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.

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.

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.

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.

To determine the profile of bicycle injury and possible risk factors for severe injuries, we studied patients with bicycle-related accidents attending the Accident and Emergency Department of North District Hospital between 1 May 1999 to 31 October 1999. Of the 424 patients, 52 (12.3%) were admitted and one (0.24%) died. Comparing to those not admitted, significantly more of the admitted cases suffered from major injuries, rode on rainy days and involved in collision with motor vehicles. A total of 160 patients (37.8%) had documented head injuries. However the extremely low utilisation rates of helmet at the time of injury implied that action should be taken in this direction to reduce bicycle-related morbidity and mortality.