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Leong W, Zhang Y, Huang X, Luo Z, Wang Y, Rainer TH, Wai AKC, Huang Y. Seizure as the clinical presentation of massive pulmonary embolism: Case report and literature review. Front Med (Lausanne) 2022; 9:980847. [PMID: 36479099 PMCID: PMC9721361 DOI: 10.3389/fmed.2022.980847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/25/2022] [Indexed: 09/19/2023] Open
Abstract
Massive pulmonary embolism (MPE) is a high-risk medical emergency. Seizure as the clinical presentation of MPE is extremely rare, and to our knowledge, there have been no reports on successful percutaneous, catheter-based treatment of MPE presenting with new-onset seizures and cardiac arrest. In this report, we discuss the case of a 64-year-old woman who presented with an episode of seizure that lasted 5 h. Seizure occurred four times within 12 h after arrival at the hospital, and in the end, she sustained a cardiac arrest. The patient had no past history of seizure or cardiopulmonary disease. Bilateral MPE was detected by a computed tomography pulmonary angiogram, and she was successfully treated with percutaneous, catheter-directed anticoagulant therapy. Pulmonary embolism-related seizures are more difficult to diagnose and have higher mortality rates than seizures. MPE should be suspected in patients presenting with new-onset seizures and hemodynamic instability.
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Affiliation(s)
- Waiian Leong
- Department of Accident and Emergency, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yueqi Zhang
- Department of Neurology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xinxiang Huang
- Department of Accident and Emergency, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zhendong Luo
- Department of Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yanli Wang
- Department of Accident and Emergency, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Timothy Hudson Rainer
- Department of Emergency Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Abraham K. C. Wai
- Department of Accident and Emergency, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Emergency Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yi Huang
- Department of Accident and Emergency, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Chou OHI, Chang C, Zhou J, Chan J, Leung KSK, Lee TTL, Wong WT, Liu T, Zhang Q, Lee S, Wai AKC, Tse G. Predictive value of neutrophil-to-lymphocyte ratio for atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Neutrophil-to-lymphocyte ratio (NLR) is a routinely available biomarker that reflects systemic inflammation. The study evaluated the predictive value of NLR for ischemic stroke and atrial fibrillation (AF) in patients with type 2 diabetes mellitus.
Methods
This was a population-based cohort study of patients with type 2 diabetes mellitus and complete blood count tests at baseline between January 1st, 2009 to December 31st, 2009 at government-funded hospitals/clinics in Hong Kong. Follow-up was until December 31st, 2019 or death.
Results
A total of 85351 patients (age=67.6±13.2 years old, male=48.8%, follow-up=3101±1441 days) were included. Univariable Cox regression found that increased NLR at quartiles 2, 3 and 4 was significantly associated with higher risks of new onset ischemic stroke (HR: 1.28 [1.20–1.37], P<0.001, HR: 1.41 [1.32–1.51], P<0.001 and HR: 1.38 [1.29–1.47], P<0.001) and AF (hazard ratio [HR]: 1.09 [1.02–1.17], P<0.015; HR: 1.28 [1.20–1.37], P<0.001; HR: 1.39 [1.31–1.49], P<0.001) compared to quartile 1. On multivariable analysis, NLR remained a significant predictor of ischemic stroke risk for quartiles 2 and 3 (quartile 2: HR: 1.14 [1.05, 1.22], p=0.001; quartile 3: HR: 1.14 [1.06, 1.23], p<0.001) but not quartile 4 (HR: 1.08 [0.994, 1.17], p=0.070). By contrast, NLR was not predictive of AF after adjusting for confounders (quartile 2: HR: 0.966 [0.874, 1.07], p=0.499; quartile 3: HR: 0.978 [0.884, 1.08], p=0.661; quartile 4: HR: 1.05 [0.935, 1.16], p=0.462).
Conclusion
NLR is a significant predictor of new onset ischaemic stroke but not AF after adjusting for significant confounders.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- O H I Chou
- The University of Hong Kong, Division of Clinical Pharmacology, Department of Medicine, School of Clinical Medicine , Hong Kong , Hong Kong
| | - C Chang
- Queen Mary Hospital, Department of Medicine , Hong Kong , Hong Kong
| | - J Zhou
- University of Oxford, Nuffield Department of Medicine , Oxford , United Kingdom
| | - J Chan
- Cardiovascular Analytics Group , Hong Kong , Hong Kong
| | - K S K Leung
- Cardiovascular Analytics Group , Hong Kong , Hong Kong
| | - T T L Lee
- The University of Hong Kong, Emergency Medicine Unit, Li Ka Shing Faculty of Medicine , Hong Kong , Hong Kong
| | - W T Wong
- The Chinese University of Hong Kong, School of Life Sciences , Hong Kong , Hong Kong
| | - T Liu
- 2nd Hospital of Tianjin Medical University, Department of Cardiology , Tianjin , China
| | - Q Zhang
- City University of Hong Kong, School of Data Science , Hong Kong , Hong Kong
| | - S Lee
- Cardiovascular Analytics Group , Hong Kong , Hong Kong
| | - A K C Wai
- The University of Hong Kong, Emergency Medicine Unit, Li Ka Shing Faculty of Medicine , Hong Kong , Hong Kong
| | - G Tse
- Kent and Medway Medical School , Canterbury , United Kingdom
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Xiong X, Wai AKC, Wong JYH, Tang EHM, Chu OCK, Wong CKH, Rainer TH. Impact of varying wave periods of COVID-19 on in-hospital mortality and length of stay for admission through emergency department: A territory-wide observational cohort study. Influenza Other Respir Viruses 2021; 16:193-203. [PMID: 34643047 PMCID: PMC8653231 DOI: 10.1111/irv.12919] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 01/02/2023] Open
Abstract
Background The COVID‐19 pandemic has been associated with excess mortality and reduced emergency department attendance. However, the effect of varying wave periods of COVID‐19 on in‐hospital mortality and length of stay (LOS) for non‐COVID disease for non‐COVID diseases remains unexplored. Methods We examined a territory‐wide observational cohort of 563,680 emergency admissions between January 1 and November 30, 2020, and 709,583 emergency admissions during the same 2019 period in Hong Kong, China. Differences in 28‐day in‐hospital mortality risk and LOS due to COVID‐19 were evaluated. Results The cumulative incidence of 28‐day in‐hospital mortality increased overall from 2.9% in 2019 to 3.6% in 2020 (adjusted hazard ratio [aHR] = 1.22, 95% CI 1.20 to 1.25). The aHR was higher among patients with lower respiratory tract infection (aHR: 1.30 95% CI 1.26 to 1.34), airway disease (aHR: 1.35 95% CI 1.22 to 1.49), and mental disorders (aHR: 1.26 95% CI 1.15 to 1.37). Mortality risk in the first‐ and third‐wave periods was significantly greater than that in the inter‐wave period (p‐interaction < 0.001). The overall average LOS in the pandemic year was significantly shorter than that in 2019 (Mean difference = −0.40 days; 95% CI −0.43 to −0.36). Patients with mental disorders and cerebrovascular disease in 2020 had a 3.91‐day and 2.78‐day shorter LOS than those in 2019, respectively. Conclusions Increased risk of in‐hospital deaths was observed overall and by all major subgroups of disease during the pandemic period. Together with significantly reduced LOS for patients with mental disorders and cerebrovascular disease, this study shows the spillover effect of the COVID‐19 pandemic.
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Affiliation(s)
- Xi Xiong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Abraham K C Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China.,Accident and Emergency Department, Queen Mary Hospital, Hong Kong SAR, China
| | - Janet Y H Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric H M Tang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Owen C K Chu
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Carlos K H Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Timothy H Rainer
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China.,Accident and Emergency Department, Queen Mary Hospital, Hong Kong SAR, China
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Wai AKC, Wong CKH, Wong JYH, Xiong X, Chu OCK, Wong MS, Tsui MSH, Rainer TH. Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study. Ann Emerg Med 2021; 79:148-157. [PMID: 34742591 PMCID: PMC8461293 DOI: 10.1016/j.annemergmed.2021.09.424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE We aimed to evaluate and characterize the scale and relationships of emergency department (ED) visits and excess mortality associated with the early phase of the COVID-19 pandemic in the territory of Hong Kong. METHODS We conducted a territory-wide, retrospective cohort study to compare ED visits and the related impact of the COVID-19 pandemic on mortality. All ED visits at 18 public acute hospitals in Hong Kong between January 1 and August 31 of 2019 (n=1,426,259) and 2020 (n=1,035,562) were included. The primary outcome was all-cause mortality in the 28 days following an ED visit. The secondary outcomes were weekly number of ED visits and diagnosis-specific mortality. RESULTS ED visits decreased by 27.4%, from 1,426,259 in 2019 to 1,035,562 in 2020. Overall period mortality increased from 28,686 (2.0%) in 2019 to 29,737 (2.9%) in 2020. The adjusted odds ratio for 28-day, all-cause mortality in the pandemic period of 2020 relative to 2019 was 1.26 (95% confidence interval 1.24 to 1.28). Both sexes, age more than 45 years, all triage categories, all social classes, all ED visit periods, epilepsy (odds ratio 1.58, 95% confidence interval 1.20 to 2.07), lower respiratory tract infection, and airway disease had higher adjusted ORs for all-cause mortality. CONCLUSION A significant reduction in ED visits in the first 8 months of the COVID-19 pandemic was associated with an increase in deaths certified in the ED. The government must make provisions to encourage patients with alarming symptoms, mental health conditions, and comorbidities to seek timely emergency care, regardless of the pandemic.
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Affiliation(s)
- Abraham K C Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Accident and Emergency Department, Queen Mary Hospital, Hong Kong SAR, China
| | - Carlos K H Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Janet Y H Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xi Xiong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Owen C K Chu
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Man S Wong
- Department of Land Surveying and Geo-informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Matthew S H Tsui
- Accident and Emergency Department, Queen Mary Hospital, Hong Kong SAR, China
| | - Timothy H Rainer
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Accident and Emergency Department, Queen Mary Hospital, Hong Kong SAR, China
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Wong CKH, Wong JYH, Tang EHM, Au CH, Lau KTK, Wai AKC. Impact of National Containment Measures on Decelerating the Increase in Daily New Cases of COVID-19 in 54 Countries and 4 Epicenters of the Pandemic: Comparative Observational Study. J Med Internet Res 2020; 22:e19904. [PMID: 32658858 PMCID: PMC7377680 DOI: 10.2196/19904] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) is a worldwide epidemic, and various countries have responded with different containment measures to reduce disease transmission, including stay-at-home orders, curfews, and lockdowns. Comparative studies have not yet been conducted to investigate the impact of these containment measures; these studies are needed to facilitate public health policy-making across countries. OBJECTIVE The aim of this study was to describe and evaluate the impact of national containment measures and policies (stay-at-home orders, curfews, and lockdowns) on decelerating the increase in daily new cases of COVID-19 in 54 countries and 4 epicenters of the pandemic in different jurisdictions worldwide. METHODS We reviewed the effective dates of the national containment measures (stay-at-home order, curfew, or lockdown) of 54 countries and 4 epicenters of the COVID-19 pandemic (Wuhan, New York State, Lombardy, and Madrid), and we searched cumulative numbers of confirmed COVID-19 cases and daily new cases provided by health authorities. Data were drawn from an open, crowdsourced, daily-updated COVID-19 data set provided by Our World in Data. We examined the trends in the percent increase in daily new cases from 7 days before to 30 days after the dates on which containment measures went into effect by continent, World Bank income classification, type of containment measures, effective date of containment measures, and number of confirmed cases on the effective date of the containment measures. RESULTS We included 122,366 patients with confirmed COVID-19 infection from 54 countries and 24,071 patients from 4 epicenters on the effective dates on which stay-at-home orders, curfews, or lockdowns were implemented between January 23 and April 11, 2020. Stay-at-home, curfew, and lockdown measures commonly commenced in countries with approximately 30%, 20%, or 10% increases in daily new cases. All three measures were found to lower the percent increase in daily new cases to <5 within one month. Among the countries studied, 20% had an average percent increase in daily new cases of 30-49 over the seven days prior to the commencement of containment measures; the percent increase in daily new cases in these countries was curbed to 10 and 5 a maximum of 15 days and 23 days after the implementation of containment measures, respectively. CONCLUSIONS Different national containment measures were associated with a decrease in daily new cases of confirmed COVID-19 infection. Stay-at-home orders, curfews, and lockdowns curbed the percent increase in daily new cases to <5 within a month. Resurgence in cases within one month was observed in some South American countries.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Janet Y H Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Eric H M Tang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Chi Ho Au
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Kristy T K Lau
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Abraham K C Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Abstract
This article briefly reviews the development of emergency medicine (EM) in Hong Kong with particular focus on the parallel development of training in EM at the undergraduate level. The practice of EM in Hong Kong started more than 50 years ago but the development of the specialty progressed slowly until the 1980s. Since then, although there have been major advances in postgraduate training, the specialty still features poorly in undergraduate medical training. We compared emergency medicine training in Hong Kong, Australia, USA, UK and Singapore, in order to identify areas in the medical curriculum where EM could contribute more to undergraduate medical training. The growth of EM in Hong Kong depends on recruiting good trainees who are attracted by what they observe and what they learn during their undergraduate EM clerkship.
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Wai AKC, Cameron P, Cheung CK, Mak P, Rainer TH. Out-of-Hospital Cardiac Arrest in a Teaching Hospital in Hong Kong: Descriptive Study Using the Utstein Style. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To describe, using the Utstein template, the characteristics of patients presenting with out-of-hospital cardiac arrest to a university teaching hospital in the New Territories of Hong Kong, and to evaluate survival. Design Prospective study. Setting The emergency department of a teaching hospital in the New Territories, Hong Kong. Participants Patients older than 12 years with non-traumatic out-of-hospital cardiac arrest who were transported to the hospital between 1 July 2002 and 31 December 2002. Main outcome measures Demographic data, characteristics of cardiac arrest and response time intervals of the emergency medical service presented according to the Utstein style, and also survival to hospital discharge rate. Results A total of 124 patients were included (49.2% male; mean age 71.9 years). The majority of cardiac arrests occurred in patients' home. The overall bystander cardiopulmonary resuscitation (CPR) rate was 15.3% (19/124). The most common electrocardiographic rhythm at scene was asystole, whilst pulseless ventricular tachycardia (VT)/ventricular fibrillation (VF) was found in 18.0%. The overall survival was 0.8% (1/124), and survival to hospital discharge was significantly higher for patients with VF or pulseless VT than those patients with other rhythms of cardiac arrest (11.1% versus 0%). The median witnessed/recognised collapse to defibrillation time was 14 minutes. The median prehospital time interval from collapse/recognition to arrival at hospital was 33 minutes. Conclusion The prognosis of out-of-hospital cardiac arrest in Hong Kong was poor. Major improvements in every component of the chain of survival are necessary.
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Wai AKC, Graham CA. Effects of an elevated position on time to tracheal intubation by novice intubators using Macintosh laryngoscopy or videolaryngoscopy: randomized crossover trial. Clin Exp Emerg Med 2016; 2:174-178. [PMID: 27752593 PMCID: PMC5052847 DOI: 10.15441/ceem.15.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/12/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the time to tracheal intubation using Glidescope videolaryngoscopy (GVL) compared to that of standard laryngoscopy, by using a Macintosh blade (SLM) in a human patient simulator in supine and elevated (ramped) positions. Methods In this randomized crossover design, novice intubators (first-year medical students), using both laryngoscopic techniques, attempted tracheal intubation on a human patient simulator with a “normal airway” anatomy (Cormack-Lehane grade I). The simulator was placed in both supine and ramped positions using a commercial mattress system. The mean time to intubation and complications were compared between GVL and SLM in both positions. The percentage of glottic opening (POGO, GVL only) was estimated during intubation in the ramped and supine positions. The primary outcome was time to intubation, and the secondary outcomes included complication rates such as esophageal intubation and dental trauma. Results There was no difference in the mean time to intubation in either position (P=0.33). The SLM intubation was significantly faster than GVL (mean difference, 1.5 minutes; P<0.001). The mean POGO score for GVL improved by 8% in the ramped position compared to that in supine position (P=0.018). The esophageal intubation rate for SLM was 15% to 17% compared to 1.3% for GVL; dental trauma occurred in 53% to 56% of GVL, compared to 2% to 6% for SLM (P<0.001, respectively). Conclusion Novices had shorter intubation times using standard laryngoscopy with a SLM compared to GVL in both supine and ramped positions. GVL resulted in fewer esophageal intubations, but more dental trauma than standard laryngoscopy.
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Affiliation(s)
- Abraham K C Wai
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong
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Rotheray KR, Cheung PSY, Cheung CSK, Wai AKC, Chan DYS, Rainer TH, Graham CA. What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population? Resuscitation 2011; 83:86-9. [PMID: 21787740 DOI: 10.1016/j.resuscitation.2011.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 06/20/2011] [Accepted: 07/16/2011] [Indexed: 11/18/2022]
Abstract
AIM To describe the relationship of gag and cough reflexes to Glasgow coma score (GCS) in Chinese adults requiring critical care. METHOD Prospective observational study of adult patients requiring treatment in the trauma or resuscitation rooms of the Emergency Department, Prince of Wales Hospital, Hong Kong. A long cotton bud to stimulate the posterior pharyngeal wall (gag reflex) and a soft tracheal suction catheter were introduced through the mouth to stimulate the laryngopharynx and elicit the cough reflex. Reflexes were classified as normal, attenuated or absent. RESULTS A total of 208 patients were recruited. Reduced gag and cough reflexes were found to be significantly related to reduced GCS (p=0.014 and 0.002, respectively). Of 33 patients with a GCS≤8, 12 (36.4%) had normal gag reflexes and 8 (24.2%) had normal cough reflexes. 23/62 (37.1%) patients with a GCS of 9-14 had absent gag reflexes, and 27 (43.5%) had absent cough reflexes. In patients with a normal GCS, 22.1% (25/113) had absent gag reflexes and 25.7% (29) had absent cough reflexes. CONCLUSIONS Our study has shown that in a Chinese population with a wide range of critical illness (but little trauma or intoxication), reduced GCS is significantly related to gag and cough reflexes. However, a considerable proportion of patients with a GCS≤8 have intact airway reflexes and may be capable of maintaining their own airway, whilst many patients with a GCS>8 have impaired airway reflexes and may be at risk of aspiration. This has important implications for airway management decisions.
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Affiliation(s)
- K R Rotheray
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong
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Wai AKC, Chor CM, Lee ATC, Sittambunka Y, Graham CA, Rainer TH. Analysis of trends in emergency department attendances, hospital admissions and medical staffing in a Hong Kong university hospital: 5-year study. Int J Emerg Med 2009; 2:141-8. [PMID: 20157463 PMCID: PMC2760706 DOI: 10.1007/s12245-009-0098-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 02/11/2009] [Indexed: 11/24/2022] Open
Abstract
Background The workload of emergency departments (ED) continually changes in response to presentations, overcrowding and availability of expertise and investigations. Aims To investigate changes in ED presentations and care processes, and the relationship of patient demand and ED staff resources to waiting times and processing times. Methods Retrospective analysis of prospectively collected administrative data from January 1999 to April 2005 in an emergency department in a university teaching hospital in Hong Kong. All patients attending the emergency department during the study period were included. Monthly attendance data were retrieved and analysed to determine both qualitative and quantitative changes in the patterns of presentation to the ED using prospectively gathered data. Results Total ED attendances decreased by 25% during the study with little seasonal variation. The admission rate and the use of ambulances increased steadily and significantly. Medical patients are increasing proportionately, but trauma patients are decreased in number. Conclusion There have been major changes in the patterns of ED attendances and ED waiting times over the study period in this teaching hospital ED. Decreasing overall ED numbers are offset by an increasingly elderly population and a more complex case mix. Reducing clinical staff numbers appears to reduce the ED’s capacity to provide timely assessments and care and to function as hospital gatekeepers. Restoring staff numbers to previous levels may improve the quality and timeliness of ED services. It is necessary to refine measures of ED complexity and workload to determine appropriate staffing levels in the future.
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Wai AKC, Kwok WO, Chan MS, Graham CA, Rainer TH. Patients' perceptions of nasopharyngeal aspiration in the emergency department of a teaching hospital in Hong Kong. Emerg Med J 2007; 24:35-6. [PMID: 17183041 PMCID: PMC2658151 DOI: 10.1136/emj.2006.039701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Nasopharyngeal aspiration (NPA) is the preferred method for collecting specimens for viral culture in patients with respiratory tract infection. As virus identification may influence admission and treatment decisions, it is important to perform NPA in the emergency department. The test may be uncomfortable and poorly tolerated. This prospective study investigated patients' perceptions of NPA. Patients in the emergency department with upper respiratory tract infection undergoing NPA between 9 March 2005 and 12 August 2005 were included. 86 patients (mean (SD) age 47 (23) years; 49 women) were recruited. 22 (26%) patients complained that NPA was very uncomfortable, 59 (69%) reported that it was mildly uncomfortable and 5 (6%) patients reported no discomfort. On a 10-point scale, the median discomfort score was 4. 29 (34%) patients stated that NPA was more uncomfortable than blood taking, 19 (22%) patients felt that both were similar and 38 (44%) patients felt that NPA was less uncomfortable (p value not significant). NPA performed in the emergency department is well tolerated and should be considered in emergency departments when results may influence patient management.
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Affiliation(s)
- A K C Wai
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Administrative Region
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