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Abstract
Sodium hypochlorite is widely used as an irrigating solution in dental practice. Despite its safe properties, serious complications can result from inadvertent use. We report a patient presenting to the accident and emergency department for sodium hypochlorite accident during dental root canal therapy. The management of this dental emergency condition is discussed.
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Wong CY, Lui CT, So FL, Tsui KL, Tang SYH. Prevalence and Predictors of Under-Diversion in the Primary Trauma Diversion System in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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
Introduction Primary trauma diversion (PTD) enables direct transfer of major trauma patients to trauma centres for definitive care. This study aimed to evaluate the performance of PTD in the New Territories West Cluster (NTWC) of Hospital Authority and to identify the predictors for under-diversion. Methods A cross-sectional study based on local trauma registry. All major trauma patients (defined as ISS>15 or requiring trauma team activation) in the catchment area of the local hospital from September 2007 to December 2011 were included. The appropriateness of diversion decision was independently evaluated by an expert team (a trauma nurse coordinator and an emergency medicine practitioner). The sensitivity, specificity, predictive values, agreement, over-diversion and under-diversion rates were calculated. Potential predictors for under-diversion including age, Glasgow Coma Scale, mechanism of injury, injured body part, and the distance from scene to the trauma centre/local hospital were employed for logistic regression analysis. Results There were 141 eligible cases identified. The sensitivity and specificity for PTD were 59.5% and 96.5% respectively. The over-diversion rate was 3.5% and the under-diversion rate was 40.5%. The overall accuracy was around 74.5%. Non-motor vehicle accident (OR 13, 95% confidence interval [CI]=3.5-48.0, p<0.01) and isolated head injury (OR 5.35, 95% CI=1.5-19.5, p=0.01) were 2 independent predictors for under-diversion in PTD. Conclusions The overall field triage compliance by the paramedics is satisfactory. Under-diversion rate in NTWC is high. Non-motor vehicle accident mechanism and isolated head injury are 2 significant predictors for under-diversion. Reinforcement in training to avoid potential pitfalls would improve the paramedics' trauma triage performance.
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Tse CL, Lui CT, Wong CY, Ong KL, Fung HT, Tang SYH. Impact of a Sepsis Guideline in Emergency Department on Outcome of Patients with Severe Sepsis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective A dedicated program with guideline to enhance sepsis care was launched in July 2014 in Emergency Department (ED) of two regional hospitals. The study aimed to evaluate the effectiveness of the interventional program for severe sepsis patients, in antibiotic delivery rate and survival outcome. Methods It is a before-and-after interventional study with data from July to December 2013 and August 2014 to January 2015. A dedicated program for severe sepsis patients was introduced in July 2014. The outcome measures were blood culture rate, antibiotic administration rate in ED and mortality. Kaplan-Meier analysis and log-rank test was used for comparison of the survival. Multivariate Cox proportional hazards model was constructed to predict time to mortality adjusted for covariates. Results 64 patients were included, 31 patients were in the pre-intervention group whereas 33 post-intervention. Both blood culture rate (29% vs 72.7%; p<0.001) and antibiotics administration in ED (38.7% vs 72.7%, p=0.0011) were significantly increased. Survival outcome was significantly improved in patients receiving timely antibiotics in ED (log-rank test p=0.016). Antibiotics administered in ED had hazard ratio of 0.178 (95% CI 0.053 to 0.595; p=0.005) in the Cox Proportional hazard regression model with adjustment of covariates. Age (adjusted odds ratio 1.06, 95% CI 1.01 to 1.12, p=0.033) and initial hypotension (adjusted odds ratio 0.97, 95% CI 0.95 to 0.99, p=0.005) were significant predictors of mortality. Conclusion A dedicated guideline for severe sepsis management could improve blood culture rate, early antibiotics administration in the emergency department. Patients received early antibiotic had better outcome and survival.
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Affiliation(s)
- CL Tse
- Pok Oi Hospital, Department of Accident and Emergency, Au Tau, Yuen Long, N.T., Hong Kong
| | - CT Lui
- Tuen Mun Hospital, Department of Accident and Emergency, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - CY Wong
- Pok Oi Hospital, Department of Accident and Emergency, Au Tau, Yuen Long, N.T., Hong Kong
| | - KL Ong
- Pok Oi Hospital, Department of Accident and Emergency, Au Tau, Yuen Long, N.T., Hong Kong
| | - HT Fung
- Tuen Mun Hospital, Department of Accident and Emergency, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - SYH Tang
- Tuen Mun Hospital, Department of Accident and Emergency, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
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Abstract
Chemical warfare agent is defined as a chemical which is intended for use in military operations to kill, seriously injure, or incapacitate humans (or animals) through its toxicological effects. Chemical agents are relatively simple to make and easy to transport. Moreover, their effects are immediate and dramatic. Therefore chemical weapons are commonly used by terrorists to kill or injure in order to achieve certain political purposes. Although chemical incident is uncommon, however, once it occurs, the consequence will be great. Therefore, fundamental knowledge about the basic concepts, toxicity, personal protection, decontamination and treatment with respect to chemical incident are very important.
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Lui CT, Chan TWT, Fung HT, Tang SYH. A Retrospective Study on Imperforate Hymen and Haematometrocolpos in a Regional Hospital. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To find out the characteristics and presentations of imperforate hymen in the local population in Hong Kong and to assess if diagnosis of imperforate hymen made in the emergency department can reduce time to operation and length of hospital stay. Design Retrospective study. Setting A regional public hospital in Hong Kong. Patients We retrospectively collected data of all patients with the diagnosis of imperforate hymen (ICD 9 coding 752.42) from the period of January 1999 to June 2009. Demographics of the patients, their presenting symptoms and signs, the diagnostic process, investigation findings and time of operation were recorded and analysed. Results Fifteen cases of imperforate hymen were reported during that period. All were adolescent girls aged from 10 to 15 years. A total of 13 patients presented to the accident and emergency department (AED). Seven patients had the diagnosis made in the AED and 2 patients received bedside pelvic ultrasound. More than half of them (8 patients) presented with acute retention of urine. Other presentations included lower abdominal pain, constipation, lower abdominal mass, and protruding introital mass. Most cases diagnosed in the AED (5 out of 7) were admitted to the gynaecology ward while the others were admitted to the surgical or urology wards. Five out of the 7 cases diagnosed in the AED received operation within 24 hours; whereas only 1 out of the 6 cases with the diagnosis made after admission had operation within 24 hours. The difference was statistically significant (p=0.035, Fisher's exact test). The mean length of stay of the group diagnosed in the AED was 1.9 days while the mean length of stay for the group diagnosed after admission was 4.2 days. Conclusion Early diagnosis of imperforate hymen and haematometrocolpos in the AED for adolescent girls with primary amenorrhoea could have positive impact on proper admission to the gynaecology ward, prompt operation and shorter length of stay in hospital.
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Abstract
The incidence of Tokyo subway attack by the Aum Shinrikyo cult in 1995 had raised the concern of the use of nerve agent as a weapon in terrorist attack. The recent event in World Trade Centre in New York city had further brought our attention to the possibility of terrorist attacks using these agents. In view of the high possibility of nerve agents being used as chemical weapon, medical personnel should have a clear knowledge of these agents. This article aim to provide a detailed discussion of these agents.
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Wong YK, Lui CT, Li KK, Wong CY, Lee MM, Tong WL, Ong KL, Tang SYH. Prediction of en-route complications during interfacility transport by outcome predictive scores in ED. Am J Emerg Med 2016; 34:877-82. [PMID: 26947612 DOI: 10.1016/j.ajem.2016.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/06/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department. DESIGN This was a retrospective cohort study. METHODS All IFT cases by ambulances with either nurse-led or physician-led escort, occurring between 1 January 2011 and 31 December 2012, were included. Obstetric and pediatric cases (age < 18 years) were excluded. The condition of patients was quantified by using the predictive scores (MEWS, HOTEL, and SCS) at triage station and on ambulance departure. The accuracy of predictive scores was compared by the receiver operating characteristic (ROC) curves. RESULTS A total of 659 cases were included. Seventeen cases had en-route complications (2.6%). The complication rate in physician-escorted transport (2.2%) was similar to that in nurse-escorted transport (2.6%). None of the 57 intubated cases had en-route complications. The area under the ROC curve for MEWS was 0.662 (triage) and 0.479 (departure). The accuracy of MEWS at triage was better than that at departure (P = .049). The area under the ROC curve for HOTEL was 0.613 (triage) and 0.597 (departure), and that for SCS was 0.6 (triage) and 0.568 (departure). In general, the predictive scores at triage were better than those on departure. CONCLUSION None of the scores had good accuracy in prediction of en-route complications during IFT. MEWS at triage was among the best one already but was not ideal.
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Affiliation(s)
- Y K Wong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - C T Lui
- Department of Accident and Emergency Medicine, Tuen Mun Hospital.
| | - K K Li
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - C Y Wong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - M M Lee
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - W L Tong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - K L Ong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - S Y H Tang
- Department of Accident and Emergency Medicine, Tuen Mun Hospital
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Yeung KL, Chan MWS, Tam PF, Lee LLY, Tong WL, Kalinowski E, Tang SYH, Chan JTS. Outcome Evaluation on the Use of Nurse-Led Transport Kit in Inter-Facility Transport. HONG KONG J EMERG ME 2011. [DOI: 10.1177/102490791101800203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Transport kit is a key element to ensure safe inter-facility transport (IFT). The kit was generally reported by transport staff to be heavy and inconvenient in accessing the required items. Objective This study aimed at evaluating the outcome and the feedback from emergency nurses on the use of a new and lighter nurse-led transport kit (NLTK) in IFT. Methods A cross sectional study was carried out in two Accident and Emergency Departments in Hong Kong from 1st January 2008 to 31st March 2008. All cases involving nurse-led IFT were included into the study. Questionnaires for assessing the rating of satisfaction were distributed to the staff after every mission. Results Eighty-four questionnaires were returned with a response rate of 80.8%. The overall rating on satisfaction before and after the use of NLTK was 14.6±3.0 and 19±3.2 respectively (mean±SD) with statistically significant improvement in terms of its weight, convenience and spaciousness of kit (p<0.05). Conclusion: The new NLTK is more user-friendly than the traditional kit in nurse-led IFT.
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Lo SM, Choi KTY, Lee LLY, Graham CA, Tang SYH, Chan JTS. Resource implications of inter-facility transport between emergency departments in Hong Kong. Emerg Med J 2011; 28:151-4. [PMID: 21239422 DOI: 10.1136/emj.2009.080309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Inter-facility Transport (IFT) service provided by the Emergency Department (ED) is a vital service in Hong Kong. Patients need to be rapidly transported over distances to access appropriate healthcare facilities. METHODS This study aims 1. to examine the resource utilisation of IFT accompanied by ED staff and 2. to analyse the crude, fixed and variable costs of IFT. A retrospective review was conducted of all IFT from Alice Ho Miu Ling Nethersole Hospital in the New Territories of Hong Kong where ED staff accompanied patients from 1 January 2006 to 31 December 2008. Descriptive analysis was used to evaluate the crude, fixed and variable costs per year for providing an ED-based IFT service. RESULTS There were 337 transports accompanied by either medical or nursing staff from the ED that accounted for around 2% of all IFT. The most common indication for mobilising the transport team was an unstable clinical condition that required neurosurgical care. The average transport service time was 57.7 min per transport (SD 11.0). Resource utilisation consisted of fixed and variable costs that summed up to a cost of HKD $87,224.3 (USD $11,182.6) per year and the crude cost of providing IFT service by the ED was HKD$852.2 (USD $109.3) per patient. CONCLUSION The crude cost of providing IFT service by the ED was reasonable and acceptable.
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Affiliation(s)
- S M Lo
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR.
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Lee LLY, Lo WYL, Yeung KL, Kalinowski E, Tang SYH, Chan JTS. Risk stratification in providing inter-facility transport: Experience from a specialized transport team. World J Emerg Med 2010; 1:49-52. [PMID: 25214941 PMCID: PMC4129761] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 04/26/2010] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The role of Inter-facility transport (IFT) of patients is an emerging specialty requiring service reorganization, diversion of major trauma to trauma center. This study aimed to determine the patients who are more prone to en route adverse event during the period of 22:00 to 07:00, based on critical in-patient needs provided by the Emergency Department (ED) nursing staff at Alice Ho Miu Ling Nethersole Hospital (AHNH). METHODS This study included all 22:00 to 07:00 IFTs accompanied by ED nurses at AHNH for a period of 28 months from August 2006 until December 2008. The transports were reviewed for: (1) age, (2) gender, (3) transport configuration, (4) clinical category, and (5) physiological instability before transport. RESULTS A total of 79 patients were transported during the 22:00 to 07:00 timeframe within the study period. The types of patients were mainly neurosurgical emergencies (n=32; 40.5%), surgical emergencies (n=28; 35.4%), and upper gastrointestinal bleeding (UGIB) (n=11; 13.9%). En route adverse events were encountered by the accompanying nurses in 16 transports (20.3%) with a higher incidence of adverse events during transport of surgical emergencies, UGIB and patients who were physiological unstable before transport (P< 0.05). CONCLUSION A specialized transport team from the ED can assist other clinical departments by providing expert care during IFT. In spite of the high quality of care, adverse events do commonly occur.
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Affiliation(s)
- LLY Lee
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital (Lee LLY, Lo WYL, Yeung KL, Chan JTS); Department of Emergency Medical Services, Kapiolani Community College, University of Hawaii, Honolulu Hawaii(Kalinowski E); Emergency Department, Pok Oi Hospital (Tang SYH)
| | - WYL Lo
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital (Lee LLY, Lo WYL, Yeung KL, Chan JTS); Department of Emergency Medical Services, Kapiolani Community College, University of Hawaii, Honolulu Hawaii(Kalinowski E); Emergency Department, Pok Oi Hospital (Tang SYH)
| | - KL Yeung
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital (Lee LLY, Lo WYL, Yeung KL, Chan JTS); Department of Emergency Medical Services, Kapiolani Community College, University of Hawaii, Honolulu Hawaii(Kalinowski E); Emergency Department, Pok Oi Hospital (Tang SYH)
| | - E Kalinowski
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital (Lee LLY, Lo WYL, Yeung KL, Chan JTS); Department of Emergency Medical Services, Kapiolani Community College, University of Hawaii, Honolulu Hawaii(Kalinowski E); Emergency Department, Pok Oi Hospital (Tang SYH)
| | - SYH Tang
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital (Lee LLY, Lo WYL, Yeung KL, Chan JTS); Department of Emergency Medical Services, Kapiolani Community College, University of Hawaii, Honolulu Hawaii(Kalinowski E); Emergency Department, Pok Oi Hospital (Tang SYH)
| | - JTS Chan
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital (Lee LLY, Lo WYL, Yeung KL, Chan JTS); Department of Emergency Medical Services, Kapiolani Community College, University of Hawaii, Honolulu Hawaii(Kalinowski E); Emergency Department, Pok Oi Hospital (Tang SYH)
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Chan JTS, Yeung RSD, Tang SYH. Hospital preparedness for chemical and biological incidents in Hong Kong. Hong Kong Med J 2002; 8:440-6. [PMID: 12459601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
The risk of mass exposure to toxic substances has increased steadily during the twentieth century due to the expansion of industry and the deliberate development and use of agents of chemical warfare. Although Hong Kong is considered a relatively safe place, hoax anthrax attacks have occurred since 17 October 2001. People who have been seriously injured by hazardous materials have a greater chance of recovery without complications when appropriate emergency treatments are provided. Recognition and identification of hazardous materials, assessment of the conditions, decontamination, and protection of staff and facilities are important elements in the formulation of a contingency plan. The objective of this article is to outline the efforts of the Hong Kong Hospital Authority in formulating a hospital response to incidents involving hazardous materials.
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Affiliation(s)
- J T S Chan
- Accident and Emergency Department, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, Hong Kong
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