Psoas abscess is an uncommon condition. Most patients presented with only non-specific symptoms leading to difficulty in making an early diagnosis. In more than half of these patients, the psoas abscesses were secondary, the aetiology of which differed from reported overseas experience.

Methadone overdose is expected to result in intoxication simulating the other opioids. We report a case of hypoglycaemia following accidental methadone ingestion. A 21-year-old woman presented to a local accident and emergency department 10 hours after ingestion of 800 mg of methadone. She was found to have coma, respiratory suppression, hypotension, prolonged QTc and hypoglycaemia. The hypoglycaemia was reversed by dextrose replacement. The patient required intubation and inotropic support because of cardio-respiratory instability. She eventually recovered without consequence. To date, this is the first reported case of methadone overdose induced hypoglycaemia.

A couple of spouse mistook the Gelsemium elegans Benth. collected in countryside for Mussaenda pubescens Ait. f. and suffered toxicity soon after ingestion. One went into respiratory failure necessitating intubation and the other developed dizziness. The morphological differences between Gelsemium elegans Benth. and Mussaenda pubescens Ait. f. may not be easily recognised by the general public. Close monitoring and respiratory support are the cornerstones of management.

Hong Kong Journal of Emergency MedicineWith the advance in diagnostic radiology, penetrating atherosclerotic ulcers of the aorta become increasingly recognised in our daily practice. However, their natural history and treatment are not well defined. We report a case of penetrating atherosclerotic ulcer at the aortic arch and review the literature. (Hong Kong j. emerg.med. 2009;16:246-251)

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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.

To compare the performance of the McGrath Mac ® and the Airtraq ® with the Macintosh laryngoscope for tracheal intubation. Design: A manikin study with different simulated difficult airway scenarios. Methods: Thirty intensive care unit (ICU) doctors (10 specialists and 20 non-specialists) performed intubation by using the 3 airway devices in the manikin with (i) normal airway, (ii) cervical rigidity, and (iii) tongue oedema. The intubation time, success rate, oesophageal intubation and number of episodes of dental injury were measured and compared. Results: The mean intubation time was significantly less by using the Airtraq ® comparing to the McGrath Mac ® in the manikin with normal airway (12.77 sec vs. 24.23 sec; p<0.001). Similarly, the mean intubation time was less by using Airtraq ® when comparing to the McGrath Mac ® in the manikin with cervical rigidity (12.73 sec vs. 17.5 sec; p=0.013). In the scenario of simulated tongue oedema, the mean intubation time of Airtraq ® was shorter than Macintosh laryngoscope (24.83 sec vs. 34.20 sec; p=0.011) while there was no difference between Airtraq ® and the McGrath Mac ®. Less dental injury was noted when using the Airtraq ® compared to the Macintosh laryngoscope in simulated cervical rigidity (p=0.005) and tongue oedema (p<0.001). Less dental injury was also noted when using the McGrath Mac ® compared to the Macintosh laryngoscope in simulated tongue oedema (p<0.001). Conclusion: Even with prior limited experience in using the McGrath Mac ® , the performance of tracheal intubation by using this new device is comparable with the Airtraq ®. The McGrath Mac ® can be a good alternative for tracheal intubation in difficult airway situations.

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