribed penicillins and cephalosporins at least once as recorded in the electronic medical records (EMR), were included. Patients having penicillin and cephalosporin allergies were defined as those who were diagnosed in the EMR as allergic to drugs in the penicillin/ cephalosporin groups, in either the probable or definite categories with respect to the Naranjo's algorithm. Cross-reactivity is defined as patients who were diagnosed as being allergic to both penicillin and cephalosporin. Data about characteristics and types of allergic reactions (type I and IV) were obtained from the EMR.

      Results: A total of 13,959 patients were included in the study. Of these, 99 penicillin-allergic and 13,860 non-penicillinallergic patients were identified. The prevalence of cross-reactivity among patients with a history of penicillin allergy was 8.1%. Results showed high cross-reactivity rates among patients with type 1 (16.7%) and type 4 (13.3%) hypersensitivity, in relation to other allergic manifestations (3.4%).

      Conclusions: This study raises the possibility that cross-reactivity reported in previous research may differ from that in the Asian population. More Asian-based studies are needed to evaluate this cross-reaction so that this information can further assist medical professionals in clinical decision-making.

      PubDate: Fri, 21 Jun 2019 16:25:29 GMT
       
  • Volume 26 Issue 3 - The effectiveness of modified basic life support
           module on knowledge, attitude, and performance of cardiopulmonary
           resuscitation among university students
    • Abstract: Jusoh, Azizul Fadzli Wan; Yahaya, Rosliza; Him, Nik Ahmad Shaiffudin Nik; Mohamed, Nik Arif Nik; Zahary, Mohd Nizam; Ibrahim, Wan Pauzi Wan
      Introduction: Cardiopulmonary resuscitation is a primary method used in the treatment of sudden cardiac arrest. It is a crucial skill that a healthcare provider and a lay rescuer should acquire to improve the survival and the neurological outcome of out-of-hospital cardiac arrest. Several modules were used to teach cardiopulmonary resuscitation for the healthcare provider and lay rescuer, but no module been developed that could be utilised in both population. Thus, this study aims to investigate the effectiveness of modified cardiopulmonary resuscitation training to knowledge (K), attitude (A), and performance (P) between medical and non-medical university students.

      Methods: This research was a single experimental study involving a total number of 125 students: 58 for a medical group and 67 for a non-medical group. A modified basic life support module, based on American Heart Association guideline 2015 was delivered to both groups under the same study setting. Pre and post KA scores were assessed using Res-Q questionnaire. The performance was evaluated by resuscitation feedback machine. The KA scores were analysed using repeated measure analysis of variance, and performance was examined using Pearson chi-square.

      Results: The study showed 64.8% of the participants were able to perform high-quality chest compression. Despite significant differences of sociodemographic background, there was no significant difference on effective chest compression between two groups (p = 0.200). There were also significant improvements in KA scores in both groups after intervention (p < 0.001).

      Conclusion: The knowledge of cardiopulmonary resuscitation can be delivered to everyone as aspired by our stakeholder to have one qualified cardiopulmonary resuscitation provider in a family. This modified basic life support module is reliably applicable to both healthcare and lay rescuer cardiopulmonary resuscitation training. All rescuers will perform in a similar manner, and this will tremendously reduce the discrepancy in the cardiopulmonary resuscitation qualities. Ultimately, this will improve an out-of-hospital return of spontaneous circulation rate.

      PubDate: Fri, 21 Jun 2019 16:25:29 GMT
       
  • Volume 26 Issue 3 - The effects of prearrival direct notification call to
           interventional cardiologist on door-to-balloon time in patients who
           required secondary diversion with ST-elevation myocardial infarction for
           primary percutaneous coronary intervention
    • Abstract: Choe, Jeong Cheon; Cha, Kwang Soo; Choi, Jin Hee; Ahn, Jinhee; Kim, Jin Hee; Park, Jin Sup; Yang, Mi Jin; Lee, Hye Won; Oh, Jun-Hyok; Choi, Jung Hyun; Lee, Han Cheol; Hong, Taek Jong
      Background: Rapid door-to-balloon times in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention are associated with favorable outcomes.

      Objectives: We evaluated the effects of prearrival direct notification calls to interventional cardiologists on door-toballoon time for ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

      Methods: A 24-h hotline was created to allow prearrival direct notification calls to interventional cardiologists when transferring ST-elevation myocardial infarction patients. In an urban, tertiary referral center, patients who visited via inter-facility or the emergency department directly were included. Clinical parameters, time to reperfusion therapy, and in-hospital mortality were compared between patients with and without prearrival notifications.

      Results: Of 228 ST-elevation myocardial infarction patients, 95 (41.7%) were transferred with prearrival notifications. In these patients, door-to-balloon time was shorter (50.0 vs 60.0 min, p = 0.010) and the proportion of patients with doorto- balloon time < 90 min was higher (89.5% vs 75.9%, p = 0.034) than patients without notifications. These improvements were more pronounced during "off-duty" hours (52.0 vs 78.0 min, p = 0.001; 88.3% vs 72.3%, p = 0.047, respectively) than during "on-duty" hours (37.5 vs 43.5 min, p = 0.164; 94.4% vs 79.4%, p = 0.274, respectively). In addition, door-toactivation time (-39 vs 11 min, p < 0.001) and door-to-catheterization laboratory arrival time (33 vs 42 min, p = 0.007) were shorter in patients with prearrival notifications than those without. However, in-hospital mortality was similar between the two groups (6.3% vs 6.8%, p = 0.892).

      Conclusion: Prearrival direct notification calls to interventional cardiologists significantly improved the door-to-balloon time and the proportion of patients with door-to-balloon time < 90 min through rapid patient transport in primary percutaneous coronary intervention scheduled hospital and readiness of the catheterization laboratory.

      PubDate: Fri, 21 Jun 2019 16:25:29 GMT
       
  • Volume 26 Issue 3 - 9-year review of new psychoactive substance use in
           Hong Kong: A clinical laboratory perspective
    • Abstract: Tang, Magdalene HY; Hung, LY; Lai, CK; Mak, Tony Wing Lai; Ching, CK
      Background: New psychoactive substances are constantly evolving structural analogues of traditional drugs of abuse that have become a threat to public health worldwide and within our locality. An understanding of the local pattern of new psychoactive substance use will help guide frontline clinical management.

      Objectives: This study was conducted to review the new psychoactive substances detected in cases referred to the authors' laboratory (a tertiary clinical toxicology centre), as well as the associated clinical features and toxicological findings.

      Methods: All cases referred to the laboratory for toxicology analysis between January 2009 and December 2017, and which were analytically confirmed to involve new psychoactive substance use, were retrospectively reviewed. Demographic data, clinical features and toxicology findings were studied.

      Results: A total of 111 cases involving 104 patients and 22 types of new psychoactive substances were identified, with an increasing trend in the number of cases and subclass of new psychoactive substances detected. Up to half of the cases (n = 64) were related to the use of 2-phenyl-2-(ethylamino)-cyclohexanone (2-oxo-PCE, a ketamine analogue); other new psychoactive substances detected included para-methoxymethamphetamine, 4-fluoroamphetamine, phenazepam, 3-trifluoromethylphenylpiperazine, 5-methoxy-diisopropyltryptamine, 2-diphenylmethylpyrrolidine, methoxyphenidine, the N-methoxybenzyl drugs, cathinones, synthetic cannabinoids and opioids. Among the acute poisoning cases attributable to new psychoactive substance use, the severity was fatal (n = 3), severe (n = 17), moderate (n = 67) and minor (n = 17). And 11 patients required intensive care unit admission. All three fatal cases were associated with paramethoxymethamphetamine use.

      Conclusion: A rising trend of new psychoactive substance use is observed locally, which is associated with considerable morbidity and mortality. Continued vigilance from frontline clinicians and medical professionals is imperative in the combat against new psychoactive substance use.

      PubDate: Fri, 21 Jun 2019 16:25:29 GMT
       
  • Volume 26 Issue 3 - Syncope due to a silent mass
    • Abstract: Cheung, Jonathan Chun-Hei; Lee, Kwok Fung; Law, Kam Leung; Kitchell, Abdul Karim Bin
      A middle-aged man presented to the emergency department with syncope. Point-of-care echocardiography was performed and helped made the diagnosis. The patient thereby received the definitive treatment in the shortest possible time.

      PubDate: Fri, 21 Jun 2019 16:25:29 GMT
       
  • Volume 26 Issue 3 - Reciprocal abstract publication
    • PubDate: Fri, 21 Jun 2019 16:25:29 GMT
       
  • Volume 26 Issue 3 - Readiness of Hong Kong secondary school teachers for
           
    • Abstract: Fan, Min; Leung, Ling-Pong; Leung, Reynold; Hon, Suet; Fan, Kit Ling
      Background: Bystander cardiopulmonary resuscitation can improve the survival rate of patients with out-of-hospital cardiac arrest. Teaching cardiopulmonary resuscitation in schools by teachers is one of the ways to increase the number of bystanders who can perform cardiopulmonary resuscitation. Nevertheless, there have been no studies on the readiness of teachers in Hong Kong to teach cardiopulmonary resuscitation in their schools.

      Objective: To assess whether secondary school teachers are prepared to teach their students cardiopulmonary resuscitation.

      Methods: This was a questionnaire survey. Teachers from 22 local secondary schools were recruited. The questionnaires were designed with questions covering their knowledge about cardiopulmonary resuscitation and attitudes towards teaching their students cardiopulmonary resuscitation. A knowledge score and attitude score were calculated.

      Result: 557 teachers completed the questionnaires. Most had never witnessed a cardiac arrest and over half of them had never been trained cardiopulmonary resuscitation or use of an automated defibrillator. About 25% of them answered all questions on knowledge wrong. Only 25% supported teaching cardiopulmonayr resuscitation in schools and 32% were willing to teach it. Legal liability was a major concern.

      Conclusion: Local teachers' readiness for teaching students cardiopulmonary resuscitation in secondary schools is likely poor. More efforts are required to raise their knowledge level on cardiopulmonary resuscitation and instill a positive attitude towards cardiopulmonary resuscitation education in schools.

      PubDate: Fri, 21 Jun 2019 16:25:29 GMT
       
  • Volume 26 Issue 2 - Therapeutic measures in a moving ambulance:
           Qualitative study of professional opinions regarding prehospital
           emergencies
    • Abstract: Castejon-de la Encina, Maria Elena; Quiles, Angela Sanjuan; Garcia-Aracil, Noelia; Lopez, Beatriz Morales; Martinez, Miguel RichartIgnacio Del Moral Vicente Mazariegos
      Background: current organization of the prehospital emergency teams, decreasing the prehospital times, given the possibility of working during the patient's transport and, therefore, the consequences that may result from the same improving the prognostic.

      Objectives: To explore the opinion of professional healthcare experts regarding prehospital emergencies arising when forced to assist a critical patient in a moving vehicle, based on a high-fidelity clinical simulation, as well as the factors influencing them.

      Methods: An exploratory study of content analysis with qualitative methodology, via semi-structured questionnaires that are self-completed anonymously, before and after the clinical simulation intervention in which participants intubate a mannequin in a moving ambulance. The sample consisted of 36 experts in prehospital emergencies from the province of Alicante (Spain). Codification and assessment of the data obtained was carried out via triangulation, respecting the language and literal expressions of the participants.

      Results: Thirty-two pre- and post-intervention questionnaires were completed. Four different units of meaning or categories emerged which were organized based on two thematic structures, from the perspective of professional and patient needs. Twenty-three participants had never previously intubated in a moving vehicle.

      Discussion: Working in a moving vehicle may be yet another aspect to consider in the specialized teaching-learning process of prehospital emergency medicine.

      Conclusion: Based on the need to decrease prehospital assistance times, a new paradigm has been opened in prehospital emergencies with the possibility of being able to safely assist our patients during their transport on a moving ambulance or helicopter. It will be necessary further research in the future.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - A short report on the acquisition of point-of-care
           ultrasound skills and knowledge by the ambulance personnel in Hong Kong
    • Abstract: Hon, Suet; Fan, Min; Leung, Ling-Pong; Mok, Ka-Leung; Kwok, Kin-Man
      Background: Point-of-care ultrasound plays an important role in patient management in the prehospital setting. Prehospital ultrasound training for the paramedics has been developed in the West for many years. However, the present training curriculum for the local ambulance personnel does not include point-of-care ultrasound. This study is the first of its kind in Hong Kong on the feasibility of teaching ambulance personnel how to perform focused assessment with sonography in trauma by a 1-day course.

      Objective: It aimed to assess whether the ultrasound-naive ambulance personnel could acquire the skills and knowledge of point-of-care ultrasound following a tailor-made training programme.

      Methods: This was a prospective observational study. The training programme was a 1-day course consisted of didactic lectures and hands-on practice. Each participant was assessed by a written test and a skills test. Descriptive statistics were used to describe the ambulance personnel and their results of the written and skills test. Significance testing was by Mann-Whitney U test and Spearman correlation test where appropriate.

      Results: Seventeen members of Ambulance Service Institute (Hong Kong Branch) participated in the programme. All of them currently are the ambulance personnel and they joined the programme via the captioned institute. Enrollment was voluntary. The median score in the written test was 20 out of 25. The median time to complete the four views of the focused assessment with sonography in trauma scan was 3.4 min. There was no significant relationship between test performance and educational background and work experience of the ambulance personnel.

      Conclusion: Training the local ambulance personnel point-of-care ultrasound is feasible. Their acquisition of skills and knowledge of point-of-care ultrasound after a 1-day course was satisfactory.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - Intensive care unit admission protocol controlled by
           intensivists can reduce transfer delays from the emergency department in
           critically ill patients
    • Abstract: Kim, Ji Eun; Lee, Seul; Jeong, Jinwoo; Lee, Dong Hyun; Jeong, Jin-Heon
      Background: Delayed transfer of patients from the emergency department to the intensive care unit is associated with adverse clinical outcomes. Critically ill patients with delayed admission to the intensive care unit had higher inhospital mortality and increased hospital length of stay.

      Objectives: We investigated the effects of an intensive care unit admission protocol controlled by intensivists on the emergency department length of stay among critically ill patients.

      Methods: We designed the intensive care unit admission protocol to reduce the emergency department length of stay in critically ill patients. Full-time intensivists determined intensive care unit admission priorities based on the severity of illness. Data were gathered from patients who were admitted from the emergency department to the intensive care unit between 1 April 2016 and 30 November 2016. We retrospectively analyzed the clinical data and compared the emergency department length of stay between patients admitted from the emergency department to the intensive care unit before and after intervention.

      Results: We included 292 patients, 120 and 172 were admitted before and after application of the intensive care unit admission protocol, respectively. The demographic characteristics did not differ significantly between the groups. After intervention, the overall emergency department length of stay decreased significantly from 1045.5 (425.3-1665.3) min to 392.0 (279.3-686.8) min (p < 0.001). Intensive care unit length of stay also significantly decreased from 6.0 (4.0-11.8) days to 5.0 (3.0-10.0) days (p = 0.015).

      Conclusion: Our findings suggest that introduction of the intensive care unit admission protocol controlled by intensivists successfully decreased the emergency department length of stay and intensive care unit length of stay among critically ill patients at our institution.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - Is lung ultrasonography a useful method to diagnose
           children with community-acquired pneumonia in emergency settings'
    • Abstract: Caglar, Aykut; Ulusoy, Emel; Er, Anil; Akgul, Fatma; Citlenbik, Hale; Yilmaz, Durgul; Duman, Murat
      Background: Lung ultrasonography is a new method for diagnosing community-acquired pneumonia. Lung ultrasonography has some advantages over chest X-ray, such as lack of ionizing radiation risk, bedside performance, and cost-effectiveness.

      Objectives: In this study, we aimed to determine the feasibility of lung ultrasonography in emergency settings in children with community-acquired pneumonia.

      Methods: The study included patients younger than 18 years of age with suspicion of community-acquired pneumonia. On the first evaluation, patients with positive clinical and/or chest X-ray findings were defined to have community-acquired pneumonia, and this was accepted as the gold standard. The chest X-rays were evaluated by the chief of the pediatric emergency department, who was blinded to the patients and the lung ultrasonography results. Lung ultrasonography was performed by another pediatric emergency physician who was also blinded to the chest X-ray results and clinical findings such as fever, respiratory distress, rales, and wheezing.

      Results: Of the 91 patients enrolled, 71 (78.0%) were diagnosed with community-acquired pneumonia based on clinical and chest X-ray findings. The median (interquartile range) duration of the lung ultrasonography procedure was 4.0 (3.5- 6.0) min. Shred sign, air bronchogram, and hepatization were significantly more frequent in the patients with communityacquired pneumonia (p < 0.01, p < 0.01, and p = 0.01, respectively). Sensitivity and specificity of lung ultrasonography were 78.5% (67.1-87.4) and 95.2% (76.1-99.8), respectively.

      Conclusion: Lung ultrasonography is a useful diagnostic method for children with suspicion of community-acquired pneumonia.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - Prophylactic metoclopramide use in trauma patients
           given tramadol: A randomised, double-blinded, placebo-controlled trial
    • Abstract: Choo, Kim Hoon; Manikam, Rishya A/L; Yoong, Khadijah Poh Yuen
      Background: Tramadol is a common analgesia used in Emergency Department for trauma patients. However, it causes multiple side effects, most notably nausea and vomiting.

      Objectives: The aim of this study is to determine whether routine administration of prophylactic metoclopramide in patients receiving intravenous tramadol for injuries of extremities is beneficial.

      Method: A randomised, double-blinded, placebo-controlled trial was carried out on 200 trauma patients requiring tramadol for acute pain in Emergency and Trauma Department of Sarawak General Hospital. Patients were randomised into two groups, group one received metoclopramide 10 mg intravenously while group two received placebo. Nausea severity (measured on a visual analogue scale) before and after tramadol administration, number of episodes of vomiting and patients' demographic data were recorded.

      Results: A total of 191 patients were recruited, in which the metoclopramide group had 96 patients while the placebo group had 95 patients. In total, 5 out of 191 patients had significant worsening of nausea severity and all were from the placebo group (5.26%). The difference was statistically significant (p = 0.029, Fisher's exact test). Only 1 out of 191 patients vomited and was from the placebo group. No adverse reaction was reported in both groups of patients.

      Conclusion: Routine administration of intravenous metoclopramide may be beneficial in musculoskeletal trauma patients receiving tramadol.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - The potential of leg-foot chest compression as an
           alternative to conventional hands-on compression during cardiopulmonary
           resuscitation
    • Abstract: Takahashi, Yoshiaki; Saitoh, Takeji; Okada, Misaki; Satoh, Hiroshi; Akai, Toshiya; Mochizuki, Toshiaki; Hozumi, Hironao; Saotome, Masao; Urushida, Tsuyoshi; Katoh, Hideki; Hayashi, Hideharu; Yoshino, Atsuto
      Background: Conventional hands-on chest compression, in cardiopulmonary resuscitation, is often inadequate, especially when the rescuers are weak or have a small physique.

      Objectives: This study aimed to investigate the potential of leg-foot chest compression, with and without a footstool, during cardiopulmonary resuscitation.

      Methods and Results: We prospectively enrolled 21 medical workers competent in basic life support. They performed cardiopulmonary resuscitation on a manikin for 2 min using conventional hands-on compression (HO), legfoot compression (LF), and leg-foot compression with a footstool (LF + FS). We analyzed the compression depths, changes in the rescuers' vital signs, and the modified Borg scale scores after the trials. The compression depth did not differ between the cases using HO and LF. In the case of LF + FS, compression depths ⩾5 cm were more frequently observed (median, inter-quartile range: 93%, 81%-100%) than in HO (9%, 0%-57%, p < 0.01) and LF (28%, 11%-47%, p < 0.01). The increase in the heart rate or modified Borg scale scores, after the trials, did not differ between the HO and LF group; however, the values were the lowest in the case of LF + FS (49 +- 18 beats/min and 5 (4-7) in HO, 46 +- 18 and 6 (5-7) in LF, and 32 +- 11 and 2 (1-3) in LF + FS, respectively, p < 0.01). However, the increase in blood pressure, SpO2, and respiratory rate were not different among each group. The increases in the heart rate and modified Borg scale scores negatively were correlated with the rescuers' body size, in the case of HO and LF, but not LF + FS.

      Conclusion: LF can be used as an alternative to HO, when adequate HO is difficult. LF + FS could be used when rescuers are weak or have a small physique and when the victims are bigger than the rescuers.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - The value of ultrasound in diagnosis of
           pneumoperitoneum in emergent or critical conditions: A meta-analysis
    • Abstract: Jiang, Libing; Wu, Jing; Feng, Xia
      Background: Hollow organs perforation is a life-threatening condition. Early diagnosis and emergent intervention are important. Bedside ultrasound may be an alternative diagnostic tool for this condition.

      Objective: The aim of this study was to explore the diagnostic value of ultrasound of pneumoperitoneum in emergent or critical conditions through meta-analysis.

      Methods: PubMed, EMBASE, and Cochrane Library were systematically searched for potential studies. Then, two reviewers performed the processes of study selection, data extraction, and quality assessment independently. Finally, diagnostic indexes were analyzed with STATA 12.0 software (Serial No. 40120519635).

      Results: A total of five studies with moderate to high quality were eligible for meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio and their 95% confidence interval were 0.91 (95% confidence interval = 0.86-0.94), 0.96 (95% confidence interval = 0.75-0.99), 22.05 (95% confidence interval = 3.10-156.96), and 0.10 (95% confidence interval = 0.07-0.15), respectively. The area under the summary receiver operating characteristic curve was 0.92 (95% confidence interval = 0.90-0.94).

      Conclusion: Abdominal ultrasound is a useful alternative tool in diagnosing of pneumoperitoneum. However, due to limited evidence, it is not yet indicated for routine clinical use.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - Extracorporeal life support: The final 'antidote' for
           massive propranolol overdose
    • Abstract: Chen, Liang-Wen; Mao, Desmond Renhao; Chen, Yih-Sharng
      Massive propranolol overdose may result in severe cardiotoxicity. A 48-year-old female had consumed more than 5000 mg of propranolol. Despite high-dose insulin, intravenous sodium bicarbonate, glucagon and inotropic support, she became hypotensive and subsequently arrested. Following cardiopulmonary resuscitation, she had a return of spontaneous circulation but continued to experience refractory hypotension. Resuscitation continued with venoarterial extracorporeal life support. Therapeutic plasma exchange was initiated to shorten time on extracorporeal life support. Extracorporeal life support was weaned off within 67 h, and she survived without neurological deficits. This records the largest propranolol overdose in recent years. When traditional antidotes are insufficient to prevent collapse, extracorporeal life support is a salvage therapy to maintain perfusion and reduce vasopressor requirements. As drug clearance is significantly prolonged, therapeutic plasma exchange can enhance removal of propranolol and reduce the time to extracorporeal life support removal. With increasing expertise and availability, extracorporeal life support should be considered early in patients who have overdosed with significant cardiotoxicity.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - Man with sudden upper abdominal pain
    • Abstract: Hsu, Hung-Lin; Lee, Wei-Jing
      A 52-year-old man without systemic disease presented to the emergency department with sudden-onset epigastric pain for 2 h. He had vomiting for several times without fever, diarrhea, or recent abdominal trauma. Point-of-care ultrasound revealed flap in the superior mesenteric artery. Percutaneous endovascular stent placement was arranged due to refractory upper abdominal pain and poor response to medical treatment.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - Suicidal hanging patient with complete tracheal
           rupture
    • Abstract: Jeong, Hyun Ho; Choi, Kyoung Ho; Oh, Young Min; Kyong, Yeon Young; Choi, Se Min; Oh, Joo Suk; Park, Taek Jung
      In attempted suicide, laryngotracheal rupture caused by hanging leads to rapid death at the scene or before arrival at hospital. The case presented here describes a patient with complete tracheal rupture from an attempted suicidal hanging who was successfully resuscitated. Pre-hospital providers transferred the patient to hospital without being aware of the possibility of airway damage. Cardiac arrest occurred shortly after arrival at hospital. During the cardiopulmonary resuscitation, endotracheal intubation was performed, and fortunately, the tracheal tube was located just below the ruptured trachea and thus enabled ventilation. For patients suspected of having airway damage at the pre-hospital stage, awareness of the patient's condition and adequate airway management are important. The management of laryngotracheal rupture which suggests that for patients not adequately ventilated, immediate treatment with flexible fiberoptic intubation or tracheostomy is needed to secure the airway. Equipment and personnel at the receiving hospital need to be prepared for immediate treatment.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - Toothpick injury mimicking acute holecystitis
    • Abstract: Lee, Duk Hee; Choi, Yoon Hee
      Introduction: Accidental foreign bodies ingestion is common in emergency department. However, if the objects are sharp, the complication rate is higher. Toothpick can cause severe complications of gastrointestinal tract due to being long, sharp ends on both sides, slender, and resistant to digestion.

      Case presentation: A 64-year-old man presented to the emergency department with fever and right upper abdominal pain for 3 days. The physical examination revealed severe pain with rebound tenderness in the right upper abdominal quadrant and positive Murphy's sign. The provisional diagnosis of acute cholecystitis was made. The contrast abdominal-pelvic computed tomography scan revealed linearshaped lesion penetrating hepatic flexure of colon and proximal transverse colon. The patient showed deterioration of vital sign, and therefore, emergency laparotomy was performed. Colon perforation by wooden toothpick was diagnosed.

      Discussion and conclusion: Toothpick ingestion without awareness is rare but fatal, especially when physicians failed to suspect foreign body ingestion. We think of this as one of the differential diagnoses, so we use contrast computed tomography scan.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - A young woman with right upper quadrant pain
    • Abstract: Lee, Sun Hwa; Yun, Seong Jong
      Patients with right upper quadrant pain are commonly encountered in the emergency department. The causes of right upper quadrant range from infection or inflammation to malignancy. Thus, prompt and accurate diagnoses are essential in the emergency department. However, vicarious excretion of contrast media via the gallbladder, presenting as right upper quadrant pain, has been rarely reported and is not well known. The present case is instructive because gallbladder opacification is often considered a pathologic condition in patients with right upper quadrant pain. Although vicarious excretion via the gallbladder is uncommon in patients with right upper quadrant pain, inaccurate or delayed diagnoses may prolong hospitalization and increase medical costs due to unnecessary and invasive diagnostic procedures.

      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - A multicentered pharmacoepidemiological approach to
           evaluate clinically significant potential drug-drug interactions in
           medical intensive care settings in Pakistan
    • Abstract: Shakeel, Faisal; Khan, Jamshaid Ali; Aamir, Muhammad; Asim, Syed Muhammad; Ullah, Irfan
      PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - Reviewer thank you
    • PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 2 - Reciprocal abstract publication
    • PubDate: Mon, 22 Apr 2019 18:42:21 GMT
       
  • Volume 26 Issue 1 - Ten-year profile of acute poisoning patients
           presenting to an accident and emergency department requiring intensive
           care in a regional hospital of Hong Kong
    • Abstract: Ng, Fu
      Background: Hong Kong Poison Information Centre publishes annual reports on all poisoning cases received by the Centre in that year since 2006. However, there is little data about acute poisoning cases requiring intensive care unit admissions in Hong Kong.

      Objective: To report and analyze the 10-year poisoning data of acute poisoning patients presenting to an Accident and Emergency Department requiring intensive care in a regional hospital of Hong Kong.

      Methods: This was a retrospective study on patients presented from January 2007 to December 2016. These cases were retrieved from Clinical Data Analysis and Reporting System of the Hospital Authority, Hong Kong. Clinical data of these cases were then retrieved from patients' electronic records.

      Results: A total of 270 cases were analyzed during the period. There were 152 (56.3%) male patients and 118 (43.7%) female patients. The middle aged group (age 30-39 and age 40-49) constitutes nearly half (48.6%) of all these admissions. Around 50% of them had history of psychiatric illness. Nearly 40% of them were known substance abusers. Majority of the patients (66.7%) were admitted directly from Accident and Emergency Department. The commonest cause was suspected self-harm (56.3%). When ethanol (13%) was excluded, the five commonest types of poisons were benzodiazepine (26.3%), opioids (20.7%), zopiclone (18.5%), carbon monoxide poisoning (13%), and household products (10.7%). Twenty-seven patients (10%) had decontamination done in Accident and Emergency Department or Emergency Medicine Ward. 112 patients (41.5%) were given one or more antidotes in Accident and Emergency Department and Emergency Medicine Ward. Altered mental status was the most frequently found complications (72.2%) in these patients. 76 patients (28.1%) required endotracheal intubation in Accident and Emergency Department. The length of stay in Intensive Care Unit ranged from 1 to 7 days with an average of 2.1 days. There were 25 deaths (9.3%) and 31 patients with major effects (11.5%).

      Conclusion: An estimate of 9.4% of acute poisoning patients presenting to Accident and Emergency Department might need Intensive Care Unit care at certain stage of their hospital stay. Benzodiazepine, opioids, zopiclone, carbon monoxide poisoning, and ethanol were the top five poisons in our series from 2007 to 2016. The mortality rate (9.3%) was high in our series given that there were more substance abusers.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - Attempted suicide by poisoning of self-prepared
           arsenic trioxide solution
    • Abstract: Poon, KM; Lam, SK; Lai, CH; Fung, HT
      Introduction: Arsenic is a traditional poison that has a history extending back to ancient times.

      Case presentation: A 43-year-old male presented to our Emergency Department 50 min after ingestion of 300 mL self-prepared arsenic trioxide solution. He produced the solution from heating xionghuang, an arsenic sulfide mineral (As4S4) which is a Chinese herb, for academic purposes a few years ago.

      Discussion: Supportive care including fluid replacement and decontamination with gastric lavage and chelation therapy with intravenous dimercaptopropanesulphonate sodium was given to patient. Spot urine arsenic to creatinine ratio significantly decreased from 343,124 nmol/mmol (day 3) to 7116 nmol/mmol (day 5). He had an uneventful course without any neurological deficit.

      Conclusions: Treatment of acute arsenic poisoning includes supportive care, decontamination, and chelation therapy. DMPS is an antidote for arsenic poisoning and its use should be directed by clinical status and urinary arsenic excretion.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - Reciprocal abstract publication
    • PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - A preliminary report of clinical experience in
           
    • Abstract: Li, Chun Kit; Wong, Oi Fung; Ko, Shing; Ma, Hing Man; Lit, Chau Hung Albert
      Background: Sepsis and septic shock are common causes of hospital admission, morbidity, and mortality, posing a significant burden on the health-care systems.

      Objective: The objective of this study was to report the clinical experience of management and outcomes of sepsis patients in the emergency medical ward of a community hospital. The risk factors associated with adverse outcomes of sepsis patients were also analyzed.

      Methods: This was a retrospective cohort study of patients with sepsis or septic shock managed in the emergency medical ward of North Lantau Hospital from 1 March 2015 to 31 March 2017. Their characteristics, clinical outcomes, risk factors associated with in-hospital mortality, 28-day mortality, and prolonged hospital stay (>14 days) were analyzed.

      Results: A total of 68 eligible patients met the inclusion criteria during the study period. The mean age of the patients was 73 (standard deviation, 16.7; range, 34-100) years. The mean Sequential Organ Failure Assessment score of all the cases was 4.5 (standard deviation, 2.4); range, 2-11). The most common source of infection was pneumonia (50%). During the stay in the emergency medical ward, 35 cases (49%) required vasopressor support for management of septic shock, and 12 cases required non-invasive ventilation (NIV) support. Five patients were eventually transferred to tertiary hospital (Princess Margaret Hospital) for further management. There were five in-hospital mortality cases and two 28-day mortality cases. From the univariate analysis, factors associated with in-hospital mortality included Sequential Organ Failure Assessment score >6 (p < 0.000), increasing number of organ dysfunction (p < 0.000), presence of chronic liver disease (p = 0.025), respiratory dysfunction during admission (p = 0.028); factors associated with 28-day mortality were advanced age (p < 0.000), increasing number of organ dysfunction (p = 0.033), presence of congestive heart failure (p = 0.004), and the presence of cancer (p = 0.034); factors associated with prolonged hospital stay were advanced age, presence of chronic obstructive airway disease (p = 0.003), advanced age (p = 0.041), and the use of NIV support (p = 0.001). In multivariate analysis, weak associations between in-hospital mortality and Sequential Organ Failure Assessment score >6 (p = 0.226) and increased number of organ dysfunction (p = 0.108) were demonstrated; there was a trend of prolonged length of stay with increased age (p = 0.139).

      Conclusion: Our experience and knowledge in managing sepsis patients in the emergency medical ward with implementation of critical care bed services increased significantly. These preliminary results demonstrated that, with appropriate patient selection, sepsis patients can be safely managed in the emergency medical ward. Further study with larger sample size is needed to identify risk factors of adverse outcomes in this group of patients managed in the emergency medical ward.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - Are the Filipino domestic helpers caring the
           home-dwelling elders in Hong Kong competent to provide first aid in a
           medical emergency'
    • Abstract: Ho, Cheuk-Him; Chan, Tsz-Kit; Leung, Nicholas ATC; Leung, Reynold; Fan, Kit-Ling; Leung, Ling-Pong
      Background: The healthcare need of the elderly in Hong Kong is a major issue. Foreign domestic helpers, especially those from the Philippines, play a significant role in response to the healthcare need of a home-dwelling elder as they are often the sole caregiver of the elders.

      Objectives: This study primarily aimed at exploring the Filipino domestic helpers' knowledge of and attitude to managing a medical emergency of a home-dwelling elder.

      Methods: This was a questionnaire survey of the Filipino domestic helpers working in Hong Kong and was conducted from 1 July 2015 to 29 February 2016. The survey collected their demographic data, evaluated their first aid knowledge by a test of multiple-choice questions and assessed their attitudes to providing first aid to the elders they cared in terms of confidence and perceived responsibility. Descriptive statistics were used to describe the findings.

      Results: In all, 398 Filipino domestic helpers were surveyed. Most had completed university education. About one third had been trained in first aid. The average mark attained by the respondents on first aid knowledge assessment was 4.5 (full mark = 16). Their knowledge was especially poor in heat exhaustion, choking, external bleeding, epistaxis and scald injury. Their median confidence score was 10 (full score = 15) and median perceived responsibility score was 13 (full score = 20).

      Conclusion: The first aid knowledge among the Filipino domestic helpers surveyed in this study was poor. They were not confident enough in providing first aid to an elder and their perceived responsibility was also low.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - Modification of Glasgow-Blatchford scoring with
           lactate in predicting the mortality of patients with upper
           gastrointestinal bleeding in emergency department
    • Abstract: Konyar, Zeynep; Guneysel, Ozlem; Sari Dogan, Fatma; Gokdag, Eren
      Background: Gastrointestinal bleeding is a commonly seen multidisciplinary clinical condition in emergency departments which has high treatment cost and mortality in company with hospital admission. Risk evaluation before endoscopy is based on clinical and laboratory findings at patient's emergency visit.

      Objective: The purpose of this study is to investigate the efficacy of "Glasgow-Blatchford scale + lactate levels" to predict the mortality of patients detected with gastrointestinal bleeding in the emergency department.

      Methods: A total of 107 patients with preliminary diagnosis of upper gastrointestinal bleeding included in the study after approval of the ethics committee were prospectively evaluated. Glasgow-Blatchford scale scores were calculated and venous blood lactate levels were assessed. Need for blood transfusion in the follow-up, the amount of transfusion, and mortality in the next 6 months were evaluated.

      Results A statistically significant difference was found in mortality rates between the lactate and Glasgow-Blatchford scale cohorts in our study (p = 0.001 and p < 0.01, respectively). The mortality rate was significantly higher in the lactate(+) GBS(+) cases compared to the lactate(-) GBS(+), lactate(+) GBS(-), and lactate(-) GBS(-) cases compared to the bilateral comparisons (p = 0.004, p = 0.001, p = 0.001, and p < 0.01, respectively). There was a statistically significant relationship between the rate of erythrocyte suspension replacement in the cases according to Glasgow-Blatchford scale levels (p = 0.001 and p < 0.01, respectively). The incidence of erythrocyte suspension replacement was 7.393 times greater in patients with Glasgow-Blatchford scale score of 12 and above.

      Conclusion: Glasgow-Blatchford scale is highly sensitive to the determination of mortality risk and the need for blood transfusion in upper gastrointestinal bleeding. Glasgow-Blatchford scale with lactate evaluation is more sensitive and more significant than Glasgow-Blatchford scale alone. This significance provides us to establish "modified Glasgow- Blatchford scale." In the future, studies which will use Glasgow-Blatchford scale supported by lactate could be increased and the results should be supported more.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - Risk factors for delayed-onset rhabdomyolysis in
           doxylamine succinate intoxication patients
    • Abstract: Lim, Ji Yeon; Choi, Yoon Hee; Lee, Duk Hee; Lee, Dong Hoon
      Background and Objectives: Patients who overdose on doxylamine, hypnotic agent, usually exhibit good outcomes, but some experience serious complications. Some patients who present with normal creatinine phosphokinase levels in the emergency department later develop rhabdomyolysis during observation. We investigated factors associated with delayed-onset rhabdomyolysis in patients with doxylamine overdoses.

      Methods: Our investigation period was between 1 January 2011 and 29 February 2016. The initial blood samples were obtained for arterial blood gas analysis and measurements of the levels of electrolytes, creatinine phosphokinase, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase. Urine analyses including pH and occult blood analyses were performed. Follow-up samples were obtained at 6 and 12 h after admission. Delayed-onset rhabdomyolysis was defined by a follow-up serum creatinine phosphokinase level greater than fivefold the upper limit of normal (>1000 IU/L). Comparisons of categorical variables between groups were performed using either the χ2 or Fisher exact tests. Continuous variables were compared between groups using the Mann-Whitney U test.

      Results: A total of 337 patients were enrolled. The large amount of ingested doxylamine (odds ratio = 7.002), tachycardia (odds ratio = 2.809), low arterial blood gas analysis pH (odds ratio = 2.267), and presence of occult blood in the urine (odds ratio = 2.048) were significant associated with delayed-onset rhabdomyolysis.

      Conclusion: Laboratory follow-up examinations were required for patients, ingested more than 18 mg/kg doxylamine poisoning, who had pulses exceeding 120 beats/min, had arterial blood gas analysis pH values below 7.3 on blood and urine testing, and/or exhibited the presence of occult blood in the urine, even if the initial creatinine phosphokinase level was normal.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - The effectiveness of traditional basic life support
           training and alternative technology-enhanced methods in high schools
    • Abstract: Onan, Arif; Turan, Sevgi; Elcin, Melih; Erbil, Bulent; Bulut, Sule Cinar
      Background: Implementation of resuscitation training in school programs is a promising approach to improve rates of cardiopulmonary resuscitation use by trained bystanders. Unfortunately, theoretical cardiopulmonary resuscitation instruction alone is not sufficiently effective in developing practical skills.

      Objectives: This study aimed to investigate the effectiveness of traditional Basic Life Support training and alternative instructional methods to achieve learning objectives of Basic Life Support education.

      Methods: This quasi-experimental study was conducted in a secondary school in Ankara, Turkey. Eighty-three voluntary students were randomly allocated to theoretical (Group A), video-based (Group B), and mobile-assisted video-based instructions (Group C). All groups were led by the course teacher. Assessments were conducted in training and again 1 week later. Assessments were based on Basic Life Support knowledge and confidence performance scores.

      Results: Statistically significant difference was found for the groups' Confidence Scale scores (F(2, 73) = 3.513, p = 0.035, ηp2 = 0.088); Group C (6.76 +- 1.70) scored higher than Group A. The groups' Basic Life Support checklist scores were statistically significant (F(2, 73) = 28.050, p = 0.000, ηp2 = 0.435); Group C (32.32 +- 3.84) scored higher than the other groups. Statistically significant difference was found for the groups' measurable Basic Life Support scores (F(2, 73) = 13.527, p = 0.000, ηp2 = 0.270); and Group C (23.76 +- 3.98) scored higher than the other groups.

      Conclusion: Our findings showed that all instruction methods led to increased Basic Life Support knowledge scores. The mobile-assisted program significantly increased knowledge scores. Same-group high-quality cardiopulmonary resuscitation parameters were more positive than the other instruction groups except for hand position. Group C students expressed higher confidence in their ability to act in an emergency when witnessing a victim collapse.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - Distal ulnar fracture nonunion management: An uncommon
           case report
    • Abstract: Lo, Chi Kin; Kam, Wing Lok
      Introduction: Isolated distal ulnar fracture is an uncommon injury. Only a few case series that look into the management of ulnar fracture nonunion have been reported in the literature.

      Case presentation: A middle-aged manual worker presented to us for isolated fracture of his left distal ulna. He received open reduction and fixation of the distal ulnar fracture using distal ulna locking plate. It was complicated with nonunion and he complained of persistent wrist pain. This distal ulnar fracture nonunion was finally treated by Sauve-Kapandji procedure with good functional outcome.

      Discussion: Displaced distal ulnar fracture should be reduced anatomically with rigid fixation to prevent disruption of the distal radioulnar joint. Fracture nonunion was traditionally managed with revision osteosynthesis and bone grafting. It is, however, technically difficult at the distal ulnar region because of the poor bone stock and lack of soft tissue coverage.

      Conclusion: We have demonstrated that the Sauve-Kapandji procedure is a good treatment alternative for distal ulnar fracture nonunion.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - Right time, right place, and right direction: First
           reported use of dual simultaneous external defibrillation in Hong Kong
    • Abstract: Lau, James Siu Ki; Yau, Ming Chau; Wong, Yau Tak; Kan, Pui Gay
      Introduction: Refractory ventricular fibrillation is not uncommon and can be extremely difficult to abort. There is currently no standard guideline to effectively manage this electrical storm.

      Case Presentation: We hereby present the first successful reported use of dual simultaneous external defibrillation on a patient with refractory ventricular fibrillation in Hong Kong.

      Conclusion: Given the numerous successful cases with intact neurology in literature, dual simultaneous external defibrillation should be employed in indicated patients.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - Woman with left-side weakness
    • Abstract: Tsai, Yu-Chieh; Tsai, Hui-Chu; Lee, Wei-Jing
      Most acute intracranial hemorrhages present to the emergency department are due to severe hypertension, coagulopathies, aneurysm, or tumor. We describe a 41-year-old female presented with progressive left-side weakness for 6 h. Initial computed tomography of the brain showed acute hemorrhage at right temporo-parietal region. Subsequent brain magnetic resonance imaging confirmed right cerebral cortical venous thrombosis complicated by acute intraparenchymal hematoma. This report provides a rare etiology of acute intracranial hemorrhage in which early diagnosis and prompt anticoagulation are crucial for patient well-being.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
  • Volume 26 Issue 1 - Imaging quiz: A child with multiple trauma
    • Abstract: Ozkacmaz, Sercan
      Splenic and renal infarctions are embolic conditions which usually occur secondary to cardiac problems, thromboembolic systemic diseases, and infectious conditions such as sepsis. Trauma is a relatively rare cause of visceral infarctions. Traumatic segmental renal infarction associated with total splenic infarction is extremely rare. For detecting these visceral infarctions, contrast-enhanced computed tomography is essential, and a very careful examination is required for detecting very small infarctions and excluding total visceral infarctions. In isolated splenic or renal infarctions secondary to trauma, the common contrast-enhanced computed tomography findings are wedge-shaped or segmental hypodense areas in kidneys or spleen and rarely total visceral infarctions. Usually, intraperitoneal or retroperitoneal fluid collection which corresponds to bleeding from kidney or spleen is not seen in such cases. Also, the lack of evidence of active extravasation from renal/splenic arteries and pseudoaneurysm or dissection is an important finding of isolated traumatic splenic or renal infarctions. Because total infarctions can be misinterpreted in some cases, differences in density between intra-abdominal organs allowed by computed tomography must be carefully examined. Intestinal infarctions, the other abdominal injuries, pulmonary injuries, and pelvic or thoracic bone fractures usually accompany traumatic renal or splenic infarctions. In this report, we present contrast-enhanced computed tomography findings of a multitrauma pediatric case of traumatic total splenic and bilateral segmental renal infarction by reviewing the literature.

      PubDate: Thu, 14 Feb 2019 21:07:01 GMT
       
 
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