How much do we know about ST elevation?: case report of a patient with acute coronary syndrome in the observation wardThe identification of acute coronary syndrome continues to challenge even experienced clinicians. Emergency physicians have the responsibility to identify, treat and admit those patients with true acute coronary syndrome to the appropriate units. This article described a case of acute coronary syndrome that developed in the observation ward, with discussion on some recent reviews of standard electrocardiogram analysis. It is very important to point out that controversy over the measurement of ST elevation exists which may adversely affect patient management. (Hong Kong j.emerg.med. 2004;11:230-235) ST

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respiratory, cutaneous/ limb and urinary tract (41.7%, 26.4% and 20.8% respectively). Positivity of blood cultures were 43.1%. A total of 66 subjects (91.7%) were mechanically ventilated (median duration 5 days), while 59 (81.9%) required inotropic support (median duration 3 days). Modalities for RRT were haemodialysis (HD) in 84.7% of cohort (n ¼ 61), peritoneal dialysis (PD) in 4.2% of cohort (n ¼ 3), or a combined modality of HD and PD in 11.1% of cohort (n ¼ 8). Median HD catheter days and PD catheter days were 4 days (IQR 3 days) and 2 days (IQR 3 days) respectively. Percentages of subjects receiving 1, 2, 3 and > 4 sessions of HD were 44.1%, 26.5%, 8.8% and 20.6% respectively. Median length of hospitalisation was 14 days (IQR 16 days) with in-hospital mortality of 54.2% (n¼ 39). Causes of death attributed directly to index infection, nosocomial infection and noninfectious causes were 74.4%, 10.3% and 15.4% respectively. Among survivors, 11 (34.4%) were functionally dependent at discharge. Predictors of mortality were use of mechanical ventilation, inotrope use, younger patients, and cutaneous/ limb infection. Comorbidities, CKD status, CCI, positivity of blood culture and SOFA score did not predict mortality. Conclusion: Mortality and morbidity remain high for patients with SA-AKI requiring RRT, primarily driven by the index infection.