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Li PH, Chua GT, Leung ASY, Chan YC, Chan KKL, Cheung KH, Chong PCY, Ho PPK, Kwan MYW, Lai JCH, Lam KK, Lam TSK, Leung TF, Li TY, Duque JSR, So JLT, Wan KA, Wong HCY, Wu AYY, Lee TH, Ho MHK, Siu AYC. Hong Kong Anaphylaxis Consortium Consensus Statements on prescription of adrenaline autoinjectors in the acute care setting. Asia Pac Allergy 2021; 11:e1. [PMID: 33604271 PMCID: PMC7870372 DOI: 10.5415/apallergy.2021.11.e1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022] Open
Abstract
Background Adrenaline autoinjectors (AAInj) facilitates early administration of adrenaline and remains the first-line treatment for anaphylaxis. However, only a minority of anaphylaxis survivors in Hong Kong are prescribed AAInj and formal guidance do not exist. International anaphylaxis guidelines have been largely based on Western studies, which may not be as relevant for non-Western populations. Objective To formulate a set of consensus statements on the prescription of AAInj in Hong Kong. Methods Consensus statements were formulated by the Hong Kong Anaphylaxis Consortium by the Delphi method. Agreement was defined as greater than or equal to 80% consensus. Subgroup analysis was performed to investigate differences between allergy and emergency medicine physicians. Results A total of 7 statements met criteria for consensus with good overall agreement between allergy and emergency medicine physicians. AAInj should be used as first-line treatment and prescribed for all patients at risk of anaphylaxis. This should be prescribed prior to discharge from the Accident and Emergency Department together with an immediate referral to an allergy center. The decision for prescribing AAInj should be based on the severity of previous reactions; including objective signs of respiratory involvement, objective signs of cardiovascular involvement and multiorgan involvement (regardless of severity). Patient demographics and comorbidities, specifically history of asthma or chronic obstructive pulmonary disease, should also be considered. Patients deemed eligible for AAInj should be offered avoidance advice and prescribed one AAInj while awaiting review by allergists. AAInj technique should be demonstrated by a healthcare professional or instruction video, and a return demonstration by the patient is required. The patient should also be counseled that the decision on the continued need of AAInj prescription in the long-term should be reviewed by an allergist. Conclusion Consensus statements support the prescription of AAInj by front-line physicians with subsequent allergist review when treating patients at risk of anaphylaxis in Hong Kong.
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Affiliation(s)
- Philip H Li
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Gilbert T Chua
- Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Agnes S Y Leung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Yiu-Cheung Chan
- Accident & Emergency Department, United Christian Hospital, Hong Kong
| | - Karen K L Chan
- 24-Hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, Hong Kong
| | - Koon-Ho Cheung
- Accident & Emergency Department, Prince of Wales Hospital, Hong Kong
| | | | - Polly P K Ho
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong
| | - Mike Y W Kwan
- Department of Paediatrics & Adolescent Medicine, Princess Margaret Hospital, Hong Kong
| | - Jeffrey C H Lai
- Accident & Emergency Department, Tin Shui Wai Hospital, Hong Kong
| | - Kin-Kwai Lam
- Accident & Emergency Department, United Christian Hospital, Hong Kong
| | - Tommy S K Lam
- Accident & Emergency Department, Pok Oi Hospital, Hong Kong
| | - Ting-Fan Leung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tin-Yan Li
- Accident & Emergency Department, Queen Elizabeth Hospital, Hong Kong
| | - Jaime S Rosa Duque
- Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Jerome L T So
- Accident & Emergency Department, Tseung Kwan O Hospital, Hong Kong
| | - Kuang-An Wan
- Accident & Emergency Department, Ruttonjee Hospital, Hong Kong
| | - Henry C Y Wong
- Accident & Emergency Department, Pok Oi Hospital, Hong Kong
| | | | - Tak-Hong Lee
- Allergy Centre, Hong Kong Sanatorium and Hospital, Hong Kong
| | - Marco H K Ho
- Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Axel Y C Siu
- Accident & Emergency Department, Ruttonjee Hospital, Hong Kong
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Lui CT, Lau CL, Siu AYC, Fan KL, Leung LP. Hong Kong needs a territory-wide registry for out-of-hospital cardiac arrest. Hong Kong Med J 2019; 25:222-227. [PMID: 31178443 DOI: 10.12809/hkmj187661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is an urgent disease entity, and the outcomes of OHCA are poor. This causes a significant public health burden, with loss of life and productivity throughout society. Internationally, successful programmes have adopted various survival enhancement measures to improve outcomes of OHCA. A territory-wide organised survival enhancement campaign is required in Hong Kong to maintain OHCA survival rates that are comparable to those of other large cities. One key component is to establish an OHCA registry, such as those in Asia, the United States, Europe, Australia, and New Zealand. An OHCA registry can provide benchmarking, auditing, and surveillance for identification of weak points within the chain of survival and evaluation of the effectiveness of survival enhancement measures. In Hong Kong, digitisation of records in prehospital and in-hospital care provides the infrastructure for an OHCA registry. Resources and governance to maintain a sustainable OHCA registry are necessary in Hong Kong as the first step to improve survival and outcomes of OHCA.
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Affiliation(s)
- C T Lui
- Accident and Emergency Department, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - C L Lau
- Accident and Emergency Department, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - A Y C Siu
- Accident and Emergency Department, Ruttonjee Hospital, Wanchai, Hong Kong
| | - K L Fan
- Accident and Emergency Department, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - L P Leung
- Emergency Medicine Unit, The University of Hong Kong, Pokfulam, Hong Kong
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Siu AYC, Chung CH. X-Ray Quiz: Lower Jaw Swelling. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Siu AYC, Chung CH. X-Ray Quiz: More than a Coin Lesion. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Choi YF, Siu AYC, Wong TW, Lau CC. ST Elevation is not Always Equivalent to Acute Myocardial Infarction: a Case of Brugada Syndrome. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute myocardial infarction (AMI) is one of the most alerting situations in emergency department. Electrocardiogram (ECG) is one of the most important diagnostic tools and the decision about thrombolytic therapy is usually based upon ECG findings when clinically suspicious. However, ST segment elevation is not always equivalent to acute myocardial infarction. We present a rare syndrome whose ECG shows persistent ST elevation not related to AMI.
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Affiliation(s)
- YF Choi
- Pamela Youde Nethersole Eastern Hospital, Accident and Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| | - AYC Siu
- North District Hospital, Accident and Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong
| | - TW Wong
- Pamela Youde Nethersole Eastern Hospital, Accident and Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| | - CC Lau
- Pamela Youde Nethersole Eastern Hospital, Accident and Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
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Siu AYC. Brain drain of emergency physician in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- AYC Siu
- President, Hong Kong Society for Emergency Medicine and Surgery
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Choi YF, Wong TW, Lau CC, Siu AYC, Lo CB, Yuen MC, Tung WK, Ng P, Kam CW, Mui TK, Yuen WL, Lim B, Lit ACH. A Study of Orotracheal Intubation in Emergency Departments of Five District Hospitals in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To study the success rates and complications of orotracheal intubation in emergency departments of five district hospitals in Hong Kong in order to identify ways for improvement. Method This was a prospective observational study. The emergency department doctors performing the intubation were asked to complete an intubation study form immediately after the procedure over a period of four months. Data collected included vital signs, experiences of intubators, method of intubation and complications. Results A total of 347 cases were collected and 93% of them were non-trauma cases. Fifty-two percent (52%) of the cases were in cardiac arrest before intubation. Rapid sequence intubation (RSI) was applied in 36% of the cases. Junior doctors first intubated about 72% of the patients. Successful intubation was achieved in 1 and 2 attempts in 70% and 89% of the cases respectively. In 10 cases (3%), secondary methods such as laryngeal mask airway, Combitube, Trachlight or cricothyroidotomy were needed. The overall complication rate was 7.8% and the complication rate in the RSI group was 15.3%. The complication rate was even higher (20%) if intubation without medication was used in non-cardiac arrest patients. Significant drop in blood pressure was the most common complication and it could be attributed to the use of midazolam as induction medication. The success rate was found to correlate with the experience of the first intubator (p<0.05) and the laryngeal view (p<0.001). The complication rate increased with repeated attempts (p<0.001) and was higher among junior doctors (p<0.05). Early use of elastic gum bougie was associated with lower complication and higher success rates. Conclusion Orotracheal intubation in the emergency department was associated with high complication rate. Many complications came from junior intubators. Hypotension was the most common complication. Potentially avoidable complications may be a result of failure to use RSI in non-cardiac arrest patients and failure to use bougie in cases of poor laryngeal view.
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Affiliation(s)
- YF Choi
- Pamela Youde Nethersole Eastern Hospital, Accident and Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| | - TW Wong
- Pamela Youde Nethersole Eastern Hospital, Accident and Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| | - CC Lau
- Pamela Youde Nethersole Eastern Hospital, Accident and Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| | - AYC Siu
- North District Hospital, Accident and Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong
| | - CB Lo
- North District Hospital, Accident and Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong
| | - MC Yuen
- Kwong Wah Hospital, Accident and Emergency Department, 25 Waterloo Road, Kowloon, Hong Kong
| | - WK Tung
- Kwong Wah Hospital, Accident and Emergency Department, 25 Waterloo Road, Kowloon, Hong Kong
| | - P Ng
- Tuen Mun Hospital, Accident and Emergency Department, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - CW Kam
- Tuen Mun Hospital, Accident and Emergency Department, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - TK Mui
- Caritas Medical Centre, Accident and Emergency Department, Shamshuipo, Kowloon, Hong Kong
| | - WL Yuen
- Caritas Medical Centre, Accident and Emergency Department, Shamshuipo, Kowloon, Hong Kong
| | - B Lim
- Yan Chai Hospital, Accident and Emergency Department, Tsuen Wan, N.T., Hong Kong
| | - ACH Lit
- Yan Chai Hospital, Accident and Emergency Department, Tsuen Wan, N.T., Hong Kong
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Abstract
Introduction Tramadol hydrochloride is a synthetic μ,-opioid agonist. It has been used in the control of moderate to severe pain. Most of the studies on tramadol were related to post-operative pain control. Data on acute pain control in the emergency setting were limited. This study reported on the initial evaluation of tramadol for pain control in an emergency department. Materials and methods It was a prospective observational study. Patients aged 16 years or above attending our emergency department with moderate to severe pain were recruited. Patients with known allergy, current psychiatric medication, intake of alcohol, major systemic illness and opioid dependence were excluded. All patients received 100 mg intramuscular tramadol injection. A 10 cm Visual Analogue Scale (VAS) was used to assess the pain severity before injection, 30 minutes and 60 minutes after injection. Vital signs and side effects were also recorded. Results Forty patients (M: 24, F: 16) were recruited from October to December 2002. Their mean age was 53.5 years. The majority of them suffered from acute musculoskeletal pain or arthritis. Tramadol was shown to be effective in pain control. The VAS decreased by 1.90 (p<0.001) and 3.38 (p<0.001) at 30 minutes and 60 minutes respectively. Four patients reported nausea and three patients vomited. Conclusion Tramadol appeared to be a safe drug to be used in the emergency setting. Only a few insignificant side effects were reported. The comparison of efficacy with other analgesics requires further studies.
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Affiliation(s)
- AYC Siu
- North District Hospital, Accident and Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong
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Siu AYC, Chung CH. Can Tension Haemopneumothorax Have Stable Haemodynamics? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tension pneumothorax or haemopneumothorax is a clinical diagnosis. Plain radiography is not advised to confirm the diagnosis and may delay definitive treatment. Unstable haemodynamics is one of the prerequisites for the diagnosis. We report a case in which the patient suffered from haemopneumothorax with all the typical radiological features of tension, but without any clinical sign of unstable haemodynamics. Close monitoring of patients suspected to have pneumothorax is recommended, especially in the radiology suite.
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Affiliation(s)
- AYC Siu
- North District Hospital, Accident and Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong
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Abstract
A study was carried out in a district hospital located close to the Hong Kong - Shenzhen border, in order to get a picture of the epidemiology of diseases and injuries sustained by Hong Kong residents in China. The emergency medical treatment provided and the degree of patient satisfaction were also analysed. The majority of the patients were adult males. Trauma constituted more than 50% of the attendance, with traffic accident and common assault being the leading causes. This group of Hong Kong residents preferred to be treated in Hong Kong hospitals because of perceived better quality of care. There was a high demand on the local ambulance service and this might have financial and resource implications.
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Siu AYC, Chung CH. The Use of Ultrasonography to Assess Patients with Right Lower Quadrant Pain in the Emergency Department. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790701400202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute appendicitis is always a clinical challenge to emergency physicians. Clinical examination or blood tests are notoriously unreliable in making the diagnosis, especially in the early phase of the disease. Computed tomogram can facilitate the diagnosis, however it is usually not easily accessible to emergency physicians. Bedside ultrasonography is now frequently used by emergency physicians in various situations for the assessment of patients. This study aimed at exploring the potential use of bedside ultrasonography in the diagnosis of acute appendicitis in patients presenting with right lower quadrant abdominal pain.
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Siu AYC, Kwok SL, Chung CH, Lai KK. A Rare Cause of Necrotizing Fasciitis: Psoas Abscess. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Necrotizing fasciitis always carries very high mortality and morbidity rates. It can be due to group A beta-haemolytic streptococci, which are traditionally described as the flesh-eating bacteria. More commonly, it is related to a mixed growth of bacteria that can be secondary to trauma or surgery. Secondary necrotizing fasciitis due to concomitant soft tissue infection is uncommon. We reported a fatal case of necrotizing fasciitis which was caused by a coexisting psoas abscess. A search for concomitant soft tissue infection is warranted in patients presenting with necrotizing fasciitis. This article also reviewed the clinical tools that may help to make an early diagnosis of the disease.
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Abstract
Psoas abscess is an uncommon clinical entity. It can be a primary infection with no obvious source of infection or a secondary infection from other sites, e.g. gastrointestinal tract or spinal pathology. The triads of presentation: fever, loin pain and limitation of hip movement may not be found in all patients. The correct diagnosis can be made with a vigilant clinical examination and appropriate investigation, for example ultrasonography. We present two cases of psoas abscess. One was a primary case and the other was secondary to carcinoma of caecum. Both of them presented with recent onset of back pain. Emergency physicians consider psoas abscess as one of the differential diagnosis for patient complaining of low back pain.
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Abstract
Introduction Catheter aspiration is a relatively new treatment for spontaneous pneumothorax in emergency departments in Hong Kong. It causes less pain and shortens hospitalisation. However, there is limited local experience especially in regard to the target group that can be benefited. We reported on the initial experience of catheter aspiration in the management of spontaneous pneumothorax in our emergency department. Method Patients (age >=16 years) presenting with spontaneous pneumothorax were recruited. Patients with history of asthma or chronic obstructive airway disease were excluded. History of smoking, previous pneumothorax and pleurodesis were recorded. The aspiration catheter was inserted by the Seldinger technique. The extent of pneumothorax was assessed from the chest X-ray and initial aspirated volume. Successful patients were observed in the department and discharged if chest X-rays were reassuring after 12 hours. Factors associated with the outcome of patients were analysed. Result Seventeen patients were recruited from October 1999 to September 2000. Their age ranged from 16 to 40 years (mean 22.6). The overwhelming majority (16) was male. Twelve cases (70.6%) occurred on the left side. Five patients had previous pneumothorax and one had previous pleurodesis. Fifteen succeeded in immediate re-expansion, but seven re-collapsed during observation. The overall success rate was 47.1%. Initial aspiration volume >2,000 ml was associated with early failure (p=0.01). Conclusion Our initial experience did not support catheter aspiration to completely replace chest drain in the initial management of spontaneous pneumothorax. The procedure is likely to fail if the initial aspirated volume is greater than 2,000 ml. Further study is needed to identify the subgroup that may be benefited.
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Affiliation(s)
- AYC Siu
- North District Hospital, Accident and Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong
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Siu AYC. From A-B-C to C-A-B. HONG KONG J EMERG ME 2011. [DOI: 10.1177/102490791101800101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chung CH, Siu AYC, Po LLK, Lam CY, Wong PCY. Comparing the effectiveness of video self-instruction versus traditional classroom instruction targeted at cardiopulmonary resuscitation skills for laypersons: a prospective randomised controlled trial. Hong Kong Med J 2010; 16:165-170. [PMID: 20519751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE To determine whether in the local lay Hong Kong population, video self-instruction about cardiopulmonary resuscitation has comparable results to traditional classroom instructions. DESIGN Prospective randomised single-blind controlled trial. SETTING A first-aid training organisation in Hong Kong. PARTICIPANTS Cantonese applicants for cardiopulmonary resuscitation courses aged between 18 and 70 years were recruited into the study. They were randomised into two groups. Those selected for self-learning were given a kit (consisting of a mini-manikin, a video compact disc, and an instruction manual) and sent home. The other group underwent usual classroom training. Both groups were examined together; the examiners remained blinded to the background training of the subjects. Those who passed were asked to come back for re-examination after 1 year. MAIN OUTCOME MEASURES The examination passing rates initially and after 1 year. RESULTS During a 1-year period between 1 April 2007 to 31 March 2008, 256 subjects were recruited into this study, 124 for self-learning and 132 for classroom training. The age range was 18 to 62 (mean, 39; standard deviation, 10) years. There was no significant difference in passing rate between the two groups at the initial examination or at the re-examination after 1 year. Notably, 28 (23%) of the participants of the self-learning group taught cardiopulmonary resuscitation to relatives and friends. CONCLUSION Video self-learning resulted in cardiopulmonary resuscitation performance as good as traditional classroom training.
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Affiliation(s)
- C H Chung
- Hong Kong St John Ambulance, St John Tower, 2 Macdonnell Road, Hong Kong.
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