Pub Date : 2021-06-02DOI: 10.1177/10249079211020868
W. Lo, K. Mok, Ying Ying Poon
Objective: To evaluate the safety and effectiveness of olanzapine compared to midazolam for the pre-hospital management of excited delirium syndrome. Methods: A retrospective review of patients who were treated by ambulance crew for excited delirium syndrome from 2016 to 2019 was performed. The drug of choice was given per Fire Service Department’s paramedic protocol (intramuscular midazolam January 2016 to October 2018 and intramuscular olanzapine October 2018 to December 2019). The primary outcome was the proportion of patients experienced at least one adverse event. The secondary outcome was the successful sedation rate. Results: A total of 201 patients were included in the study. Ninety-nine patients had pre-hospital midazolam and 102 received olanzapine. Thirty-one patients experienced adverse event after arrival to A&E, including a drop of Glasgow Coma Scale score to below 8 (90%), hypotension (6%), and airway obstruction (3%): 17 (17% patients; 1 airway obstruction and 16 Glasgow Coma Scale score below 8) in midazolam group and 14 (14% patients; 2 hypotension and 12 Glasgow Coma Scale score below 8) in olanzapine group (p = 0.41). Sixty-eight patients (69%) in midazolam group achieved successful sedation, compared with 79 (77%) in olanzapine group (p = 0.20). More adverse events were seen with midazolam than olanzapine in alcohol intoxication subgroup with statistical significance (12 vs 2, p = 0.03). Conclusion: Both midazolam and olanzapine can achieve a satisfactory success rate of sedation. More adverse events are associated with midazolam use in patients with acute alcohol intoxication, especially over-sedation and airway compromise. Olanzapine would be a safer choice in the pre-hospital setting where the resource is limited, and differentiation of underlying causes is not always possible.
{"title":"A retrospective study on the safety and effectiveness of olanzapine versus midazolam for pre-hospital management of excited delirium syndrome","authors":"W. Lo, K. Mok, Ying Ying Poon","doi":"10.1177/10249079211020868","DOIUrl":"https://doi.org/10.1177/10249079211020868","url":null,"abstract":"Objective: To evaluate the safety and effectiveness of olanzapine compared to midazolam for the pre-hospital management of excited delirium syndrome. Methods: A retrospective review of patients who were treated by ambulance crew for excited delirium syndrome from 2016 to 2019 was performed. The drug of choice was given per Fire Service Department’s paramedic protocol (intramuscular midazolam January 2016 to October 2018 and intramuscular olanzapine October 2018 to December 2019). The primary outcome was the proportion of patients experienced at least one adverse event. The secondary outcome was the successful sedation rate. Results: A total of 201 patients were included in the study. Ninety-nine patients had pre-hospital midazolam and 102 received olanzapine. Thirty-one patients experienced adverse event after arrival to A&E, including a drop of Glasgow Coma Scale score to below 8 (90%), hypotension (6%), and airway obstruction (3%): 17 (17% patients; 1 airway obstruction and 16 Glasgow Coma Scale score below 8) in midazolam group and 14 (14% patients; 2 hypotension and 12 Glasgow Coma Scale score below 8) in olanzapine group (p = 0.41). Sixty-eight patients (69%) in midazolam group achieved successful sedation, compared with 79 (77%) in olanzapine group (p = 0.20). More adverse events were seen with midazolam than olanzapine in alcohol intoxication subgroup with statistical significance (12 vs 2, p = 0.03). Conclusion: Both midazolam and olanzapine can achieve a satisfactory success rate of sedation. More adverse events are associated with midazolam use in patients with acute alcohol intoxication, especially over-sedation and airway compromise. Olanzapine would be a safer choice in the pre-hospital setting where the resource is limited, and differentiation of underlying causes is not always possible.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"29 1","pages":"281 - 288"},"PeriodicalIF":0.6,"publicationDate":"2021-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211020868","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48203475","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 : 2021-05-13DOI: 10.1177/10249079211016225
Wong Yu Him Michael, Poon Tak Shun, NG Wah Shan
Introduction: Neutropenic sepsis is an emergency sequela in post-chemotherapy fever. Its definition comprises of spectrums of diseases with variable quoted mortality. This study aims to evaluate the incidence of “modified” neutropenic sepsis, with a more stringent definition employed. Predictive risk factors toward occurrence of “modified” neutropenic sepsis among Chinese patients would also be explored. Methods: A single-center retrospective longitudinal study was conducted in a medium-sized regional hospital in Hong Kong. All patients with diagnoses of post-chemotherapy fever fulfilling the inclusion and exclusion criteria were recruited. Baseline characteristics and outcome variables of each case subject were collected. Six potential predictive risk factors were chosen for further analysis. Case subjects were followed up for the inpatient progress and outcomes. Relative risks of each risk factor to “modified” neutropenic sepsis were calculated. Results: A total of 135 case subjects were recruited. Five developed “modified” neutropenic sepsis, that is, incidence 3.70% (95% confidence interval = 1.59%–8.38%). Only background hematological malignancy was found to be significantly associated with the outcome of “modified” neutropenic sepsis (Relative Risk [RR] 13.2, 95% confidence interval = 1.56–115.70, p = 0.010), with an incidence of 12.9% (95% confidence interval = 5.14%–28.85%). Hematological malignancy was also found to be significantly associated with lower median absolute neutrophil counts (0.95 × 109/L vs 2.3 × 109/L, p = 0.005) and longer median hospital stay (8 days vs 6 days, p < 0.001). Conclusion: Incidence of “modified” neutropenic sepsis is low. Hematological malignancy is associated with significantly higher rate of “modified” neutropenic sepsis.
{"title":"Incidence and predictive risk factors of neutropenic sepsis in post-chemotherapy febrile patients in emergency department: A single-center retrospective longitudinal study","authors":"Wong Yu Him Michael, Poon Tak Shun, NG Wah Shan","doi":"10.1177/10249079211016225","DOIUrl":"https://doi.org/10.1177/10249079211016225","url":null,"abstract":"Introduction: Neutropenic sepsis is an emergency sequela in post-chemotherapy fever. Its definition comprises of spectrums of diseases with variable quoted mortality. This study aims to evaluate the incidence of “modified” neutropenic sepsis, with a more stringent definition employed. Predictive risk factors toward occurrence of “modified” neutropenic sepsis among Chinese patients would also be explored. Methods: A single-center retrospective longitudinal study was conducted in a medium-sized regional hospital in Hong Kong. All patients with diagnoses of post-chemotherapy fever fulfilling the inclusion and exclusion criteria were recruited. Baseline characteristics and outcome variables of each case subject were collected. Six potential predictive risk factors were chosen for further analysis. Case subjects were followed up for the inpatient progress and outcomes. Relative risks of each risk factor to “modified” neutropenic sepsis were calculated. Results: A total of 135 case subjects were recruited. Five developed “modified” neutropenic sepsis, that is, incidence 3.70% (95% confidence interval = 1.59%–8.38%). Only background hematological malignancy was found to be significantly associated with the outcome of “modified” neutropenic sepsis (Relative Risk [RR] 13.2, 95% confidence interval = 1.56–115.70, p = 0.010), with an incidence of 12.9% (95% confidence interval = 5.14%–28.85%). Hematological malignancy was also found to be significantly associated with lower median absolute neutrophil counts (0.95 × 109/L vs 2.3 × 109/L, p = 0.005) and longer median hospital stay (8 days vs 6 days, p < 0.001). Conclusion: Incidence of “modified” neutropenic sepsis is low. Hematological malignancy is associated with significantly higher rate of “modified” neutropenic sepsis.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"283 - 290"},"PeriodicalIF":0.6,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211016225","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49098539","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 : 2021-05-01DOI: 10.1177/1024907921994422
S. Chang, Dae Sung Ma, Ye Rim Chang, D. H. Kim
Background: Hemorrhage is the leading cause of death in trauma settings. Non-compressible torso hemorrhage, which is caused by abdominopelvic and thoracic injuries, is an important cause of subsequent organ dysfunction and poor outcomes in multiple trauma patients. The management of hemodynamically unstable patients with non-compressible torso hemorrhage has changed, and the concept of damage control resuscitation has been developed in the last decades. Currently, resuscitative endovascular balloon occlusion of the aorta (REBOA) as a method of temporary stabilization is the modern evolution of bleeding control, and it is in the middle of a paradigm shift as a treatment for non-compressible torso hemorrhage. Despite its effectiveness in patients with hemorrhagic shock, the application of REBOA remains limited because of lack of experience and troubleshooting guidelines. Objectives: The aim of study was to provide useful tips for the implementing a step-by-step procedure for REBOA in various hospital settings and capabilities. Methods: We introduced REBOA procedures using a REBOA-customized 7 Fr balloon catheter through the animation models or radiography from preparation to access, catheter management, and device removal after procedure completed. Results: We have described REBOA procedures as follows: identification of the common femoral artery, arterial access for placement of a guidewire, precautions during a sheath insertion, guidewire and balloon positioning in the aorta, occlusion zones and adjustment of balloon location, REBOA strategy for extending the occlusion time, balloon deflation and removal, sheath removal, and medical records. Conclusion: We believe that the practical tips mentioned in this article will help in performing the REBOA procedure systematically and developing an effective REBOA framework.
{"title":"Practical tips for performing resuscitative endovascular balloon occlusion of the aorta","authors":"S. Chang, Dae Sung Ma, Ye Rim Chang, D. H. Kim","doi":"10.1177/1024907921994422","DOIUrl":"https://doi.org/10.1177/1024907921994422","url":null,"abstract":"Background: Hemorrhage is the leading cause of death in trauma settings. Non-compressible torso hemorrhage, which is caused by abdominopelvic and thoracic injuries, is an important cause of subsequent organ dysfunction and poor outcomes in multiple trauma patients. The management of hemodynamically unstable patients with non-compressible torso hemorrhage has changed, and the concept of damage control resuscitation has been developed in the last decades. Currently, resuscitative endovascular balloon occlusion of the aorta (REBOA) as a method of temporary stabilization is the modern evolution of bleeding control, and it is in the middle of a paradigm shift as a treatment for non-compressible torso hemorrhage. Despite its effectiveness in patients with hemorrhagic shock, the application of REBOA remains limited because of lack of experience and troubleshooting guidelines. Objectives: The aim of study was to provide useful tips for the implementing a step-by-step procedure for REBOA in various hospital settings and capabilities. Methods: We introduced REBOA procedures using a REBOA-customized 7 Fr balloon catheter through the animation models or radiography from preparation to access, catheter management, and device removal after procedure completed. Results: We have described REBOA procedures as follows: identification of the common femoral artery, arterial access for placement of a guidewire, precautions during a sheath insertion, guidewire and balloon positioning in the aorta, occlusion zones and adjustment of balloon location, REBOA strategy for extending the occlusion time, balloon deflation and removal, sheath removal, and medical records. Conclusion: We believe that the practical tips mentioned in this article will help in performing the REBOA procedure systematically and developing an effective REBOA framework.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"165 - 173"},"PeriodicalIF":0.6,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907921994422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43783745","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 : 2021-04-07DOI: 10.1177/1024907921997614
Jia-Hua Ye
Background: Acute myocardial infarction–induced cardiac arrest has high mortality rate. Objective: To investigate the risk factors of extracorporeal membrane oxygenation combined with percutaneous coronary intervention in rescuing acute myocardial infarction–induced cardiac arrest. Methods: Forty-three eligible patients were assigned into death and survival groups. Their general clinical data, treatment outcomes, and various indicators 24, 48, and 72 h after extracorporeal membrane oxygenation implantation were compared. The factors affecting clinical outcomes were determined by multivariate logistic regression analysis. A nomogram prediction model was constructed and validated. Results: After removing extracorporeal membrane oxygenation device, 19 patients recovered and 24 died (mortality rate: 55.81%). The two groups had different conventional cardiopulmonary resuscitation duration, number of diseased vessels, distribution of culprit vessel, time from cardiac arrest to extracorporeal membrane oxygenation implantation, length of stay in critical care unit, and mean arterial pressure 24 and 48 h after extracorporeal membrane oxygenation implantation (p < 0.05). Left anterior descending as the culprit vessel, number of diseased vessels, conventional cardiopulmonary resuscitation duration, time from cardiac arrest to extracorporeal membrane oxygenation implantation, and mean arterial pressure 48 h after extracorporeal membrane oxygenation resuscitation were independent risk factors for death. The predicted mortality rate was 72.6%, and the actual concordance index (C-index) was 0.869. Such indices after internal and external validations were 0.861 and 0.848, respectively, suggesting a good concordance. Conclusion: Left anterior descending as the culprit vessel, number of diseased vessels, conventional cardiopulmonary resuscitation duration, time from cardiac arrest to extracorporeal membrane oxygenation implantation, and mean arterial pressure 48 h after extracorporeal membrane oxygenation resuscitation are independent risk factors for patients with acute myocardial infarction–induced cardiac arrest undergoing extracorporeal membrane oxygenation combined with percutaneous coronary intervention.
{"title":"Adverse prognostic factors for rescuing patients with acute myocardial infarction–induced cardiac arrest receiving percutaneous coronary intervention under extracorporeal membrane oxygenation","authors":"Jia-Hua Ye","doi":"10.1177/1024907921997614","DOIUrl":"https://doi.org/10.1177/1024907921997614","url":null,"abstract":"Background: Acute myocardial infarction–induced cardiac arrest has high mortality rate. Objective: To investigate the risk factors of extracorporeal membrane oxygenation combined with percutaneous coronary intervention in rescuing acute myocardial infarction–induced cardiac arrest. Methods: Forty-three eligible patients were assigned into death and survival groups. Their general clinical data, treatment outcomes, and various indicators 24, 48, and 72 h after extracorporeal membrane oxygenation implantation were compared. The factors affecting clinical outcomes were determined by multivariate logistic regression analysis. A nomogram prediction model was constructed and validated. Results: After removing extracorporeal membrane oxygenation device, 19 patients recovered and 24 died (mortality rate: 55.81%). The two groups had different conventional cardiopulmonary resuscitation duration, number of diseased vessels, distribution of culprit vessel, time from cardiac arrest to extracorporeal membrane oxygenation implantation, length of stay in critical care unit, and mean arterial pressure 24 and 48 h after extracorporeal membrane oxygenation implantation (p < 0.05). Left anterior descending as the culprit vessel, number of diseased vessels, conventional cardiopulmonary resuscitation duration, time from cardiac arrest to extracorporeal membrane oxygenation implantation, and mean arterial pressure 48 h after extracorporeal membrane oxygenation resuscitation were independent risk factors for death. The predicted mortality rate was 72.6%, and the actual concordance index (C-index) was 0.869. Such indices after internal and external validations were 0.861 and 0.848, respectively, suggesting a good concordance. Conclusion: Left anterior descending as the culprit vessel, number of diseased vessels, conventional cardiopulmonary resuscitation duration, time from cardiac arrest to extracorporeal membrane oxygenation implantation, and mean arterial pressure 48 h after extracorporeal membrane oxygenation resuscitation are independent risk factors for patients with acute myocardial infarction–induced cardiac arrest undergoing extracorporeal membrane oxygenation combined with percutaneous coronary intervention.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"152 - 159"},"PeriodicalIF":0.6,"publicationDate":"2021-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907921997614","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44627453","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 : 2021-03-30DOI: 10.1177/10249079211004319
S. Chiu, W. C. Wong, E. Yu
Emergency department management of transient ischaemic attack varies from admission for all to outpatient referral. We studied the short-term outcomes of transient ischaemic attack managed with an agreed protocol. Predictors of stroke can be different for Asians and non-Asians. ABCD2 as initial triage of transient ischaemic attack is debatable. The predictive ability of ABCD2 score was studied as well. This was a prospective observational study with consecutive subject recruitment in Emergency department. All transient ischaemic attacks were admitted, hard and e-records of Emergency department, transient ischaemic attack clinic, Medical and Neurosurgical department and general follow-ups in Hospital Authority hospitals were studied up to 1 year. Stroke-day was measured from symptom-onset to time-of-stroke. In 18-month period, 124 patients were recruited. The median onset-to-door time was 3.5 h. All computed tomography brain positive findings, except one subdural haematoma, were ischaemic in origin. Six strokes, all disabling, recurred within 90 days, three on day 1–3, two died in 6 months. The stroke risks at 2, 7, 90 days and 1 year were 1.61%, 3.23%, 4.84% and 4.84%, respectively. No significant trend was observed in stroke risk across ABCD2 scores ( p = 0.783) with area under the curve of 0.537 (95% confidence interval = 0.380–0.694; p = 0.762). The short-term stroke risk was associated with atrial fibrillation ( p = 0.002). The median Emergency Medicine ward length of stay was 1.33 days. In our Emergency department–based management, the short-term stroke risk of transient ischaemic attack is low, and the predictivity of ABCD2 score in risk stratification cannot be validated. Stroke recurrences were associated with atrial fibrillation. A low ABCD2 could be falsely reassuring. As half of the strokes recurred very early, we recommend admission in the hyperacute phase.
{"title":"Short-term outcomes of Chinese transient ischaemic attack patients in an Emergency department in Hong Kong: Result of management with an agreed protocol with neurologists","authors":"S. Chiu, W. C. Wong, E. Yu","doi":"10.1177/10249079211004319","DOIUrl":"https://doi.org/10.1177/10249079211004319","url":null,"abstract":"Emergency department management of transient ischaemic attack varies from admission for all to outpatient referral. We studied the short-term outcomes of transient ischaemic attack managed with an agreed protocol. Predictors of stroke can be different for Asians and non-Asians. ABCD2 as initial triage of transient ischaemic attack is debatable. The predictive ability of ABCD2 score was studied as well. This was a prospective observational study with consecutive subject recruitment in Emergency department. All transient ischaemic attacks were admitted, hard and e-records of Emergency department, transient ischaemic attack clinic, Medical and Neurosurgical department and general follow-ups in Hospital Authority hospitals were studied up to 1 year. Stroke-day was measured from symptom-onset to time-of-stroke. In 18-month period, 124 patients were recruited. The median onset-to-door time was 3.5 h. All computed tomography brain positive findings, except one subdural haematoma, were ischaemic in origin. Six strokes, all disabling, recurred within 90 days, three on day 1–3, two died in 6 months. The stroke risks at 2, 7, 90 days and 1 year were 1.61%, 3.23%, 4.84% and 4.84%, respectively. No significant trend was observed in stroke risk across ABCD2 scores ( p = 0.783) with area under the curve of 0.537 (95% confidence interval = 0.380–0.694; p = 0.762). The short-term stroke risk was associated with atrial fibrillation ( p = 0.002). The median Emergency Medicine ward length of stay was 1.33 days. In our Emergency department–based management, the short-term stroke risk of transient ischaemic attack is low, and the predictivity of ABCD2 score in risk stratification cannot be validated. Stroke recurrences were associated with atrial fibrillation. A low ABCD2 could be falsely reassuring. As half of the strokes recurred very early, we recommend admission in the hyperacute phase.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"1 1","pages":"102490792110043"},"PeriodicalIF":0.6,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211004319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47624082","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 : 2021-03-14DOI: 10.1177/10249079211000969
Hei Jim Leung, L. Y. Wong, C. Pak, Yang Li Chuan Marc
Introduction: Ultrasound guidance is commonly used during central venous cannulation. Subclavian vein is a commonly chosen site, but previous studies found varying results in the ideal positioning of the shoulder for subclavian vein cannulation. The objective of this study is to determine which shoulder position results in the greatest cross-sectional area of the right subclavian vein for cannulation. Methods: In this prospective observational study, ultrasound was performed on healthy adult volunteers to visualise the right subclavian vein in three different shoulder positions: neutral, abduction and retraction. A blinded independent investigator measured the cross-sectional areas by computer software using planimetry method. Statistical analysis was performed by one-way repeated measures analysis of variance. Results: Forty-four adults participated in the study. The mean cross-sectional area of the right subclavian vein in shoulder neutral, abduction and retraction positions were 1.05 ± 0.33 cm2, 1.01 ± 0.31 cm2 and 0.82 ± 0.28 cm2, respectively. When compared to shoulder retraction, the cross-sectional areas were significantly increased in shoulder neutral (P < 0.01) and abduction (P < 0.01) positions. There was no significant difference between shoulder neutral and abduction position (P = 0.71). Conclusion: Positioning the shoulder in neutral or abduction results in the greatest cross-sectional area of the right subclavian vein and may be more ideal for ultrasound guided cannulation.
{"title":"Effect of shoulder positioning on ultrasonic visualisation of the subclavian vein in healthy adults: A prospective observational study","authors":"Hei Jim Leung, L. Y. Wong, C. Pak, Yang Li Chuan Marc","doi":"10.1177/10249079211000969","DOIUrl":"https://doi.org/10.1177/10249079211000969","url":null,"abstract":"Introduction: Ultrasound guidance is commonly used during central venous cannulation. Subclavian vein is a commonly chosen site, but previous studies found varying results in the ideal positioning of the shoulder for subclavian vein cannulation. The objective of this study is to determine which shoulder position results in the greatest cross-sectional area of the right subclavian vein for cannulation. Methods: In this prospective observational study, ultrasound was performed on healthy adult volunteers to visualise the right subclavian vein in three different shoulder positions: neutral, abduction and retraction. A blinded independent investigator measured the cross-sectional areas by computer software using planimetry method. Statistical analysis was performed by one-way repeated measures analysis of variance. Results: Forty-four adults participated in the study. The mean cross-sectional area of the right subclavian vein in shoulder neutral, abduction and retraction positions were 1.05 ± 0.33 cm2, 1.01 ± 0.31 cm2 and 0.82 ± 0.28 cm2, respectively. When compared to shoulder retraction, the cross-sectional areas were significantly increased in shoulder neutral (P < 0.01) and abduction (P < 0.01) positions. There was no significant difference between shoulder neutral and abduction position (P = 0.71). Conclusion: Positioning the shoulder in neutral or abduction results in the greatest cross-sectional area of the right subclavian vein and may be more ideal for ultrasound guided cannulation.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"271 - 276"},"PeriodicalIF":0.6,"publicationDate":"2021-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211000969","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44382204","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 : 2021-03-11DOI: 10.1177/10249079211000976
Howard Chan, L. Leung, A. Law, Chi-hung Cheng, C. Graham
Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.
{"title":"Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward","authors":"Howard Chan, L. Leung, A. Law, Chi-hung Cheng, C. Graham","doi":"10.1177/10249079211000976","DOIUrl":"https://doi.org/10.1177/10249079211000976","url":null,"abstract":"Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"277 - 282"},"PeriodicalIF":0.6,"publicationDate":"2021-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211000976","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46892526","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 : 2021-03-01DOI: 10.1177/1024907921994970
Min Wang, Tianyu Liu, Zheng Niu, Jingzhi Zuo, D. Qi
Background: Sepsis patients with insufficient tissue perfusion and hypoxia should be identified and resuscitated immediately. Recently, venous-to-arterial carbon dioxide pressure changes and the arteriovenous oxygen content difference ratio (Pcv-aCO2/Ca-vO2) as a predictor of tissue perfusion recovery and poor prognosis. Objectives: Pcv-aCO2/Ca-vO2 is a substitute for respiratory entropy, the elevation of which indicates a lack of tissue perfusion. Pcv-aCO2/Ca-vO2 can be used as an indicator to predict the prognosis of patients with sepsis or septic shock, but its prognostic value has not been fully evaluated. Here, we have performed a meta-analysis to assess its predictive value for mortality. Methods: Meta-analysis of Observational Studies in Epidemiology group guidelines were followed for this meta-analysis. We searched the comprehensive electronic databases of PubMed, EMBASE, Web of Science, and Cochrane libraries from inception to March 2019, using the terms including “venous-arterial,” “carbon dioxide,” “Shock, Septic,” and related keywords. The Newcastle-Ottawa scale was used for quality evaluation of the literature. A meta-analysis was performed using RevMan 5.3 and Stata 14.0 software to evaluate the effects of Pcv-aCO2/Ca-vO2 on short-term mortality, sequential organ failure assessment, and acute physiology and chronic health evaluation scores in patients with sepsis or septic shock. Results: The final analysis included 13 clinical studies involving a total of 940 subjects. The results of the meta-analysis showed that non-surviving patients had higher Pcv-aCO2/Ca-vO2 than survivors after fluid resuscitation (standardized mean difference = 0.68, 95% confidence interval = 0.24–1.12) and blood samples taken 6 h after resuscitation showed a greater risk of mortality (risk ratio = 1.89, 95% confidence interval = 1.48–2.41) and sequential organ failure assessment scores (mean difference = 1.58, 95% confidence interval = 0.88–2.28, P < 0.01) in patients with high Pcv-aCO2/Ca-vO2. These differences were statistically significant. Conclusion: This meta-analysis indicates that Pcv-aCO2/Ca-vO2 has predictive value for mortality in patients with sepsis or septic shock. Further studies are now required to determine the optimal threshold for predicting sepsis mortality. Prospero Registration: The protocol for this systematic review was registered on PROSPERO (CRD 42019128134).
{"title":"Utility of venous-to-arterial carbon dioxide changes to arteriovenous oxygen content ratios in the prognosis of severe sepsis and septic shock: A systematic review and meta-analysis","authors":"Min Wang, Tianyu Liu, Zheng Niu, Jingzhi Zuo, D. Qi","doi":"10.1177/1024907921994970","DOIUrl":"https://doi.org/10.1177/1024907921994970","url":null,"abstract":"Background: Sepsis patients with insufficient tissue perfusion and hypoxia should be identified and resuscitated immediately. Recently, venous-to-arterial carbon dioxide pressure changes and the arteriovenous oxygen content difference ratio (Pcv-aCO2/Ca-vO2) as a predictor of tissue perfusion recovery and poor prognosis. Objectives: Pcv-aCO2/Ca-vO2 is a substitute for respiratory entropy, the elevation of which indicates a lack of tissue perfusion. Pcv-aCO2/Ca-vO2 can be used as an indicator to predict the prognosis of patients with sepsis or septic shock, but its prognostic value has not been fully evaluated. Here, we have performed a meta-analysis to assess its predictive value for mortality. Methods: Meta-analysis of Observational Studies in Epidemiology group guidelines were followed for this meta-analysis. We searched the comprehensive electronic databases of PubMed, EMBASE, Web of Science, and Cochrane libraries from inception to March 2019, using the terms including “venous-arterial,” “carbon dioxide,” “Shock, Septic,” and related keywords. The Newcastle-Ottawa scale was used for quality evaluation of the literature. A meta-analysis was performed using RevMan 5.3 and Stata 14.0 software to evaluate the effects of Pcv-aCO2/Ca-vO2 on short-term mortality, sequential organ failure assessment, and acute physiology and chronic health evaluation scores in patients with sepsis or septic shock. Results: The final analysis included 13 clinical studies involving a total of 940 subjects. The results of the meta-analysis showed that non-surviving patients had higher Pcv-aCO2/Ca-vO2 than survivors after fluid resuscitation (standardized mean difference = 0.68, 95% confidence interval = 0.24–1.12) and blood samples taken 6 h after resuscitation showed a greater risk of mortality (risk ratio = 1.89, 95% confidence interval = 1.48–2.41) and sequential organ failure assessment scores (mean difference = 1.58, 95% confidence interval = 0.88–2.28, P < 0.01) in patients with high Pcv-aCO2/Ca-vO2. These differences were statistically significant. Conclusion: This meta-analysis indicates that Pcv-aCO2/Ca-vO2 has predictive value for mortality in patients with sepsis or septic shock. Further studies are now required to determine the optimal threshold for predicting sepsis mortality. Prospero Registration: The protocol for this systematic review was registered on PROSPERO (CRD 42019128134).","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"241 - 253"},"PeriodicalIF":0.6,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907921994970","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46814514","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 : 2021-02-15DOI: 10.1177/1024907921994426
Yongil Cho, T. Lim, B. Ko, Hyunggoo Kang, Jaehoon Oh, Heekyung Lee
Introduction: The risk of venous thromboembolism increases after acute carbon monoxide poisoning. However, studies on the characteristics of patients who develop venous thromboembolism after carbon monoxide poisoning are rare. The aim of this study was to identify the risk factors for venous thromboembolism within 3 months after carbon monoxide poisoning. Methods: This is a population-based study that employed nationwide claims data from South Korea. Among the carbon monoxide poisoning patients (⩾18 years), the characteristics of the groups with and without venous thromboembolism (pulmonary embolism or deep vein thrombosis) were identified. All the significant variables in the univariable analysis were included in the multivariable logistic regression to determine the risk factors for venous thromboembolism occurrence. Results: Among the 24,232 carbon monoxide poisoning patients, 130 subjects developed venous thromboembolism within 90 days of their carbon monoxide poisoning diagnosis. The significant risk factors for venous thromboembolism in the multivariable analysis were age (adjusted odds ratio (aOR) = 1.01; 95% confidence interval (CI) = 1.003–1.03), intensive care unit admission (aOR = 3.80; 95% CI = 2.34–6.12), length of stay (aOR = 1.02; 95% CI = 1.0001–1.04), congestive heart failure (aOR = 2.17; 95% CI = 1.36–3.42), and cancer (aOR = 1.94; 95% CI = 1.10–3.22). The adjusted odds ratios for intensive care unit admission for patients with pulmonary embolism and deep vein thrombosis were 3.05 (95% CI = 1.61–5.61) and 5.60 (95% CI = 2.89–10.90), respectively. Conclusion: Patients with older age, intensive care unit admission, a longer length of stay, congestive heart failure, or cancer are at greater risk of developing venous thromboembolism after carbon monoxide poisoning. In particular, intensive care unit admission was the strongest risk factor for venous thromboembolism, pulmonary embolism, and deep vein thrombosis. Monitoring and administering prophylactic treatments to prevent venous thromboembolism would be helpful in high-risk in carbon monoxide poisoning patients.
简介:急性一氧化碳中毒后静脉血栓栓塞的风险增加。然而，关于一氧化碳中毒后发生静脉血栓栓塞的患者特征的研究很少。本研究的目的是确定一氧化碳中毒后3个月内静脉血栓栓塞的危险因素。方法:这是一项基于人群的研究，采用了来自韩国的全国索赔数据。在一氧化碳中毒患者(大于或小于18年)中，确定了有和没有静脉血栓栓塞(肺栓塞或深静脉血栓形成)的组的特征。将单变量分析中的所有显著变量纳入多变量logistic回归，以确定静脉血栓栓塞发生的危险因素。结果:24232例一氧化碳中毒患者中，130例在一氧化碳中毒诊断后90天内发生静脉血栓栓塞。多变量分析中静脉血栓栓塞的显著危险因素为年龄(校正优势比(aOR) = 1.01;95%可信区间(CI) = 1.003-1.03)，重症监护病房入院(aOR = 3.80;95% CI = 2.34-6.12)、住院时间(aOR = 1.02;95% CI = 1.0001-1.04)，充血性心力衰竭(aOR = 2.17;95% CI = 1.36-3.42)和癌症(aOR = 1.94;95% ci = 1.10-3.22)。肺栓塞和深静脉血栓患者入住重症监护病房的校正优势比分别为3.05 (95% CI = 1.61-5.61)和5.60 (95% CI = 2.89-10.90)。结论:年龄较大、入住重症监护病房、住院时间较长、充血性心力衰竭或癌症患者发生一氧化碳中毒后静脉血栓栓塞的风险较大。特别是，重症监护病房入住是静脉血栓栓塞、肺栓塞和深静脉血栓形成的最强危险因素。监测和实施预防性治疗以预防静脉血栓栓塞对一氧化碳中毒高危患者有帮助。
{"title":"Risk factors for venous thromboembolism after carbon monoxide poisoning: A nationwide population-based study","authors":"Yongil Cho, T. Lim, B. Ko, Hyunggoo Kang, Jaehoon Oh, Heekyung Lee","doi":"10.1177/1024907921994426","DOIUrl":"https://doi.org/10.1177/1024907921994426","url":null,"abstract":"Introduction: The risk of venous thromboembolism increases after acute carbon monoxide poisoning. However, studies on the characteristics of patients who develop venous thromboembolism after carbon monoxide poisoning are rare. The aim of this study was to identify the risk factors for venous thromboembolism within 3 months after carbon monoxide poisoning. Methods: This is a population-based study that employed nationwide claims data from South Korea. Among the carbon monoxide poisoning patients (⩾18 years), the characteristics of the groups with and without venous thromboembolism (pulmonary embolism or deep vein thrombosis) were identified. All the significant variables in the univariable analysis were included in the multivariable logistic regression to determine the risk factors for venous thromboembolism occurrence. Results: Among the 24,232 carbon monoxide poisoning patients, 130 subjects developed venous thromboembolism within 90 days of their carbon monoxide poisoning diagnosis. The significant risk factors for venous thromboembolism in the multivariable analysis were age (adjusted odds ratio (aOR) = 1.01; 95% confidence interval (CI) = 1.003–1.03), intensive care unit admission (aOR = 3.80; 95% CI = 2.34–6.12), length of stay (aOR = 1.02; 95% CI = 1.0001–1.04), congestive heart failure (aOR = 2.17; 95% CI = 1.36–3.42), and cancer (aOR = 1.94; 95% CI = 1.10–3.22). The adjusted odds ratios for intensive care unit admission for patients with pulmonary embolism and deep vein thrombosis were 3.05 (95% CI = 1.61–5.61) and 5.60 (95% CI = 2.89–10.90), respectively. Conclusion: Patients with older age, intensive care unit admission, a longer length of stay, congestive heart failure, or cancer are at greater risk of developing venous thromboembolism after carbon monoxide poisoning. In particular, intensive care unit admission was the strongest risk factor for venous thromboembolism, pulmonary embolism, and deep vein thrombosis. Monitoring and administering prophylactic treatments to prevent venous thromboembolism would be helpful in high-risk in carbon monoxide poisoning patients.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"79 - 86"},"PeriodicalIF":0.6,"publicationDate":"2021-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907921994426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41670063","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 : 2021-02-15DOI: 10.1177/1024907921994423
Hyeongjung Lee, W. Sung
Introduction: Although cardiopulmonary resuscitation is an emergency life-saving procedure, the intervention itself can cause major and often fatal injuries, with diaphragmatic rupture being very rare. This report describes a patient who experienced bilateral pneumothoraces, left diaphragmatic rupture, and pneumoperitoneum after extended cardiopulmonary resuscitation. Case presentation: A 90-year-old woman experienced a cardiac arrest. Spontaneous circulation was restored after 49 min of cardiopulmonary resuscitation performed by a bystander, emergency medical service providers, and emergency department staff. Imaging showed bilateral pneumothoraces, left diaphragmatic rupture, and massive pneumoperitoneum. The patient’s guardian refused to permit surgery for the diaphragmatic rupture, and the patient died despite chest and abdominal decompression and post-cardiac arrest care. Discussion and conclusion: Procedures to restore spontaneous circulation in patients experiencing cardiac arrest may result in fatal cardiopulmonary resuscitation–related injuries. Clinicians providing post-cardiac arrest care should plan management for these iatrogenic injuries.
{"title":"Diaphragmatic rupture and massive pneumoperitoneum after cardiopulmonary resuscitation","authors":"Hyeongjung Lee, W. Sung","doi":"10.1177/1024907921994423","DOIUrl":"https://doi.org/10.1177/1024907921994423","url":null,"abstract":"Introduction: Although cardiopulmonary resuscitation is an emergency life-saving procedure, the intervention itself can cause major and often fatal injuries, with diaphragmatic rupture being very rare. This report describes a patient who experienced bilateral pneumothoraces, left diaphragmatic rupture, and pneumoperitoneum after extended cardiopulmonary resuscitation. Case presentation: A 90-year-old woman experienced a cardiac arrest. Spontaneous circulation was restored after 49 min of cardiopulmonary resuscitation performed by a bystander, emergency medical service providers, and emergency department staff. Imaging showed bilateral pneumothoraces, left diaphragmatic rupture, and massive pneumoperitoneum. The patient’s guardian refused to permit surgery for the diaphragmatic rupture, and the patient died despite chest and abdominal decompression and post-cardiac arrest care. Discussion and conclusion: Procedures to restore spontaneous circulation in patients experiencing cardiac arrest may result in fatal cardiopulmonary resuscitation–related injuries. Clinicians providing post-cardiac arrest care should plan management for these iatrogenic injuries.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"26S - 30S"},"PeriodicalIF":0.6,"publicationDate":"2021-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1024907921994423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49518616","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}
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