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: 5)
Aboriginal and Islander Health Worker J.     Full-text available via subscription   (Followers: 18)
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: 29)
ACCESS: Critical Perspectives on Communication, Cultural & Policy Studies     Full-text available via subscription   (Followers: 16)
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: 26, 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: 2)
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: 17, SJR: 0.142, CiteScore: 0)
Analysis     Full-text available via subscription   (Followers: 4)
Ancient History : Resources for Teachers     Full-text available via subscription   (Followers: 10)
Anglican Historical Society J.     Full-text available via subscription   (Followers: 5)
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  
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: 12)
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: 6)
Asia Pacific J. of Clinical Nutrition     Full-text available via subscription   (Followers: 13, 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: 2)
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: 7, 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: 4)
Australasian Music Research     Full-text available via subscription   (Followers: 5)
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: 9, 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: 2)
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: 2)
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: 23)
Australian Intl. Law J.     Full-text available via subscription   (Followers: 23)
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: 16, 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: 10)
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: 29, SJR: 0.354, CiteScore: 0)
Australian J. of French Studies     Full-text available via subscription   (Followers: 8, 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: 5, SJR: 0.282, CiteScore: 1)
Australian J. of Legal History     Full-text available via subscription   (Followers: 16)
Australian J. of Medical Science     Full-text available via subscription   (Followers: 2)
Australian J. of Music Education     Full-text available via subscription   (Followers: 6)
Australian J. of Music Therapy     Full-text available via subscription   (Followers: 10, 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: 7)
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: 6)
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: 15)
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: 21, 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: 4)
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: 9)
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: 27, 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: 21)
Early Days: J. of the Royal Western Australian Historical Society     Full-text available via subscription  
Early Education     Full-text available via subscription   (Followers: 11)
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: 19)
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: 2)
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: 13)
He Puna Korero: J. of Maori and Pacific Development     Full-text available via subscription   (Followers: 3)
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: 18)
Indigenous Law Bulletin     Full-text available via subscription   (Followers: 22)
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: 13)
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: 9)
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Intl. J. of Punishment and Sentencing, The     Full-text available via subscription   (Followers: 10)
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)
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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 27 Issue 5 - Rose Angina Questionnaire: Validation in emergency
           department to detect myocardial infarction in a tertiary hospital of
           eastern Nepal
    • Abstract: Poudel, Masum; Bhandari, Rabin; Malla, Gyanendra; Baral, Dharanidhar; Uprety, Samyog; Chaudhary, Ritesh; Sharma, Sanjib Kumar
      Background: Rose Angina Questionnaire (RAQ) is a useful screening questionnaire for ischemic heart disease validated in different settings; however, its diagnostic ability to predict myocardial infarction (MI) in the emergency is less clear.

      Objectives: To find out the usefulness of RAQ to predict MI in patients presenting to the emergency.

      Methods: A cross-sectional study was conducted at the BP Koirala Institute of Health Sciences (BPKIHS), a teaching hospital in eastern Nepal from 1 January to 30 March 2017, after ethical clearance from the Institutional Review Committee. Informed consent was obtained from the patients for their anonymised information to be published in this study The samples were collected from 100 patients with chest pain aged 40 to 70 years presenting to the emergency. RAQ was applied and its performance to detect MI was compared with emergency and cardiologist diagnosis of MI. Sensitivity, specificity, positive predictive value and negative value were calculated along with descriptive analysis.

      Results: A total of 100 patients were analysed with the mean age of 63.78 years (SD 11.60) and male to female ratio of 1.94. RAQ detected 58 cases (63.8%) with emergency department (ED) diagnosis of MI (true positive) and identified 3 (33.3%) cases with non-MI (true negative). The true positive rate for RAQ to detect MI after cardiologist consultation was 71.6%. RAQ had a sensitivity of 84.91% (95% confidence interval (CI) 72.41% -93.25%) to detect positive troponin, 63.74% (52.99 - 73.56) to detect positive electrocardiogram (ECG) and 71.60% (95% CI 60.5% to 81.07%) to detect final diagnosis of MI.

      Conclusion: RAQ is a good screening tool to detect MI in the emergency that can be used in isolation or in combination with other diagnostic modalities to detect it early.

      PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - COVID-19 swab shield
    • PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - 'Transvenous' pleurocentesis
    • Abstract: Siew, Kelvin Shenq Woei; Hieu, Huynh Quoc; Loch, Alexander
      A middle-aged woman had a central venous catheter insertion for fluid resuscitation presented with tachypnea and oxygen desaturation 6 h later. Diagnosis was made based on the chest X-ray performed 6 h after the catheter placement. Thereafter, the patient received appropriate treatment.

      PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - Predictive value of scoring systems for the diagnosis
           of acute appendicitis in emergency department patients: Is there an
           accurate one'
    • Abstract: Ak, Rohat; Doganay, Fatih; Akoglu, Ebru Unal; Akoglu, Haldun; Ucar, Asli Bahar; Kurt, Erdem; Turan, Cansu Arslan; Onur, Ozge
      Background: Acute appendicitis is one of the challenging surgical conditions presented in the emergency departments. Clinical scoring systems were developed to reduce the negative appendectomy rate and also to avoid unnecessary diagnostic evaluation.

      Objectives: The primary aim was to compare the clinical adequacy of the Alvarado, Acute Inflammatory Response, and the Raja Isteri Pengiran Anak Saleha Appendicitis scores in patients with right lower quadrant pain for the diagnosis of acute appendicitis.

      Methods: This was a prospective and observational study. All patients over the age of 18 years who presented with a complaint of right lower quadrant pain were enrolled. The Alvarado, Acute Inflammatory Response, and Raja Isteri Pengiran Anak Saleha Appendicitis scoring systems were compared. The patients were either admitted or followed-up as out-patient. Face-to-face or telephone follow-up visits were arranged for the patients who did not have surgery and who were not admitted.

      Results: 232 patients were included and 14 patients were excluded from the study. Of the 218 patients, 114 patients underwent surgery. Of the 114 patients, 107 patients were pathologically diagnosed with acute appendicitis. It was determined that Raja Isteri Pengiran Anak Saleha Appendicitis score was the most valuable score with 0.88 accuracy, followed by Acute Inflammatory Response (area under the curve = 0.79) and Alvarado (area under the curve = 0.71) scores.

      PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - Evaluation of prognostic value of MEDS, MEWS, and
           CURB-65 criteria and sepsis I and sepsis III criteria in patients with
           community-acquired infection in emergency department
    • Abstract: Begenen, Maruf; Durak, Vahide Aslihan; Akalin, Halis; Armagan, Erol
      Background: Early and effective treatment of patients with sepsis requires early recognition in emergency department and understanding the severity of the disease. Many studies have been conducted for this purpose, and many of scoring systems have been developed that provide early recognition of these patients and show their severity.

      Objectives: The aim of this study is to evaluate the efficacy of the scoring systems used to determine the mortality of patients with infections admitted in emergency department.

      Methods: In all, 400 patients who admitted to Uludag University Hospital Emergency Department were prospectively included in this study. In addition to Systemic Inflammatory Response Syndrome score, Quick SOFA score, Mortality in Emergency Department Sepsis score, Modified Early Warning Score, and Charlson Comorbidity Index score in all patients, CURB-65 score was calculated in the patients diagnosed with pneumonia. It has been aimed to determine the power of these scores' predictive mortality rates and their superiority to each other.

      Results: It was found that Mortality in Emergency Department Sepsis score and Quick SOFA score could be used with similar efficacy (respectively p = 0.761 and p = 0.073) in determining early mortality in emergency department (5th and 14th days) and that MEDS score was more effective (p < 0.001) in predicting the 28th-day mortality. While these recommendations were valid in patients diagnosed with pneumonia, it was determined that CURB-65 score could also be used to estimate 5th-, 14th-, and 28th-day mortalities (respectively, for the 5th day, p = 0.894 and p = 0.256; for the 14th day, p = 0.425 and p = 0.098; and for the 28th day, p = 0.095 and p = 0.158). The power of Systemic Inflammatory Response Syndrome score, previously used to identify sepsis, in predicting mortality was detected to be lower.

      Conclusion: Mortality in Emergency Department Sepsis score and Quick SOFA score could be used with similar efficacy in determining early mortality in emergency department. However, if you want to predict 28th-day mortality rate, it can be better to use Mortality in Emergency Department Sepsis score or CURB-65 (in patients diagnosed with pneumonia).

      PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - A novel prediction of simulated fluid responsiveness
           by echocardiography assessment of tricuspid annulus tissue velocity with
           passive leg raising
    • Abstract: Unluer, Erden Erol; Karagoz, Arif; Bayata, Serdar; Catalkaya, Sibel; Bozdemir, Huseyin
      Background: Fluid responsiveness can be predicted by the effect of passive leg raising on cardiac output. Objectives: This research aimed to compare the changes in cardiac output and the peak systolic velocity values of Tricuspid annulus velocity at the free wall (S') before and after passive leg raising in healthy volunteers.

      Methods: The study was approved by ethical commission. The desired sample size was 28, and 57 volunteers were included after they signed informed consent. The first measurements, including vital signs, S', and cardiac output, were taken with the participants lying supine and were performed in the morning after 12 h fast. The participants were then asked to lie in a semirecumbent position for 3 min. After 3 min, the head of the bed was lowered to the supine position and the participants' legs were elevated at 45 degrees. Secondary measurements were repeated in this position. The differences between vital signs, cardiac output, and S' measurements before and after passive leg raising were statistically compared. The level of significance was set as p < 0.05.

      Results: The mean values of cardiac output and S' before passive leg raising was 9.59 L/min and 11.57 cm/s, respectively; however, those increased to 11.44 L/min and 13.72 cm/s after passive leg raising. The average increases were 16.17% for cardiac output and 15.67% for S'. The changes of cardiac output and S' were statistically significant. The changes of vital signs before and after passive leg raising were statistically insignificant.

      Conclusion: This study has demonstrated the concordance of rise in cardiac output with S' change by passive leg raising in healthy subjects. Further studies are needed to validate the use of S' values in critically ill subjects.

      PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - The effects of cardiac arrest recognition by
           dispatcher on Smart Advanced Life Support
    • Abstract: Lee, Choung Ah; Kim, Gi Woon; Kim, Yu Jin; Moon, Hyung Jun; Park, Yong Jin; Lee, Kyoung Mi; Woo, Jae Hyug; Jeong, Won Jung; Choi, Il Kug; Choi, Han Joo; Choi, Hyuk Joong
      Objectives: The purpose of this study was to analyze the effect of cardiac arrest recognition by emergency medical dispatch on the pre-hospital advanced cardiac life support and to investigate the outcome of out-of-hospital cardiac arrest.

      Method: This study was conducted to evaluate the out-of-hospital cardiac arrest patients over 18 years of age, excluding trauma and poisoning patients, from 1 August 2015 to 31 July 2016. We investigated whether it was a cardiac-arrest recognition at dispatch. We compared the pre-hospital return of spontaneous circulation, the rate of survival admission and discharge, good neurological outcome, and also analyzed the time of securing vein, time of first epinephrine administration, and arrival time of paramedics.

      Results: A total of 3695 out-of-hospital cardiac arrest patients occurred during the study period, and 1468 patients were included in the study. Resuscitation rate by caller was significantly higher in the recognition group. The arrival interval between the first and second emergency service unit was shorter as 5.1 min on average, and the connection rate of paramedics and physicians before the arrival was 32.3%, which was significantly higher than that of the unrecognized group. The mean time required to first epinephrine administration was 13.1 min, which was significantly faster in the recognition group. However, there was no statistically significant difference between the two groups in patients with good neurological outcome, and rather the rate of return of spontaneous circulation and survival discharge was significantly higher in the non-recognition group.

      Conclusion: Although the recognition of cardiac arrest at dispatch does not directly affect survival rate and good neurological outcome, the activation of pre-hospital advanced cardiac life support and the shortening the time of epinephrine administration can increase pre-hospital return of spontaneous circulation. Therefore, effort to increase recognition by dispatcher is needed.

      PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - Effect of serum albumin level on hospital outcomes in
           out-of-hospital cardiac arrest
    • Abstract: Yoon, Hanna; Song, Kyoung Jun; Shin, Sang Do; Ro, Young Sun; Hong, Ki Jeong; Park, Jeong Ho
      Background: Background: Serum albumin has been known as a strong predictive value of mortality in various disease conditions, severe burns, major surgeries, stroke, myocardial infarction, etc. But little is known for the effect of serum albumin level on out-of-hospital cardiac arrest patients.

      Objectives: This study aimed to investigate the effect of serum albumin level on the outcome of out of hospital cardiac arrest.

      Methods: This study was a prospective hospital-based patient cohort study, conducted during January to December 2014 at 27 emergency departments in Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance project. The albumin was measured immediately after arrival to the emergency department during cardiopulmonary resuscitation, and albumin was categorized into two groups, group < 3.5 g/dL group and ⩾ 3.5 g/dL group. The primary outcome was a good neurological recovery at discharge (cerebral performance category scale 1 or 2). Multivariable logistic regression was used for adjusting for confounders.

      Results: During the study period, 1616 out-of-hospital cardiac arrest patients with presumed cardiac etiology were enrolled, and the total of 1013 patients were analyzed in this study. A total 452 (44.6%) patients had serum albumin level less than 3.5 g/dL. The serum albumin ⩾ 3.5 g/dL group showed better neurological outcomes than the serum albumin < 3.5 g/dL group: 18.5% versus 4.0%, and ⩾ 3.5 g/dL group had higher survival discharge rates than the < 3.5 g/dL group: 23.9% versus 9.1% (p < 0.01). After adjusting for potential covariates, patients with serum albumin ⩾ 3.5 g/dL had a higher odds of good neurological recovery (adjusted odds ratio: 2.94 (95% confidence interval: [1.57, 5.49])), and higher survival to discharge (adjusted odds ratio: 1.74 (95% confidence interval: [1.10, 2.76])).

      Conclusion: Low serum albumin levels are associated with a worse neurologic outcome in patients with out-of-hospital cardiac arrest.

      PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - Recurrent diclofenac-induced acute myocardial
           infarction: An interesting case with wandering ST-segment elevation
    • Abstract: Ozdemir, Emre; Karakaya, Zeynep; Karaca, Mustafa; Topal, Fatih; Payza, Umut
      Introduction: Allergic acute myocardial infarction with ST-segment elevation is rare, and vasoconstrictor mediators released from mast cells are responsible for its pathogenesis. Several medications have been reported to lead to acute myocardial infarction with ST-segment elevation, as a part of systemic allergic reactions and this entity is known as Kounis syndrome (KS).

      Case presentation: We presented a patient with recurrent KS who had no allergic reactions, except coronary spasm after parenteral diclofenac administration. First, she experienced anterior myocardial infarction with ST-segment elevation after administration of diclofenac 2 years ago. The second presentation was acute inferior-posterior myocardial infarction with ST-segment elevation with atrioventricular complete block leading to cardiogenic shock. She had no significant coronary stenosis responsible for each myocardial infarction with ST-segment elevation. However, she had a catheter-induced coronary spasm of non-dominant right coronary artery. She was considered to have a recurrent allergic myocardial infarction with ST-segment elevation due to parenteral diclofenac usage and treated with a calcium antagonist, statin, and dual antiplatelet agent.

      Discussion: KS can manifest as same as acute coronary syndrome. All drugs or any allergen can cause this event.KS had three variants but In all three conditions, treatment is antithrombotic or vasodilatator regime.

      Conclusion: As atherosclerosis events on coronary, allergic coronary events also may recurs. However, unlike the literature, our case is differentiated by recurrence of similar events in different coronary vessels.

      PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - A 10-year retrospective review of stonefish sting
           injury in Hong Kong
    • Abstract: Poon, KM; Ng, Chun Ho Vember; Tse, ML
      Background: Stonefish sting injury is one of the common marine stings in Hong Kong. It is commonly sustained during maritime activities, and it could be regarded as occupational hazard for chefs or domestic hazard for family. Its envenomation could lead to significant local symptoms (pain or swelling) and serious complications, including infection and compartment syndrome.

      Objectives: This study is to review its clinical presentation and various treatment modalities. Methodology and study design: Reported cases of stonefish stings to Hong Kong Poison Information Centre from October 2008 to October 2018 were included in the study. The cases were retrieved from the Hong Kong Poison Information Centre electronic database. Information on patient demographic data, clinical parameters (e.g. the site of injury, presenting symptoms), and various treatment modalities (e.g. analgesics, hot water immersion, and use of antivenom) was collected.

      Results: There were 32 eligible patients included in this case series. All of them sustained the injury over either their fingers or hands. All patients reported pain over the site of injury. Other reported symptoms included numbness (41%), swelling (81%), and redness (47%). Twenty-five patients (78%) had radiograph done, and one of them was noted to have foreign body retained at the site of envenomation. All patients received hot water immersion to the affected part at 40 degreesC-45 degreesC for at least 30 min. Altogether eight patients (25%) received stonefish antivenom for pain relief. One patient developed compartment syndrome and received emergency operation of fasciotomy of right hand and forearm.

      Conclusion: Stonefish envenomation can cause extreme pain, swelling, and erythema, which can be managed with hot water immersion, analgesics, and prophylactic antibiotics. Use of antivenom can be considered in selected case.

      PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - Stranger in the garden: Ricinus communis, 17 cases of
           intoxication
    • Abstract: Bogan, Mustafa; Oktay, MMurat; Sabak, Mustafa; Gumusboga, Hasan; Eren, Sevki Hakan
      Introduction: 'Ricinus communis' is used as a decoration in landscape gardening in Turkey. In industrialized countries, however, it is used in many sectors, including the chemical, pharmaceutical, and fertilizer sectors; it is also used in cosmetics and biodiesel fuel production. In this presentation, 17 patients who ingested 'R. communis' seeds are examined.

      Cases: Seventeen patients who ate the seeds of an unknown plant that grows in their gardens came to the emergency department with nausea, vomiting, and stomach ache complaints 4 h after ingesting the seeds. All patients were admitted to the critical care unit, monitored, and started on supportive treatment. After the treatment, patients' vital signs and laboratory parameters were stable. Seven patients were discharged the next day upon the regression of symptoms. The remaining 10 patients were successfully discharged 2 days after the treatment. There are cases in medical literature where consumption of one-half of a 'R. communis' seed resulted in death. In our presentation, each patient consumed one to four (2.18 on average) 'R. communis' seeds, and the symptoms were over within 2 days. The clinical course ended without any cases of death, and all patients were discharged in good condition.

      Conclusion: Emergency physicians have to know the clinical course and medical methods regarding intoxication due to oral consumption of toxic plants. Severe toxicity and even mortality can be observed with the ingestion of the seeds of the plant. Similar symptoms (nausea, vomiting, and abdominal pain) were observed in all our cases, but no mortality was observed.

      PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 5 - A familial COVID-19 cluster and quarantine strategy
           shift in the first month in Taiwan
    • PubDate: Thu, 17 Sep 2020 23:48:44 GMT
       
  • Volume 27 Issue 4 - Effect of real-time feedback during cardiopulmonary
           resuscitation training on quality of performances: A prospective
           cluster-randomized trial
    • Abstract: Kong, So Yeon Joyce; Song, Kyoung Jun; Shin, Sang Do; Ro, Young Sun; Myklebust, Helge; Birkenes, Tonje Soraas; Kim, Tae Han; Park, Kwan Jin
      Background: The evidence supporting delivery of quality cardiopulmonary resuscitation is growing and significant attention has been focused on improving bystander cardiopulmonary resuscitation education for laypeople. The aim of this randomized trial was to assess the effectiveness of instructor's real-time objective feedback during cardiopulmonary resuscitation training compared to conventional feedback in terms of trainee's cardiopulmonary resuscitation quality.

      Methods: We performed a cluster-randomized trial of community cardiopulmonary resuscitation training classes at Nowon District Health Community Center in Seoul. Cardiopulmonary resuscitation training classes were randomized into either intervention (instructor's objective real-time feedback based on the QCPR Classroom device) or control (conventional, instructor's judgment-based feedback) group. The primary outcome was total cardiopulmonary resuscitation score, which is an overall measure of chest compression quality. Secondary outcomes were individual cardiopulmonary resuscitation performance parameters, including compression rate, depth, and release. Generalized linear mixed models were used to analyze the outcome data, accounting for both random and fixed effects.

      Results: A total of 149 training sessions (2613 trainees) were randomized into 70 intervention (1262 trainees) and 79 control (1351 trainees) groups. Trainees in the QCPR feedback group significantly increased overall cardiopulmonary resuscitation score performance compared with those in the conventional feedback group (model-based mean Delta increment from baseline to session 5: 11.2 (95% confidence interval 9.2-13.2) and 8.0 (6.0-9.9), respectively; p = 0.02). Individual parameters of compression depth and release also showed higher improvement among trainees in QCPR group with positive trends (p < 0.08 for both).

      Conclusion: This randomized trial suggests beneficial effect of instructor's real-time objective feedback on the quality of layperson's cardiopulmonary resuscitation performance.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - The low accuracy of the non-ST-elevation myocardial
           infarction electrocardiograph criteria of the fourth universal definition
           of myocardial infarction
    • Abstract: Morris, Niall; Reynard, Charles; Body, Richard
      Background: The electrocardiograph has been integral to the diagnosis of acute coronary syndromes since the mid- 20th Century and is an important initial investigation that chest pain patients undergo on presentation to the Emergency Department. The Fourth Universal Definition of Myocardial Infarction recommends using dichotomous cut-offs to identify ischaemic electrocardiographs.

      Objectives: We aimed to summarise the existing knowledge to inform emergency clinicians about the diagnostic accuracy of the new guidelines.

      Methods: We performed a systematic review and a narrative analysis due to the heterogeneity of the studies.

      Results: We were able to obtain diagnostic characteristics for 10 papers. The ST-depression criteria were highly specific but poorly sensitive in five papers, with a specificity of 97.2%-99.3% and a sensitivity of 16.6%-20.0%. The remaining papers reported a higher sensitivity of 25.7%-58.6% but a lower specificity of 86.0%-91.2%. T wave inversion demonstrated poor specificity; the papers that looked at 0.1 mV T wave inversion demonstrated a sensitivity of 26.9%- 46.8% and a specificity of 68.6%-86.4%.

      Conclusion: The heterogeneous evidence database demonstrates that the Fourth universal definition's diagnostic performance varies wildly. Apart from two outlying papers, ST-depression has suboptimal sensitivity but high specificity. T wave inversion appears to be more sensitive yet less specific.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - Transient binocular blindness: A rare presentation of
           aortic dissection
    • Abstract: Shaharudin, Abdul Hafiz; Ab Hamid, Muhamad Hafiq; Yahaya, Rosliza; Nik Him, Nik Ahmad Shaiffudin; Mohamed, Nik Arif Nik; Jusoh, Azizul Fadzli Wan
      Introduction: Aortic dissection is a clinical chameleon that can have variable presenting features that require a careful history and physical examination. A non-specific presentation of this life-threatening condition causes a diagnostic dilemma among clinicians especially in the emergency department leading to grave consequences.

      Case Presentation: We present a case of aortic dissection that presented as an acute bilateral blindness that was associated with a sudden onset of loss of consciousness and central chest pain. Bedside carotid ultrasound showed a double lumen carotid artery suggesting an intraluminal flap. Computed tomography angiography revealed extensive dissection of the entire length of the aorta.

      Discussion: This case illustrated the need for a high index of suspicion to diagnose patients with aortic dissection especially as the patient presented with an acute binocular visual loss and chest pain.

      Conclusion: A bedside carotid artery ultrasound in the emergency department was found useful in screening and diagnosing a carotid artery-related pathology.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - A distressingly painful neck
    • Abstract: Lau, James Siu Ki; Kan, Pui Gay
      Neck pain is a common complaint in the emergency department. It is often attributed to sprain and strain, and cervical spine degeneration. However, when the pain is prolonged, refractory to treatment and not improved after multiple consultations, an alternate diagnosis should be considered.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - Reciprocal Abstracts Publication
    • PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - Early experience of a regional trauma center in
           Gangwon province: First step toward organizing a regional trauma system
    • Abstract: Kim, Kwangmin; Shim, Hongjin; Jung, Pil Young; Kim, Seongyup; Bang, Hui-Jae; Kwon, Hye Youn; Choi, Young Un; Bae, Keum Seok; Jang, Ji Young
      Background: The Korean Ministry of Health and Welfare decided to establish a trauma medical service system to reduce preventable deaths. OO hospital in Gangwon Province was selected as a regional trauma center and was inaugurated in 2015.

      Objectives: This study examines the impact of this center, comparing mortality and other variables before and after inaugurating the center.

      Methods: Severely injured patients (injury severity score > 15) presenting to OO hospital between January 2014 and December 2016 were enrolled and categorized into two groups: before trauma center (n = 365) and after trauma center (n = 904). Patient characteristics, variables, and patient outcomes (including mortality rate) before and after the establishment of trauma centers were compared accordingly for both groups. Risk factors for in-hospital mortality were also identified.

      Results: Probability of survival using trauma and injury severity score (%) method was significantly lower in the after trauma center group (81.3 +- 26.1) than in the before trauma center group (84.7 +- 21.0) (p = 0.014). In-hospital mortality rates were similar in both groups (before vs after trauma center group: 13.2% vs 14.2%; p = 0.638). The Z and W statistics revealed higher scores in the after trauma center group than in the before trauma center group (Z statistic, 4.69 vs 1.37; W statistic, 4.52 vs 2.10); 2.42 more patients (per 100 patients) survived after trauma center establishment.

      Conclusion: Although the mortality rates of trauma patients remained unchanged after the trauma center establishment, the Z and W statistics revealed improvements in the quality of care.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - The optimal chest compression point on sternum based
           on chest-computed tomography: A retrospective study
    • Abstract: Jiang, Libing; Min, Jie; Yang, Fan; Shao, Xiaotong
      Background: High-quality chest compression is crucial for cardiac arrest patients. However, only few studies are focusing on the optimal compression point. Objective: The aim of this study was to explore the optimal compression point based on chest-computed tomography.

      Methods: We retrospectively selected 166 adult health subjects between January 2018 and May 2018 in a university-affiliated hospital.

      Results: The median length of sternum was 14.9 cm. The median length from the inter-nipple line to the distal end of sternum was 1.0 cm. The median length from the point at which the maximal left ventricular diameter projected onto the sternum to the distal end of the sternum was −1.4 (-2.2 to 0.0) cm. The median value of the length from the inter-nipple line to the distal end of sternum plus the length from the point at which the maximal left ventricular diameter projected onto the sternum to the distal end of the sternum was 2.0 (1.0-3.1) cm.

      Conclusion: One size does not fit all. The point recommended by the current guideline may not appropriate for Chinese person. Further studies are required focusing on individual chest compression during cardiopulmonary resuscitation.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - Triage accuracy of online symptom checkers for
           Accident and Emergency Department patients
    • Abstract: Yu, Wing Yin Stephanie; Ma, Andre; Tsang, Vivian Hiu Man; Chung, Lulu Suet Wing; Leung, Siu-Chung; Leung, Ling-Pong
      Background: Overutilisation of the Accident and Emergency Department is an increasingly serious healthcare challenge. Online symptom checkers could help alleviate this challenge by allowing patients to self-triage before visiting the Accident and Emergency Department.

      Objectives: This study aimed to assess the triage accuracy of online symptom checkers, which would help determine the potential roles of symptom checkers in an Accident and Emergency Department setting.

      Methods: A total of 100 random Accident and Emergency Department records were sampled from the Queen Mary Hospital in Hong Kong. The inclusion criteria were patients over the age of 18 attending the Queen Mary Hospital Accident and Emergency Department in 2016. Symptom checkers by Drugs.com and FamilyDoctor were selected as representative tools. One triage recommendation was generated by each symptom checker for each case record. Each symptom checker's triage accuracy was then evaluated using a few outcome measures: overall sensitivity, sensitivity for emergency cases and specificity for non-emergency cases, when compared with the triage categories assigned by the triage nurses.

      Results: The results showed that Drugs.com had a higher overall triage accuracy than FamilyDoctor (74% and 50%, respectively), but both checkers are inadequately sensitive to emergency cases (70% and 45%, respectively) with low negative predictive values (43% and 24%, respectively).

      Conclusion: In their current states, symptom checkers are not yet suitable as alternatives to Accident and Emergency Department triage protocols due to their low overall sensitivities and negative predictive values. However, symptom checkers might serve as useful Accident and Emergency Department adjuncts in other ways, such as to provide more information prior to a patient's arrival to streamline the triage and preparation process at the Accident and Emergency Department.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - The identification of key factors predictive of
           traumatic brain injury in paediatric patients with a minor blunt head
           injury
    • Abstract: Song, Cheng Hee; Ahmad, Mohammad Zikri; Siti-Azrin, Ab Hamid; Wan-Nor-Asyikeen, Wan Adnan
      Introduction: Traumatic brain injury (TBI) is a major public health concern, and contributes significantly to mortality and morbidity in paediatric patients.

      Objective: The study is aimed to identify the factors predictive of TBI in paediatric patients with a minor blunt head injury.

      Methods: This was a retrospective cohort study conducted on 274 paediatric patients with a minor head injury and registered to Hospital Universiti Sains Malaysia (USM) from the year 2009 to 2013. Patients with a minor blunt head injury aged less than 18 years who underwent computed tomography (CT) of the brain were included, while the patients with penetrating head injuries were excluded from the study. Simple and multiple logistic regression analysis were performed.

      Results: TBI occurred in 49% of the patients. Headache (adjusted odd ratio (AOR): 2.24; 95% confidence interval (CI): 1.24, 4.05, p = 0.008), dizziness (AOR: 3.08, 95% CI: 1.27, 7.51, p = 0.013) and the presence of scalp haematoma (AOR: 2.93, 95% CI: 1.60, 5.34, p < 0.001) were the most important clinical variables for predicting TBI following a minor blunt head injury in paediatric populations.

      Conclusion: Headache, dizziness and scalp haematoma were identified as important clinical variables that can be used to predict TBI on a CT scan of paediatric minor head injury. The presence of these factors should alert emergency physicians to the need to monitor such children closely.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - Variability of optic nerve sheath diameter in acute
           ischemic stroke
    • Abstract: Kozaci, Nalan; Avci, Mustafa; Caliskan, Gulsum; Yuksel, Serkan
      Background: Stroke is the third leading cause of death and the first cause of disability in the world. It holds an important place in hospital admissions and health expenses in the industrialized world.

      Objective: The aim of the study was to evaluate the relationship between optic nerve sheath diameter and the findings of brain computerized tomography scans and brain diffusion-weighted imaging and investigate the variability of optic nerve sheath diameter measured by ultrasonography in acute ischemic stroke.

      Methods: Patients who had acute ischemic stroke were included in Group A. Healthy adults were included in Group B as the control group. In addition, according to computerized tomography scans and diffusion-weighted imaging findings, Group A was divided into three subgroups. Patients with normal computerized tomography and diffusion-weighted imaging were included in Group 1, patients with normal computerized tomography and ischemic area on diffusion-weighted imaging were included in Group 2, and patients with ischemic area on computerized tomography and diffusion-weighted imaging were included in Group 3.

      Results: A total of 100 patients were included in Group A and 100 healthy adults included in Group B. The optic nerve sheath diameter values of Groups A and B were 5.4 +- 0.6 and 4.2 +- 0.4 mm (p < 0.001), respectively. The optic nerve sheath diameter cutoff value for detection of acute ischemic stroke was determined as 4.7 mm. The sensitivity and specificity at this cutoff value were determined as 89% and 90%, respectively. According to computerized tomography scans and diffusion-weighted imaging findings, there were 18 patients in Group 1, 56 patients in Group 2, and 26 patients in Group 3. Time from onset of symptoms to presentation to emergency department was shortest in Group 1 (3.0 +- 1.8 h). The widest optic nerve sheath diameter was calculated in Group 3 (optic nerve sheath diameter: 5.7 +- 0.6 mm).

      Conclusion: This study demonstrates that the optic nerve sheath diameter increases in acute ischemic stroke and it increases earlier than computerized tomography and diffusion-weighted imaging alteration occur. Therefore, optic nerve sheath diameter can be applied to assist the diagnosis of acute ischemic stroke with other imaging techniques with equivocal/negative results and determination of appropriate treatment, especially in cases with normal computerized tomography scan and diffusion-weighted imaging.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - Levosimendan treatment in a child with
           treatment-resistant left ventricular systolic dysfunction after scorpion
           sting
    • Abstract: Yontem, Ahmet; Yildizdas, Riza Dincer; Horoz, Ozden Ozgur; Aslan, Nagehan; Misirlioglu, Merve; Yılmaz, Hayri Levent; Erdem, Sevcan
      Background: Scorpion stings are common in countries dominated by rural and coastal settlements with temperate climate. Scorpion stings are usually harmless and can be seen in local findings, but in some cases, systemic, neurotoxic, and cardiotoxic findings can be seen.

      Case report: A 3 year 7 month old girl was referred to pediatric emergency care 2 h after yellow scorpion (species of 'Leiurus abdullahbayrami') sting. In our case, cardiac function insufficiently progressed in spite of the standard inotropic and milrinone treatment. On the third day of hospitalization, levosimendan was initiated with good clinical effect.

      Conclusion: In the literature, the use of levosimendan in pediatric patients has been limited to those with low cardiac output syndrome after cardiovascular surgery. The use of levosimendan in children with scorpion sting has been previously reported only in Banille et al.'s study. Scorpion antivenom should be administered intravenously as soon as possible in cases of systemic findings that develop after scorpion stings. This report suggests that levosimendan is temporally associated with improvement in patients who have severe cardiac dysfunction due to scorpion sting and refractory to current treatment.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 4 - Elevated procalcitonin levels in anaphylaxis
    • Abstract: Shiang, Ang Joo
      Background: The most common role procalcitonin play in current-day medicine is in the diagnosis and management of sepsis. Aside from sepsis, there are other known causes of elevated procalcitonin, for example, trauma and severe pancreatitis. We herein present a case of markedly elevated procalcitonin levels with an unusual cause, that is, anaphylaxis.

      Case report: A young lady presented to our hospital consecutively for anaphylaxis. Both presentations were associated with a markedly elevated procalcitonin level. She was discharged with an epinephrine autoinjector after the second visit. Recognition of anaphylaxis as a cause of elevated procalcitonin level can potentially change management as shown in this case report. This case report also highlights the importance of history taking and not to over rely on investigation results for patient management.

      PubDate: Wed, 16 Sep 2020 23:08:12 GMT
       
  • Volume 27 Issue 3 - A multi-objective evaluation method based on
           connection numbers theory of hazardous chemical accidents emergency
           medical rescue capability
    • Abstract: Wang, Yapeng; Zhang, Jinguo; Wang, Yundou; Xiong, Xiaowen; Zhao, Xin
      Background: An objective, comprehensive and scientific evaluation of emergency medical rescue capability (EMRC) is of great realistic significance in assisting the health administrative department to grasp the overall response capability of all emergency medical rescue teams, enabling each team to have a full understanding of its own strengths and weakness and improve itself accordingly. At present, the research on the evaluation of EMRC in Hazardous Chemicals Accidents (HCA) is not systematic and in-depth, and the existing research results also have some shortcomings, such as, the lack of strong theoretical support for the evaluation index system, the relatively single function of evaluation methods, and so on.

      Objectives: The objective of this article is to research the evaluation index system and a new evaluation method of EMRC in HCA to overcome the above shortcomings.

      Methods: It establishes an emergency medical rescue capability model by employing the competency model and then constructs the evaluation index system on the basis of the analysis of all the factors of emergency medical rescue capability in hazardous chemical accidents and sets up an evaluation model based on the theory of connection numbers and partial connection numbers. It determines the competence ranking of several emergency medical rescue teams and the competence state of an individual emergency medical rescue team by calculating the connection principal value, and it also predicts how the emergency medical rescue capability will develop based on the values of partial connection numbers.

      Results: The example shows that the calculation process of this model is relatively simple, and its assessment results are objective and authentic, and moreover, its multi-functions can make up for the deficiency of the simplified function of other evaluation models.

      Conclusion: This method is scientific and rational to some extent and can provide reference for evaluation problems of the same kind.

      PubDate: Mon, 29 Jun 2020 11:07:23 GMT
       
  • Volume 27 Issue 3 - Geoclinical analyses for areas at high risk for
           motorcycle-related road traffic injury in a district in Malaysia
    • Abstract: Rahman, Nik Hisamuddin NA; Naing, Nyi Nyi
      Objective: The goal of this prospective cross-sectional study was particularly to collect data on the epidemiology, the pattern of injury among motorcyclists and to relate with spatial data in a local district.

      Methods: It involved data collection from prehospital care and inhospital care record. In addition, it utilized geospatial ARCGIS version 10.1 software in the identification of hotspot location of road traffic injury. Written informed consent was obtained from patient(s) or relatives for their anonymized information to be published in any article.

      Results: A total of 439 cases were recruited over 10 months. The mean age (standard deviation) of the motorvehicle crash victims was 26.04 (15.26) years. Male comprised 302 (73.3%) of the cases. A total of 176 (42.7%) of the victims were between the ages of 20-40 years. A total of 176 (42.7%) of the motorcyclists admitted were wearing the safety helmets either from the history taking or from the witness. A total of 117 (28.4%) and 28 (6.8%) of the victims were admitted to the general wards and critical care units, respectively for further management. The mean (standard deviation) length of hospital stays was 7.19 (6.94) days. Based on hotspot mapping using ARCGIS 10.1, most of the motorvehicle crash cases occurred mainly within the specific borough. This finding concurred with the locations of the state roads involved that traversed mainly within the same borough. Further geospatial and temporal analysis showed that most of the motorvehicle crash that occurred during the weekend were located within the suburban areas.

      Conclusion: Motorcyclists, being male and young age are the vulnerable group of road users commonly injured on our road. The initial geospatial analysis of injury-related motorvehicle crash cases has shown common hotspot trending along certain roads and borough within the district. This new knowledge can be used in the future for preventive and road safety programs in high-risk areas.

      PubDate: Mon, 29 Jun 2020 11:07:23 GMT
       
  • Volume 27 Issue 3 - A study on modified accelerated diagnostic protocol to
           safely discharge low-risk chest pain patients in emergency department
    • Abstract: Yean, Kok Siew; Bin Abd. Wahab, Mahathar; Bin Zakaria, Mohd Idzwan
      Background: Evaluation of chest pain patients in emergency departments to distinguish between high-risk patients who require admission and low-risk patients who can be managed as outpatients is a challenging task.

      Objective: The aim of this study was to evaluate the efficacy of Observation Ward Short Stay Evaluation Service for Chest Pain Protocol to identify and safely discharge low-risk patients with low incidence of major adverse cardiac events within 30 days.

      Methods: This was a single center prospective observational study, conducted from 1 March 2016 to 31 August 2016 at the Emergency and Trauma Department, Hospital Kuala Lumpur, Kuala Lumpur. Observation Ward Short Stay Evaluation Service for Chest Pain Protocol was used to evaluate patients presented with chest pain or angina equivalents. The components involved Thrombolysis in Myocardial Infarction (TIMI) score, serial electrocardiograms, high-sensitivity cardiac troponin T, and exercise treadmill test. Low-risk patients were patients with TIMI < 2, normal serial electrocardiogram, high-sensitivity cardiac troponin T
      PubDate: Mon, 29 Jun 2020 11:07:23 GMT
       
  • Volume 27 Issue 3 - Optic nerve sheath diameter as a predictor of acute
           cerebellar infarction in acute vertigo patients without brain computed
           tomography abnormalities
    • Abstract: You, Myoung Sun; Lee, Sun Hwa; Yun, Seong Jong; Ryu, Seokyong; Choi, Seung Woon; Kim, Hye Jin; Kang, Tae Kyung; Oh, Sung Chan; Cho, Suk Jin
      Background and objectives: To date, no study has investigated the ability of optic nerve sheath diameter calculated from non-contrast brain computed tomography to predict acute cerebellar infarction in patients with acute vertigo. The aim of our study was to evaluate the predictive utility of optic nerve sheath diameter for diagnosing acute cerebellar infarction in patients with acute vertigo without computed tomography abnormalities.

      Methods: We retrospectively enrolled patients with acute vertigo without computed tomography abnormalities who underwent magnetic resonance imaging including diffusion-weighted imaging at our emergency department between January 2016 and December 2017. Two emergency physicians independently measured optic nerve sheath diameter at 3 mm (ONSD3) and 10 mm (ONSD10) behind the globe in each patient. Final magnetic resonance imaging reports with clinical progress notes were used as the reference standard. A multivariate logistic regression analysis, receiver operating characteristic curves, and intra-class correlation coefficients were calculated to estimate predictive value.

      Results: A total of 34 patients (16.1%) were diagnosed with acute infarction and 177 patients (83.9%) were diagnosed with peripheral vertigo. Mean ONSD3 (p < 0.001) and ONSD10 (p < 0.001) were independent predictive factors for distinguishing acute infarction and peripheral vertigo. ONSD3 (cut-off = 4.22 mm) had 100% (95% confidence interval = 89.7-100.0) sensitivity and 97.7% (95% confidence interval = 95.1-99.6) specificity with area under the receiver operating characteristic curve of 0.988 (95% confidence interval = 0.978-1.0), while ONSD10 (cut-off = 3.63 mm) had 100% (95% confidence interval = 89.7-100.0) sensitivity and 87.6% (95% confidence interval = 81.8-92.0) specificity with area under the receiver operating characteristic curve of 0.976 (95% confidence interval = 0.959-0.997). There were good inter- and intra-observer agreements for both sides of ONSD3 and ONSD10 (intra-class correlation coefficient range = 0.652-0.773).

      Conclusion: Optic nerve sheath diameter, in particular OSND3, is a feasible predictive marker for acute infarction in patients with acute vertigo without computed tomography abnormalities. This information can assist decision-making in ordering brain magnetic resonance imaging for the assessment of acute vertigo.

      PubDate: Mon, 29 Jun 2020 11:07:23 GMT
       
  • Volume 27 Issue 3 - The effectiveness of an emergency physician-led
           frailty unit for the living-alone elderly: A pilot retrospective cohort
           study
    • Abstract: Leung, Tsz-Hang; Leung, Sai-Choi; Wong, Chi-Keung Gordon
      Background: We are facing an ageing population in Hong Kong. In response to the surge in service demand resulted from Silver Tsunami, a six-bed frailty unit was established in the Emergency Medicine Ward of Queen Elizabeth Hospital in December 2015. Frailty unit offers a bundle of multi-disciplinary approach for geriatric patients with an aim for early supported discharge.

      Objective: To evaluate whether this novel frailty care pathway, compared to the conventional general care pathway, would improve the outcome of the local elderly who were living alone.

      Method: This is a retrospective cohort study. Patients who were admitted from 1 September 2015 to 31 October 2017 were included in this study. Data were retrieved from the electronic patient record (ePR) of Hospital Authority. The outcome measurements are lengths of stay in acute and convalescent hospitals, transferral rate to a convalescent hospital and 28-day re-attendance rate.

      Results: A total of 190 patients were recruited (150 frailty vs 40 general). Baseline characteristics, including age, gender distribution, vital signs, laboratory results, use of mobility aids, Morse fall risk scale, Norton ulcer scale and Barthel Index were similar in both groups; except a higher diastolic blood pressure in novel frailty-care pathway. The length of stay in the acute hospital is significantly shortened (2.38 vs 3.27 days, p = 0.00018). The transferral rate to a convalescent hospital was less in frailty group (21.3% vs 42.5%, p = 0.00655). There was no significant difference in terms of total (7.10 vs 10.99 days, 'p' = 0.09638) and convalescent (22.09 vs 18.16 days, p = 0.48183) length of stay between frailty group and general group, respectively; while the 28-day re-attendance rate was similar (26.7% vs 15.0%, 'p' = 0.12589).

      Conclusion: This is a pilot study to first report a novel frailty-care model for the local geriatric population. It has shown a reduction in length of stay in acute hospital and transferral rate to convalescent hospitals, while introducing a non-significant reduction in total hospital stay, maintaining 28-day re-attendance rate and at an expense of a probable increase in the convalescent stay.

      PubDate: Mon, 29 Jun 2020 11:07:23 GMT
       
  • Volume 27 Issue 3 - Post out-of-hospital cardiac arrest care in a tertiary
           care center in Southern Thailand: From emergency department to intensive
           care unit
    • Abstract: Vattanavanit, Veerapong; Uppanisakorn, Supattra; Nilmoje, Thanapon
      Background: Out-of-hospital cardiac arrest results in a high mortality rate. The 2015 American Heart Association guideline for post-cardiac arrest was launched and adopted into our institutional policy.

      Objectives: We aimed to evaluate post-cardiac arrest care and compare the results with the 2015 American Heart Association guideline and clinical outcomes of out-of-hospital cardiac arrest patients. Methods Included in this study were all adult patients who survived out-of-hospital cardiac arrest and were admitted to the Medical Intensive Care Unit of Songklanagarind Hospital, Thailand. The retrospective review was from 1 January 2016 to 31 December 2017.

      Results: From a total of 161 post-cardiac arrest patients admitted to the medical intensive care unit, 69 out-of-hospital cardiac arrest patients were identified. The most common cause of arrest was presumed cardiac in origin (45.0%) in which the majority was acute myocardial infarction (67.8%). Coronary intervention and targeted temperature management were performed in 27.5% and 13% of all out-of-hospital cardiac arrest patients, respectively. Survival to hospital discharge was 42%. Independent factors associated with survival to discharge were shockable rhythms, lower adrenaline doses, and the absence of hypotension at medical intensive care unit admission.

      Conclusion: Compliance with the 2015 American Heart Association post-cardiac arrest care guideline was low in our institution, especially in coronary intervention and targeted temperature management.

      PubDate: Mon, 29 Jun 2020 11:07:23 GMT
       
  • Volume 27 Issue 3 - Bufotoxin poisoning that showed the sign of acute
           digitalis overdose in the patient of Kyushin intoxication
    • Abstract: Cha, Kyungman; So, Byung Hak; Jeong, Won Jung
      Introduction: Kyushin is a widely used herbal medicine in East Asia for heart failure. Toad venom in present in Kyushin, which has positive inotropic effect as digitoxin.

      Case presentation: An 81-year-old, female patient presented with decreased mental status after overdose of Kyushin. The first electrocardiogram showed junctional tachycardia with 142/min, suddenly dropped to 27/min and followed by ventricular fibrillation. After one cycle of CPR, spontaneous circulation returned but junctional bradycardia, tachycardia, and ventricular fibrillation appeared. After six times of defibrillation, spontaneous circulation returned, and mechanical ventilator and transcutaneous pacing were applied. Plasma toxicology test revealed digitoxin 66.90 ng/mL by cloned enzyme donor immunoassay and digoxin 0.76 ng/mL by kinetic interaction of microparticles in solution immunoassay. After 8 h from presentation, the patient's mental status came to be alert, and then transcutaneous pacing was removed.

      Discussion: Cloned enzyme donor immunoassay has been reported to be highly cross-reactive with digoxin-like substances, which strongly supports bufotoxin to be responsible for arrhythmia of the patient.

      Conclusion: Poisoning of bufotoxin in Kyushin can cause cardiac arrhythmia, even arrest, but without digoxin-specific Fab, conventional therapy could be successful.

      PubDate: Mon, 29 Jun 2020 11:07:23 GMT
       
  • Volume 27 Issue 3 - Spontaneous orbital subcutaneous emphysema mimicking
           lacrimal duct obstruction after sneezing: A case report
    • Abstract: Chan, Hung-Yen; Lio, Chon-Fu; Yu, Chang-Ching; Peng, Nan-Jing; Chan, Hung-Pin
      Introduction: Orbital subcutaneous emphysema after trauma has been carefully reported, but its development in the absence of trauma is rare.

      Case presentation: We report on a 70-year-old patient who developed unilateral orbital subcutaneous emphysema, mimicking lacrimal duct occlusion, after this man sneezed, and presented with right crepitant eyelid swelling and progressive ptosis. Orbital subcutaneous emphysema develops when air can get into the periorbital soft tissue, which presents as a result of facial bone trauma, iatrogenic procedures, and gas-forming infectious microorganisms, as seen in many published articles. It is very uncommon to see this kind of case report after sneezing; however, in our case, spontaneous orbital subcutaneous emphysema occurred after sneezing that resolved slowly after a few weeks without surgical intervention. Our patient denied any painful sensation over the right orbital area, including no visual problems with the right eye but right eyeball limited movements. It can be stressful to patients due to its symptoms but is not a true emergency.

      Conclusion: In this article, we should bring awareness to physicians of the possibility of a spontaneously orbital subcutaneous emphysema with complications after sneezing, yielding relevant information for patients to be informed about avoid excessive nose blowing or occluding the nose, creating controlled symptoms.

      PubDate: Mon, 29 Jun 2020 11:07:23 GMT
       
  • Volume 27 Issue 2 - Heightened anxiety state among parents of sick
           children attending emergency department using state-trait anxiety
           inventory
    • Abstract: Embong, Hashim; Ting, Chiew Yuen; Ramli, Muhamad Supi; Harunarashid, Husyairi
      Background: The anxiety and stress level of both parent and child seeking treatment at the emergency department is assumed to be high. However, it is rarely quantified as to ascertain any need for intervention.

      Objective: The study seeks to quantify anxiety of parents accompanying sick children presenting acutely to the emergency department and to explore possible pre-visit factors that may contribute to anxiety.

      Methods: A 12-month cross-sectional study was conducted at the Emergency Department, Universiti Kebangsaan Malaysia Medical Centre. All parents accompanying a child presenting to the study location, fitting the inclusion and exclusion criteria, were invited to participate. Parents required to fill a self-administered questionnaire on anxiety, State- Trait Anxiety Inventory and any related factors that can influence anxiety.

      Results: A total of 233 subjects were recruited. The mean state anxiety score was 53.48 +- 11.36, compared to the mean score for trait anxiety of 39.85 +- 7.66, suggesting a heightened state of anxiety. Majority of subjects (65.7%) had reported clinically detected anxiety as defined by state anxiety score above 49. There was no significant association between parental anxiety level with pre-visit factors: children's age, duration of illness, the presence of co-morbidities, time of presentation, prior medical contact and primary care referral. The child's state of illness was the dominant psychosocial factor associated with parental anxiety reported by the subjects.

      Conclusion: Parental anxiety upon arrival appeared to be significantly higher than expected, suggesting intervention may be needed.

      PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - Professionalizing peer instructor skills in basic life
           support training for medical students: A randomized controlled trial
    • Abstract: Benthem, Yvet; van de Pol, Eva MR; Draaisma, Jos MTh; Donders, Rogier; van Goor, Harry; Tan, Edward CTH
      Background: The Radboud university medical center designed an obligatory basic life support and first-aid course for first-year medical students.

      Objectives: We evaluated the value of an additional train-the-trainer course following European Resuscitation Council guidelines, which focuses on practical basic life support training and providing feedback, in comparison with standard in-service instructor training.

      Methods: This study was a prospective randomized controlled trial. A total of 10 intervention instructors, 14 control instructors, and 337 first-year medical students participated in the study. Students, blinded for the type of instructor, completed questionnaires evaluating the quality of the basic life support training (theoretical and practical) and provided feedback. The secondary endpoint was the basic life support examination to assess whether the instructors' training influenced the quality of the participants' basic life support.

      Results: The response rate of the questionnaire was 82% on average. No differences were found between intervention and control group concerning theoretical basic life support training. The intervention instructors scored significantly higher on practical basic life support training according to student evaluations (p < 0.001). The pass rate on basic life support examinations did not differ significantly (p = 0.669). Appreciation of given feedback was independent of instructors' educational training.

      Conclusion: This study is the first to establish that the 12-h train-the-trainer course following European Resuscitation Council guidelines improves students' appreciation of practical basic life support training. The additional course did not influence appreciation of theoretical basic life support training or perceived feedback.

      PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - Role of emergency physician-performed ultrasound in
           the differential diagnosis of abdominal pain
    • Abstract: Kozaci, Nalan; Avci, Mustafa; Tulubas, Gul; Ararat, Ertan; Karakoyun, Omer Faruk; Karaman, Cagri; Erol, Bekir
      Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain.

      Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard.

      Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients.

      Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.

      PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - Effect of a crisis intervention team for suicide
           attempt patients in an emergency department in Korea
    • Abstract: Ahn, Eusang; Kim, Jooyeong; Moon, Sungwoo; Ko, Young-Hoon; Cho, Hanjin; Park, Jong-Hak; Song, Ju Hyun; Kim, Han Na; Jee, Ju Yeon; Han, Ra Young
      Background: South Korea has one of the highest rates of suicide in the world, which poses an immense socioeconomic burden on the healthcare system.

      Objectives: We hypothesized that the implementation of a Crisis Intervention Team would lead to an improvement in completion rates of suicide prevention counseling programs.

      Methods: This is a retrospective before-and-after analysis, and was carried out in the emergency department in the city of Ansan, South Korea. The Crisis Intervention Team, funded by the Ministry of Health and Welfare, counsels suicide attempt patients with the ultimate goal of assuring proper administration of mental healthcare from community suicide support programs. Data on suicide attempt patients were collected using medical records. The primary outcome was defined as completion of the 8-week follow-up period for suicide attempt patients with the community suicide support programs.

      Results: A total of 246 patients from the pre-intervention period and 296 patients from the post-intervention period were included in the study. The completion rates of the 8-week follow-up period increased significantly after the intervention. During the pre-intervention period, 9 patients (3.7%) who were referred to the community suicide support program completed the 8 weeks of follow-up, whereas in the post-intervention period, 56 patients (18.9%) followed up for 8 weeks or more (p < 0.0001). The secondary outcome, overall linkage rates to community suicide support program, did not change significantly, with a minor increase from 46 (18.7%) to 63 (21.3%) (p = 0.45).

      Conclusion: The implementation of an in-hospital Crisis Intervention Team dedicated to active and assertive counseling that begins in the emergency department was correlated with significantly increased completion rates of the 8-week follow-up counseling program.

      PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - No better outcome of using antibiotic broadly in
           hospitalized adult patients with leukocytosis in emergency department
    • Abstract: Chang, Chia-Peng; Wu, Shu-Ruei; Lin, Chun-Nan
      Background: Leukocytosis is a common laboratory finding in emergency departments worldwide. Various infectious diseases are common causes of leukocytosis in hospitalized adult patients. Most emergency physicians have a high awareness of sepsis or severe infection, which requires empirical antibiotics. However, there are many other etiologies for leukocytosis. The outcome of prescribing broad-spectrum antibiotics in the emergency department for leukocytosis patients is not well-understood.

      Objectives: Our objectives were to determine whether prescribing antibiotics in the emergency department affect outcome for hospitalized adult patients with leukocytosis.

      Methods: A retrospective cohort study of hospitalized adult emergency department patients with leukocytosis was conducted in a tertiary hospital in Taiwan between June 2016 and June 2017. Patients with leukocytosis (white blood cell count >11,000 cells per muL) who were admitted via the emergency department at the Kaohsiung Veterans General Hospital, from June 2016 to June 2017 were enrolled. Patients aged ⩽18 years, pregnant women, those who received prophylactic antibiotics prior to operation, and those with a final diagnosis of hematologic malignancy were excluded from this study. The primary outcome measure was hospital stay, and the secondary outcome measure was mortality. All collected data were statistically analyzed.

      Results: A total of 8054 hospitalized adult patients with leukocytosis were included (the exclusion criteria included patients aged ⩽18 years, pregnant women, those who received prophylactic antibiotics prior to surgery, and those with a final diagnosis of hematologic malignancy); all patients were admitted via the emergency department. In all, 4486 patients received initial antibiotic treatment in the emergency department, whereas 3568 patients did not receive antibiotics in the emergency department and ward/intensive care unit within 3 days. There was no statistically significant difference in hospital days (p = 0.239) or mortality (p = 0.345) between those who received and did not receive antibiotics in the emergency department.

      Conclusion: Hospitalized adult patients with leukocytosis did not necessarily require antibiotics in the emergency department except when they had a differential diagnosis that requires antibiotic treatment.

      PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - Cardiac tamponade as a late complication of a minor
           trauma due to syncope: A case report and literature review
    • Abstract: Guarino, Matteo; Bologna, Alessandra; de Giorgi, Alfredo; Spampinato, Michele D; Molino, Christian; Gozzi, Dario; Tonelli, Laura; Fabbian, Fabio; Strada, Andrea; de Giorgio, Roberto
      Haemopericardium with cardiac tamponade following minor blunt trauma is a rare, life-threatening condition. The diagnosis of cardiac tamponade as well as therapeutic management may be delayed, since the link between trauma and illness is often overlooked. We report the case of an old woman who developed a relatively delayed cardiac tamponade due to an otherwise minor blunt chest trauma following syncope.

      PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - Cervical spinal epidural abscess following
           needle-knife acupotomy, with an initial presentation that mimicked an
           acute stroke: A case report
    • Abstract: Tsai, Sheng-Ta; Huang, Wei-Shih; Jiang, Shin-Kuang; Liao, Hsien-Yin
      Introduction: A spinal epidural abscess is difficult to diagnose and it can sometimes mimic an acute ischemic stroke.

      Case presentation: We report a 69-year-old woman attended our emergency department because of gross hematuria for 1 week, with fever and bilateral flank pain. Two weeks earlier, she had received needle-knife acupotomy (a more invasive procedure than the traditional acupuncture) for chronic neck pain. Acute pyelonephritis was diagnosed; however, 4 h later, she developed weakness of both right limbs. Acute lacunar infarction was tentatively diagnosed. After admission, weakness of the left limbs developed, with a feeling of fullness and discomfort around the entire T6 dermatome with urinary retention. Neck magnetic resonance imaging showed extensive cervical epidural abscesses from C3 to T1. After an operation, her neck pain and the weakness of the four limbs gradually improved.

      Discussion: Spinal epidural abscess is a rare complication, and which should be considered for patients who have undergone invasive cervical procedures. Needle-knife acupotomy is a more invasive procedure than the traditional acupuncture.

      Conclusion: Although it is considered safe and effective for cervical spondylosis, it can be complicated by spinal infection. Careful disinfection should therefore be performed, and disposable needleknives should be used.

      PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - A case of nontyphoidal 'Salmonella' gastroenteritis
           complicated with acute acalculous cholecystitis
    • Abstract: Li, Chun Kit; Wong, Oi Fung; Ko, Shing; Ma, Hing Man; Lit, Chau Hung Albert
      Background: Acute acalculous cholecystitis is an acute inflammation of the gall bladder in the absence of gallstones and is known to occur in those critically ill patients, including those after major surgery, patients with trauma or burn, and patients with sepsis and various infectious diseases. 'Salmonella' infection is one of the commonest food-borne illnesses. Although cholecystitis is a well-reported complication of typhoidal 'Salmonella' infection, it is rarely reported in nontyphoidal 'Salmonella' infection.

      Case Presentation: We report a case of nontyphoidal 'Salmonella' infection complicated by acute acalculous cholecystitis. Prompt diagnosis was made and the patient was recovered after percutaneous cholecystostomy.

      Conclusion: Acute acalculous cholecystitis is a rare, but potentially lethal, complication of Salmonella infection. The clinical presentation is often subtle; therefore, a high degree of suspicion should be maintained in managing patients with Salmonella infection and ongoing sepsis.

      PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - Intraperitoneal hemorrhage after cupping therapy
    • Abstract: Lu, Meng-Chuan; Yang, Chih-Jen; Tsai, Shih-Hung; Hung, Chih-Chieh; Chen, Sy-Jou
      Introduction: Cupping therapy has been widely performed in oriental countries and considered a safety alternative to relieve pain. Here, we report a rare complication from abdominal cupping.

      Case presentation: A 49-year-old man presented with a 2-day history of left upper quadrant abdominal pain after cupping therapy 3 days earlier. His abdomen was soft but appeared a localized rebounding tenderness. Contrast-enhanced computed tomography of the abdomen showed intraperitoneal hemorrhage originated from the left upper quadrant of the omentum.

      Discussion: Several mechanisms are proposed for the development of intraperitoneal hemorrhage after cupping therapy, including the tensile stress generated by cupping that facilitates the disruption of omentum vessels, strong negative pressure generated by cupping that suppresses blood supply to the cup-applied sites causing adjacent tissue ischemia, and subsequent vascular extravasation. Treatment for intraperitoneal hemorrhage depends on clinical conditions. Stable patients can be managed conservatively, whereas surgery is reserved for those with continuous bleeding and hypovolemic shock.

      Conclusion: Cupping therapy complicated with omentum bleeding can present insidiously until peritoneal irritation developed by intraperitoneal hemorrhage. A comprehensive history taking and a high degree of vigilance are crucial to diagnose early patients with this rare complication.

      PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - Reviewer thank you 2019
    • PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - Modified nasotracheal tube for rescue from airway
           obstruction
    • PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 2 - Effect of introducing a feedback device during adult
           and infant cardiopulmonary resuscitation training: A 'before and after'
           study
    • Abstract: Kim, Kwan Ho; Kim, Chan Woong; Oh, Je Hyeok
      Objective: This study aimed to verify the effect of introducing a feedback device during adult and infant cardiopulmonary resuscitation training.

      Methods: A feedback device was introduced in the cardiopulmonary resuscitation training course of our medical school in the middle of the last semester. The cardiopulmonary resuscitation training course consisted of 2 h of instructorled cardiopulmonary resuscitation training and 1 h of self-practice time. All students should complete the adult and infant cardiopulmonary resuscitation skill tests just after the course. Each test consisted of five cycles of single-rescuer cardiopulmonary resuscitation. A feedback device was introduced only in the self-practice session. The cardiopulmonary resuscitation parameters of the skill tests before ('n' = 40) and after ('n' = 39) introducing the feedback device were analysed.

      Results: The ratios of correct rate significantly increased after introducing the feedback device in both the skill tests (adult test: 58.5 +- 37.2 vs 85.5 +- 21.4, 'p' = 0.001; infant test: 55.0 +- 32.4 vs 80.2 +- 20.7, 'p' = 0.001). Although the average depths did not significantly differ between those before and after introducing the feedback device in the adult test (58.4 +- 4.0 mm vs 59.0 +- 3.7 mm, 'p' = 0.341), it increased significantly after introducing the feedback device in the infant test (38.3 +- 4.3 mm vs 40.8 +- 1.1 mm, 'p' = 0.001).

      Conclusion: Introducing a feedback device might have enhanced the accuracies of compression rate in adult and infant cardiopulmonary resuscitation training. However, the potential positive effect on chest compression depth was limited to infant cardiopulmonary resuscitation training.

      PubDate: Wed, 6 May 2020 01:50:51 GMT
       
  • Volume 27 Issue 1 - Effects and safety of separate low-dose hydrocortisone
           use in patients with septic shock: A meta-analysis
    • Abstract: Wu, Jing; Huang, Man; Wang, QianWen; Ma, Yuefeng; Jiang, Libing
      Objective: The aim of this study was to explore the effects and safety of low-dose hydrocortisone in patients with septic shock.

      Methods: The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched from database inception until 1 August 2018. Two reviewers performed literature selection, data extraction, and quality evaluation independently.

      Results: Twelve randomized controlled trials were included in this meta-analysis. The combined results showed that low-dose hydrocortisone use had no survival benefit in patients with septic shock (relative risk = 1.09; 95% confidence interval = 0.88-1.05; P = 0.37). But low-dose hydrocortisone use was useful for shock reverse (relative risk = 1.09; 95% confidence interval = 1.00-1.19; P = 0.04) and in shortening the time of vasopressor support (weighted mean difference = −1.79, 95% confidence interval = −2.05 to −1.52; P < 0.00001). In addition, use of low-dose hydrocortisone was associated with a higher risk of hyperglycemia (relative risk = 1.21; 95% confidence interval = 1.04-1.40; P = 0.01) and hypernatremia (relative risk = 6.34; 95% confidence interval = 1.19-33.81; P = 0.03). There was no significant improvement of intensive care unit mortality (relative risk = 1.11; 95% confidence interval = 0.93-1.33; P = 0.23) or hospital mortality (relative risk = 1.08; 95% confidence interval = 0.94-1.24; P = 0.29), length of intensive care unit (weighted mean difference = −1.84; 95% confidence interval = −5.80 to 2.11; P = 0.36) or length of hospital (weighted mean difference = 0.11; 95% confidence interval = −2.06 to 2.29; P = 0.98), and time of mechanical support (weighted mean difference = −0.69; 95% confidence interval = −1.76 to −0.38; P = 0.20) with the use of low-dose hydrocortisone. There was no significant difference in secondary infection (relative risk = 1.04; 95% confidence interval = 0.91-1.18; P = 0.57), recurrence of shock (relative risk = 1.47; 95% confidence interval = 0.64-3.39; P = 0.36), and gastrointestinal bleeding (relative risk = 1.41; 95% confidence interval = 0.89-2.22; P = 0.14) with the use of low-dose hydrocortisone.

      Conclusion: Although there was no effect of low-dose hydrocortisone on survival of patients with septic shock, it is associated with a higher rate of shock reversal and shortening duration of vasopressor support; thus, low-dose hydrocortisone may be an alternative drug in septic shock patients who are refractory to fluid resuscitation and vasopressors.

      PubDate: Fri, 7 Feb 2020 20:26:16 GMT
       
  • Volume 27 Issue 1 - Expression of peripheral blood monocyte human
           leukocyte antigen DR in patients with cardiac arrest and its clinical
           significance
    • Abstract: Zhang, Junli; Wang, Yanjuan; Gu, Wei
      Background: In the early period of spontaneous circulation (ROSC), the body may show severe immunosuppression and excessive activation of inflammatory response, This is very similar to sepsis in many ways.

      Objective: The aim of this study is to observe changes of the early expression of monocyte human leukocyte antigen DR in patients with cardiac arrest, so as to explore the clinical significance of the related immune assessment and prognosis prediction.

      Methods: A total of 43 patients with cardiac arrest who have been treated in the emergency department of Beijing Chaoyang Hospital from January 2015 to February 2018 are selected. By taking the survival rate on the 28th day of hospitalization as the end of observation, the patients are divided into the survival group and the death group. Changes of APACHE-II scores and monocyte human leukocyte antigen DR levels on the first, second, and third day after admission are analyzed.

      Results: On the first, second, and third day after onset, cardiac arrest patients show significantly decreased levels of monocyte human leukocyte antigen DR which are obviously lower in the death group than in the survival group. In addition, human leukocyte antigen DR levels were significantly negatively correlated with APACHE-II scores.

      Conclusion: The expression of monocyte human leukocyte antigen DR is proven to be an ideal indicator to evaluate the immune function and prognosis of cardiac arrest patients. A constantly low expression of human leukocyte antigen DR indicates impaired immune function and increased mortality of patients.

      PubDate: Fri, 7 Feb 2020 20:26:16 GMT
       
  • Volume 27 Issue 1 - Utility of neutrophil gelatinase-associated lipocalin
           in the management of acute kidney injury: A prospective, observational
           study
    • Abstract: Isikkent, Ali; Yilmaz, Serkan; Ozturan, Ibrahim Ulas; Dogan, Nurettin Ozgur; Yaka, Elif; Gultekin, Haldun; Kum, Tugba; Pekdemir, Murat
      Background: Utilization of renal biomarkers such as neutrophil gelatinase-associated lipocalin in the management of acute kidney injury may be useful as a diagnostic tool in the emergency department.

      Objective: The aim of this study is to determine the relationship between serum neutrophil gelatinase-associated lipocalin level and the severity of the acute kidney injury based on the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) classification, and to investigate the role of the serum neutrophil gelatinase-associated lipocalin level in differentiating the etiology and predicting the 30-day mortality rate and need for dialysis.

      Methods: This prospective, observational study was conducted from March 2015 to 2016. Adult patients with acute kidney injury in the emergency department were enrolled in the study. Demographic and clinical features such as hypovolemic state, nephrotoxic substance exposure, renal functions, and serum neutrophil gelatinase-associated lipocalin level were evaluated. After the etiology of the acute kidney injury was ascertained, the severity of the acute kidney injury was determined according to RIFLE criteria. Primary outcome was defined as the correlation between serum neutrophil gelatinase-associated lipocalin level and the severity of the acute kidney injury according to RIFLE classification. Secondary outcomes were defined as the relationship between the serum neutrophil gelatinase-associated lipocalin level and the etiology of the acute kidney injury; need for dialysis and 30-day mortality were defined as poor outcomes.

      Results: A total of 87 patients were included in the study. Mean serum neutrophil gelatinase-associated lipocalin levels were 380.14 +- 276.65 ng/mL in RIFLE-R, 425.80 +- 278.99 ng/mL in RIFLE-I, and 403.60 +- 293.15 ng/mL in RIFLE-F groups. There was no statistically significant relationship between the severity of acute kidney injuries and serum neutrophil gelatinase-associated lipocalin level. Initial serum neutrophil gelatinase-associated lipocalin levels in the emergency department did not indicate a statistically significant ability to predict the etiology of acute kidney injury, 30-day mortality rates, or need for dialysis.

      Conclusion: Initial serum neutrophil gelatinase-associated lipocalin level in the emergency department is not a determinant tool for predicting the severity, etiology, 30-day mortality rates, or need for dialysis in cases of acute kidney injuries.

      PubDate: Fri, 7 Feb 2020 20:26:16 GMT
       
  • Volume 27 Issue 1 - Video clip training improved emergency medicine
           residents' interpretation ability of visual ejection fraction
    • Abstract: Yang, Eun-Suk; Yeo, Woonhyung; Ko, Jung-In; Kwon, Jaehyun; Choi, Seung-Min; Chung, Jaehoon; Lee, Yu Jin; Cho, Gyu Chong; Park, Taejin
      Background: Information on cardiac contractility is very important in resuscitation of critically ill patients. However, the measurement of ejection fractions by echocardiography is very difficult to perform for non-cardiologists. We developed a video clip to train emergency medicine residents to measure visual ejection fraction and compared the improvement in their interpretation ability with that following the conventional training method.

      Objectives: Improvement of interpreting ability of vEF in short period.

      Methods: A total of 27 multicentre emergency medicine residents were recruited and divided into conventional training group (N = 13) and video clip training group (N = 14). Self-training was done for 1 week. Pre-test and post-test comprising 20 questions were used for evaluation, and scores and interpretation time were recorded.

      Results: The score of the video clip training group showed a statistically significant improvement in contrast to the conventional training group (the score of pre- and post-test, +-5% scoring method: correct answer; video clip training group, 5.4/20 to 10.4/20 (p < 0.001) versus conventional training group, 5.8/20 to 6.7/20 (p = 0.204)). Furthermore, there was a statistically significant reduction in the interpretation time (interpretation time of video clip training group, 417.7-358.8 s (p = 0.005) versus conventional training group, 416.8-411.5 s (p = 0. 497)).

      Conclusion: In the video clip training group, interpretation accuracy improved, and the interpretation time was shorter than that of the conventional training group. Based on these results, we conclude that improvement in the visual ejection fraction interpretation ability by emergency medicine residents can be expected.

      PubDate: Fri, 7 Feb 2020 20:26:16 GMT
       
  • Volume 27 Issue 1 - Comparison of the efficacy of three cervical collars
           in restricting cervical range of motion: A randomized study
    • Abstract: Kim, Jae Guk; Sung Hwan, Bang; Kang, Gu Hyun; Jang, Yong Soo; Kim, Wonhee; Choi, Hyun Young; Kim, Gyoung Mo
      Background: The cervical collar has been used as a common device for the initial stabilization of the cervical spine. Although many cervical collars are commercially available, there is no consensus on which offers the greatest protection, with studies showing considerable variations in their ability to restrict cervical range of motion. The use of the XCollar (Emegear, Carpinteria, CA) has been known to decrease the risk of spinal cord injury by minimizing potential cervical spinal distraction. We compared XCollar with two other cervical collars commonly used for adult patients with cervical spine injury to evaluate the difference in effectiveness between the three cervical collars to restrict cervical range of motion.

      Objectives: This study aimed to evaluate the difference between the three cervical collars in their ability to restrict cervical range of motion.

      Method: A total of 30 healthy university students aged 21-25 years participated in this study. Participants with any cervical disease and symptoms were excluded. Three cervical collars were tested: Philadelphia Collar, Stifneck Select Collar, and XCollar. A digital camera and an image-analysis technique were used to evaluate cervical range of motion during flexion, extension, bilateral bending and bilateral axial rotation. Cervical range of motion was evaluated in both the unbraced and braced condition.

      Results: XCollar permitted less than a mean of 10 degrees of movement during flexion, extension, bilateral bending and bilateral axial rotation. This was less than the movement permitted by the other two cervical collars.

      Conclusion: XCollar presented superior cervical immobilization compared to the other two commonly used cervical collars in this study. Thus, when cervical collar is considered for an adult patient with cervical spine injury, XCollar might be one of the considerate options as a cervical immobilization device.

      PubDate: Fri, 7 Feb 2020 20:26:16 GMT
       
  • Volume 27 Issue 1 - Heart pathway and emergency department assessment of
           chest pain score-accelerated diagnostic protocol application in a local
           emergency department of Hong Kong: An external prospective validation
           study
    • Abstract: Yang, Siu Ming; Chan, Chi Ho; Chan, Tung Ning
      Background: The conventional chest pain protocol using thrombolysis in myocardial infarction score as the risk stratifying tool may not perform well in the emergency department in which a mix of low- and high-risk patients are encountered. Newer chest pain scores such as HEART pathway and Emergency Department Assessment of Chest Pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) are found to have high sensitivity with good specificity.

      Objectives: This study aims to validate and compare two chest pain scores: HEART pathway and EDACS-ADP in the Accident and Emergency Department of a local hospital in Hong Kong.

      Methods: A prospective cohort study was carried out at the Accident and Emergency Department of Kwong Wah Hospital in Hong Kong from 1 June 2016 to 31 May 2017. Patients >=18 years old with chest pain lasting 5 min or more who were observed with chest pain protocol on observation ward were recruited.

      Results: A total of 238 patients were recruited; 231 eligible patients completed follow-up. There were five patients with major adverse cardiac events in 30 days of follow-up. The sensitivity, specificity, and negative predictive values of HEART pathway and EDACS-ADP were 100%, 74.3%, 100% and 100%, 73.5.0% and 100%, respectively. Both scores had almost the same performance in terms of major adverse cardiac events at 30 days (area under the curve = 0.87).

      Conclusion: Our study showed both EDACS-ADP (modified) and HEART pathway achieved high sensitivity ( 100%) for detecting major adverse cardiac events in 30 days while being able to discharge more than 70% of patients as low risk for early discharge.

      PubDate: Fri, 7 Feb 2020 20:26:16 GMT
       
  • Volume 27 Issue 1 - Reciprocal abstract publication
    • PubDate: Fri, 7 Feb 2020 20:26:16 GMT
       
  • Volume 27 Issue 1 - An uncommon disease with an under-recognised finding
    • Abstract: Cheung, Jonathan Chun-Hei; Kitchell, Abdul Karim Bin; Law, Kam Leung
      A 44-year-old healthy man presented to the emergency department with left hip pain for a week. The physical exam did not point to a specific disease and his serum inflammatory markers were all increased. Point-of-care ultrasound was performed to help guide the management. The patient was able to receive definitive operation in a day.

      PubDate: Fri, 7 Feb 2020 20:26:16 GMT
       
  • Volume 27 Issue 1 - Disseminated Nocardia infection in a female patient
           
    • Abstract: Li, Shu; Ma, Qingbian; Li, Shuo; Zheng, Yaan; Chen, Yujiao; Xie, Rui; Ma, Jingwei
      Introduction: Nocardiosis is a rare kind of opportunistic infections. Because of its insidious onset and atypical clinical manifestations, diagnosis and early treatment are often delayed.

      Case presentation: Here we present a 60-year-old Chinese female patient with systemic Nocardia infection, who had been diagnosed with idiopathic thrombocytopenic purpura previously and was misdiagnosed for up to 6 months prior to presenting at our hospital and ultimately achieved clinical cure.

      Discussion: The patient took prednisone because of ITP for several years which led to immunosuppression. Nocardia infection began from the skin rupture and then spread all over the body with multiple system involvement. The pus culture eventually found Nocardia. Sulphonamides have been the standard treatment for decades and there are several other options. Patients with severe Nocardia infection or immunosuppression are suggested a combined therapy.

      Conclusion: Nocardiosis is an infection that often resulted in delayed diagnosis because of lack of specificity of the clinical profile and the difficulty in culturing the bacteria. It should be included in the differential diagnosis of patients in which there are cutaneous, respiratory or neurological manifestations, especially in immunosuppressed individuals.

      PubDate: Fri, 7 Feb 2020 20:26:16 GMT
       
  • 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
       
 
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