{"title":"HKJEM November 2023 Reciprocal Abstracts","authors":"","doi":"10.1177/10249079231202132","DOIUrl":"https://doi.org/10.1177/10249079231202132","url":null,"abstract":"Free accessAbstractFirst published online October 9, 2023HKJEM November 2023 Reciprocal AbstractsOnlineFirsthttps://doi.org/10.1177/10249079231202132","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135095532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-21DOI: 10.1177/10249079231202169
Kevin KC Hung, Rex PK Lam, Chun Tat Lui
{"title":"Towards the third decade of <i>Hong Kong Journal of Emergency Medicine</i>","authors":"Kevin KC Hung, Rex PK Lam, Chun Tat Lui","doi":"10.1177/10249079231202169","DOIUrl":"https://doi.org/10.1177/10249079231202169","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136236099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-03DOI: 10.1177/10249079231191371
C. Tsui, R.K.M. Cheung, K. Mok
{"title":"POCUS in Hong Kong – past, present, future","authors":"C. Tsui, R.K.M. Cheung, K. Mok","doi":"10.1177/10249079231191371","DOIUrl":"https://doi.org/10.1177/10249079231191371","url":null,"abstract":"","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"269 - 270"},"PeriodicalIF":0.6,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42114635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-22DOI: 10.1177/10249079231189376
A. Law, K. K. Hung, Kirstin Stuart James, A. Kelly, C. Graham
Objective: To examine whether a 2-week or 4-week virtual patient simulation program can improve clinical competence for undergraduate emergency medicine education during COVID-19. Methods: This randomized controlled trial was conducted between October and December 2021. Final-year medical students were randomized into a 2-week short exposure group and a 4-week long exposure group on a 1:1 allocation. They were assessed using a virtual case with structured scoring system before and after the virtual patient simulation learning program. An end-of-program questionnaire on learners’ perceptions was also administered. Results: A total of 138 students were recruited. After the virtual patient simulation program, the virtual case score increment in the long exposure group was significantly higher than in the short exposure group with a mean score difference of 18/100 (95% confidence interval = 9.8 to 26.3). Questionnaire showed generally positive perceptions toward the use of virtual patient simulation program for emergency medicine teaching. Conclusion: Virtual reality learning of 2 and 4 weeks’ duration may be beneficial for improving emergency medicine clinical competence for final-year medical students, especially during periods of limited clinical exposure like the COVID-19 pandemic. A longer 4-week virtual patient simulation program may produce a better learning effect on clinical competence.
{"title":"Virtual patient simulation in undergraduate emergency medicine education during COVID-19: Randomized controlled trial","authors":"A. Law, K. K. Hung, Kirstin Stuart James, A. Kelly, C. Graham","doi":"10.1177/10249079231189376","DOIUrl":"https://doi.org/10.1177/10249079231189376","url":null,"abstract":"Objective: To examine whether a 2-week or 4-week virtual patient simulation program can improve clinical competence for undergraduate emergency medicine education during COVID-19. Methods: This randomized controlled trial was conducted between October and December 2021. Final-year medical students were randomized into a 2-week short exposure group and a 4-week long exposure group on a 1:1 allocation. They were assessed using a virtual case with structured scoring system before and after the virtual patient simulation learning program. An end-of-program questionnaire on learners’ perceptions was also administered. Results: A total of 138 students were recruited. After the virtual patient simulation program, the virtual case score increment in the long exposure group was significantly higher than in the short exposure group with a mean score difference of 18/100 (95% confidence interval = 9.8 to 26.3). Questionnaire showed generally positive perceptions toward the use of virtual patient simulation program for emergency medicine teaching. Conclusion: Virtual reality learning of 2 and 4 weeks’ duration may be beneficial for improving emergency medicine clinical competence for final-year medical students, especially during periods of limited clinical exposure like the COVID-19 pandemic. A longer 4-week virtual patient simulation program may produce a better learning effect on clinical competence.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45427493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-19DOI: 10.1177/10249079231188843
J. Cheung, E. Cheung, L. Ho, Chiu Lun Joseph Tse, Y. Yip, K. Lam
Background: Patients with severe euvolemic hyponatremia can be challenging to treat, and the COVID-19 pandemic has added to the complexity of the situation. Methods: Data were collected from all patients treated in a local intensive care unit (ICU) with the protocolized proactive desmopressin plus 3% saline (PD-3 S) approach in March 2022. Results: Six patients were treated with the protocol, whose initial serum sodium level (SNa) ranged from 98 to 108 mmol/L. SNa of one patient dropped further due to delayed initiation of protocolized PD-3 S because of access block. But otherwise, the protocol had been effective in achieving a controlled rise of SNa in all patients. No major complications have been observed, and the feedback from both medical and nursing staff was overall positive. Conclusion: This case series shows that the protocolized PD-3 S is safe and effective. This protocol is currently being used in two ICUs in our cluster. And our unit is currently working with the emergency department to initiate the protocol earlier, before ICU admission.
{"title":"Protocolized proactive desmopressin plus 3% saline therapy for severe euvolemic hyponatremia in the wave of COVID-19: The local experience and the potential role of emergency departments","authors":"J. Cheung, E. Cheung, L. Ho, Chiu Lun Joseph Tse, Y. Yip, K. Lam","doi":"10.1177/10249079231188843","DOIUrl":"https://doi.org/10.1177/10249079231188843","url":null,"abstract":"Background: Patients with severe euvolemic hyponatremia can be challenging to treat, and the COVID-19 pandemic has added to the complexity of the situation. Methods: Data were collected from all patients treated in a local intensive care unit (ICU) with the protocolized proactive desmopressin plus 3% saline (PD-3 S) approach in March 2022. Results: Six patients were treated with the protocol, whose initial serum sodium level (SNa) ranged from 98 to 108 mmol/L. SNa of one patient dropped further due to delayed initiation of protocolized PD-3 S because of access block. But otherwise, the protocol had been effective in achieving a controlled rise of SNa in all patients. No major complications have been observed, and the feedback from both medical and nursing staff was overall positive. Conclusion: This case series shows that the protocolized PD-3 S is safe and effective. This protocol is currently being used in two ICUs in our cluster. And our unit is currently working with the emergency department to initiate the protocol earlier, before ICU admission.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49058616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-18DOI: 10.1177/10249079231187781
L. Leung, Loskutova Ng, S. Ko, O. Wong, Yau Ngai Shih
Traveller patients have distinctive clinical characteristics compared to non-traveller patients. Local information about the clinical features of traveller patients is lacking. The objective of this study is to evaluate the clinical characteristics of traveller patients presenting to a hospital near the Hong Kong International Airport. This was a single-centred, retrospective cohort study. Medical records of all traveller patients presenting to the Accident and Emergency Department of North Lantau Hospital in Hong Kong from 1 January 2019 to 31 December 2019 were reviewed. The demographics, triage category, presentation, outcomes and disposal were retrospectively evaluated and compared between traveller and non-traveller patients. There were 528 traveller patients attending the Accident and Emergency Department of North Lantau Hospital during the study period, constituting 0.6% of total annual attendance. About one-third of the traveller patients required admission. The most common discharge diagnoses were gastrointestinal diseases (14.8%), followed by trauma (12.9%) and other neurological diseases (12.9%). Traveller patients had a higher rate of being triaged as critical and emergency categories (p < 0.001), higher admission rate (p < 0.001), higher need for active resuscitation (p < 0.001) and escort (p < 0.001) when compared to non-traveller patients. Around 1.3% of traveller patients presented with out-of-hospital cardiac arrest and were eventually certified dead in Accident and Emergency Department. The traveller population constitutes a small proportion of the patient population, but they can have a significant impact on the Accident and Emergency Departments in high-impact traveller areas. Additional resources such as manpower support and training programmes would be beneficial for Accident and Emergency Departments in high-impact traveller areas.
{"title":"Retrospective cohort study of the characteristics of traveller patients presenting to the accident and emergency department of a regional hospital in Hong Kong","authors":"L. Leung, Loskutova Ng, S. Ko, O. Wong, Yau Ngai Shih","doi":"10.1177/10249079231187781","DOIUrl":"https://doi.org/10.1177/10249079231187781","url":null,"abstract":"Traveller patients have distinctive clinical characteristics compared to non-traveller patients. Local information about the clinical features of traveller patients is lacking. The objective of this study is to evaluate the clinical characteristics of traveller patients presenting to a hospital near the Hong Kong International Airport. This was a single-centred, retrospective cohort study. Medical records of all traveller patients presenting to the Accident and Emergency Department of North Lantau Hospital in Hong Kong from 1 January 2019 to 31 December 2019 were reviewed. The demographics, triage category, presentation, outcomes and disposal were retrospectively evaluated and compared between traveller and non-traveller patients. There were 528 traveller patients attending the Accident and Emergency Department of North Lantau Hospital during the study period, constituting 0.6% of total annual attendance. About one-third of the traveller patients required admission. The most common discharge diagnoses were gastrointestinal diseases (14.8%), followed by trauma (12.9%) and other neurological diseases (12.9%). Traveller patients had a higher rate of being triaged as critical and emergency categories (p < 0.001), higher admission rate (p < 0.001), higher need for active resuscitation (p < 0.001) and escort (p < 0.001) when compared to non-traveller patients. Around 1.3% of traveller patients presented with out-of-hospital cardiac arrest and were eventually certified dead in Accident and Emergency Department. The traveller population constitutes a small proportion of the patient population, but they can have a significant impact on the Accident and Emergency Departments in high-impact traveller areas. Additional resources such as manpower support and training programmes would be beneficial for Accident and Emergency Departments in high-impact traveller areas.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46530087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-13DOI: 10.1177/10249079231183428
Irene Nga King Wong, Y. Choi, R. Lam, A. Siu
In Hong Kong, the post-dispatch advice on cardiopulmonary resuscitation has been implemented since October 2018. Our study aimed to (1) evaluate the impact of post-dispatch advice on the bystander cardiopulmonary resuscitation rate and out-of-hospital cardiac arrest survival and (2) characterise the reasons for not providing dispatch-assisted cardiopulmonary resuscitation, which have important implications in public cardiopulmonary resuscitation education. We retrospectively analysed the records of 749 adult patients with out-of-hospital cardiac arrest between 1 September 2021 and 31 October 2021. The primary outcome was survival to hospital discharge. The secondary outcomes included return of spontaneous circulation and survival to hospital admission. The overall dispatch-assisted cardiopulmonary resuscitation rate was 49.6%. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher proportion of witnessed cardiac arrest (37.7% vs 24.7%, p < 0.001) and a shorter time interval from recognition of cardiac arrest to chest compression (median 3.0 min vs 13.0 min, p < 0.001) compared with patients without dispatch-assisted cardiopulmonary resuscitation. 16.8% of out-of-hospital cardiac arrest victims had return of spontaneous circulation before or upon arrival at the hospital. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher return of spontaneous circulation (18.3% vs 15.4%), survival to hospital admission (15.9% vs 13.3%) and survival to hospital discharge (2.7% vs 1.3%) rates compared with those who did not. However, the differences did not reach statistical significance. Post-dispatch advice improved the overall bystander cardiopulmonary resuscitation rate in out-of-hospital cardiac arrest and shortened the time from out-of-hospital cardiac arrest recognition to chest compression, but the improvement in survival did not reach statistical significance. Further public education on cardiac arrest recognition and dispatch-assisted cardiopulmonary resuscitation is necessary.
香港自2018年10月起实施心肺复苏后建议。我们的研究旨在(1)评估调度后建议对旁观者心肺复苏率和院外心脏骤停生存率的影响;(2)描述不提供调度辅助心肺复苏的原因，这对公共心肺复苏教育具有重要意义。我们回顾性分析了2021年9月1日至2021年10月31日期间749例院外心脏骤停的成年患者的记录。主要终点是存活至出院。次要结局包括自发循环恢复和住院生存。总体调度辅助心肺复苏率为49.6%。与未接受调频辅助心肺复苏的患者相比，接受调频辅助心肺复苏的患者发生心脏骤停的比例更高(37.7% vs 24.7%， p < 0.001)，从识别心脏骤停到胸部按压的时间间隔更短(中位3.0 min vs 13.0 min, p < 0.001)。16.8%院外心脏骤停患者在到达医院前或到达医院后恢复了自发循环。与未接受调度辅助心肺复苏的患者相比，接受调度辅助心肺复苏的患者具有更高的自发循环恢复(18.3%对15.4%)、住院生存率(15.9%对13.3%)和出院生存率(2.7%对1.3%)。但差异无统计学意义。急救后建议提高了院外心脏骤停的总体旁观者心肺复苏率，缩短了院外心脏骤停识别到胸部按压的时间，但生存率的提高没有达到统计学意义。进一步的公众教育，心脏骤停识别和调度辅助心肺复苏是必要的。
{"title":"Impact of post-dispatch advice on bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest in Hong Kong","authors":"Irene Nga King Wong, Y. Choi, R. Lam, A. Siu","doi":"10.1177/10249079231183428","DOIUrl":"https://doi.org/10.1177/10249079231183428","url":null,"abstract":"In Hong Kong, the post-dispatch advice on cardiopulmonary resuscitation has been implemented since October 2018. Our study aimed to (1) evaluate the impact of post-dispatch advice on the bystander cardiopulmonary resuscitation rate and out-of-hospital cardiac arrest survival and (2) characterise the reasons for not providing dispatch-assisted cardiopulmonary resuscitation, which have important implications in public cardiopulmonary resuscitation education. We retrospectively analysed the records of 749 adult patients with out-of-hospital cardiac arrest between 1 September 2021 and 31 October 2021. The primary outcome was survival to hospital discharge. The secondary outcomes included return of spontaneous circulation and survival to hospital admission. The overall dispatch-assisted cardiopulmonary resuscitation rate was 49.6%. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher proportion of witnessed cardiac arrest (37.7% vs 24.7%, p < 0.001) and a shorter time interval from recognition of cardiac arrest to chest compression (median 3.0 min vs 13.0 min, p < 0.001) compared with patients without dispatch-assisted cardiopulmonary resuscitation. 16.8% of out-of-hospital cardiac arrest victims had return of spontaneous circulation before or upon arrival at the hospital. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher return of spontaneous circulation (18.3% vs 15.4%), survival to hospital admission (15.9% vs 13.3%) and survival to hospital discharge (2.7% vs 1.3%) rates compared with those who did not. However, the differences did not reach statistical significance. Post-dispatch advice improved the overall bystander cardiopulmonary resuscitation rate in out-of-hospital cardiac arrest and shortened the time from out-of-hospital cardiac arrest recognition to chest compression, but the improvement in survival did not reach statistical significance. Further public education on cardiac arrest recognition and dispatch-assisted cardiopulmonary resuscitation is necessary.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45550705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-13DOI: 10.1177/10249079231187769
Tak Wah Man, Ying Kit Wong, I. Lee
The prevalence of sexually transmitted infections in Hong Kong is not high. The objective of this study was to determine the risk factors that associated with occurrence of sexually transmitted infections in local sexual assault victims, so as to facilitate the counseling and management of victims upon their initial attendance at an Accident and Emergency Department. This was a retrospective cohort of sexual assault victims presented to Accident and Emergency Department of Kwong Wah Hospital between 1 January 2016 and 31 December 2021. The outcome was the occurrence of sexually transmitted infections. Variables were analyzed using univariate and multivariable analyses. A total of 190 victims were included in the study. Univariate analysis indicated that sexual assault involving multiple perpetrator, oral penetration, and anal penetration were associated with increased occurrence of sexually transmitted infections in the victims (all with p < 0.05). Among these, multiple perpetrator was the only statistically significant risk factor on multivariable analysis ( p < 0.05). Multiple-perpetrator sexual assault was identified as a significant risk factor of sexually transmitted infections. Emergency physicians should consider explaining to victims of multiple-perpetrator sexual assault that they have a higher risk of contracting sexually transmitted infections and emphasizing on the importance of complying with medical treatments, attending follow-up and observing symptoms of sexually transmitted infections. Proper clinical assessment, adequate follow-up, and reassurance for the victims with lower likelihood of contracting sexually transmitted infections are suggested for managing sexual assault victims.
{"title":"Risk factors for sexually transmitted infections in sexual assault victims attending an Accident and Emergency Department in Hong Kong","authors":"Tak Wah Man, Ying Kit Wong, I. Lee","doi":"10.1177/10249079231187769","DOIUrl":"https://doi.org/10.1177/10249079231187769","url":null,"abstract":"The prevalence of sexually transmitted infections in Hong Kong is not high. The objective of this study was to determine the risk factors that associated with occurrence of sexually transmitted infections in local sexual assault victims, so as to facilitate the counseling and management of victims upon their initial attendance at an Accident and Emergency Department. This was a retrospective cohort of sexual assault victims presented to Accident and Emergency Department of Kwong Wah Hospital between 1 January 2016 and 31 December 2021. The outcome was the occurrence of sexually transmitted infections. Variables were analyzed using univariate and multivariable analyses. A total of 190 victims were included in the study. Univariate analysis indicated that sexual assault involving multiple perpetrator, oral penetration, and anal penetration were associated with increased occurrence of sexually transmitted infections in the victims (all with p < 0.05). Among these, multiple perpetrator was the only statistically significant risk factor on multivariable analysis ( p < 0.05). Multiple-perpetrator sexual assault was identified as a significant risk factor of sexually transmitted infections. Emergency physicians should consider explaining to victims of multiple-perpetrator sexual assault that they have a higher risk of contracting sexually transmitted infections and emphasizing on the importance of complying with medical treatments, attending follow-up and observing symptoms of sexually transmitted infections. Proper clinical assessment, adequate follow-up, and reassurance for the victims with lower likelihood of contracting sexually transmitted infections are suggested for managing sexual assault victims.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42036367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-12DOI: 10.1177/10249079231179103
R. Lam, C. Chan, M. Tse, E. Lau, M. S. H. Tsui, T. Rainer
Recreational use of methamphetamine is increasing worldwide, but epidemiology studies from Asia are lacking. We aimed to characterise the trends, drug use pattern, clinical presentations and health services utilisation of acute methamphetamine toxicity presenting to emergency departments and the current practice of emergency department psychosocial interventions in Hong Kong. This was a secondary analysis of a retrospective study on emergency department patients reported to the Hong Kong Poison Information Centre between 2010 and 2019 for acute toxicity related to recreational methamphetamine use. We studied the trend using a negative binominal regression model. During the study period, 1225 episodes (involved 979 patients; 68.9% men; with a median age of 33.0 years) were reported. Acute methamphetamine toxicity did not increase significantly (odds ratio = 1.10, 95% confidence interval = 0.86–1.40, p = 0.46). Polysubstance abuse predominated. Many patients developed hypokalaemia (24.0%), rhabdomyolysis (17.2%), acute kidney injury (9.4%) and myocardial injury (4.7%); psychotic symptoms including auditory hallucination (23.8%) and paranoid delusion (21.1%); various acute behavioural disturbances and injuries. Overall, 66 patients required intensive care and 14 patients died. Only a minority of the patients were referred to social workers and voluntary drug treatment and rehabilitation services. Methamphetamine has a significant impact on physical and mental health in Hong Kong. Our findings highlight the need for screening for hypokalaemia, rhabdomyolysis, acute kidney injury, myocardial injury and psychosis in methamphetamine users and support policies that address polysubstance abuse, prevent drug use through continued public education and strengthen the referral system by integrating substance abuse services at the emergency department.
{"title":"The epidemiology of acute methamphetamine toxicity presenting to emergency departments in Hong Kong","authors":"R. Lam, C. Chan, M. Tse, E. Lau, M. S. H. Tsui, T. Rainer","doi":"10.1177/10249079231179103","DOIUrl":"https://doi.org/10.1177/10249079231179103","url":null,"abstract":"Recreational use of methamphetamine is increasing worldwide, but epidemiology studies from Asia are lacking. We aimed to characterise the trends, drug use pattern, clinical presentations and health services utilisation of acute methamphetamine toxicity presenting to emergency departments and the current practice of emergency department psychosocial interventions in Hong Kong. This was a secondary analysis of a retrospective study on emergency department patients reported to the Hong Kong Poison Information Centre between 2010 and 2019 for acute toxicity related to recreational methamphetamine use. We studied the trend using a negative binominal regression model. During the study period, 1225 episodes (involved 979 patients; 68.9% men; with a median age of 33.0 years) were reported. Acute methamphetamine toxicity did not increase significantly (odds ratio = 1.10, 95% confidence interval = 0.86–1.40, p = 0.46). Polysubstance abuse predominated. Many patients developed hypokalaemia (24.0%), rhabdomyolysis (17.2%), acute kidney injury (9.4%) and myocardial injury (4.7%); psychotic symptoms including auditory hallucination (23.8%) and paranoid delusion (21.1%); various acute behavioural disturbances and injuries. Overall, 66 patients required intensive care and 14 patients died. Only a minority of the patients were referred to social workers and voluntary drug treatment and rehabilitation services. Methamphetamine has a significant impact on physical and mental health in Hong Kong. Our findings highlight the need for screening for hypokalaemia, rhabdomyolysis, acute kidney injury, myocardial injury and psychosis in methamphetamine users and support policies that address polysubstance abuse, prevent drug use through continued public education and strengthen the referral system by integrating substance abuse services at the emergency department.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47056445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-02DOI: 10.1177/10249079231177853
Hoi Yee Yeung, R. Lam, M. S. H. Tsui
Activated charcoal is administered through a nasogastric tube to some poisoned patients, but occasionally the insertion of unweighted nasogastric tube fails in the emergency department. Weighted nasogastric tube with a stylet, for example, the Corflo® nasogastric tube, facilitates insertion, but it is not clear whether it would impede activated charcoal delivery. We aimed to compare the utility of the Corflo® and usual (Comforsoft®) nasogastric tubes in administering activated charcoal in manikins. This was a single-centre, randomised, single-blinded, crossover manikin non-inferiority trial involving 28 participants. Each participant administered 50 g of activated charcoal using the Corflo® and Comforsoft® nasogastric tubes in a random sequence interspersed with a 2-hour washout period. We compared the difference in the time required for activated charcoal administration with a pre-defined non-inferiority margin of 300 seconds and the perceived level of effort between the two nasogastric tubes. The mean time for administering 50 g of activated charcoal through the Comforsoft® and the Corflo® nasogastric tube were 87.1 s and 301.6 s, respectively. The mean difference of 203.2 s (95% confidence interval: 147.5–258.9, p < 0.001) was within the non-inferiority margin. The perceived level of effort was significantly higher with the Corflo® nasogastric tube (mean effort score 7.0 vs 1.4, p < 0.001). Our study provides experimental data to support the use of the Corflo® nasogastric tube as a non-inferior alternative to the usual nasogastric tube in administering activated charcoal to poisoned emergency department patients. More studies are warranted to verify the findings and optimise the settings for AC administration.
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