Department Of Emergency Research Articles

Epidemiology of paediatric poisoning presenting to a children's emergency department in Singapore over a five-year period.

Paediatric poisoning accounts for 1% of daily emergency department presentations. The aim of this study was to review the characteristics and outcomes of paediatric patients who presented with drug overdose over a five-year period. We performed a retrospective review of paediatric poisoning cases at KK Women's and Children's Hospital (KKH), the largest children's public hospital in Singapore, from 1 January 2009 to 31 December 2013. A total of 1,208 cases of poisoning were seen in KKH's Department of Children's Emergency during the study period. The gender distribution was about equal, with a slight male predominance. The majority of the poisoning cases were accidental. Slightly more than half of the intentional ingestions were of paracetamol and the majority were female patients belonging to the 12-16 year age group. The bulk of poisonings occurred in children aged 1-4 via the oral route, slightly more than half of the oral ingestions consisted of oral medications and a sizeable portion were of household liquids. Mothballs and silica gels accounted for almost a quarter of the solid household products ingested. Slightly less than half of the patients required admission and only a small portion of the admitted patients required intensive or high dependency care. The prognosis of paediatric patients who presented with poisoning in our study was good, with a short median length of stay for those admitted and no fatalities being reported across the span of five years.

Interposed abdominal pulling-pressing cardiopulmonary resuscitation improve the resuscitation effect for patients with cardiac arrest

To study the impact of interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) for patients with cardiac arrest (CA). A prospective study was conducted. A total of 122 CA patients admitted to Department of Emergency of Shandong Provincial Mining Industry Group Company Central Hospital from July 2013 to December 2017 were enrolled. They were divided into standard cardiopulmonary resuscitation (S-CPR) group (n = 62) and IAPP-CPR group (n = 60) according to order of admission. The patients in S-CPR group received external cardiac compression, open airway, endotracheal intubation, mechanical ventilation, routine drug rescue, and defibrillation when ventricular fibrillation was found. And the patients in IAPP-CPR group received the IAPP-CPR on the basis of the routine chest compression. During the relaxation period, the patients were subjected to abdominal lifting and compressing with amplitude of 4-5 cm, frequency of 100 times/min, and the time ratio of lifting to compressing was 1:1. The data of demographics and clinical signs of patients were collected. The markers of respiratory and circulatory performance of all patients after CPR were determined. The rates of restoration of spontaneous circulation (ROSC), successful resuscitation, and the prognosis were recorded. With the success of CRP as the dependent variable, the factors with statistical significance showed by univariate analysis were used as the independent variable to carry out two classification Logistic regression analysis for screening the influence factors of CPR success. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of various factors on the success of CPR. 122 patients were enrolled in the analysis. Compared with the S-CPR group, heart rate (HR), mean arterial pressure (MAP), arterial partial pressure of oxygen (PaO2), and end-tidal carbon dioxide partial pressure (PETCO2) were significantly increased at 30 minutes after CPR in IAPP-CPR group [HR (bpm): 66.3±11.5 vs. 53.1±12.6, MAP (mmHg, 1 mmHg = 0.133 kPa): 65.4±6.5 vs. 53.2±5.4, PaO2 (mmHg): 77.7±11.8 vs. 61.8±14.3, PETCO2 (mmHg): 45.5±9.6 vs. 31.8±8.2, all P < 0.05], and arterial partial pressure of carbon dioxide (PaCO2) and lactic acid (Lac) were significantly lowered [PaCO2 (mmHg): 46.7±6.2 vs. 57.9±9.5, Lac (mmol/L): 2.1±1.5 vs. 4.4±2.2, both P < 0.05]. The time of CA to ROSC in IAPP-CPR group was significantly shorter than that in S-CPR group (minutes: 6.3±1.8 vs. 11.2±1.4, P < 0.05), the ROSC rate and CPR success rate were significantly higher than those in S-CPR group [ROSC rate: 61.7% (37/60) vs. 43.5% (27/62), CPR success rate: 40.0% (24/60) vs. 21.0% (13/62), both P < 0.05], and 24-hour survival rate and survival and discharge rate of patients were significantly higher than those in the S-CPR group [24-hour survival rate: 46.7% (28/60) vs. 29.0% (18/62), survival and discharge rate: 20.0% (12/60) vs. 11.3% (7/62), both P < 0.05]. Logistic regression analysis showed that PaO2, PaCO2 and PETCO2 were the factors that affect the success of CPR [PaO2: β= -3.76, odds ratio (OR) = 0.23, 95% confidence interval (95%CI) = 0.12-0.86, P = 0.031; PaCO2: β= 1.41, OR = 4.09, 95%CI = 1.70-9.82, P = 0.002, PETCO2: β= 0.78, OR = 2.18, 95%CI = 1.42-3.35, P = 0.000]. ROC curve analysis showed that the above three factors had good predictive value for the success of CPR. The predictive value of PaCO2 and PETCO2 were better, the area under ROC curve (AUC) was 0.93 and 0.92, respectively, when the cut-off values was 46.7 mmHg and 48.8 mmHg, the sensitivity was 92.0%, 88.0%, respectively, and the specificity was both 94.3%. PaO2, PaCO2 and PETCO2 are the factors that influence the success of CPR. PaCO2 and PETCO2 have great value in predicting the success of CPR. Compared with the S-CPR group, IAPP-CPR group results in better hemodynamic and pulmonary ventilation effects, and remarkably improve ROSC and successful resuscitation. IAPP-CPR has obvious clinical value for CA patients.

Predictive values of different critical scoring systems for survival rate after discharge in critically ill patients supported by extracorporeal membrane oxygenation

To determine the predictive values of different critical scoring systems for survival rate after discharge in critically ill patients supported by extracorporeal membrane oxygenation (ECMO). The clinical data of 34 critically ill patients supported by ECMO admitted to Department of Emergency of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital) from July 2015 to September 2017 were retrospectively analyzed. The general information and the worst values of vital signs and related pathophysiological indicators within 12 hours before ECMO treatment of patients were collected, and sequential organ failure assessment (SOFA), multiple organs dysfunction score (MODS), simplified acute physiology score II (SAPS II), and acute physiology and chronic health evaluation IV (APACHE IV) scores were calculated. The patients were divided into survival group and non-survival group according to 28-day survival after hospital discharge. General clinical characteristics and aforementioned scores were compared between the two groups. Scoring systems for predicting prognosis were assessed by using the receiver operating characteristic (ROC) curve. The Kaplan-Meier method was used to depict the surviving curve. Thirty-four patients were finally enrolled, 13 of whom were dead at the follow-up period of 28 days after hospital discharge, and 21 survived. Duration of ECMO support in non-survival group was significantly shorter than that in survival group (hours: 101.4±7.8 vs. 134.4±12.6), SOFA, SAPS II, and APACHE IV scores were significantly higher than those of survival group (SOFA score: 10.6±3.6 vs. 8.8±3.3, SAPS II score: 38.7±14.3 vs. 31.8±12.5, APACHE IV score: 46.5±15.5 vs. 38.1±11.3, all P < 0.05). There was no significant difference in gender, age, body mass index (BMI), vital signs or related pathophysiological indicators within 12 hours before ECMO treatment, or MODS score between the two groups. ROC curve analysis showed that the area under ROC curve (AUC) of SAPS II score for predicting 28-day survival rate was the highest, which was significantly higher than that of SOFA, MODS, and APACHE IV score (0.880 vs. 0.694, 0.654, 0.682, all P < 0.05). When the best cut-off value of SAPS II score was 43, the sensitivity was 81.2%, and the specificity was 77.9%. Kaplan-Meier survival analysis showed that 28-day survival rate after hospital discharge in patients with SAPS II score < 43 (n = 18) was significantly higher than that in patients with SAPS II score ≥ 43 (n = 16; χ2 = 2.444, P = 0.018). Four critical scoring systems of SOFA, MODS, SAPS II and APACHE IV have been proved to have good prognostic ability to predict 28-day survival after hospital discharge in critically ill patients supported by ECMO. Among them, SAPS II score system has more accurate prediction value.

PERBEDAAN KADAR PROLYLCARBOXYPEPTIDASE DI PASIEN SINDROM KORONER AKUT DENGAN PASIEN ANGINA STABIL (The Difference of Prolylcarboxypeptidase Level in Acute Coronary Syndrom and Stable Angina Patient)

Coronary arterial disease (CAD) is the main cause of mortality across many countries throughout the world. Formation ofatherosclerosis plaque is the early cause for cardiovascular dysfunction in CAD. Detecting of atherosclerosis plaque instability is veryimportant to predict the risk of acute coronary syndrome (ACS). Various biomarkers have been studied to find the good marker fordetecting atherosclerosis and its instability, but until now there is no biomarker meet the requirements to be used in routine clinicaltests. Prolylcarboxypeptidase (PRCP) is the alternative parameter in the detection of atherosclerosis, assessing the degree of its plaqueand instability in CAD patients. The benefits of PRCP level test in serum, compared to angiography that is currently used in the detectionof atherosclerosis plaque is that this test is non-invasive, provides quantitative level information, able to estimate the instability of theplaque and the fact that it is a laboratorial test that can be performed in hospitals with less advance facilities. The aim of this study isto know the different PRCP level between ACS and stable angina patients by determination. This study was held in the period betweenMarch–May 2014, in Rumah Sakit dr. Hasan Sadikin Bandung. The subjects were selected on the basis of consecutive sampling onpatients that are presented in the Emergency Departement and Cardiovascular Clinic. From 88 patients consisted of 44 patients withACS and 44 patients with stable angina, were tested for PRCP level in the serum using the ELISA sandwich method. This study wascarried out by observational design with cross sectional method. The statistical analysis uses the Saphiro Wilk data normality test,Mann Whitney test and Kruskal Wallis test. There was no characteristic difference between the two groups. This research identifiedsignificant difference of PRCP level between the ACS group and stable angina (P=0.005). Prolylcarboxy peptidase level in the ACS group(156,3í—102 pg/mL) is higher compared to the stable angina (143.8í—102pg/mL). PRCP level test hopefully can be recommended asone of the laboratorycal parameter in measuring the degree and instability of atherosclerosis plaque, in the absence of angiography orintravascular ultrasonography test facility.

Influence of intravenous thrombolysis on prognosis of acute ischemic stroke in patients with moderate to severe leukoaraiosis

Objective: To investigate the influence of intravenous thrombolysis on prognosis of acute ischemic stroke in patients with moderate to severe leukoaraiosis and to analyze influencing factors of the clinical prognosis. Methods: We consecutively included acute ischemic stroke patients with middle cerebral artery occlusion (n=101) from Department of Neurology or Emergency, and patients were divided into two groups according to whether on intravenous thrombolysis therapy (IVT) or not. The Fugl-Meyer scale score (FMS) was used to assess motor function outcome and the National Institutes of Health Stroke Scale (NIHSS) score was used to assess neurologic function. Clinical data were obtained and compared between the two groups. Patients were followed up for 90 days, the primary clinical endpoint events included stroke recurrence and death, and the key secondary endpoint events included other vascular events after IVT. Multivariate linear regression analysis was used to analyze the relevant factors influencing the motor function 90 days later. Results: Among the 101 enrolled patients, 37 (36.6%) were classified as IVT group and 64 (63.4%) as no IVT group. In IVT group, hemorrhagic transformation and symptomatic intracranial hemorrhage were observed in 32.4% (12/37) and 13.5% (5/37) of the patients, which were higher than those in the no IVT group (9.4% (6/64) and 1.6% (1/64) , respectively) (χ(2)=8.511, P=0.004; χ(2)=5.993, P=0.014). And there was no significant difference between the two groups in NIHSS score and FMS score at any time point. In addition, there was no significant increase in 90-day FMS score in the two groups compared with the FMS score on admission (83±9 vs 80±12; 86±8 vs 80±10). After followed up for 90 days, the primary clinical endpoints were obtained in 32 patients (32/101; 31.9%), including 18 cases of stroke recurrence (18/101; 17.8%) and 14 cases of death (14/101; 13.9%). No significant difference was found in primary clinical endpoints between the two groups. Multivariate linear regression analysis revealed that symptomatic intracranial hemorrhage (t=-2.318; P=0.023), baseline NIHSS score (t=-4.263; P=0.000), recurrent stroke (t=-9.114; P=0.000) and hemorrhage transformation (t=-2.121; P=0.037) were risk factors of poor 90-day motor function recovery, but not application of intravenous thrombolysis therapy (t=0.328; P=0.744). Conclusions: Acute ischemic stroke patients with moderate to severe LA have higher risk of hemorrhagic transformation and symptomatic intracranial hemorrhage after intravenous thrombolysis. However, there is no association of intravenous thrombolysis therapy with motor function recovery.

TCTAP C-118 Complications During Rotablator Atherectomy in Heavily Calcified and Tortuous Right Coronary Artery

### Patient Initials or Identifier Number S.F.L. ### Relevant Clinical History and Physical Exam The 78-year-old female with past history of diabetes mellitus and hypertension presented to our emergent department with chest pain and cold sweating. ECG revealed ST-segment depression over lateral

KORELASI ANTARA NEURON-SPECIFIC ENOLASE SERUM DAN GLASGOW COMA SCALE DI PASIEN CEDERA KEPALA

The outcome after head injury is mostly determined by Glasgow Coma Scale (GCS) and the degree of brain damage which reveals.CT scan is also important to assess its severity. However relatively it is not in a less costly manner and sometimes patients mobilisationare needed. Brain damage due to traumatic head injury refers to homeostasis unbalance, and it is the important causes of releasingbiochemical analyte from neuron via injured blood brain barrier to circulation. Neuron-specific enolase as a glycolytic enzyme in neuroncytoplasm might increase. Hopefully, measurement of NSE levels can provide information about the extent of the disease. The objectiveof the study is to test the correlation between the Neuron Specific Enolase (NSE) serum as a one of biochemical marker of brain injuryand the GCS. For this purpose, a cross sectional, analytical observasional study was carried out at the Emergency Departement andDepartement of Clinical Laboratory, Sardjito General Hospital, Yogyakarta, Indonesia. Fifty-one patients selected by an eligible criteriawere included in the study, which consist of severe, moderate and mild head injury. Blood samples were collected and serum NSE wasmeasured by immunoanalyzer using Electro Cheluminescence ImmunoAssay (ECLIA). Chi square test was used to test the differenceproportion of the group: NSE ≥ 21.7 ng/mL and NSE &lt; 21.7 ng/mL according to measured variables, and Spearman correlation testwas used to correlate serum NSE and GCS, and other variables. In the study fifty-one patients with head injury were included, 74.5%of patients were males and 68.6% is in the age of 15–45 years old. The patients were further divided into two groups on the basis ofserum NSE ≥ 21.7 ng/mL and &lt; 21.7 ng/mL; the former group was dominated by severe head injury patients (54.1%). In addition, aproportion of non survivors (66.6%) in group NSE ≥ 21.7 ng/mL was higher compared to those in NSE &lt; 21.7 ng/mL group. Moreover,a large number of mild head injury (95.45%) and survivors (83.33%) had lower serum NSE (&lt; 21.7 ng/mL). In the study, was found anegative correlation between serum NSE and GCS (r = -0.552; p = 0.00). Also, serum NSE were inversely correlated with blood kaliumand hemoglobin (r = -0.162; p = 0.027 dan r = -0.376; p = 0.009), in contrast with leucocytes count (r = 0.485; p = 0.001). Theconclusion so far there was a negative correlation between serum NSE and GCS. It is suggested that neuron-specific enolase can be veryuseful as a biochemical marker in assesssing the severity of head injury. Therefore, it is nessessary to carry out the prognostic study toknow to what extent it can predicting the outcomes.

Serum levels of irisin predict short-term outcomes in ischemic stroke

ObjectiveIrisin is a 112-amino acid peptide found in rat and human skeletal muscle after exercise. Previous studies had suggested that higher circulating irisin levels were associated with an increased risk of vascular atherosclerosis and cardiovascular diseases. In this study, we determined irisin levels in serum, and investigated their associations with functional outcomes in a 3-month follow-up study in Chinese patients with first-ever acute ischemic stroke (AIS). MethodsFrom September 2015 to December 2016, consecutive first-ever AIS patients admitted to the Department of Emergency of our hospital were identified. Serum irisin levels were measured at admission. Functional impairment was evaluated at discharge using the modified Rankin scale. The levels of irisin were expressed as median and interquartile ranges [IQR]. ResultsThe irisin level was obtained in 324 patients (97.6%) with a median value of 291.2 ng/ml (IQR: 214.1–404.2 ng/ml). There were significantly negative correlations between levels of irisin and NHISS (r = −0.272; P < 0.001) and BMI (r = −0.193; P = 0.003). A poor functional outcome was found in 99 patients (30.6%; 95%CI: 25.5–35.6%). The poor functional outcome distribution across the irisin quartiles ranged between 51.9% (first quartile: Q1) to 12.4% (fourth quartile: Q4). In a multivariate model using the Q1 of irisin vs. Q2-4 together with the clinical variables, the marker displayed prognostic information and increased risk of poor outcomes by 94% (OR for Q1, 1.94 [95% CI, 1.19–3.42]; P = 0.018) and mortality 66% (OR for Q1, 1.66 [95% CI, 1.11–3.07]; P = 0.009). In addition, a model containing known risk factors plus irisin compared with a model containing known risk factors without irisin showed a greater discriminatory ability to predict poor outcomes (P = 0.01) and mortality (P = 0.02). ConclusionsA low serum irisin level is a predictor of poor early functional outcome in ischemic stroke patients. The underlying mechanisms of these associations remain to be investigated.

Interventional treatment experience in multiple injury with major abdominal or pelvic injuries: 160 cases analysis

PurposeTo observe the therapeutic effect of interventional embolization and haemorrhage control in multiple trauma patients with a major abdominal or pelvic injury. MethodsData of 160 multiple trauma patients with a major abdominal or pelvic injury were retrospectively analyzed. They were admitted into the Department of Emergency of the First Affiliated Hospital of Zunyi Medical College from October 2013 to April 2016. Eighty-seven patients who received emergent intervention for embolization and haemorrhage control were set as group A, including 72 males and 15 females, with an average age of (39.32 ± 14.0) years. Patients underwent emergent intervention for embolization and hemostasis. The other 73 patients who received traditional surgeries were set as group B, including 62 males and 11 females, with an average age of (38.48 ± 13.12) years. The time from admission to emergency intervention, the time of interventional embolization, transfusion during hospitalization, length of stay and prognosis were observed. The whole treatment and prognosis were compared between group A and group B. ResultsIn group A, the average time from admission to intervention exploration was (132.05 ± 86.80) min, the average operation time was (149 ± 49.69) min, the average hospitalization time was (18.37 ± 4.71) days, the average amount of RBC transfusion during hospitalization was (7.2 ± 4.33) units, and the mortality was 4.60% (4 patients died). The corresponding data in group B were respectively (138.95 ± 82.49) min, (183 ± 52.39) min, (22.72 ± 6.63) days, (12.23 ± 5.43) units, and 9.59% (7 cases died). There was no statistical difference in the time from admission to operation between the two groups (p > 0.05), but there was statistical difference in operation time, RBC transfusion, hospitalization time, prognosis, and mortality between the two groups (all p < 0.05). ConclusionThe emergent intervention for embolization and haemorrhage control of multiple trauma patients with a major abdominal or pelvic injury and visceral organ haemorrhage has the advantages of less trauma, shorter operation time, shorter hospital stay, less blood transfusion in comparison to the traditional emergency surgeries.

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. ‘Other’ ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal ‘need’, including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.

Profile of Medico-legal Cases Admitted in the Department of emergency F.H.M.C., tundla, Uttar Pradesh

Profile of Medico-legal Cases Admitted in the Department of emergency F.H.M.C., tundla, Uttar Pradesh

To study the epidemiological and clinical profile of ocular trauma at a tertiary health-care facility

Aim To study the profile of ocular trauma and to find out its risk factors. Settings and design This is a prospective hospital-based study that included patients of ocular trauma presenting to the Department of Ophthalmology and Emergency, Guru Gobind Singh Medical College and Hospital, Faridkot, India during the period from May 2015 to November 2016. Patients and methods The study included patients with recent history of trauma ( Results A total of 200 patients were studied. Men had twofold higher rates of injury than women. The predominant age group was between 21 and 30 years with a mean age of 29.87±12.46 years. Daily laborers were most frequently involved in trauma (n=64; 32%). The workplace trauma was the most common mode accounting for 27.5% of the cases and was most commonly sustained by laborers (50.90%). Metallic objects were responsible in 28.5% followed by vegetative matter (11%). Mechanical trauma was present in 94.5% while 5.5% suffered from chemical trauma. In 94.5% cases with mechanical trauma, 60.5% sustained closed globe injuries and 26% had open globe injuries. Contusions and penetrating injuries were the most common in closed and open globe injuries, respectively. Corneoscleral perforation was the most common clinical presentation in 50 patients. Forty-two percent of patients required only medical management and 58% required surgical management with the most frequent being corneal/scleral perforation repair. Conclusion Workplace-related eye injuries were noted in a significant number of cases. Strict implementation of health education and preventive strategies especially at the workplace will help to decrease the occurrence of ocular injuries.

Knowledge and Practice of Exclusive Breastfeeding Among Mothers Seen at the University of PortHarcourt Teaching Hospital

Exclusive breastfeeding for the first six months of life is a natural, cost effective and feasible intervention that promotes child survival. Exclusive breastfeeding has been promoted severally but its practice has remained poor in Nigeria. This study aims to determine the knowledge and practice of exclusive breastfeeding among mothers who bring their children to the department of Paediatrics University of Port Harcourt Teaching Hospital. This was a descriptive cross-sectional hospital based study carried out from January 2012 to December 2013. A total of three hundred mothers presenting with their children for treatment at the Department of Paediatrics outpatient clinics, emergency and children medical wards were consecutively recruited into the study. Data on demographics, marital status, socioeconomic characteristics, knowledge and practice of breastfeeding were obtained using a structured self-administered questionnaire. The respondents were aged between 18 and 55years with a mean age of 31.59+6.6years. Most of the women were between 26-35years, majority (39%) were aged 25-30years and majority(89.3%) were married. Thirteen percent had no formal education while majority (63.8%) had tertiary education. Ninety eight percent of the respondents had heard about EBF. Knowledge of the correct meaning of EBF was 91.3% while awareness of the benefits of EBF was 69.3%. Thirty five (11.7%) practiced EBF for the first 6months. More than half (57.7%) of the respondents initiated breastfeeding within 1hour of delivery while 24.7% did so after 1hour but within 24hours of delivery. One hundred and twenty seven (42.3%) of the mothers had given prelacteal feeds to their babies. Of those who gave prelacteal feeds, 8.6% gave plain water, 6.3% glucose water, and 0.3% infant formula and herbs. In conclusion, the practice of exclusive breastfeeding in this study is very low and therefore there is an urgent need to scale up programmes that will promote exclusive breastfeeding in our region.

The Effect of Concurrent Tetanus-diphtheria Vaccination on the Antibody Response to Rabies Vaccine: A Preliminary Study.

The number of studies in the literature investigating the effect of tetanus vaccination on rabies prophylaxis is rather limited. In this study, we aimed to investigate the effect of concurrent tetanus-diphtheria (Td) vaccination on the antibody response to rabies vaccine. The data of consecutive 80 patients who presented to Sakarya University Training and Research Hospital, Department of Emergency due to rabies suspected exposure between 15 October 2012 and 12 June 2013 were enrolled to this study. Postexposure rabies prophylaxis had been given to all cases, however concurrent tetanus vaccination had been administered to some of them according to their need. Cases were divided into two parts according to their receipt of tetanus prophylaxis as rabies only group (group R, n=37), and rabies and tetanus-diphtheria group (group R+Td, n=43). Rabies antibody levels were tested in sera of the cases at first and postvaccination 21st day. The median antibody levels of each group were measured and compared with each other statistically. In our study, postvaccination 21st day antibody level of group R was 0.68 IU/ml (IQR: 0.79), while the same for group R+Td was 0.52 IU/ml (IQR: 0.48) (p=0.022). Concurrent administration of Td vaccine was found to have a significant negative effect on the antibody response to rabies vaccine. Our results should be confirmed with further studies including more cases.

Clinical application of VSD negative pressure aspiration and detoxification in severe snake bite

To assess the clinical efficacy of vacuum sealing drainage (VSD) in the treatment of mixed poisonous snake bite. A prospective study was conducted. Forty-three snake bite patients by mixed poisonous snakes admitted to Department of Emergency of the 175th Hospital of People's Liberation Army from February 2015 to February 2017 were enrolled. All patients were divided into routine treatment group (n = 20) and VSD treatment group (n = 23) according to whether early incision decompression and using the VSD technique. The patients in the routine treatment group were treated with injection of antivenoms, Jidesheng snake tablets external coating, and wound incision detoxification. Beside the routine treatments, patients in the VSD treatment group were treated with incision decompression and the VSD suction aspiration for the swelling limb. Bite wound infection rate, local skin necrosis area, maximum level of C-reactive protein (CRP), length of hospital stay and disability rate were compared between the two groups. Forty-three patients were followed up for 6-12 months with average of (10.3±1.4) months postoperatively. There were no deaths in both groups. Compared with the routine treatment group, wound infection rate in the VSD treatment group was significantly lowered [8.7% (2/23) vs. 40.0% (8/20)], local skin necrosis area was significantly reduced (cm2: 4.2±0.8 vs. 6.0±1.3), the maximum CRP was significantly lowered (mg/L: 50.0±12.1 vs. 68.0±13.4), the hospitalization time was significantly shortened (days: 11.7±2.9 vs. 17.7±4.9), and the difference above was statistically significant (all P < 0.05). The disability rate of the VSD treatment group was lowered as compared with routine treatment group [13.0% (3/23) vs. 13.0% (6/20)] without statistically significant difference. Early incision decompression and VSD pressure suction of the swelling limb associated with combination therapy of drugs is a reliable and effective method for severe snakebite, and can promote physical rehabilitation and shorten hospital stay.

Adherence rate of quality-of-care indicators for Staphylococcus aureus bacteremia is extremely low in Japanese emergency and critical care departments: a multicenter retrospective observational study.

Aim Staphylococcus aureus bacteremia causes significant morbidity and mortality and requires specific management to prevent complications. Most studies evaluating quality of care have been carried out in Europe and North America, and accurate epidemiological data are lacking in Asia. We aimed to describe the epidemiology and evaluate the quality of care for S. aureus bacteremia in Japan.MethodsFrom February 2011 to January 2014, we undertook a multicenter retrospective observational study in 10 departments of emergency and critical care in Japan. We included 118 hospitalized adult patients with S. aureus bacteremia and evaluated three quality‐of‐care indicators: follow‐up blood culture, treatment duration, and echocardiography.ResultsThe mean age of the patients was 63.5 ± 17.0 years. The major source of bacteremia was pneumonia (n = 22, 19%), followed by skin and soft tissue infection (n = 18, 15%). Thirty patients (25%) died in the hospital. Follow‐up blood culture was performed in 21/112 patients (19%). The duration of antimicrobial treatment was sufficient in 49/87 patients (56%). Echocardiography for patients with clinical indication was undertaken in 39/59 patients (66%). Any of the three indicators were inadequate in 101/118 (86%).ConclusionThe rate of adequate care for S. aureus bacteremia is low in Japan. The low adherence rate for follow‐up blood culture was particularly notable. Staphylococcus aureus bacteremia can be an important target of quality improvement interventions.

Exploring the multiple disciplinary model of emergent extracorporeal membrane oxygenation for cardiac arrest patients

Objective To explore the multiple disciplinary model of emergent extracorporeal membrane oxygenation (ECMO) for cardiac arrest (CA) patients. Methods A retrospective investigation was done to analyze the general material, multiple disciplinary corporations, the complication and its treatment of patients who underwent emergent ECMO for non-surgery CA from January 2016 to August 2017. Results Three patients were all men with mean age 45.3±20.3 years. Their mean cardiopulmonary resuscitation duration was 34±10 min, and 2 patients returned to spontaneous circulation, yet hemodynamics instability. 2 patients discharged with cerebral performance category 1-2, however the third died. 3 cannulation of femoral artery and venous were all operated by cardiac surgery using surgical exposure via open cutdown. Mean duration of CA to ECMO pump-on was 132±93 min, while the mean duration of ECMO was 3 858±1 092min. The implementation and maintenance of ECMO needed collaboration of emergent physicians, cardiovascular medicine and surgeon, anesthetists, nurses and so on. At the same time, incision site oozing blood, platelet counting decreasing, coagulopathy and other complications would occur, which needed interventional vascular surgeon and blood bank to participate in. Conclusions Emergent ECMO for CA patients need corporations of prehospital emergent medical system, emergent physicians, cardiovascular physicians and surgeons, anesthetists, perfusionists, blood bank and so on. Establishing coordination and cooperation model of multiple disciplinary quick response team with emergency department as the guide is the important guarantee for emergent department developing emergent extracorporeal resuscitation. Key words: Cardiac arrest; Emergent extracorporeal membrane oxygenation; Multiple disciplinary networks; Model

A clinical study of cerebral venous thrombosis

Background: Cerebral venous thrombosis (CVT) is an uncommon form of stroke, usually affecting young population. Clinical features of CVT are diverse, and for this reason, high degree of clinical suspect is mandatory to diagnose the conditions. The objectives of the study were to analyse the commonest clinical modes of presentation, possible etiologies, and to evaluate clinical outcome.Methods: This study was prospective, clinical study was conducted on 40 patients during the period of September 2010 to September 2011 in the Department of Emergency, Institute of Internal medicine at Government General Hospital (GGH), Chennai. All the patients included in the study were subjected to neuroimaging techniques like Computed tomography (CT), magnetic resonance imaging (MRI) along with magnetic resonance venography (MRV) according to guidelines and standard protocol.Results: Majority of the patients involved in the study were in the age group of 15-35 years contributing to 75%. Male: female ratio was 1.5: 1. Headache was the most common presenting symptom seen in 36 (87.5%) cases followed by convulsions in 32 (80%) patients. Altered sensorium was observed in 26 (65%), focal deficits in 22 (55%), and 18 (45%) had fever. Two of them had ear discharge and another with diarrhea. Cranial nerve involvement in 35% and pappiledema was noted in 20% of patients. Out of 40, 17 (42.5%) patients were anemic. Eighteen (18) patients who were suspected of meningitis underwent CSF analysis. Abnormality was seen in 10 patients with pleocytosis being the maximum. On CT scan, haemorrhagic infarct was seen in 22 (55%) cases followed by edema in 8 (20%) and 10% showed normal CT picture. On MRI scan, superior sagittal sinus thrombosis was observed in 24 (60%) patients followed by transverse sinus in 20 (50%) patients. Etiology factor were identified in 25 (62.5%) of patients and in 15 (37.5%) cases risk factors could not be identified. The mortality rate in the study was 20%.Conclusions: The clinical symptoms of CVT are not specific, as a result of chances of misdiagnosis tends to be more. CT scan and MRI along with MRV can improve the precision of CVT diagnosis.

The application of biomarkers in early identification and risk stratification of acute chest pain

Chest pain is among the most frequent cause of emergence department (ED) encounters. The etiological factors of chest pain are various and complex, which make early diagnosis remains a clinical challenge. Even worse, on account of the difficulty in rapid risk stratification, some high-risk patients didn't get optimal therapy, whereas low-risk patients got unnecessary hospitalization and extensive evaluation. With the quick development of biomarkers, early diagnosis and risk stratification becomes possible. In this paper, a systemic review of these biomarkers was performed.(Chin J Lab Med, 2017, 40: 677-681) Key words: Chest pain; Acute pain; Early diagnosis; Diagnosis, differential; Risk factors; Biological markers

Analysis of 139 patients with wide QRS complex tachycardia in emergency departent

Objective To study the clinical characterics of 139 patients with wide QRS complex tachycardia. Methods Retrospective analysis was performed on 139 patients with QRS wave tachycardia treated by radiofrequency ablation at TEDA International Cardiovascular Hospital. The patients were divided into supra-ventricular tachycardia with intra-ventricular aberrany group(group A, n=84) and ventricular tachycardia(group B, n=55). The clinical data, electrocardiogram(ECG) and echocardiographic features between the two groups were compared. Results There was no statistical significance between the two groups in terms of gender, height, weight and ventricular rate(P>0.05). The difference in the course of disease, blood pressure, age, QRS duration, left ventricular diameter by echocardiography and ejection fraction was statistically significant(P<0.05). Radiofrequency ablation result showed that 81 (96.4%) cases were successful in group A, and 37(67.3%) cases were successful in group B. The difference in the success rate was statistically significant(P<0.05). After 1 year of follow-up, 4 (2.9%) cases in group A were recurred, 13 (23.6%)cases in group B were recurred. The difference in the recurrence rate was statistically significant. Conclusion The wide QRS wave tachycardia is often accompanied with left ventricular diameter enlargement and left ventricular ejection fraction reduction, The success rate of radiofrequency ablation is low, and the recurrence rate is high when diagnosis is ventricular tachycardia. Key words: Tachycardia; Wide QRS complex; Electrocardiogram; Differential diagnosis; Emergency department