To compare the effectiveness and efficacy of self-administered nitrous oxide and haematoma block in pain relief during close reduction of fractured distal radius in adult patients. Methods: This was a prospective clinical trial. All adult patients aged 18 years or above with fracture of the distal radius within 24 hours requiring close reduction in the Accident and Emergency Department of Kwong Wah Hospital were included. Patients with known contraindications were excluded. A consecutive series of patients were randomised into the two groups in alternating fashion. Pain perception (VAS score), procedure time, patient acceptance and complications were measured and monitored. Results: A total of 67 patients (53 females and 14 males) with age ranging from 26 to 94 years were enrolled during the period from April 2008 to December 2008; 33 patients received Entonox and 34 received haematoma block. The average VAS score before reduction was 6.97 cm for the Entonox group and 6.76 cm for the haematoma block group (p=0.61). The average VAS score during reduction was 7.19 cm for the Entonox group and 2.80 cm for the haematoma block group (p<0.0001). For the difference of average VAS scores during and before reduction, there was 0.22 cm increase in the Entonox group and 3.95 cm decrease in the haematoma block group (p<0.0001). The relative change of mean VAS score was 3% increase in the Entonox group and 58% decrease in the haematoma block group (p<0.0001). The average procedure time was 6.29 min for the Entonox group and 6.44 min for the haematoma block group (p=1). In the Entonox group, 64% patients agreed to use the same analgesia method under similar circumstances whereas in the haematoma block group, it was 91% (p=0.009). There were no complications or failed reductions in both groups. Conclusion: Haematoma block is a safe and effective analgesia in the reduction of fractured distal radius with less pain perception, more patient acceptance and similar procedure time compared with Entonox.

The primary aim of this study was to understand emergency physicians' (EP) relative satisfaction with different facets of their job and their impact on EPs' intention to quit their current job. We also investigated the frequency and intensity of different stress factors on EPs. Method: Data were collected by questionnaires distributed to 320 EPs working in emergency department (ED) of the public hospitals in Hong Kong. Satisfaction levels to nine facets of job (autonomy, personal time, relationship with patients, patient management, relationship with fellow physicians, relationship with nursing staff, income, administration, and resources), and three global measures (global job satisfaction, specialty satisfaction and training opportunity satisfaction) were determined. Physician's intention to quit their present job was also assessed. Descriptive and correlation coefficients were used to explore the satisfaction levels to different facets of job and their association with EP's turnover intention. Results: A total of 103 questionnaires were analysed, of which 77.7% were male. Overall, the satisfaction levels across the 9 facets and the 3 global measures were moderate. The job facets which respondents found most satisfied were the 'relation with other physicians' (mean=3.62, SD=0.67). The job facet that respondents found least satisfied was the 'patient care issues' (mean=2.02, SD=0.58). 'Negative publicity in media' was the most stressful factor to EPs. 36.89% of the respondents indicated a "moderate", "likely", or "definite" chance of leaving current ED. There was statistically significant correlation between the intention to leave EDs and EP's satisfaction levels to 'personal time', 'relationship with physician colleague', 'relationship with nursing staff ', 'income', 'administration', 'resources', 'global job satisfaction' and emergency medicine (EM) specialty. Conclusion: This study reveals that EPs working in public hospital in Hong Kong are moderately satisfied with their jobs. EPs' global job satisfaction levels and their satisfaction levels to EM specialty correlate with their intention to leave their EDs.