Video-assisted airway management is a new concept for monitoring and managing both normal and difficult tracheal intubations, with the aid of video-transmission of the view from the tip of intubating devices such as stylets or intubating laryngoscopes. Its principle, practical application and local experience are illustrated by some sample cases and its future development is discussed. (Hong Kong j.emerg.med. 2007;14:89-93)
A case of blast injury with tympanic perforation and limb laceration is reported. The classification (into four types), mechanism and pathogenesis of blast injury are discussed. Detection of early air embolism, especially on site, can be very difficult. Victims who appear to have only superficial secondary injuries (by missile fragments) should not be discharged without a careful examination since overt air embolism can occur later. To prevent or reduce air embolism, mechanical ventilation should be avoided.
The growth rate of emergency department visit locally is disproportionate to the population growth. The number of emergency hospital admission has also increased leading to congested ward environment. A retrospective clinical audit on short stay (discharged within 24 hours) emergency medical and geriatric admission was done to look at the appropriateness of our emergency medical and geriatric admission. This study was carried out in April 2000. The Appropriateness Evaluation Protocol was employed as an objective tool for initial assessment. A peer panel, composed of Fellows from the Colleges of Physicians and Emergency Medicine, was formed to check for appropriateness of admission for those cases without objective admission criteria. Thirteen out of the 177 cases (7.3%) available for analysis were considered as “inappropriate” admission. If we assume that those emergency admissions that stayed for longer than 24 hours were appropriately admitted, the “inappropriate” admission rate for medical and geriatric cases would be 0.67% (13 out of 1930). Suggestions for further improvement include: (1) longer and intensive observation for selected patients before admission; (2) access to early specialist outpatient review; (3) ad-hoc clinics to be run by other specialists for selected “old” cases; and (4) strengthening of the primary health care service.
There has been a vast difference in the reported value for carboxyhaemoglobin (COHb) half-life (COHbt 1/2) in carbon monoxide (CO) poisoning patients breathing 100% normobaric oxygen (O 2). This could be due to the fact that all previous studies were performed on heterogeneous groups of patients with different aetiology. We wished to determine the COHbt 1/2 in a homogenous group of acute CO poisoning patients who attempted suicide by burning charcoal and were treated with normobaric high flow oxygen. Methods: It was a retrospective descriptive cohort study for a period of 60 months (January 2001 to December 2005). Setting: Accident and Emergency Department of Tuen Mun Hospital, serving a population of 1.5 millions. Population: We recruited all cases of CO poisoning by burning charcoal for suicidal attempt and we excluded the cases if (1) there was only one COHb measurement; (2) the patient had not received high flow O 2 therapy via tightly fitting facial mask with O 2 reservoir, given before the first blood sample or throughout the period until a second blood sample was taken; (3) the first COHb was <10%; (4) the second COHb was <2%; (5) there was significant co-poisoning; (6) the patient was haemodynamically unstable; or (7) the time of blood sampling was not documented. We believed that the elimination of COHb under 100% normobaric O 2 was constant and followed a simple exponential decay. Results: Forty-three (27.4%) cases met all of the selection criteria and the mean COHbt 1/2 was 78±9 minutes. Conclusion: We believed that our patients (i.e. CO poisoning patients who committed suicide by burning charcoal) represented a homogenous group of acute CO poisoning of unique aetiology. The estimated COHbt 1/2 would be useful in deciding the length of normobaric oxygen therapy for this group of patients.
Every year there was significant number of burn cases during the Lantern (Mid-Autumn) Festival in Hong Kong because children liked to play with fire on that day. They would either burn the lantern or boil the wax from candles in a pot over a fire. When the wax has melted, they poured cold water into it, causing a small explosion with water vapour and wax droplets. Children and adolescents were more common than adults to be burnt by the hot vapour, fire or hot wax. The majority sustained partial thickness burns involving the face. Such burn injuries should be preventable by education and legislation.
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