Background: Patients with severe euvolemic hyponatremia can be challenging to treat, and the COVID-19 pandemic has added to the complexity of the situation. Methods: Data were collected from all patients treated in a local intensive care unit (ICU) with the protocolized proactive desmopressin plus 3% saline (PD-3 S) approach in March 2022. Results: Six patients were treated with the protocol, whose initial serum sodium level (SNa) ranged from 98 to 108 mmol/L. SNa of one patient dropped further due to delayed initiation of protocolized PD-3 S because of access block. But otherwise, the protocol had been effective in achieving a controlled rise of SNa in all patients. No major complications have been observed, and the feedback from both medical and nursing staff was overall positive. Conclusion: This case series shows that the protocolized PD-3 S is safe and effective. This protocol is currently being used in two ICUs in our cluster. And our unit is currently working with the emergency department to initiate the protocol earlier, before ICU admission.

Background: Traveller patients have distinctive clinical characteristics compared to non-traveller patients. Local information about the clinical features of traveller patients is lacking. Objectives: The objective of this study is to evaluate the clinical characteristics of traveller patients presenting to a hospital near the Hong Kong International Airport. Methods: This was a single-centred, retrospective cohort study. Medical records of all traveller patients presenting to the Accident and Emergency Department of North Lantau Hospital in Hong Kong from 1 January 2019 to 31 December 2019 were reviewed. The demographics, triage category, presentation, outcomes and disposal were retrospectively evaluated and compared between traveller and non-traveller patients. Results: There were 528 traveller patients attending the Accident and Emergency Department of North Lantau Hospital during the study period, constituting 0.6% of total annual attendance. About one-third of the traveller patients required admission. The most common discharge diagnoses were gastrointestinal diseases (14.8%), followed by trauma (12.9%) and other neurological diseases (12.9%). Traveller patients had a higher rate of being triaged as critical and emergency categories (p < 0.001), higher admission rate (p < 0.001), higher need for active resuscitation (p < 0.001) and escort (p < 0.001) when compared to non-traveller patients. Around 1.3% of traveller patients presented with out-of-hospital cardiac arrest and were eventually certified dead in Accident and Emergency Department. Conclusion: The traveller population constitutes a small proportion of the patient population, but they can have a significant impact on the Accident and Emergency Departments in high-impact traveller areas. Additional resources such as manpower support and training programmes would be beneficial for Accident and Emergency Departments in high-impact traveller areas.

Objective: The prevalence of sexually transmitted infections in Hong Kong is not high. The objective of this study was to determine the risk factors that associated with occurrence of sexually transmitted infections in local sexual assault victims, so as to facilitate the counseling and management of victims upon their initial attendance at an Accident and Emergency Department. Methods: This was a retrospective cohort of sexual assault victims presented to Accident and Emergency Department of Kwong Wah Hospital between 1 January 2016 and 31 December 2021. The outcome was the occurrence of sexually transmitted infections. Variables were analyzed using univariate and multivariable analyses. Results: A total of 190 victims were included in the study. Univariate analysis indicated that sexual assault involving multiple perpetrator, oral penetration, and anal penetration were associated with increased occurrence of sexually transmitted infections in the victims (all with p < 0.05). Among these, multiple perpetrator was the only statistically significant risk factor on multivariable analysis ( p < 0.05). Conclusion: Multiple-perpetrator sexual assault was identified as a significant risk factor of sexually transmitted infections. Emergency physicians should consider explaining to victims of multiple-perpetrator sexual assault that they have a higher risk of contracting sexually transmitted infections and emphasizing on the importance of complying with medical treatments, attending follow-up and observing symptoms of sexually transmitted infections. Proper clinical assessment, adequate follow-up, and reassurance for the victims with lower likelihood of contracting sexually transmitted infections are suggested for managing sexual assault victims.

Background: In Hong Kong, the post-dispatch advice on cardiopulmonary resuscitation has been implemented since October 2018. Our study aimed to (1) evaluate the impact of post-dispatch advice on the bystander cardiopulmonary resuscitation rate and out-of-hospital cardiac arrest survival and (2) characterise the reasons for not providing dispatch-assisted cardiopulmonary resuscitation, which have important implications in public cardiopulmonary resuscitation education. Method: We retrospectively analysed the records of 749 adult patients with out-of-hospital cardiac arrest between 1 September 2021 and 31 October 2021. The primary outcome was survival to hospital discharge. The secondary outcomes included return of spontaneous circulation and survival to hospital admission. Results: The overall dispatch-assisted cardiopulmonary resuscitation rate was 49.6%. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher proportion of witnessed cardiac arrest (37.7% vs 24.7%, p < 0.001) and a shorter time interval from recognition of cardiac arrest to chest compression (median 3.0 min vs 13.0 min, p < 0.001) compared with patients without dispatch-assisted cardiopulmonary resuscitation. 16.8% of out-of-hospital cardiac arrest victims had return of spontaneous circulation before or upon arrival at the hospital. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher return of spontaneous circulation (18.3% vs 15.4%), survival to hospital admission (15.9% vs 13.3%) and survival to hospital discharge (2.7% vs 1.3%) rates compared with those who did not. However, the differences did not reach statistical significance. Conclusion: Post-dispatch advice improved the overall bystander cardiopulmonary resuscitation rate in out-of-hospital cardiac arrest and shortened the time from out-of-hospital cardiac arrest recognition to chest compression, but the improvement in survival did not reach statistical significance. Further public education on cardiac arrest recognition and dispatch-assisted cardiopulmonary resuscitation is necessary.

Introduction: Recreational use of methamphetamine is increasing worldwide, but epidemiology studies from Asia are lacking. We aimed to characterise the trends, drug use pattern, clinical presentations and health services utilisation of acute methamphetamine toxicity presenting to emergency departments and the current practice of emergency department psychosocial interventions in Hong Kong. Methods: This was a secondary analysis of a retrospective study on emergency department patients reported to the Hong Kong Poison Information Centre between 2010 and 2019 for acute toxicity related to recreational methamphetamine use. We studied the trend using a negative binominal regression model. Results: During the study period, 1225 episodes (involved 979 patients; 68.9% men; with a median age of 33.0 years) were reported. Acute methamphetamine toxicity did not increase significantly (odds ratio = 1.10, 95% confidence interval = 0.86–1.40, p = 0.46). Polysubstance abuse predominated. Many patients developed hypokalaemia (24.0%), rhabdomyolysis (17.2%), acute kidney injury (9.4%) and myocardial injury (4.7%); psychotic symptoms including auditory hallucination (23.8%) and paranoid delusion (21.1%); various acute behavioural disturbances and injuries. Overall, 66 patients required intensive care and 14 patients died. Only a minority of the patients were referred to social workers and voluntary drug treatment and rehabilitation services. Conclusion: Methamphetamine has a significant impact on physical and mental health in Hong Kong. Our findings highlight the need for screening for hypokalaemia, rhabdomyolysis, acute kidney injury, myocardial injury and psychosis in methamphetamine users and support policies that address polysubstance abuse, prevent drug use through continued public education and strengthen the referral system by integrating substance abuse services at the emergency department.

Introduction: Activated charcoal is administered through a nasogastric tube to some poisoned patients, but occasionally the insertion of unweighted nasogastric tube fails in the emergency department. Weighted nasogastric tube with a stylet, for example, the Corflo® nasogastric tube, facilitates insertion, but it is not clear whether it would impede activated charcoal delivery. We aimed to compare the utility of the Corflo® and usual (Comforsoft®) nasogastric tubes in administering activated charcoal in manikins. Method: This was a single-centre, randomised, single-blinded, crossover manikin non-inferiority trial involving 28 participants. Each participant administered 50 g of activated charcoal using the Corflo® and Comforsoft® nasogastric tubes in a random sequence interspersed with a 2-hour washout period. We compared the difference in the time required for activated charcoal administration with a pre-defined non-inferiority margin of 300 seconds and the perceived level of effort between the two nasogastric tubes. Results: The mean time for administering 50 g of activated charcoal through the Comforsoft® and the Corflo® nasogastric tube were 87.1 s and 301.6 s, respectively. The mean difference of 203.2 s (95% confidence interval: 147.5–258.9, p < 0.001) was within the non-inferiority margin. The perceived level of effort was significantly higher with the Corflo® nasogastric tube (mean effort score 7.0 vs 1.4, p < 0.001). Conclusion: Our study provides experimental data to support the use of the Corflo® nasogastric tube as a non-inferior alternative to the usual nasogastric tube in administering activated charcoal to poisoned emergency department patients. More studies are warranted to verify the findings and optimise the settings for AC administration.

Objective: To externally validate the use of the Oakland score in identification of low-risk lower gastrointestinal bleeding patients who can be safely managed without hospitalisation in an accident and emergency department in Hong Kong. Methods: This single-centre retrospective cohort study included adult patients who attended the accident and emergency department for lower gastrointestinal bleeding and were subsequently admitted to hospital from 1 January 2020 to 31 December 2020. Safe discharge was defined as absence of all of the following adverse outcomes after hospital presentation: blood transfusion; therapeutic colonoscopy, mesenteric embolisation, or laparotomy for bleeding; in-hospital death (all causes); and readmission with subsequent lower gastrointestinal bleeding within 28 days. The sensitivities, specificities and area under the receiver-operating characteristic curve of the Oakland score were calculated. Results: Among 376 patients who were included in this study, 114 (30.3%) of them experienced one or more adverse outcomes. The area under the receiver-operating characteristic curve for safe discharge was 0.88 (95% confidence interval, 0.84–0.91). Using an Oakland score threshold of ⩽8 points as in the original derivation study can achieve 100% sensitivity (95% confidence interval, 96.8%–100%) and 7.3% specificity (95% confidence interval, 4.4%–11.1%) for safe discharge. When the Oakland score threshold was extended to ⩽11 points, a much greater proportion of low-risk patients could be identified, with 97.4% sensitivity (95% confidence interval, 92.5%–99.5%) and 32.8% specificity (95% confidence interval, 27.2%–38.9%) for safe discharge. Conclusion: The Oakland score performed well in identification of lower gastrointestinal bleeding patients who were at low risk of experiencing adverse outcomes and could thus be safely managed without hospitalisation. Extension of the Oakland score threshold to ⩽11 points can allow identification of a greater proportion of low-risk patients while sensitivity is reasonably maintained.

Background: Despite the increasing demand for procedural sedation and analgesia training, the number of available instructors remains limited. Objective: The aim of this study is to compare distance education with in-person learning for knowledge acquisition and participant satisfaction in procedural sedation and analgesia education. Methods: We conducted a randomized controlled trial comparing distance education with in-person learning in Japan on three occasions. Twenty participants per course were randomly divided into five groups with stratification by year of graduation. The groups were randomized to either a distance education group or an in-person group. We conducted pre- and post-testing of procedural sedation and analgesia knowledge and surveyed participants’ perceptions by using a scale ranging from 0 (not enough) to 100 (enough). Our primary outcomes were knowledge acquisition and the quality of discussion. Results: We included 48 healthcare professionals in the analysis. Forty-one participants (83.6%) were men and the median years of experience was 5 (interquartile range: 3–9). Both groups had similar knowledge acquisition with the pre-test and post-test score difference and reported similar scores on the quality of discussion with the exception of the clarity of audio quality (93 vs 100, p = 0.017). Conclusion: In a randomized trial of distance versus in-person learning for the sedation course, we did not observe statistically significant differences in knowledge acquisition and participant satisfaction between the two groups except for audio quality for the case discussion. Further efforts to improve quality for distance learning in procedural sedation and analgesia education are needed.