Publisher: RMIT Publishing   (Total: 387 journals)

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Showing 1 - 200 of 387 Journals sorted alphabetically
40 [degrees] South     Full-text available via subscription   (Followers: 4)
Aboriginal and Islander Health Worker J.     Full-text available via subscription   (Followers: 16)
Aboriginal Child at School     Full-text available via subscription   (Followers: 7)
About Performance     Full-text available via subscription   (Followers: 13)
Access     Full-text available via subscription   (Followers: 28)
ACCESS: Critical Perspectives on Communication, Cultural & Policy Studies     Full-text available via subscription   (Followers: 15)
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: 9)
Anglican Historical Society J.     Full-text available via subscription   (Followers: 4)
Annals of the Royal Australasian College of Dental Surgeons     Full-text available via subscription   (Followers: 5)
ANZSLA Commentator, The     Full-text available via subscription   (Followers: 4)
Appita J.: J. of the Technical Association of the Australian and New Zealand Pulp and Paper Industry     Full-text available via subscription   (Followers: 16, SJR: 0.168, CiteScore: 0)
AQ - Australian Quarterly     Full-text available via subscription  
Arena J.     Full-text available via subscription  
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: 6, 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: 4)
Australasian Parks and Leisure     Full-text available via subscription   (Followers: 2)
Australasian Plant Conservation: J. of the Australian Network for Plant Conservation     Full-text available via subscription   (Followers: 4)
Australasian Policing     Full-text available via subscription   (Followers: 6)
Australasian Public Libraries and Information Services     Full-text available via subscription   (Followers: 34)
Australasian Review of African Studies, The     Full-text available via subscription   (Followers: 2)
Australian Aboriginal Studies     Full-text available via subscription   (Followers: 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: 22)
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: 30, SJR: 0.354, CiteScore: 0)
Australian J. of French Studies     Full-text available via subscription   (Followers: 7, SJR: 0.123, CiteScore: 0)
Australian J. of Herbal Medicine     Full-text available via subscription   (Followers: 6)
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: 4)
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: 5)
Australian Screen Education Online     Full-text available via subscription   (Followers: 3)
Australian Senior Mathematics J.     Full-text available via subscription   (Followers: 2)
Australian Sugarcane     Full-text available via subscription  
Australian TAFE Teacher     Full-text available via subscription   (Followers: 4)
Australian Tax Forum     Full-text available via subscription   (Followers: 3)
Australian Universities' Review, The     Full-text available via subscription   (Followers: 4)
Australian Voice     Full-text available via subscription   (Followers: 6)
Bar News: The J. of the NSW Bar Association     Full-text available via subscription   (Followers: 8)
Bioethics Research Notes     Full-text available via subscription   (Followers: 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: 19, SJR: 0.183, CiteScore: 0)
British Review of New Zealand Studies     Full-text available via subscription   (Followers: 4)
Brolga: An Australian J. about Dance     Full-text available via subscription   (Followers: 3)
Cancer Forum     Full-text available via subscription   (SJR: 0.115, CiteScore: 0)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Chain Reaction     Full-text available via subscription  
Childrenz Issues: J. of the Children's Issues Centre     Full-text available via subscription  
Chiropractic J. of Australia     Full-text available via subscription   (SJR: 0.111, CiteScore: 0)
Chisholm Health Ethics Bulletin     Full-text available via subscription   (Followers: 1)
Church Heritage     Full-text available via subscription   (Followers: 5)
Commercial Law Quarterly: The J. of the Commercial Law Association of Australia     Full-text available via subscription   (Followers: 5)
Communicable Diseases Intelligence Quarterly Report     Full-text available via subscription   (Followers: 2, SJR: 0.563, CiteScore: 1)
Communication, Politics & Culture     Open Access   (Followers: 14)
Communities, Children and Families Australia     Full-text available via subscription   (Followers: 3)
Connect     Full-text available via subscription   (Followers: 2)
Contemporary PNG Studies     Full-text available via subscription  
Context: J. of Music Research     Full-text available via subscription   (Followers: 8)
Corporate Governance Law Review, The     Full-text available via subscription   (Followers: 8)
Creative Approaches to Research     Full-text available via subscription   (Followers: 14)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 26, SJR: 1.032, CiteScore: 1)
Cultural Studies Review     Full-text available via subscription   (Followers: 16)
Culture Scope     Full-text available via subscription   (Followers: 4)
Dance Forum     Full-text available via subscription   (Followers: 6)
DANZ Quarterly: New Zealand Dance     Full-text available via subscription   (Followers: 4)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Deakin Law Review     Full-text available via subscription   (Followers: 15)
Developing Practice : The Child, Youth and Family Work J.     Full-text available via subscription   (Followers: 20)
Early Days: J. of the Royal Western Australian Historical Society     Full-text available via subscription  
Early Education     Full-text available via subscription   (Followers: 10)
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: 11)
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: 21)
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: 12)
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)
Intl. J. of Home Economics     Full-text available via subscription   (Followers: 2)
Intl. J. of Narrative Therapy & Community Work     Full-text available via subscription   (Followers: 8)
Intl. J. of Punishment and Sentencing, The     Full-text available via subscription   (Followers: 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)
J. of Applied Law and Policy     Full-text available via subscription   (Followers: 3)
J. of Australian Colonial History     Full-text available via subscription   (Followers: 8)
J. of Australian Naval History, The     Full-text available via subscription   (Followers: 3)

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Similar Journals
Journal Cover
Hong Kong Journal of Emergency Medicine
Journal Prestige (SJR): 0.19
Number of Followers: 5  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1024-9079 - ISSN (Online) 2309-5407
Published by RMIT Publishing Homepage  [387 journals]
  • Volume 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
       
  • Volume 26 Issue 4 - Trauma and injury severity score modification for
           predicting survival of trauma in one regional emergency medical center in
           
    • Abstract: Kang, In Hye; Lee, Kang Hyun; Youk, Hyun; Lee, Jeong Il; Lee, Hee Young; Bae, Keum Seok
      Background: The problem that is central to trauma research is the prediction of survival rate after trauma. Trauma and Injury Severity Score is being used for predicting survival rate after trauma. Many countries have conducted a study on the classification, characteristics of variables, and the validity of the Trauma and Injury Severity Score model. However, few investigations have been made on the characteristics of coefficients or variables related to Trauma and Injury Severity Score in Korea.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      PubDate: Wed, 18 Sep 2019 13:02:51 GMT
       
 
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