To evaluate the impact of the recently established Emergency Department (ED) Toxicology Team of Queen Mary Hospital (QMH) in the management of acute intoxication. Method: A descriptive comparative study with retrospective data collection from all intoxicated and suspected intoxicated patients over two separate half-year periods in 2001 and 2006, before and after the establishment of the ED Toxicology Team in July 2005. Data on reasons of intoxication, drugs and substances involved, ED treatments, patient disposition, length of stay in ED, length of stay in hospital, patient outcome, and 30-day ED re-attendance and hospital re-admission were collected and examined. Results: A total of 333 intoxicated patients were included in the study, 171 in 2001 and 162 in 2006. The basic epidemiological data were similar in both groups. There was a marked reduction in hospital admissions from 89.5% to 40.7% (P<0.01) and significant decline in average length of hospital stay from 46.8 hours to 29.2 hours (P<0.05). There was no statistically significant difference in patient outcome, 30-day ED re-attendance and hospital re-admission. Conclusion: Our findings showed that the establishment of the ED Toxicology Team in QMH achieved significant reductions in hospital admissions and the length of stay in hospital in the management of patients with acute intoxication without jeopardising patient outcome. The results illustrate that the new model has a beneficial role in reducing cost and alleviating stress on hospital bed availability, therefore it can be recognised as a cost-effective means of management of acute intoxication.

Metformin is a widely used antidiabetic agent that is generally considered safe. Reported here is a fatal case of acute metformin overdose in a 73-year-old male patient. The rapid clinical deterioration is described to illustrate the possible severity of toxicity. It is followed by a literature review on the topics concerning acute metformin intoxication. Pathogenesis and clinical features on metformin-associated lactic acidosis, as well as the current recommendations in management are discussed in details.

Despite the frequent use of endotracheal tubes in daily practice of emergency medicine, not much emphasis has been put on the measurement of cuff pressure. We attempted to conduct a case series study of prospectively recruited patients to illustrate the risk of inappropriate cuff inflation without manometry. It was found that the pilot balloon palpation was an inaccurate method to estimate cuff under- or over-inflation, with large discrepancies when compared with an objective measure. Such discrepancies might be independent of doctors' and nurses' working experience in airway management. Use of an aneroid manometer remains an economical and cost-effective way to obtain an instantaneous yet reasonably reliable result and should become a routine in emergency departments.