Background: The Drug and Poison Information Centre (DPIC) in Singapore was piloted as a new service in April 2004. This study evaluated the cost benefits of its interventions in the first two years of its operation. Method: A two-year retrospective review of DPIC call records was performed and the following outcome measures were noted: (A) proportion of patients who were managed onsite and hence did not need to attend the emergency department (ED); and (B) proportion of patients who were managed in the ED without the need for admission. Cost savings were calculated based on admission costs for patients with poisoning, including other out-of-hospital costs.
A 29-year-old, 65 kg, Chinese man presented to hospital 10 hours after ingesting 30 g of paracetamol (462 mg/kg body weight). The blood paracetamol level was 145 µg/ml at 10 hours post-ingestion. He had no known risk factors for hepatotoxicity and was treated with intravenous N-acetylcysteine (NAC). Serum creatinine level rose to a maximum of 455 µmol/L on day 8; it gradually declined without the need for dialysis. Little is known of the risk factors for nephrotoxicity, which may occur with or without concurrent liver damage, suggesting possible primary toxic effects on the kidney. The use of NAC in this case may have prevented the progression to liver failure and reduced the severity of the nephrotoxic effects. (Hong Kong j. emerg.med. 2006;13:105-110) 29 65 kg 30 g 462 mg/kg 10 145 µg/ml 10 8 455 µmol/L
The traditional method of transporting Emergency Department (ED) patients in Singapore by trolleys is the headfirst approach. The nurse is at the trolley head to monitor the patient while the porter pushes the trolley from the trolley foot. A few patients have complained of dizziness and disorientation when they were conveyed in this direction. The purpose of this study was to determine the nature and incidence of physiological and psychological effects when patients are transported in the direction of head or feet first, and to utilize the knowledge gained to improve patients' comfort and safety. Method: This qualitative-purposive study was conducted in the ED of a tertiary-care hospital in Singapore with 118,000 visits per year. Patients were randomly assigned to two groups: headfirst (n = 20) and feet-first (n = 20). Data were collected using a 4-part questionnaire. The questionnaires obtained the patients' demographic information, heart rate and oxygen saturation before, and after transportation, as well as possible factors that may contribute to physiological and psychological effects, i.e., speed of transportation. Patients also were asked to describe the physical and psychological effects experienced. Results: Eight patients (40%) conveyed via the headfirst direction experienced physical effects such as dizziness (5), nausea (1), chest pain (1) and headache (1). Two patients (10%) experienced a sense of fear. Of those who were transported in the feet first direction, only 3 patients (15%) had physical effects such as dizziness (2) and palpitations (1) and all had positive psychological effects including 1 patient who reported a sense of well-being. The heart rate and oxygen saturation levels before and after transportation were almost similar in both groups. Conclusion: The results showed that the traditional headfirst method of transporting ED patients may cause greater discomfort than in the feet-first position.
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