Hong Kong Journal of Emergency Medicine

Poison exposure is a significant problem in emergency departments (EDs) with high admission rates. Our study aims were to describe the demographics, exposure patterns and clinical outcomes of our ED patients as well as to explore predictors of Intensive Care Unit (ICU) / High Dependency (HD) admission.

In this retrospective study, we recruited patients aged over 16 years who presented with poison exposure to our ED over one year. We collected demographical and clinical data using our hospital databases. Primary outcomes were mortality rate and disposition status. Secondary outcomes were predictors for ICU/HD admission. Logistic regression was applied to identify these predictors.

We recruited 615 patients from an ED attendance of 162,159. Four hundred and nineteen (68%) patients were females; the majority [410 (66.7%)] was Chinese. The median age was 33 years [interquartile range (IQR): 24-44]. Four hundred fifty-six (74.1%) and 159 (25.9%) exposures were intentional or accidental respectively. There were no mortalities. The majority [466 (75.8%)] was admitted to the general ward and only 24 (3.9%) cases were ICU/HD admissions. We identified four factors associated with ICU/HD admission. Odds ratios (95% confidence intervals) for hypotension (systolic blood pressure <90 mmHg), pupillary changes, previous psychiatric history and tricyclic antidepressant overdose were 19.7 (5.57-69.65), 31.9 (7.01-145.76), 3.1 (1.08-9.07) and 30.1 (9.40-96.52) respectively.

Poison exposure is an infrequent ED occurrence with high admission rates but low mortality. Our study identified risk factors for ICU/HD admission that could be used in future studies to triage at-risk patients for treatment escalation.

Hot water immersion (HWI) has been proven to be effective for the treatment of pain due to marine envenomation. Our preliminary study by simply measuring the temperature change over time on the hot water in our conventional metal tray method revealed a too rapid fall in water temperature that happened in minutes. The aim of this study was to review the current practice of HWI for patients with marine envenomation in the emergency departments in Hong Kong, and to look for the optimal equipment in performing HWI.

We first conducted a phone survey to 16 registered nurses or nursing officers from 16 emergency departments of public hospitals in Hong Kong for the current practice of hot water immersion. The second part of our study was an in-vitro experiment done in observation room that a healthy subject immersed a hand into the water bath in metallic tray, sharp box and thermal isolator with and without covering of aluminum foil or plastic foil. The temperature change of the water bath in these containers was serially monitored.

In our phone survey, 14 respondents used plastic tray or sharp box for hot water immersion. Nine of them claimed that they commonly encountered inadequate wound pain relief and early cooling of the hot water bath. The experiment showed that the water temperature dropped out of optimal range for 5 minutes and 15 minutes in metallic tray and sharp box respectively. The thermal isolator kept the optimal temperature throughout 30 minutes of the study time.

Our purposed thermal isolator is a safe, practical and effective device for HWI therapy.

Ketamine is one of the commonest abusing agents in Hong Kong. Our study aims to identify their clinical pattern of presentations to emergency departments.

This is a retrospective survey study. The studied group was ketamine abusers being referred to us from a source out of emergency department (ED). Control group was randomly selected from patients attending our ED. The electronic records of the ketamine abusers and the controls in the past 3 years (1st April 2004-31st March 2007) were reviewed and analysed.

Total 91 subjects (48 in ketamine group, 43 in control group) were included. The mean age of ketamine abusers and control group are 21 and 22.2 year-old respectively. Most of them (97.9%) did not declare their background of ketamine abuse. The mean 3-year attendance rate for the ketamine group was 2.38 and for control group was 0.91, with a difference of 1.47 (95% CI 0.54-2.41, p=0.003). Most of their illnesses were diagnosed as epigastric pain (25%), followed by upper respiratory tract infection (18.8%), head injury (10.4%) and urinary tract infection (10.4%). Significantly higher number of ketamine abusers presented with epigastric pain compared with control group (odds ratio 143, p<0.001).

Most teenage ketamine abusers do not declare their background of drug abuse when they present to emergency departments. They tend to have a higher frequency of attendances. Most of their presenting problems are related to gastrointestinal system.

Over the past years, the environmental and scientific changes have shaped the snakebite scenarios and will continue to do so. Their effects ahead are discussed.

Because of declining plant agricultural industry and rising urbanization, a falling incidence is reasonably expected in future. In order to maintain the knowledge and skills, training for clinicians will become more crucial.

Kits for Naja atra and Cryptelytrops albolabris have been available overseas. Local data should be gathered regarding their clinical application.

The common local species covered by the haemotoxic and neurotoxic polyvalent antivenoms from Thailand is only Cryptelytrops albolabris. Introduction into Hong Kong is not recommended.

With an aim to improve the control of local injury that is unsatisfactorily accomplished by antivenoms, therapy with venom enzyme inhibitors is under research.

A decreasing number of snakebite is anticipated. Venom detection kits should be explored for the use in appropriate cases. (Hong Kong j.emerg.med. 2011;18:217-220)

To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2009.

In 2009, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis.

Totally 4338 poisoned cases were analysed. There were 1955 male patients (45.1%), 2,367 female patients (54.6%) and 16 patients with no gender specified. More than two-third of cases (68.6%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, abusive use and unintentional exposure. Paracetamol, ketamine, zopiclone, benzodiazepine and household products were the common poisons exposed. Majority of the patients were managed supportively, with 13.6% and 13.1% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; about 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes.

The 2009 annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.