Telehealth helps relieve disparity in access to services and care, which is particularly problematic in pediatrics and mental health. For the patients in this case series, it was an effective modality to receive counseling services and meet needs that otherwise would not have been addressed.
Hazmat emergency preparedness is critical, especially as Hong Kong prepares for major international events, such as the 2008 Olympic Equestrian Games. No published medical study has described the identities and quantities of dangerous goods (DG) in the Kowloon area and listed what antidotes are needed for these DG. This study describes what hazardous materials are most common in Kowloon to prioritise emergency preparedness and training. Materials & methods: Design: A descriptive, cross-sectional study. Setting: The Hong Kong Special Administrative Region, specifically Kowloon. Sample: The Hong Kong Fire Services Department (HKFSD) Dangerous Goods Database (DGD). Interventions: Descriptive statistical analyses with Stata 9.2. Chief outcome: Identifying and quantifying dangerous goods in the HKFSD DGD. Results: Most DG do not have antidotes. The most common DG with recognised antidotes are carbon monoxide, methylene chloride, fluorine, fluorides, fluoroboric acid, cyanides, nitriles, methanol, nitrobenzene, nitrites, and nitrates. The most common categories of DG are substances giving off inflammable vapours, compressed gases, and corrosive and poisonous substances. Conclusions: Hazmat emergency preparedness and training should emphasize these most common categories of DG. Disaster planning should ensure adequate antidotes for DG with recognised antidotes, i.e., oxygen for carbon monoxide and methylene chloride; calcium gluconate or calcium chloride for fluorine, fluorides, and fluoroboric acid; hydroxocobalamin for cyanides and nitriles; ethanol for methanol; and methylene blue for methaemoglobinaemia produced by nitrobenzene, nitrites, and nitrates. Supportive care is essential for patients exposed to hazardous materials because most dangerous goods do not have antidotes.
Objective: Determine if the attributes and behaviors anecdotally thought to be indicative of drug seeking have statistical association with opioid seeking.Methods: Data on variables thought to be indicative of drug seeking were retrospectively extracted and compared between two patient groups seen in the Emergency Department between July 1, 2006 and December 31, 2006. Group 1 was considered to have true physical pain, and Group 2 was thought to be seeking opioids.Results: Seven variables were found to have statistical associations with opioid seeking. There was no chart documentation on absence or presence of six variables.Conclusions: Significant associations were found between several variables and opioid seeking. A prospective study should be performed so that all variables of interest can be thoroughly studied and a predictive model can be developed to differentiate patients with real pain from drug seekers.
Constipation is a common and often overlooked symptom for pediatric palliative care patients. In this chapter, constipation for children receiving palliative care is defined as the passage of small, hard feces infrequently and with difficulty. Patients with constipation may present with a variety of gastrointestinal or urinary symptoms requiring a thorough history and exam. Some patients may have a treatable underlying etiology, but it is very common that the underlying cause may not be reversible or cannot be identified. These cases will require laxatives to treat and prevent constipation. Cases of opioid-induced constipation may benefit from opioid antagonists. This chapter presents a review of etiologies of constipation in children receiving palliative care as well as a review of laxatives that may be used in these patients.
Objectives: This study was designed to look at the possible benefits of administering the influenza vaccine in the emergency department (ED), and to determine if the side-effect profile is similar to that seen nationally. Background: Influenza is a common and life-threatening illness, responsible for 114,000 hospitalizations and 36,000 deaths each year in the United States. Treatment of influenza is largely supportive and ineffective, but immunization is highly effective in preventing both morbidity and mortality. While ED patients frequently meet the Centers for Disease Control and Prevention (CDC) guidelines for vaccination, the influenza vaccine is rarely administered in the ED. Methods: A convenience sample of ED patients who met the 2007 CDC guidelines for immunization were approached and asked to participate in a research study of the influenza vaccine. Participants were offered the Sanofi-Pasteur inactivated intramuscular influenza vaccine. Acceptance and declination rates were determined. Adverse reactions were assessed at two days by telephone call. Results: Seventy patients were offered the vaccine and 60 accepted (85.72%). At the two-day follow up, 39 out of 47 patients who were reachable reported no adverse reactions to the vaccine. Reported reactions included: fever on the day of vaccination (1), soreness at injection site (1), swollen eyes (1), mild tingling (1), myalgias (1), and severe shoulder soreness(1). Each adverse reaction was reported in 2.13% of patients. Conclusions: Our results indicate that influenza vaccine is accepted at a high rate when offered to patients in the ED as part of standard care (85.72%). Adverse reactions were minimal, occurring in 17.02% in these patients. Patients will likely benefit from vaccination for influenza in the ED as it will minimize their risk of contracting influenza or complications from influenza, as well as the risk of transmitting it to others.
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