BACKGROUND: This case report describes a university student who participated in an orientation activity and developed exertional rhabdomyolysis. METHODS: With prompt intravenous volume expansion started in the accident and emergency department, he made an uneventful recovery despite a marked elevation of creatine kinase. The risk factors of developing exertional rhabdomyolysis were reviewed. Suggestions based on these risk factors were made to the organizers of such orientation programmes. RESULTS: He was discharged on day 6. On follow-up on day 8 after presentation at the accident and emergency department, the CK level was 46000 U/L and it fell to 2600 U/L in another 2 weeks. On follow-up 3 weeks after the incident, he remained well without symptoms. CONCLUSION: For the clinicians, once rhadbomyolysis is suspected or diagnosed, intravenous fluid therapy with a crystalloid should be initiated as soon as possible to prevent the occurrence of acute renal faiure.

PURPOSETo evaluate the performance of a prehospital trauma diversion system in Hong Kong, China.

METHODSA retrospective analysis of prospectively collected data in the trauma registry of Queen Mary Hospital, Hong Kong from 1 January 2009 to 31 December 2013 was done. All adult patients aged 18 years or above, either primarily or secondarily diverted to Queen Mary Hospital according to the trauma patient diversion protocol, were recruited. Need for trauma center level of care was based on a consensus-based criterion standard published in 2014. Performance of the protocol in terms of over- diversion and under-diversion was determined.

RESULTSA total of 209 patients were included for analysis. About 30% of the patients required trauma center level of care. The most common reason was the need for vascular, neurologic, abdominal, thoracic, pelvic, spine or limb-conserving surgery within 24 h of presentation. The over-diversion rate and under- diversion rate were 69.6% and 19.7% respectively.

CONCLUSIONThe trauma patient diversion protocol currently in use in Hong Kong is not accurate enough. Further revision and refinement is needed.

Adult ; Aged ; Aged, 80 and over ; Emergency Medical Services ; Female ; Hong Kong ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Trauma Centers

BACKGROUND: The epidemiological data on elderly patients attending Accident and Emergency Departments (AEDs) in Hong Kong is lacking. The study aimed to examine the epidemiology of geriatric patient visits to AEDs in Hong Kong, including demographic data and predictors of life-saving interventions (LSI) and admission. METHODS: A retrospective cross-sectional study of geriatric patients older than 64 years old attending three AEDs during the year 2012, with a sample of 1200 patient visits recruited. The data were retrieved from the medical records of the respective hospitals. Descriptive characteristics of the visits were provided. Multivariate logistic regression was performed to evaluate the predictors of LSI and hospital admission. RESULTS: The mean age of the patients was 79.1 years. Totally 49.7％ of the patients were male. "Diseases of the respiratory system" was the commonest diagnosis in AEDs as well as that required admission. The admission rate was 56.8％. Logistic regression demonstrated that dependent activity of daily living (ADL), arrival by ambulance, and the higher number of co-morbidities were predictors of LSI, while advanced age, dependent ADL, institutionalized patients, arrival by ambulance, and higher number of co-morbidities were predictors of hospital admission. CONCLUSIONS: Ageing population is creating an imminent burden on the emergency service in Hong Kong. Previously unavailable epidemiological information about geriatric attendance to AEDs was described. This forms the basis for development of future studies concerning the medical services on this specific group of patients.

OBJECTIVEFocused Abdominal Sono-graphy for Trauma (FAST) is widely used for the detection of intraperitoneal free fluids in patients suffering from blunt abdominal trauma (BAT). This study aimed at assessing the diagnostic accuracy of this investigation in a designated trauma centre.

METHODSThis was a retrospective study of BAT patients over a 6 year period seen in a trauma centre in Hong Kong. FAST findings were compared with laparotomy, abdominal computed tomography or autopsy findings, which served as the gold standard for presence of intraperitoneal free fluids. The patients who did not have FAST or gold standard confirmatory test performed, had preexisting peritoneal fluid, died at resuscitation or had imcomplete documentation of FAST findings were excluded. The performance of FAST was expressed as sensitivity, specificity, predictive values (PV), likelihood ratios (LR) and accuracy.

RESULTSFAST was performed in 302 patients and 153 of them were included in this analysis. The sensitivity, specificity, positive PV, negative PV, positive LR, negative LR and accuracy for FAST were respectively 50.0%, 97.3%, 87.0%, 84.6%, 18.8, 0.5 and 85.0%. FAST was found to be more sensitive in less severely injured patients and more specific in more severely injured patients.

CONCLUSIONFAST is a reliable investigation in the initial assessment of BAT patients. The diagnostic values of FAST could be affected by the severity of injury and staff training is needed to further enhance its effective use. Key words: Laparotomy; Autopsy; Tomography, X-ray computed; Tomography, spiral computed; Ultrasonography.

Abdominal Injuries ; diagnosis ; Hong Kong ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed ; Trauma Centers ; Wounds, Nonpenetrating ; diagnosis

BACKGROUND China is the most populated country and the second economic entity worldwide. Hong Kong and Shenzhen are two adjacent cities in southern China, with similar environmental, cultural, ethnic groups, and economic development. They both have a very interesting turning point in their destiny, leading to a miraculous economic development. However, their government structure and health care system are totally different.[1] This is a vivid example of Deng Xiaoping's formulation of the principle of "one country, two systems".