Hong Kong Journal of Emergency Medicine

In this study, we aimed to compare cardiac output, echocardiographic pulmonary velocity-time integral, and end-tidal carbon dioxide values before and after the passive leg raising maneuver in healthy volunteers.

The Ethical Commission approved the study. A total of 36 volunteers were included after signed informed consent in our study. After 12 h of fasting, vital signs, cardiac output, pulmonary velocity-time integral, and end-tidal carbon dioxide were measured when the participants were lying supine. Then, participants’ legs were elevated to 45° passively, and all measurements were repeated. Pulmonary velocity-time integral was obtained in parasternal short-axis view with the aid of pulse Doppler. Pulmonary root measurements were recorded. Echocardiographic stroke volume and cardiac output were calculated. The differences between values of cardiac output, pulmonary velocity-time integral, and end-tidal carbon dioxide before and after passive leg raising were statistically compared. The level of significance was accepted as p < 0.05.

Significant differences were found between pre- and post-passive leg raising values of these three measurements. The effect of passive leg raising on pulmonary velocity-time integral measurements was greater. The change in end-tidal carbon dioxide was not correlated with either cardiac output or pulmonary velocity-time integral alteration.

Our results showed that measurement of pulmonary velocity-time integral changes after passive leg raising is a more useful bedside method to predict fluid responsiveness than measurement of end-tidal carbon dioxide and cardiac output alteration.

Acute gastroenteritis is a clinical syndrome that may cause severe dehydration in affected individuals and a reason of mortality and morbidity in all age groups. Measurement of perfusion index and plethysmography variability index may provide emergency physicians valuable information about hemodynamics of the patient.

Our study aimed to investigate the role of perfusion index and plethysmography variability index measurement at admission for estimating dehydration severity and determiningthe possible change in those parameters after fluid replacement among patients presenting to emergency department with acute gastroenteritis.

This was a prospective cross-sectional study. Patients diagnosed with acute gastroenteritis at the emergency department were consecutively enrolled. The two groups were defined according to the severity of dehydration: mild and moderate/severe dehydration groups. The values of perfusion index and plethysmography variability index of all patients were measured.

A total of 180 patients were included in the study. As compared with the mild dehydration group, moderate/severe dehydration group had a significantly lower perfusion index value and significantly higher plethysmography variability index value on admission (p < 0.001 for both comparisons). Among moderate/severe dehydration patients, perfusion index value significantly increased and plethysmography variability index significantly decreased after treatment (p < 0.001). There was a significant positive correlation between osmolarity and plethysmography variability index (r = 0.298; p = 0.007) and a significant negative correlation between osmolality and perfusion index (r = −0.259; p = 0.019) in the patients with moderate/severe dehydration.

The study show that perfusion index and plethysmography variability index may be useful for determining the severity of dehydration in acute gastroenteritis and may be use for assessing the response to fluid replacement especially in patients with severe dehydration at emergency department.

To investigate whether high-flow nasal cannula oxygen therapy could reduce the rate of endotracheal intubation and improve arterial blood gas values, vital signs, and clinical outcomes of patients with hypoxemic acute respiratory failure as compared with conventional oxygen therapy alone.

This retrospective, observational study was performed in the 15-month study period and included adult patients with tachypnea and hypoxemia, whose vital signs and arterial blood gas were monitored. The high-flow nasal cannula oxygen group consisted of patients admitted to the emergency department with acute respiratory failure when high-flow nasal cannula oxygen treatment was available in the hospital, while the conventional oxygen therapy group consisted of patients who have presented to the emergency department with acute respiratory failure in the absence of high-flow nasal cannula oxygen device in the hospital. The primary outcome of the study was improvement in vital signs and arterial blood gas values within first and fourth hours of the treatment. The second outcome was the need for intubation in the emergency department, length of hospital stay, and hospital mortality.

The decrease in the pulse and respiratory rate of high-flow nasal cannula oxygen–treated group was significantly greater than the conventional oxygen therapy group on the first and fourth hours of treatment (p < 0.001). PaO₂ values were significantly higher in the high-flow nasal cannula oxygen group at the first and fourth hours of treatment (p ⩽ 0.001). Likewise, mean SaO₂ levels of patients receiving high-flow nasal cannula oxygen treatment was significantly higher than those of patients in the conventional oxygen therapy group (p = 0.006 at 1 h and p < 0.001 at 4 h). In the hypercapnic patients, the decrease in PaCO₂ and increase in pH and PaO₂ values were significantly greater in high-flow nasal cannula oxygen group (p < 0.001). The difference between the groups regarding the need for invasive mechanical ventilation was not statistically significant (p = 0.179).

High-flow nasal cannula oxygen treatment has been associated with favorable effects in vital signs and arterial blood gas values in patients with acute respiratory failure. High-flow nasal cannula oxygen might be considered as the first-line therapy for patients with hypoxemic and/or hypercapnic acute respiratory failure.

(1) To compare adherence of Ministry of Health Singapore Guidelines of Acute Asthma in the emergency department, in data 10 years apart, and ascertain if any difference observed impacted 72-h return rates and (2) to describe enhancement in hospital and community medical services for asthma, and its effect on disposition trends.

A retrospective comparison in guideline adherence with regard to systemic steroids administration, anti-cholinergic administration in moderately severe exacerbations and patient education in discharged patients was done. Rates of unscheduled 72-h returns were compared. A description of new community and hospital services was described, and disposition trends were compared.

In total, 630 patients 10 years ago and 635 patients in the current year were studied, after exclusions and systematic sampling applied. Steroid administration improved by 29% (adjusted p < 0.001). Steroids started in the emergency department improved by 43% (adjusted p < 0.001). Ipratropium addition to second nebulizer improved by 63% (adjusted p < 0.001). Patient education improved by 66% (adjusted p < 0.001). Unscheduled 72-h returns rate were unchanged at 4.2% (adjusted p = 0.912). Although there was no significant difference in the admission and discharge disposition (adjusted p = 0.173), there was a trend towards admission to the short stay unit as an admission option and referral to the primary healthcare provider for discharged patients.

Although guideline adherence improved in the current year, rates of 72-h unscheduled returns were similar. Disposition trends reflected emphasis and availability of healthcare services in the community and hospital.

Optimal cut-offs for B-type natriuretic peptide (BNP) for the diagnosis of heart failure differ based on ethnicity. There are no data for Southeast Asian patients. We aimed to define the optimal cut-off points and the strength of B-type natriuretic peptide as a predictor of heart failure in Southeast Asian multiethnic population.

Bedside B-type natriuretic peptide (SOB panel (Biosite®)) was measured for patients (>50 years) presenting with dyspnea. Emergency physicians (blinded to B-type natriuretic peptide result) assessed the probability of acute heart failure on a scale of 0%–100%. Heart failure diagnosis was adjudicated by two cardiologists.

In all, 43% (n = 87) of the 203 dyspneic patients (54.7% males, 453% females) had a final diagnosis of acute heart failure. B-type natriuretic peptide values ranged from 3.2 to 4960 pg/mL (median, 189 pg/mL). Median B-type natriuretic peptide values of patients with the final diagnosis of “acute heart failure,” “no acute heart failure but history of heart failure,” and “no heart failure” were 600, 301, and 68 pg/mL, respectively. The optimum cut-off was 186 pg/mL. The receiver operating characteristic curve of the emergency physician’s assessment of the probability of heart failure based on clinical assessment had an area under the curve of 85% (95% confidence interval: 80%–90%). Combining receiver operating characteristic curves of physician assessment and B-type natriuretic peptide values yielded an area under the curve of 96% (95% confidence interval: 93%–98%). B-type natriuretic peptide levels less than 100 pg/mL were the strongest predictor of heart failure (odds ratio: 26.36; confidence interval: 6.85–101.41), followed by upper lobe diversion and cardiomegaly.

The accuracy of bedside B-type natriuretic peptide was validated in a multiethnic Asian population. Optimum cut-off is 186 pg/mL. A B-type natriuretic peptide >100 pg/mL is the single strongest independent predictor of heart failure.

Epistaxis is one of the most common emergencies in the department of otolaryngology, which gives a burden to the health care system.

This study aimed to investigate the patients’ characteristics of hospital admission with epistaxis and provide an optimized protocol.

This study was a retrospective analysis of patients with epistaxis admitted to The Third Affiliated Hospital of Sun Yat-sen University in Guangzhou, China. The data were analyzed in terms of gender, age, seasonal differences, length and expenses of hospitalization, pathogenesis of epistaxis, primary medical management before hospital admission, bleeding sites, and treatment.

A total of 387 patients were included, which consisted of 270 males and 117 females with an average of 43 years. Most patients could be identified with underlying diseases, and the most commonly observed bleeding site was Little area (n = 164). Most patients received electrocauterization as a precision medical treatment (n = 288). The duration of hospitalization length ranged from a mean of 5.17–4.48 days, and the expenses of hospitalization ranged from a mean of RMB 4881–4951 yuan over the last 5 years.

Most patients with epistaxis could be treated as outpatients by endoscopic electrocauterization, and hospitalization is indicated when patients need improvement of poor general condition, posterior packing, embolization, or surgery. This study enables to provide an optimized protocol for patient with epistaxis.

Emergency nurse practitioners have traditionally been reluctant to treat acute red eyes in Hong Kong emergency departments. The Edinburgh Red Eye Diagnostic Algorithm is the only validated tool to assist non-ophthalmologists to make diagnoses.

This study investigates the utility of a modified version used by emergency nurse practitioners.

This is a prospective single-centre cohort study in a university hospital emergency department in Hong Kong, comparing red eye patients seen by emergency nurse practitioners with the aid of the algorithm to patients seen by emergency doctors. Data on patient-reported symptom severity were obtained on the day of consultation and information on resolution of symptoms at 1 week following emergency department attendance via telephone interviews.

A convenience sample of 50 patients was recruited to the emergency nurse practitioner group and 130 patients were recruited to the doctors’ group over 9 weeks. Reductions in symptom severity were seen in both groups (>70% in both groups reported moderate to very severe discomfort on day 0; ~90% in both groups reported none or mild discomfort on day 7). There was no difference between the two groups (p = 0.55, analysis of covariance). Symptom resolution was reported in 96% in the emergency nurse practitioner group and 98.5% in the doctor’s group, which was not statistically significant (p = 0.31, χ² test).

Emergency nurse practitioners using the Edinburgh Red Eye Algorithm to manage red eye patients in a Hong Kong emergency department achieve similar patient-reported outcomes compared to emergency department doctor consultations.

Pentoxifylline may be an important approach to treat neonatal sepsis. However, its use has not been well established. We conduct a systematic review and meta-analysis to evaluate the efficacy of pentoxifylline treatment for neonatal sepsis.

PubMed, Embase, and the Cochrane Central Register of Controlled Trials are searched. Randomized controlled trials assessing the influence of pentoxifylline treatment on neonatal sepsis are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. This meta-analysis is performed using the random-effect model.

Seven randomized controlled trials involving 439 patients are included in the meta-analysis. Compared with control intervention for neonatal sepsis, pentoxifylline treatment is associated with reduced hospital stay (standard mean differences = −0.61; 95% confidence interval = −0.93 to −0.29; p = 0.0002) and metabolic acidosis (risk ratio = 0.38; 95% confidence interval = 0.22 to 0.66; p = 0.0006), but has no remarkable impact on mortality (risk ratio = 0.59; 95% confidence interval = 0.30 to 1.16; p = 0.13), serum tumor necrosis factor-α (standard mean differences = −0.38; 95% confidence interval = −1.29 to 0.52; p = 0.41), serum C-reactive protein (standard mean differences = −0.25; 95% confidence interval = −0.92 to 0.42; p = 0.47), plasma interleukin-6 (standard mean differences = −0.13; 95% confidence interval = −0.41 to 0.15; p = 0.37), disseminated intravascular coagulopathy (risk ratio = 0.55; 95% confidence interval = 0.25 to 1.21; p = 0.14), and oliguria/anuria (risk ratio = 0.77; 95% confidence interval = 0.28 to 2.16; p = 0.62).

Pentoxifylline treatment may be associated with reduced mortality and hospital stay in neonatal sepsis with caution.