Hong Kong Journal of Emergency Medicine

Trauma was the fifth leading cause of death in Hong Kong in 2013.4 Injuries caused by falls ranked first in traumatic brain injury (TBI) cases among older adults (51%).5 Elderly trauma patients face an increased risk of adverse consequences6 from trauma compared with their younger counterparts, as advanced age itself is already a well-recognized risk factor for less favorable outcomes following trauma. Therefore, identifying factors associated with significant brain injury in geriatric patients in A&E triage is crucial in providing timely care to these patients.

To identify the risk factors for geriatric patients with significant brain injury from ground-level falls and to formulate their association of risk factors with significant brain injury as a consequence from ground-level falls.

This was a retrospective study with data collected from the Clinical Data Analysis and Reporting System of Queen Mary Hospital from 1 January 2013 to 31 December 2015. A total of 1101 cases were identified.

There were 76% of the recruited patients with a normal computed tomography scan. However, the remaining 24% had computed tomography scans indicative of brain injury. Severe head injuries were scored 3 -8 on the Glasgow Coma Scale and moderate head injuries were scored 9 -12. Respectively, these were 20 times (p = 0.005) and 5 times (p = 0.002) more likely to have positive computed tomography findings than patients with a Glasgow Coma Scale score from 13 to 15. Patients with loss of consciousness were two times more likely to have a positive computed tomography result than those without loss of consciousness (p = 0.001). Although warfarin use is a well-established risk factor for intracranial hemorrhage after head injury, in our dataset, the result was not statistically significant. However, the use of new oral anti-coagulants was associated with positive computed tomography findings with patients taking new oral anti-coagulants 2.3 times more likely to have positive computed tomography findings compared with those with no anticoagulant use (p = 0.033).

Early detection of patients with significant brain injury and aggressive management may prevent secondary injury from the complications of brain injury, hence improving patient mortality and morbidity, and reducing hospital stay and health care costs.

To report and analyse the poisoning data of Hong Kong Poison Information Centre in 2017.

In 2017, all poisoning cases received by Hong Kong Poison Information Centre were retrieved from its database (Poison Information and Clinical Management System) for analysis.

A total of 3956 poisoned cases were analysed. There were 1789 male patients (45.2%), 2159 female patients (54.6%) and 8 sex-unspecified patients (0.2%). The majority of cases (59.9%) were between 20 and 59 years old. The common causes of poisoning were suspected self-harm/suicidal attempt (36.2%), unintentional exposure (18.6%) and abusive substance use (13.7%). Excluding the common co-ingestant ethanol, the five commonest types of poison were benzodiazepines, paracetamol, zopiclone, Chinese herbal medicine and household products. Most patients were managed with supportive measures, while 17.4% and 13.2% of consultation cases were treated by decontamination and antidotes, respectively. The majority of the cases had uneventful recovery; 1.1% resulted in death and 4.3% had major outcomes. A total of 13 interesting cases and 1 poisoning outbreak were discussed.

This 12th annual report provided the updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparison with our previous reports.

For critical patients in resuscitation room, the early prediction of potential risk and rapid evaluation of disease progression would help physicians with timely treatment, leading to improved outcome. In this study, it focused on the application of National Early Warning Score on predicting prognosis and conditions of patients in resuscitation room. The National Early Warning Score was compared with the Modified Early Warning Score) and the Acute Physiology and Chronic Health Evaluation II.

To assess the significance of NEWS for predicting prognosis and evaluating conditions of patients in resuscitation rooms.

A total of 621 consecutive cases from resuscitation room of Xuanwu Hospital, Capital Medical University were included during June 2015 to January 2016. All cases were prospectively evaluated with Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II and then followed up for 28 days. For the prognosis prediction, the cases were divided into death group and survival group. The Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II results of the two groups were compared. In addition, receiver operating characteristic curves were plotted. The areas under the receiver operating characteristic curves were calculated for assessing and predicting intensive care unit admission and 28-day mortality.

For the prognosis prediction, in death group, the National Early Warning Score (9.50 ± 3.08), Modified Early Warning Score (4.87 ± 2.49), and Acute Physiology and Chronic Health Evaluation II score (23.29 ± 5.31) were significantly higher than National Early Warning Score (5.29 ± 3.13), Modified Early Warning Score (3.02 ± 1.93), and Acute Physiology and Chronic Health Evaluation II score (13.22 ± 6.39) in survival group (p < 0.01). For the disease progression evaluation, the areas under the receiver operating characteristic curves of National Early Warning Score, Modified Early Warning Score, and Acute Physiology and Chronic Health Evaluation II were 0.760, 0.729, and 0.817 (p < 0.05), respectively, for predicting intensive care unit admission; they were 0.827, 0.723, and 0.883, respectively, for predicting 28-day mortality. The comparison of the three systems was significant (p < 0.05).

The performance of National Early Warning Score for predicting intensive care unit admission and 28-day mortality was inferior than Acute Physiology and Chronic Health Evaluation II but superior than Modified Early Warning Score. It was able to rapidly predict prognosis and evaluate disease progression of critical patients in resuscitation room.

Patients’ movements often need to be restrained to obtain high-quality diagnostic images. Chloral hydrate is the primary agent for pediatric sedation prior to diagnostic studies in some countries. However, because of the agent’s long half-life, the need for augmentation must be minimized by ensuring the success of the initial dose. This study aimed to identify factors influencing sedation success rate and sedation duration.

Pediatric patients’ age, sex, and dose according to body weight, type of clinic, duration of stay, and weight-for-age percentile were analyzed in univariate and multivariate regression analyses.

Of the total of 1590 patients, 1325 (82.7%) were successfully sedated. Predictors of successful sedation were a minimum dosage of 60 mg/kg and a younger age. Early sedation (mean − 1 standard deviation, <18 min) occurred in 10.9% of the pediatric patients who were successfully sedated. For this value, visits to emergency center B (adjusted odds ratio, 2.673; 95% confidence interval, 1.660–4.305) and visits during daytime hours appeared to be influencing factors.

For safe and successful pediatric sedation, the child’s age and appropriate dose must be thoroughly reviewed, and a quiet and secluded environment must be ensured. Furthermore, taking into account that the patient’s age and developmental stage can affect induction time, care should be taken to avoid unnecessary augmentation

Increased femoral vein size may lead to a higher first pass success rate during central venous cannulation. The aim of this study was to evaluate the effects of body position on femoral vein anatomy for cannulation.

This prospective study examined the femoral vein of healthy volunteers by ultrasound scanner. The changes in cross-sectional area and diameter of the femoral vein were evaluated. Right-sided measurements were taken at four different leg positions: neutral, frog leg, back-up, and back-up/frog leg position.

A total of 50 subjects were enrolled in the study. The mean femoral vein cross-sectional area were 0.57 ± 0.29 cm², 0.90 ± 0.26 cm², 1.05 ± 0.33 cm², and 1.47 ± 0.34 cm², and the mean femoral vein diameter were 0.75 ± 0.20 cm, 1.05 ± 0.28 cm, 1.25 ± 0.21 cm, and 1.46 ± 0.25 cm in order of neutral, back-up, frog leg, and back-up/frog leg position (p < 0.001).

Performing the right femoral vein catheterization in back-up and frog leg position is associated with a greater cross-sectional area of the femoral vein.

Nonoperative management for hemodynamically stable splenic injury has been accepted as appropriate treatment. Objectives: This study aimed to investigate the changes in management and clinical outcomes of splenic injury by introducing a protocol for splenic injury at a newly established regional trauma center.

From January 2005 to December 2016, we reviewed the outcomes of all 257 patients who sustained blunt trauma to the spleen at the first regional trauma center in South Korea. This 11-year period was divided into two intervals, before 1 January 2014 (period I, n = 189 patients) and after 1 January 2014 (period II, n = 68 patients), when the trauma center was established and a formal management protocol was followed for patients with blunt traumatic splenic injuries.

The proportion of emergency operations performed for patients with more serious (grades 3–5) splenic injuries was lower in period II than in period I (29% vs 22%, respectively, p < 0.001) whereas the rate of angioembolization was higher (89% vs 39.0%, respectively, p < 0.001). The time to intervention, irrespective of whether emergency operation or angioembolization was performed, was shorter in period II than in period I (312.8 min vs 129 min, respectively, p = 0.001). A greater proportion of patients was managed non-operatively in period II (78% vs 71%), and the non-operative management success rate was higher in period II than it was in period I (100% vs 83%; p = 0.014). Similarly, the splenic salvage rate was higher in period II (78% vs 59%, p = 0.03).

After establishing a regional trauma center and introducing a protocol for the management of blunt splenic injuries, the rates of non-operative management and splenic salvage improved significantly. The reasons for this may be multifactorial, being related to the early involvement of a trauma surgeon, expansion of angiographic facilities and resources, and the introduction and application of a protocol for managing blunt splenic injury.

Child abuse occurs all over the world, including Hong Kong. The Accident and Emergency Department is one of the places in which cases of child abuse may present to.

As an emergency physician in the hospital, we need to understand the signs and symptoms and the risk factors of child abuse. We also need to perform risk assessment and formulate the plan of management.

Databases in Hong Kong were searched to obtain the current situation of child abuse in Hong Kong. Literature about the nature of child abuse was also searched.

The epidemiology of child abuse in Hong Kong was reviewed. Signs and symptoms, risk factors, and management of child abuse were summarized in this review article. Conclusion: High vigilance is needed for emergency physicians to pick up cases of child abuse. Most cases of child abuse would finally need assessment from a multidisciplinary team.

A variety of exotic reptiles are kept as “pets” and the ownership of these animals is rising in Hong Kong. Two lizard species are known to be venomous: the Gila monster (Heloderma suspectum) and the Mexican Beaded Lizard (Heloderma horridum). Both of them are native to the North America but are traded in the pet markets. Bites from these lizards are capable of causing severe envenomation in humans.

A 41-year-old man presented to the emergency department after bitten by his exotic pet. His right hand was bitten by a Gila monster resulting in local swelling and intense pain. The local envenomation lasted for about 12 hours and then gradually improved.

Bite by Gila monster could result in local and systemic envenomation. Local envenomation includes intense pain of the injured site, edema and paraesthesia. Systemic envenomation including hypotension and airway edema occurs in severe envenomation.

With the increasing popularity of keeping exotic pets in Hong Kong, envenomation by exotic venomous animals may be encountered by the emergency physicians. Knowledge about the potential envenomation effects of these exotic animals is essential for proper management of the patients.